Non contrast:

·  Nodules

·  Abnormal chest x-ray

·  Small airways infection

·  Bronchiectasis

·  Emphysema

Contrast:

·  Adenopathy

·  Staging malignancy

·  Sarcoid –may want to ask for thin section inspiration 1mm ( not always necessary to do HRCT unless ordered by Pulmonologist)

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

HRCT: Ideally for assessment of ILD

·  Asbestosis

·  UIP

·  NSIP

·  HP

·  Use HRCT questionnaire if you feel unsure.

Low dose:

·  Want to know that there is a documented prior showing nodules

·  Follow-up nodules

·  If there is anything else: i.e. nodules + adenopathy: may need routine dose.

Lung cancer screen: specific protocol Smokers for screening (i.e. 29+ pack years)

NB: Can always get retro recon thin sections,

Ideally ALARA on dose that means no non-contrast UNLESS there is a need:

We need non cons:

·  CT renal mass where you need non contrast to make a decision on enhancement.

·  CT adrenals

·  CT IVU: here the pre is done low dose with routine dose post.

So based on ACR AC criteria and LI-Rads we are going away from doing pres on

  1. Pancreas mass
  2. Liver mass

We are also going towards MR for the following:

·  Liver mass: characterization is best with MR.

·  For F/U cystic pancreatic lesions: MR pancreas which includes thin section MRCP for pancreatic duct.

·  For renal masses: solid/ cystic: MRI best to evaluate for solid nodules within cystic lesions and getting tumor/cortex SI ration may help differentiate clear cell, papillary and chromophobe, nuance in that chemotherapy differs for each.

·  MRE: ideally if the patient is young and has known Crohn Dz.

# of phases: portal phase is sufficient on most CRC, breast, lung, bladder, prostate, testicular mets etc. Rarely, you can do 2 phases for hypervascular primary lesions: art/ portal phase for carcinoid, melanoma, neuroendocrine tumor metastases.

CTE

·  Single phase: Crohn disease: adults or in acute phase.

·  To evaluate bowel when EGD and colonoscopy negative but complains of diarrhea/ abdominal pain.

·  Double phase: occult GI bleed/ Fe deficiency anemia.

CTIVU

·  Split bolus technique is best for assessment and keeps dose down. Caoili (U Michigan)

Low dose CT KUB

Ideally, only want this on patients who have a DOCUMENTED imaging study CT, US or KUB with stones and are following stone burden.