CT CHEST ANGIOGRAPHY

INDICATIONS: Aneurysm, dissection. “CTA: Aorta, PE. No need to do pre unless looking for acute intramural hematoma or looking at stent grafts.”

PATIENT PREP: NPO for solid food, water only, for 4 hours prior to scan

IV CONTRAST: 100mL Isovue 370 @ 4-5 mL/second

ORAL CONTRAST: None

POSITIONING: Feet First Supine, Arms above head

TOPOGRAMS: AP. Range: Aneurysm: Thoracic inlet to renal arteries, Dissection: Thoracic inlet to aortic bifurcation. 35 mA, 120 kV.

Lateral. Range: Aneurysm: Thoracic inlet to renal arteries, Dissection: Thoracic inlet to aortic bifurcation. 35 mA, 120 kV.

SCAN TYPE: Spiral/Helical

NOTES: ANEURYSM: Scan Range: Thoracic Inlet to Renal Arteries

*FOR HISTORY OF ANEURYSM, USUALLY WITH CONTRAST ONLY, RADIOLOGIST TO PROTOCOL

DISSECTION: Scan Range: Thoracic Inlet to Aortic Bifurcation

*IF DISSECTION PROTOCOL, OBTAIN ORDER FOR CT ANGIO CHEST AND AN ORDER FOR CT ANGIO ABDOMEN.

*NONCONTRAST SCAN TO BE PERFORMED FOR DISSECTION PROTOCOL

Send Recon-3D 0.6x0.3mm to Vital Workstation for 3D.

Bill for 3D (No Charge)

ALARA – Keep radiation dose As Low As Reasonably Achievable.

CARE BOLUS triggered scan.

100 kV on Arterial scan unless extra-large, then 120 kV.

*XCARE on NonContrast scan*

NONCONTRAST

Scan
Range / Scan
Direction / Respiration / Scan
Delay
Seconds / CARE
DOSE
4D / Quality
Reference
mAs / CARE
kV / Quality
Reference
kV / XCARE / Detector Configuration
Slices Per Tube Rotation / Pitch
Table Increment/Speed: (mm/rotation) / Rotation
Time
(Seconds) / SFOV
(cm)
ANEURYSM: Thoracic Inlet
To Renal Arteries
DISSECTION: Thoracic Inlet
To Aortic Bifurcation / Craniocaudal / Suspended Inspiration / 5
Seconds / ON / 66 / ON / 120 / ON / Detectors: 64 x 0.6 mm
Slices Per Tube Rotation: 32 / Pitch: 0.6
Table Increment/Speed:
11.52 mm/rotation / 0.33
seconds / 50
cm
Plane / SAFIRE
Strength / Slice Thickness / Interval / Kernal / Window
Width/Level / DFOV
(cm)
RECON / Axial / ON
3 / 3.0 mm / 3.0 mm / I31f
Medium Smooth / Mediastinum
350/50 / FOV just beyond
patient’s body

MONITORING

Scan Range
CARE BOLUS
Monitoring Location / Scan Direction
Scan Type
Number of Scans / Respiration / Threshold / Scan
Delay
Seconds / CARE
DOSE
4D / mAs / CARE
kV / kV / Detector Configuration
Slices Per Tube Rotation / Table
Feed / InterScan
Delay
(Cycle Time)
Seconds / Scan
Time
Seconds / SFOV
(cm)
Single Slice
Proximal Descending
Aorta / Craniocaudal
Sequential
30 scans / Quiet
Respiration / 150 HU / 15
Seconds / OFF / 40 / OFF / 120 / Detectors: 1 x 10.0 mm
Slices Per Tube Rotation: 1 / 0.0 mm / 1.5
Seconds / Full
0.5 Sec / 50
cm
Plane / Slice
Thickness / Interval/
Table Feed / Kernal / Window
Width/Level / DFOV
(cm)
RECON / Axial / 10.0 mm / 0.0 mm / B30s
Medium / Abdomen
300/40 / Small FOV large enough to
Cover region of interest

