CT CHEST - HIGH RESOLUTION (HRCT WEST)

INDICATIONS: Interstitial lung disease.

“Ideally for assessment of ILD.” “Asbestosis, UIP, NSIP, HP.”

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

Pulmonologist)”

“If history of scleroderma ask the radiologist if HRCT is warranted”

“NB: Can always get retro recon thin sections.”

“Use HRCT questionnaire if you feel unsure”

PATIENT PREP: None

IV CONTRAST: None

ORAL CONTRAST: None

POSITIONING: Feet First Supine, then Feet First Prone. Arms above head.

TOPOGRAMS: Supine: AP. Range: Above lung apices through lung bases/costophrenic angles or adrenals if history of lung cancer. 35 mA, 120 kV.

Supine: Lateral. Range: Above lung apices through lung bases/costophrenic angles or adrenals if history of lung cancer. 35 mA, 120 kV.

Prone: PA. Range: Above lung apices through lung bases/costophrenic angles. 35 mA, 120 kV

SCAN TYPE: Supine Inspiration: Spiral/Helical. Supine Expiration and Prone Inspiration: Sequential

NOTES: If the patient has had a previous complete HRCT within the past three months and another HRCT is ordered, DO NOT perform another complete

HRCT. Only perform the Supine Inspiration portion of the HRCT (Which includes the thin slices), and bill for a Routine Chest WithOut. Do not

perform the Expiration or Prone scans.

If a HRCT is ordered on a patient under 35 years old we will probably not perform a complete HRCT, (No matter how it is protocolled), it would be

extremely rare. Perform the Supine Inspiration portion of the HRCT (Which includes the thin slices) and have the radiologist check the exam to see if

Expiration or Prone scans are needed. If only the Supine Inspiration scan is performed then bill for a Routine Chest WithOut.

Packs Per Day X Number of Years Smoking = Pack-Years

ALARA – Keep radiation dose As Low As Reasonably Achievable.

*If the patient has a prior HRCT or CT Chest use Low Dose Protocol on the Supine Inspiration Chest scan.

LOW DOSE SUPINE INSPIRATION CHEST

Scan
Range / Scan Direction
Scan Type / 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)
-Above Lung Apices
Thru Bases/CPA
-If H/O Lung CA
Scan thru Adrenals / Craniocaudal
Spiral/Helical / Suspended
Inspiration / 5
Seconds / ON / 100 / Semi / 100 / 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 / I40f
Medium / Mediastinum
350/50 / FOV just beyond
patient’s LUNGS
RECON / Axial / ON
2 / 1.0 mm / 1.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON / Axial / ON
2 / 3.0 mm / 3.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON
Axial MIPS / Axial MIPS
Recon Card 3D Axial MIP Thin / ON
2 / 10.0 mm / 2.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON
Coronals Angled in Plane to Body Part / Coronals Angled in Plane to Body part
Recon Card 3D Coronal MPR / ON
2 / 1.0 mm / 1.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON
Sagittals Angled in Plane to Body Part / Sagittals Angled in Plane to Body Part
Recon Card 3D Sagittal MPR / ON
2 / 1.0 mm / 1.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS

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SUPINE INSPIRATION CHEST

Scan
Range / Scan Direction
Scan Type / 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)
-Above Lung Apices
Thru Bases/CPA
-If H/O Lung CA
Scan thru Adrenals / Craniocaudal
Spiral/Helical / 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 / I40f
Medium / Mediastinum
350/50 / FOV just beyond
patient’s LUNGS
RECON / Axial / ON
2 / 1.0 mm / 1.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON / Axial / ON
2 / 3.0 mm / 3.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON
Axial MIPS / Axial MIPS
Recon Card 3D Axial MIP Thin / ON
2 / 10.0 mm / 2.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON
Coronals Angled in Plane to Body Part / Coronals Angled in Plane to Body part
Recon Card 3D Coronal MPR / ON
2 / 1.0 mm / 1.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS
RECON
Sagittals Angled in Plane to Body Part / Sagittals Angled in Plane to Body Part
Recon Card 3D Sagittal MPR / ON
2 / 1.0 mm / 1.0 mm / I70f
Very Sharp ASA / Lung
1200/-7600 / FOV just beyond
patient’s LUNGS

SUPINE EXPIRATION CHEST

Scan
Range / Scan Direction
Scan Type / Respiration / Scan
Delay
(Seconds) / CARE
DOSE
4D / Quality
Reference
mAs / CARE
kV / Quality
Reference
kV / Detector Configuration
Slices Per Tube Rotation / Table
Feed / Cycle
Time
(Seconds) / Scan
Time
(Seconds) / SFOV
(cm)
Just Into Lung Apices
Through Lung Bases / Craniocaudal
Sequential / Suspended
Expiration / 7
Seconds / ON / 110 / ON / 120 / Detectors: 2 x 1.0 mm
Slices Per Tube Rotation: 2 / 20.0 mm / 1.75
Seconds / Full
0.5 Seconds / 50
cm
Plane / Slice
Thickness / Interval/
Table Feed / Kernal / Window
Width/Level / DFOV
(cm)
RECON / Axial / 1.0 mm / 20.0 mm / B60s
Sharp / Lung
1200/-600 / FOV just beyond
patient’s LUNGS
CHANGE PATIENT POSITION TO:
FEET FIRST PRONE

PRONE INSPIRATION CHEST

Scan
Range / Scan Direction
Scan Type / Respiration / Scan
Delay
(Seconds) / CARE
DOSE
4D / Quality
Reference
mAs / CARE
kV / Quality
Reference
kV / Detector Configuration
Slices Per Tube Rotation / Table
Feed / Cycle
Time
(Seconds) / Scan
Time
(Seconds) / SFOV
(cm)
Just Into Lung Apices
Through Lung Bases / Craniocaudal
Sequential / Suspended
Inspiration / 5
Seconds / ON / 110 / ON / 120 / Detectors: 2 x 1.0 mm
Slices Per Tube Rotation: 2 / 20.0 mm / 1.75
Seconds / Full
0.5 Seconds / 50
cm
Plane / Slice
Thickness / Interval/
Table Feed / Kernal / Window
Width/Level / DFOV
(cm)
RECON
MIRRORING ON:
BOTH RT/LT & UP/DOWN / Axial
MIRRORING ON:
BOTH RT/LT & UP/DOWN / 1.0 mm / 20.0 mm / B60s
Sharp / Lung
1200/-600 / FOV just beyond
patient’s LUNGS

Page 2 of 3

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.

CHARGES: CCHHR

NETWORK: Exam to PACS

1/2017 Page 3 of 3