CT Protocols
Frequently used policies (MCN links)
Head and neck protocols
| Position / Landmark | Level of Aortic Arch |
| Scan Start | Below Aortic Arch |
| Scan End | Above Skull |
| DFOV | 250mm |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 20G or larger, Antecubital |
| IV Contrast- Adult | 50ml OMNI 350 @ 5.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-4.0ml/sec. 50mL MAX |
| Contrast Delay | Bolus Tracked: Trigger Scan @ 120 HU |
| Reconstructions | |
|---|---|
| Axial Carotid/COW | 5mm x 2.5mm MIP |
| Axial COW | 5mm x 2.5mm MIP |
| Coronal COW | 5mm x 2.5mm MIP |
| Sagittal COW | 1mm x 1mm Avg |
| Coronal COW | 1mm x 1mm Avg |
| Sagittal COW | 1mm x 1mm Avg |
| Coronal Carotid | 5mm x 2.5mm MIP |
| Sagittal Carotid | 5mm x 2.5mm MIP |
| Coronal Carotid | 1mm x 1mm Avg |
| Sagittal Carotid | 1mm x 1mm Avg |
Notes
Scan a HEAD WO CONTRAST before CTA HEAD & NECK exam unless:
- Exam is ordered as Stereotactic for Surgery Planning
- Patient has had a Head WO Contrast within the last 6 hours.
- The ordering Provider or Radiologist does not want it
Philips notes: If Performed on Brilliance 16 Slice Scanners, use up to 80mL contrast.
| Position / Landmark | Level of Aortic Arch |
| Scan Start | Below base of nose |
| Scan End | Above head soft tissue |
| DFOV | 220mm (open FOV to include soft tissue anterior/posterior) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 20G or Larger, Antecubital |
| IV Contrast- Adult | 50ml OMNI 350 @ 5.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-4.0ml/sec. 50mL MAX |
| Contrast Delay | Bolus Tracked: Trigger Scan @ 120 HU |
| Reconstructions | |
|---|---|
| Axial Brain | 5mm x 2.5mm MIP |
| Coronal Brain | 5mm x 2.5mm MIP |
| Sagittal Brain | 5mm x 2.5mm MIP |
| Axial Brain | 1mm x 1mm Avg |
| Coronal Brain | 1mm x 1mm Avg |
| Sagittal Brain | 1mm x 1mm Avg |
Notes
Do not angle scan for any stereotactic or stealth exams. Position patient's head as straight as possible. Noncon head is not included in this exam unless requested by a provider.
| Position / Landmark | Center on patient's chin |
| Scan Start | Below base of nose |
| Scan End | Above Head Soft tissue |
| DFOV | 220mm (open FOV to include soft tissue soft tissue anterior/posterior) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | none |
| IV Contrast- Adults | none |
| IV Contrast- Pediatric | none |
| Contrast Delay | none |
| Reconstructions | |
|---|---|
| Axial Brain | 1mm x1mm |
Notes
Do not angle scan for any Stereotactic or Stealth exams. Position patient's head as straight as possible.
| Position / Landmark | Center on patient's chin |
| Scan Start | Below base of nose |
| Scan End | Above Head Soft tissue |
| DFOV | 220mm (OPEN FOV TO INCLUDE SOFT TISSUE ANTERIOR/POSTERIOR) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 22G or Larger, Antecubital |
| IV Contrast- Adult | 100ml OMNI 300 @ 2.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-2.0m/sec. 100mL MAX |
| Contrast Delay | Scan 5 minutes from Start of Injection |
| Reconstructions | |
|---|---|
| Axial Brain | 1mm x 1mm |
Notes
Do not angle scan for any Stereotactic or Stealth exams. Position patient's head as straight as possible.
| Position / Landmark | Center on patient's chin |
| Scan Start | Below base of skull |
| Scan End | Above skull |
| DFOV | 220mm |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 22G or Larger, Antecubital |
| IV Contrast- Adults | 100ml OMNI 300 @ 2.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-2.0m/sec. 100mL MAX |
| Contrast Delay | Scan 5 minutes from Start of Injection |
| Reconstructions | Adults |
|---|---|
| Axial Brain | 5mm x 5mm |
| Coronal Brain | 5mm x 5mm |
| Sagittal Brain | 5mm x 5mm |
| Axial Bone | 2mm x 2mm |
| Reconstructions | Pediatric |
|---|---|
| Axial Brain | 3mm x 3mm |
| Coronal Brain | 3mm x 3mm |
| Sagittal Brain | 3mm x 3mm |
| Axial Bone | 2mm x 2mm |
Notes
Toshiba notes: Angled Helical scan to avoid Orbits if possible. Volume Acquisition for repeats if motion artifacts present.