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ARTERIAL

Scan
Range / Scan
Direction / Respiration / Scan
Delay
(Seconds) / CARE
DOSE
4D / Quality
Reference
mAs / CARE
kV / Quality
Reference
kV / Detector Configuration
Slices Per Tube Rotation / Pitch
Table Increment/Speed:
(mm/rotation) / Rotation
Time
(Seconds) / SFOV
(cm)
Aneurysm: Thoracic Inlet
To Renal Arteries
Dissection: Thoracic Inlet
To Aortic Bifurcation / Craniocaudal / Suspended
Inspiration / CARE BOLUS Tracking
(Trigger 150 HU)
Plus 6 Second Delay / ON / 120 / Semi / 100 / Detectors: 64 x 0.6 mm
Slices Per Tube Rotation:
32 / Pitch: 1.2
Table Increment/Speed:
23.04 mm/rotation / 0.5
seconds / 50
cm
Plane / SAFIRE
Strength / Slice
Thickness / Interval / Kernal / Window
Width/Level / DFOV
(cm)
RECON / Axial / ON
3 / 2.0 mm / 2.0 mm / I40f
Medium / Mediastinum
350/50 / FOV just beyond
patient’s body
RECON / Axial / ON
2 / 3.0 mm / 3.0 mm / B70f
Very Sharp ASA / Lung
1200/-600 / FOV just beyond
patient’s body
RECON – 3D
Send to Vital Workstation for 3D / Axial / ON
3 / 0.6 mm / 0.3 mm / I26f
Medium Smooth / Mediastinum
350/50 / FOV just beyond
patient’s body
RECON – CORONAL MPR
Coronals Angled in Plane to Body Part / Coronals Angled in Plane to Body Part
Recon Card 3D Coronal MPR / ON
3 / 2.0 mm / 2.0 mm / I40f
Medium / Mediastinum
350/50 / FOV just beyond
patient’s body
RECON – SAGITTAL MPR
Sagittals Angled in Plane to Body Part / Sagittals Angled in Plane to Body Part
Recon Card 3D Sagittal MPR / ON
3 / 2.0 mm / 2.0 mm / I40f
Medium / Mediastinum
350/50 / FOV just beyond
patient’s body
RECON – OBLIQUE SAGITTAL MPR
Oblique Sagittals “Candy Cane” / Oblique Sagittals “Candy Cane”
Recon Card 3D Sagittal/Oblique MPR / ON
3 / 2.0 mm / 2.0 mm / I40f
Medium / Mediastinum
350/50 / FOV just beyond
patient’s body
RECON – CORONAL MIPS
Coronals Angled in Plane to Body Part / Coronal MIPS Angled in Plane to Body Part. Recon Card 3D Coronal MIP Thin / ON
3 / 10.0 mm / 2.0 mm / I40f
Medium / CT Angio
700/80 / FOV just beyond
patient’s body
RECON – SAGITTAL MIPS
Sagittals Angled in Plane to Body Part / Sagittal MIPS Angled in Plane to Body Part. Recon Card 3D Sagittal MIP Thin / ON
3 / 10.0 mm / 2.0 mm / I40f
Medium / CT Angio
700/80 / FOV just beyond
patient’s body
Approximate Values for CTDIvol
Patient Size / Weight (kg) / Weight (lbs) / CTDIvol (mGy)
Small / 50-70 / 110-155 / 4-10
Average / 70-90 / 155-200 / 8-16
Large / 90-120 / 200-265 / 14-22
Reference: AAPM

Allowed CTDIvol Dose Ranges: 3 mGy – 50 mGy

XR29 Dose Notification Value (CTDIvol): 50 mGy

*The AAPM recommended NEMA XR29 Dose Notification Value for an adult torso is 50 mGy. Dose notification levels less than the AAPM recommended can be set. The maximum CTDIvol should match the dose notification value. Exams with CTDIvol values less than the minimum allowed range should not be performed unless approved by a radiologist.

*IF DISSECTION PROTOCOL: OBTAIN ORDER FOR CT ANGIO CHEST AND AN ORDER FOR CT ANGIO ABDOMEN.

*If a NONCONTRAST scan is performed, the charge for the NONCONTRAST scan is included in the ANGIO charge.

CHARGES: ANEURYSM: CACHE/3D (No Charge Added)

DISSECTION: CACHAB/3D (No Charge Added) (Obtain Order for CT ANGIO CHEST AND an order for CT ANGIO ABDOMEN)

NETWORK: Exam to PACS. Send Recon-3D 0.6x0.3mm to Vital Workstation for 3D

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