Chest CT Protocols - VCU Radiology Resident...
Transcript of Chest CT Protocols - VCU Radiology Resident...
Chest CT Protocols Revisions Effective January 2012 Chest 1: Pulmonary Nodule Follow-up: Low-Dose Helical CT (Unenhanced) (Non-metastatic) Technologist Instructions
Technique Siemens Sensation 64 64 x 0.6
(beam collimation 32 x 0.6) Patient “must cough” several times prior to scan to clear secretions
kV 100 (≤180 LBS) 120 (180-250 LBS) 140 (>250 LBS)
Patient imaged supine with arms elevated over head to minimize beam-hardening artifact
Gantry Rotation Time 0.33 sec
Breathing: hyperventilate x3; Take a breathe in and stop breathing
mAs (Reg-Lg) 40-80
Scan extends from thoracic inlet through adrenal glands
Scanner effective mAs (Reg-Lg)
25-50
Primary Scout performed in PA projection (tube at gantry bottom, patient supine) to minimize breast dose
Detector Collimation (mm) (T)
0.6 mm
Repeat any scans with motion
Number of active channels (N)
32
Detector configuration (N x T)
32 x 0.6 mm
Collimation (on operator console)
64 x 0.6 mm
Image Sequence Cr-Ca Table incrementation
(mm/rotation) (I) 19.2 mm
Pitch ([mm/rotation]/beam collimation) (I/NT)
1.0 mm
Table Speed (mm/second) 38.4 mm/sec Scan Time (40 cm thorax) 11 sec Nominal Reconstructed Slice
Width 3 mm
Reconstruction Interval 3 mm Reconstruction Algorithm B40 CTDI vol (Dose in mGy) 1.9-3.8 mGy DFOV = smallest diameter of
the chest wall that will completely contain the lung parenchyma as measured from the widest point of outer rib to outer rib
Care Dose Breast Shield
Off” Will not be applied
PACS / TerraRecon/ Vitrea (for lung nodule volumetric analysis)
Yes
In addition to the axial soft tissue (B40f) and lung (B60f) window reconstructions, perform the following recons: Axial MIP: Lung Window (5 x 3) (B60f) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60f)
Chest CT Protocols Revisions Effective January 2012 Chest 2: Routine Chest CT (CECT) Chest CT alone or in combination with Abdomen/Pelvis CT Order Chest 2 Routine Chest Clinical Indications
Lung Cancer Staging Lymphoma Staging Solitary Lung Nodule
Evaluation (Baseline) Cancer Follow-up Baseline Baseline Metastatic Work-up Fever Unknown Origin (FUO)
Work-up Abscess Work-up
Non-Opportunistic Lung Infections
Air-space Disease (ASD) Non-resolving ASD
Pleural Effusion Empyema Malignant Pleural Disease Chest Wall Disease
Post-Thoracotomy (non-vascular)
Mediastinal Abnormalities (e.g., thymoma, vocal cord paralysis, etc)
Technologist Instructions
Technique 1st
(Soft-tissues) 2nd
(Lung) Available CXR within 1 month
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Patient “must cough” several times prior to scan to clear secretions
Collimation 24 x 1.2mm
Scan extends from thoracic inlet through adrenal glands
Slice Width 3.0mm 3.0mm
Breathing: hyperventilate x3; Take a small breathe in and stop breathing
Pitch 0.75
Repeat any scans with motion
Kernel B40f Medium
B60f Sharp
Increments 3.0mm 3.0mm Image Sequence Cr-Ca Cr-Ca FOV Tailored to
patient Same
Injection Rate 3.0ml/sec 80 ml Omni 350 30 ml saline flush
Prep Time (delay) 40 sec Care Dose
Breast Shield
“On” Appropriate patients after scout acquired
PACS Yes Yes Axial MIP: Lung
Window (5 x 3) (B60F) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)
Chest CT Protocols Revisions January 2012 Chest 3: Unenhanced Routine Chest CT Chest 3 Routine Chest Clinical Indications
Any routine CECT clinical indication but in the setting of abnormal laboratory parameters (e.g., eGFR; creatinine, etc)
Multiple myeloma Acute Sickle Cell Crisis Solitary Lung Nodule
Follow-up Chest Wall Disease Technologist Instructions
Technique 1st
(Soft-tissues) 2nd
(Lung) Scan extends from thoracic inlet through adrenal glands
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Patient “must cough” several times prior to scan to clear secretions
Collimation 24 x 1.2mm
Breathing: hyperventilate x3; Take a breathe in and stop breathing
