CT ABDOMEN FOR PANCREATIC MASS

Transcription

1 CT ABDOMEN FOR PANCREATIC MASS AP/LATERAL Mid lung through aortic bifrucation maximum machine will give and min. at around 120).5 Scan approx. 20mm above diaphragms through the aortic bifurcation for all 3 phases. 100cc omni 300/ 3 4 cc's/second 30 second delay for Group 1 Arterial Phase 20second delay for Group 2 Venous phase 5 minute delay for Group 3 Kidney delays Without Liver/Arterial Phase/Venous Phase Kidney Delays (No less than 5 minutes on delays) Recon 2: 2.5's through Pancreas 20 DFOV Recon 3: Soft 1.25X.75(for building coronals) Average Coronals on all three phases /Withouts/Helical 5's/Retro'd 2.5's Delays/Coronals protocol to "transfer by series." This will prevent any series from transfering to PACS that is not necessary. ONLY what is listed above is to be sent to PACS. If you do something extra to further display abnormal anatomy, that should be sent to PACS as well. Reformatting they should be set before saving. As a general rule the following levels are a good baseline to follow. Arterial or MIPS w500@l200 Standard Soft Tissue w400@l40 Brain include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. When Scanning for Pancreatic Mass Set Recon 2 on all three phases to 2.5's on a 20DFOV. Use the same table locations for all three phases. If you hit repeat series, make sure you put in the correct series description in the series description box. This is what displays on McKesson for the Rads.

2 CT CHEST ROUTINE Supine head or feet first/ Sternal Notch AP/LATERAL Top of Chest through Kidneys maximum machine will give and min. at around 120).5 Scan approx. 20mm above strernal notch through the adrenals. 100cc omni 300/ 2 3 cc's/second Smart Prep ascending and descending aorta. Start scan when both are lit up. Venous Phase (Entire Mediastinum bright) Recon 2: Lung 1.25X5 (w1500xl 400) Recon 3: Soft 1.25X.75 Average Coronals /Helical 5's/High Res Lungs/Coroanl MIPS further display abnormal anatomy, that should be sent to PACS as well. include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up..

3 CTA CHEST FOR PE DFOV Prospective Recons These should be set in the Protocols Supine head or feet first/ Sternal Notch AP/LATERAL Top of Chest through Kidneys sec/rotation maximum machine will give and min. at around 120).5 Group 1: Arterial for PE 1.25's X.8mm spacing Group 2:Routine Chest 5X5's Group 1: Scan bottom to top/diaphragms to arch Group 2:Routine Chest Group 1: Cone in to edges of lung fields AP/Lat. Group 2: Pt. Dependent usually cc visi 320/ 4 cc's/second Smart Prep Pulmonary trunk. Start scan as soon as trunk is lit up. Arterial/Venous Phase Group 1 Recon 1: Standard 1.25's Group 2 Recon 1: Standard 5x5 Coronal MIPS from Group 1(5mm thickness on reformats) Rotational MIPS from Group 1 (Done off of axial viewport every 3 degrees) /Helical Run/Coronal/Rotational MIPS further display abnormal anatomy, that should be sent to PACS as well. include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up.

4 CTA CHEST FOR DISSECTION Supine head or feet first/ Sternal Notch AP/LATERAL Top of Chest through Kidneys 1.375/27.5.5sec/rotation maximum machine will give and min. at around 120).5 2.5mm X 2.5mm Scan 20mm above strernal notch through the adrenals. Prospective Recons These should be set in the Protocols 100cc visi 320/4cc's/second Smart Prep ascending aorta Start scan ascending aorta is bright Arterial Phase Recon 1: Standard 2.5mmX2.5 w400 x L40 Recon 2: Lung 1.25X5 (w1500xl 400) Recon 3: Soft 1.25X.75(used to build reformats) Coronal MIPS/Oblique MIPS around Aorta (Candycane View)(5mm thickness on reformat) /Helical 2.5s/Coronall MIPS/Oblique MIPS further display abnormal anatomy, that should be sent to PACS as well.

5 include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. CT CHEST/ABDOMEN/PELVIS Supine head or feet first/ Sternal Notch AP/LATERAL Top of Chest through Symphysis maximum machine will give and min. at around 120).5 Scan approx. 20mm above strernal notch through the symphysis pubis 100cc omni 300/ 2 3 cc's/second Smart Prep ascending and descending aorta. Start scan when both are lit up. Make sure you wait for the descending to give the liver time to enhance also. Withouts through liver/venous Phase (Entire Mediastinum bright)/kidney and Bladder Delays Recon 2: Lung 1.25X5 (w1500xl 400) Recon 3: Soft 1.25X.75 Average Coronals /Helical 5's/High Res Lungs/Coronals further display abnormal anatomy, that should be sent to PACS as well.

6 include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. CT ABDOMEN/PELVIS ROUTINE AP/LATERAL Mid lung through symphysis maximum machine will give and min. at around 120).5 Scan approx. 20mm above diaphragms through symphysis pubis 100cc omni 300/ 2 3 cc's/second Approx. 60 second delay OR Smart Prep Liver/ Start when you see contrast exiting the portal vein. Without Liver/Venous Phase/Kidney and Bladder Delays (No less than 5 minutes on delays) Recon 3: Soft 1.25X.75(for building coronals) Average Coronals /Withouts/Helical 5's/Delays/Coronals further display abnormal anatomy, that should be sent to PACS as well.

7 Always retro thinner slices and smaller DFOV if you see a nodule or mass. If there is a mass in the liver, include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. If you are scanning the abdomen for a renal mass, retro 2.5's on a 20 field of view through the kidneys on all three phases and send to PACS. If Scanning Abd/Pel for diverticulitis or appendicitis, drink patient longer and give rectal contrast when possible. HOSPITAL CT ABDOMEN FOR HEMANGIOMA OR THREE PHASE LIVER AP/LATERAL Mid lung through symphysis maximum machine will give and min. at around 120).5 Scan approx. 20mm above diaphragms through the aortic bifurcation. 100cc omni 300/ 3 4 cc's/second ( NO ORAL) 30 second delay for Group 1 Arterial Phase 20second delay for Group 2 Venous phase 5 minute delay for Group 3 liver/kidney delays Without Liver/Arterial Phase/Venous Phase Kidney and Bladder Delays (No less than 5 minutes on delays/include entire liver) Recon 3: Soft 1.25X.75(for building coronals) Average Coronals on all three phases /Withouts/Helical 5's/Delays/Coronals further

8 display abnormal anatomy, that should be sent to PACS as well. include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. CT UTS AP/LATERAL Mid lung through symphysis maximum machine will give and min. at around 120).5 2.5mm X 2.5mm Scan from diaphragms through symphysis pubis NONE NONE Without Only Recon 1: Standard 2.5mmX2.5mm (w400 x L40) Recon 3: Soft 1.25X.75 Average Coronals (Built off of Recon 3) /Helical 2.5's/Coronals further display abnormal anatomy, that should be sent to PACS as well.

9 include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. Do Not let the patient empty their bladder just before scanning a UTS or Urogram. Do KUB after UTS and Urograms. Always Combine your orders to make 1 UTS order. CT UROGRAM AP/LATERAL Mid lung through symphysis maximum machine will give and min. at around 120).5 2.5mmX2.5mm Scan approx. 20mm above diaphragms through symphysis pubis 200cc Saline/100cc omni 300/ 2 3 cc's/second ( NO ORAL) Inject Saline and wait 5 min before doing withouts Inject Contrast with 60 second delay Do 10 Minute Delays Without UTS/Venous UTS/10Min Delay UTS Recon 1: Standard 2.5mmX2.5mm (w400 x L40) Recon 3: Soft 1.25X.75(turned on only on delays) Average Coronals (built off of Recon 3 on delays) /Withouts/Helical 2.5's/Delays/Coronals