Slice Width 3.0mm 3.0mm
Repeat any scans with motion
Pitch 0.75
Available CXR within 1 month
Kernel B40f Medium
B60f Sharp
Increments 3.0mm 3.0mm Image Sequence Cr-Ca Cr-Ca FOV Tailored to Same
patient Injection Rate - Prep Time (delay) - Care Dose
Breast Shield
“On” Appropriate patients after scout acquired
PACS Yes Yes Axial MIP: Lung
Window (5 x 3) (B60F) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)
Chest CT Protocols Revisions January 2012 Chest 4: CTA Pulmonary Angiography (CTA) (Preference: Flash Scanner) Chest 4 CTA Pulmonary
Angiography (CTA)
Clinical Indications
Primary diagnosis of Acute Pulmonary Embolism (PE)
Follow-up evaluation of previously diagnosed Pulmonary Embolism (PE)
Evaluation of candidates for possible Pulmonary Thromboendartectomy
Evaluation of Chronic Pulmonary Thromboembolic disease (Chronic PE)
Pulmonary Arterial Hypertension (PAH)
Pulmonary Arteriovenous Malformation (AVM)
Technologist Instructions
Technique 1st
(Soft-tissues) 2nd
(Lung) Available CXR same day if acute PE work-up; otherwise within 1 month
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Patient “must cough” several times if capable prior to scan to clear secretions
Collimation 64 x 0.6mm
Breathing: hyperventilate x3; Take a
Slice Width 2.0mm 2.0mm
breathe in and stop breathing Pitch 0.9 Kernel B31f
medium-smooth ++ B70f
very sharp Increments 1.0mm 1.0mm Image Sequence Cr-Ca FOV Tailored to
patient
Injection Rate 4.0ml/sec 80-100 ml Isovue 370 + 30 ml saline chaser
Prep Time (delay) Bolus Tracking Trigger @ Main Pulmonary Artery @ 200HU
Care Dose Breast Shield
“On” Appropriate patients after scout acquired
PACS Yes Yes Axial MIP: Lung
Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window
Chest CT Protocols Revisions January 2012 Chest 5: CTA Thoracic Aortography (CTA): Acute Dissection (Preference: Flash Scanner) Chest 5 CTA Thoracic
Angiography (CTA)
Clinical Indications
Thoracic Aorta Dissection (baseline and follow-up without stent graft)
Thoracic Aorta Aneurysms (baseline and follow-up without stent graft)
Atheromatous disease and Penetrating Ulcers
Intramural Hematoma (baseline and follow-up without stent graft)
Aortitis Technologist Instructions
Technique 1st
Unenhanced 2nd
Enhanced Available CXR same day if acute work-up; otherwise within 1 month
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Patient “must cough” several times if capable prior to scan to clear secretions
Collimation 24 x 1.2mm 64 x 0.6mm
Breathing: hyperventilate x3; Take a breathe in and stop breathing
Slice Width 5.0mm 2.0mm
Pitch 0.9 0.9 Kernel B40f
Medium B25f
Smooth Increments 5.0mm 1.0mm Image Sequence Cr-Ca FOV Tailored to patient Injection Rate N/A 4.0ml/sec
150 ml Isovue 370 + 30 ml saline chaser
Prep Time (delay)
N/A Bolus Tracking Trigger @ Arch at 150HU
Care Dose Breast Shield
“On” Appropriate patients after scout acquired
“On” Yes
PACS Yes Yes Axial MIP: Lung
Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal / Sagittal Oblique: Soft-tissue Window
Chest CT Protocols Revisions January 2012 Chest 6: Thoracic Aortography (CTA): Follow-up Aorta Dissection / Repair (Preference: Flash Scanner) Chest 6 CTA Thoracic
Angiography (CTA)
Clinical Indications
Thoracic Aorta Dissection (follow-up with stent graft / hardware)
Thoracic Aorta Aneurysms (follow-up with stent graft / hardware)
Atheromatous disease and Penetrating Ulcers (follow-up with stent graft / hardware)
Intramural Hematoma (follow-up with stent graft / hardware)
Technologist Instructions
Technique 1st
Unenhanced 2nd
Enhanced 3rd
60 sec Delay
Available CXR same day if acute work-up; otherwise within 1 month
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Same Same
Patient “must cough” several times if capable prior to scan to clear secretions
Collimation 24 x 1.2mm 64 x 0.6mm 64 x 0.6mm
Breathing: hyperventilate x3; Take a small breathe
Slice Width 5.0mm 2.0mm 2.0mm
in and stop breathing Pitch 0.9 0.9 0.9 Kernel B40f
Medium B25f
Smooth B25f
Smooth Increments 5.0mm 1.0mm 0.7mm Image
Sequence Cr-Ca
FOV Tailored to patient
Injection Rate N/A 4.0ml/sec 150 ml Isovue 370 + 30 ml saline chaser
N/A
Prep Time (delay)
N/A Bolus Tracking Trigger @ Arch at 150HU
Care Dose Breast Shield
“On” Appropriate patients after scout acquired
“On” Yes
“On” Yes
PACS Yes Yes Yes Axial MIP:
Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal / Sagittal Oblique: Soft-tissue Window
Chest CT Protocols Revisions January 2012 Chest 7: CTA Thoracic Aortography (CTA): Trauma Chest (Preference: Flash Scanner or Cardiac Gated if Non-Flash) Technologist Note: Only send 2 x 2’s to PACS (not 3 x 3’s) Chest 7 CTA Thoracic
Aortography (CTA) Clinical Indications
Suspected Acute Traumatic Aorta or Branch Vessel Injury
Trauma-related Hemomediastinum
Technologist Instructions
Technique 1st
(Soft-tissues) 2nd
(Lung) kVp
mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Collimation 64 x 0.6mm Slice Width 2.0mm 2.0mm Pitch 0.75 Kernel B40f
Medium B20f
Smooth Increments 1.0mm 1.0mm Image Sequence Cr-Ca FOV 300 300 Injection Rate 4.0ml/sec
80-100 ml Omni-300 + 30 ml saline chaser
Prep Time (delay) Bolus Tracking Trigger @ aortic arch @ 150HU
Care Dose Breast Shield
“On” “Off” Baseline exams
Breast Shield
“On” Follow-up studies on appropriate patients after scout acquired
PACS Yes Yes Axial MIP: Lung
Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal / Sagittal Oblique: Soft-tissue Window
Chest CT Protocols Revisions January 2012 Chest 8: High-Resolution (HRCT) Chest CT-Interstitial Lung Disease Chest 8 HRCT Clinical Indications
Unexplained Dyspnea on Exertion Suspected or Known
Chronic Interstitial Lung Disease Follow-up CILD on Therapy Technologist Instructions
Technique 1st
(Soft-Tissues and Lungs)
2nd HRCT
Sequence Supine
(Inspiration)
3rd HRCT
Sequence Prone
(Inspiration) Patient “must cough” several times prior to scan to clear secretions
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Same Same (Carina through Diaphragm)
Breathing: hyperventilate x3; Take a breathe in and stop breathing
Collimation 64 x 0.6mm 1mm x 2.0mm 1 x 2.0 mm
If patient unable to lie prone; must acquire HRCT supine with B70 kernel
Slice Width 3.0mm 1.0mm 1.0mm
Repeat any scans with motion
Pitch 0.75 Feed 10mm Feed 10mm
Available CXR within 1 month
Kernel B40f Medium
(soft-tissues)
B60f Sharp (lungs)
B70s Very Sharp
B70s Very Sharp
Increments 3.0mm 10mm 10mm Image Cr-Ca Cr-Ca Cr-Ca
Sequence FOV Tailored to
patient Same Same
Oral Contrast - - - Injection Rate N/A Prep Time
(delay) N/A - -
Care Dose Breast Shield
“On” Appropriate patients after scout acquired
“Off” “Off”
PACS Yes Yes Yes Axial MIP:
Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)
Chest CT Protocols January 2012 Chest 9: Chest CT-Small Airways Disease Chest 9 HRCT Clinical Indications
Suspected or Known Small Airways Disease
Suspected or Known Bronchiectasis Known or Suspected GVHD Bone Marrow Transplants
(pre- and post-procedure) Technologist Instructions
Technique 1st
Soft-Tissues and Lungs)
2nd Supine
Expiration Patient “must cough” several times prior to scan to clear secretions
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Breathing: hyperventilate x3; Take a small breathe in and stop breathing
Collimation 64 x 0.6mm 64 x 0.6mm
Repeat any scans with motion
Slice Width 2.0mm 2.0mm
Available CXR within 1 month
Pitch 0.75 0.75
Kernel B40F Medium
(soft-tissues)
B70s Very Sharp
B70s Very Sharp
Increments 1.0 mm 1.0 mm
Image Sequence
Cr-Ca Cr-Ca
FOV Tailored to patient
Same
Oral Contrast - - Injection
Rate N/A
Prep Time (delay)
N/A -
Care Dose Breast Shield
“On” Appropriate patients after scout acquired
“Off”
PACS Yes Yes Axial MIP: Lung
Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)
Chest CT Protocols Revisions January 2012 Chest 10: Large Airways Disease-Stenosis Chest 10 Large Airways
Disease Clinical Indications