10 further display abnormal anatomy, that should be sent to PACS as well. include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. Inject 200cc of saline 5 minutes prior to doing your without series. Do Not let the patient empty their bladder just before scanning a UTS or Urogram. Wait at least 10 minutes to do your delays. Do KUB after UTS and Urograms. CT ABDOMEN FOR PANCREATIC MASS AP/LATERAL Mid lung through aortic bifrucation maximum machine will give and min. at around 120).5 Scan approx. 20mm above diaphragms through the aortic bifurcation for all 3 phases. 100cc omni 300/ 3 4 cc's/second 30 second delay for Group 1 Arterial Phase 20second delay for Group 2 Venous phase 5 minute delay for Group 3 Kidney delays Without Liver/Arterial Phase/Venous Phase Kidney Delays (No less than 5 minutes on delays) Recon 2: 2.5's through Pancreas 20 DFOV Recon 3: Soft 1.25X.75(for building coronals) Average Coronals on all three phases /Withouts/Helical 5's/Retro'd 2.5's Delays/Coronals protocol to "transfer by series." This will prevent any series from transfering to PACS that is not necessary. ONLY

11 what is listed above is to be sent to PACS. If you do something extra to further display abnormal anatomy, that should be sent to PACS as well. Reformatting they should be set before saving. As a general rule the following levels are a good baseline to follow. Arterial or MIPS w500@l200 Standard Soft Tissue w400@l40 Brain include delays through the liver on the kidney delays. If it is an adrenal mass do 15 minute delays. All small solitary lung nodules you may see should also be blown up. When Scanning for Pancreatic Mass Set Recon 2 on all three phases to 2.5's on a 20DFOV. Use the same table locations for all three phases. If you hit repeat series, make sure you put in the correct series description in the series description box. This is what displays on McKesson for the Rads. CT ABDOMEN for ADRENAL MASS AP/LATERAL Mid lung through symphysis maximum machine will give and min. at around 120).5 Scan approx. 20mm above diaphragms through symphysis pubis 100cc omni 300/ 2 3 cc's/second Smart Prep Liver/ Start when you see contrast exiting the portal vein. Without Liver/Venous Phase/Adrenal and Kidney Delays (The delays to be done at 15 minutes) Recon 2: 2.5mmX2.5mm on 20 FOV through adrenals on all three phases Recon 3: Soft 1.25X.75(for building coronals) Average Coronals

12 /Withouts/Helical 5's/ Delays/ Coronals Recon 2 thins from all 3 phases further display abnormal anatomy, that should be sent to PACS as well. w150@l35 Bone w800@l200 Lung w2000@l 700 Always retro thinner slices and smaller DFOV if you see a nodule or mass. If there is a mass in the liver, include delays through the liver on the kidney delays. All small solitary lung nodules you may see should also be blown up. When scanning specifically for Adrenal Mass, 2.5's w/o, with, and 15 minute delays are necessary for the Radiologists to be able to characterize the mass. CT TRAUMA BODY (CHEST/ABD/PELVIS/SPINE) Supine head first/ Sternal Notch AP/LATERAL Top of Chest through symphysis maximum machine will give and min. at around 120).5 Scan approx. 20mm above strernal notch through the symphysis 100cc omni 300/ 3 4 cc's/second Smart Prep Ascending Aorta (start scan when it is bright with contrast) 20 second delay for Group 2/Venous phase Group 1 Arterial Phase(Entire Chest/Abd/Pelvis) Group 2 Venous Phase(Abdomen/Pelvis only) Delayed Kidney and Bladder Recon 2: Aortic Arch 1.25X.75 (standard W500L80) Recon 3: Soft 1.25X.75

13 Retro 1.25mm X.75mm in bone for Trauma Spines Axials/Sagitals/Coronals of Entire T/L Spine Average Coronals of Chest/Abd/Pelvis /Arterial and Venous Helical Runs/Recon 2: Aortic Arch/Delays/All Reformats including any reformats you may do on the workstation ie: 3d on pelvis, extrimity, or face. further display abnormal anatomy, that should be sent to PACS as well. Reformatting they should be set before saving. As a general rule the following levels are a good baseline to follow. Arterial or MIPS w500@l200 Standard Soft Tissue w400@l40 Brain w150@l35 Bone w800@l200 Lung w2000@l 700 When scanning Traumas, if you see ortho or facial fractures, make sure you retro it in standard 1.25 x.75 and send it to the workstation. If you have time, do the 3D and send it in to PACS so the Orthopedic Surgeon or Plastics guy will have what they need on PACS without having to ask.