Tracheal Stenosis Bronchial Stenosis Tracheal-Esophageal Fistula Suspected Tracheal or Bronchial Injury or
Fracture Technologist Instructions
Technique 1st
Angle of Mandible to
3rd Order Bronchi
1st
(Soft-tissues)
2nd (Lung)
3rd (Expiratory
Lung)
Available CXR within 1 month
kVp mAs Rotation time
100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s
Same Same Send to TerraRecon as 3x2 for Radiologist to reconstruct
Patient “must cough” several times prior to scan to clear secretions
Collimation 2 x 1.0 mm 24 x 1.2mm
Breathing: hyperventilate x3; Take a small breathe in and stop breathing
Slice Width 3.0mm 3.0mm 3.0mm 5.0 mm
Repeat any scans with motion
Pitch 3-5mm/sec or Pitch 1-1.6
0.75
Kernel B70s Very Sharp
B40F Medium
B60F Sharp
Increments 1-2mm 3.0mm 3.0mm 5.0 mm
Image Sequence
Cr-Ca Cr-Ca Cr-Ca
FOV Tailored to Airway
Tailored to patient
Same
Oral Contrast - 3.0ml/sec 80 ml Omni 350 30 ml saline flush
Injection Rate N/A 40 sec Prep Time
(delay) N/A “On”
Appropriate patients after scout acquired
Care Dose Breast Shield
“On” Appropriate patients after scout acquired
Yes After scout acquired
Yes
PACS Yes Yes Yes Volume
Rendering with Lung Isolation Algorithm
Yes
Axial MIP: Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window VRT: Tracheal-bronchial Tree
Chest CT Protocols Revisions January 2012 Chest 11: Large Airways Disease-Malacia Chest 11 Tracheomalacia Clinical Indications
Tracheomalacia Tracheobronchomalacia Mounier-Kuhn Syndrome SERIES 1: SCOUT AP and LATERAL Send all Data to PACS SERIES 2: TRACHEA END INSPIRATION MID C4 THRU ADRENAL GLAND HELICAL 3mm 3mm Interval DELAY 39.37 100kVp 0.5SEC .984 :1 320 mA Standard
RECON 1 3mm X 3mm Interval Standard RECON 2 2.5mm X 2.5mm Interval Lung RECON 3 1.25mm X 1.25mm Interval Standard SERIES 3 DYNAMIC BREATHING MID C4 TO DIAPHRAGM
Patient should inhale to full lung capacity and begin to forcefully exhale like “blowing out a candle” during scan. Use designated “mouthpiece” COORDINATE ONSET OF SCAN ACQUISITION WITH BEGINNING OF FORCEFUL EXHALATION
HELICAL 3mm 3 5mm Interval 39.37 120kVp 0.5SEC .984 :1 80 mA Standard
NOTE: TRACHEA SHOULD CHANGE IN SHAPE (ANT BOWING POST WALL OR COLLAPSE)
RECON 1 2.5mm X 2.5mm Interval Standard RECON 2 2.5mm X 1.25mm Interval Standard
Chest CT Protocols Revisions Effective January 2012 Designated Lung Cancer Screening Program (LCSP) Patients Only!: Chest 12: LCSP: Chest Low-Dose Helical CT (Unenhanced) Technologist Instructions
Technique Siemens Sensation 64 64 x 0.6
(beam collimation 32 x 0.6) Patient “must cough” several times prior to scan to clear secretions
kV 120
Patient imaged supine with arms elevated over head to minimize beam-hardening artifact
Gantry Rotation Time 0.5 sec
Breathing: hyperventilate x3; Take a breathe in and stop breathing
mAs (Reg-Lg) 40-80
Scan extends from thoracic inlet through adrenal glands
Scanner effective mAs (Reg-Lg)
25-50
Primary Scout performed in PA projection (tube at gantry bottom, patient supine) to minimize breast dose
Detector Collimation (mm) (T)
0.6 mm
Repeat any scans with motion
Number of active channels (N)
32
Detector configuration (N x T)
32 x 0.6 mm
Collimation 64 x 0.6 mm
(on operator console) Image Sequence Cr-Ca Table incrementation
(mm/rotation) (I) 19.2 mm
Pitch ([mm/rotation]/beam collimation) (I/NT)
1.0 mm
Table Speed (mm/second) 38.4 mm/sec Scan Time (40 cm thorax) 11 sec Nominal Reconstructed Slice
Width 2 mm
Reconstruction Interval 1.8 mm Reconstruction Algorithm B30 CTDI vol (Dose in mGy) 1.9-3.8 mGy DFOV = smallest diameter of
the chest wall that will completely contain the lung parenchyma as measured from the widest point of outer rib to outer rib
Care Dose Breast Shield
Off” Will not be applied
PACS / TerraRecon/ Vitrea (for lung nodule volumetric analysis)
Yes
In addition to the axial soft tissue (B40f) and lung (B60f) window reconstructions, perform the following recons: Axial MIP: Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window