| Position / Landmark | Level of Aortic Arch |
| Scan Start | Below base of skull |
| Scan End | Above skull |
| DFOV | 220mm |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 20G or Larger, Antecubital |
| IV Contrast- Adult | 50ml OMNI 350 @ 5.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-4.0ml/sec. 50mL MAX |
| Contrast Delay | Bolus Tracked: Trigger Scan @ 120 HU |
| Reconstructions | |
|---|---|
| Axial Brain | 5mm x 2.5mm MIP |
| Coronal Brain | 5mm x 2.5mm MIP |
| Sagittal Brain | 5mm x 2.5mm MIP |
| Axial Brain | 1mm x 1mm Avg |
| Coronal Brain | 1mm x 1mm Avg |
| Sagittal Brain | 1mm x 1mm Avg |
Notes
Scan a HEAD WO CONTRAST before CTA HEAD exam unless:
- Exam is ordered as Stereotactic for Surgery Planning
- Patient has had a Head WO Contrast within the last 6 hours.
- The ordering Provider or Radiologist does not want it
Toshiba notes: Volume Acquisition for repeats if motion artifacts present.
| Position / Landmark | Center on Patient's Chin |
| Scan Start | Below base of skull |
| Scan End | Above skull |
| DFOV | 220mm |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 20G or Larger, Antecubital |
| IV Contrast- Adult | Adults: 100ml OMNI 300 @ 4.0-5.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-4.0ml/sec. 100mL MAX |
| Contrast Delay | Adults: Scan 45 seconds after start of injection |
| Reconstructions | Adults & Peds |
|---|---|
| Axial Brain | 5mm x 2.5mm MIP |
| Coronal Brain | 5mm x 2.5mm MIP |
| Sagittal Brain | 5mm x 2.5mm MIP |
| Axial Brain | 1mm x 1mm Avg |
| Coronal Brain | 1mm x 1mm Avg |
| Sagittal Brain | 1mm x 1mm Avg |
Notes
Scan a HEAD WO CONTRAST before CTA HEAD exam unless:
- Exam is ordered as Stereotactic for Surgery Planning
- Patient has had a Head WO Contrast within the last 6 hours.
- The ordering Provider or Radiologist does not want it
Toshiba notes: Volume Acquisition for repeats if motion artifacts present.
| Position / Landmark | Center on patient's chin |
| Scan Start | Above skull |
| Scan End | Above skull |
| DFOV | 220mm |
| Breath Hold | none |
| PO Prep | none |
| IV Access | none |
| IV Contrast | none |
| Contrast Delay | none |
| Reconstructions | Adult |
|---|---|
| Axial Brain | 5mm x 5mm |
| Coronal Brain | 5mm x 5mm |
| Sagittal Brain | 5mm x 5mm |
| Axial Bone | 2mm x 2mm |
| Reconstructions | Pediatric |
|---|---|
| Axial Brain | 3mm x 3mm |
| Coronal Brain | 3mm x 3mm |
| Sagittal Brain | 3mm x 3mm |
| Axial Bone | 2mm x 2mm |
Notes
Toshiba notes: Angled Helical scan to avoid Orbits if possible. Volume Acquisition for repeats if Motion Artifacts are present.
Spine protocols
| Position / Landmark | Level of Axillary |
| Scan Start | Base of skull (to include C1) |
| Scan End | Apices of lung (to include T1) |
| DFOV | 200mm (Larger if necessary to include entire Cervical spine anatomy.) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 22G or larger, antecubital |
| IV Contrast- Adult | 100mL OMNI 300 @ 2.0mL/sec |
| IV Contrast- Pediatric | 2ml/kg OMNI 300 @ 1.0-2.0mL/sec, 100mL MAX |
| Contrast Delay | 70 Seconds after injection start |
| Reconstructions | |
|---|---|
| Axial Bone | 1mm x 1mm |
| Coronal Bone | 2mm x 2mm |
| Sagittal Bone | 2mm x 2mm |
| Axial Soft Tissue | 3mm x 3mm |
| Position / Landmark | Level of Axillary |
| Scan Start | Base of skull (to include C1) |
| Scan End | Apices of lungs (to include T1) |
| DFOV | 200mm (Larger if necessary to include entire Cervical spine anatomy.) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | none |
| IV Contrast | none |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Axial Bone | 1mm x 1mm |
| Coronal Bone | 2mm x 2mm |
| Sagittal Bone | 2mm x 2mm |
| Axial Soft Tissue | 3mm x 3mm |
| Position / Landmark | Level of Hips |
| Scan Start | Level of T12 (include T12) |
| Scan End | Level of S1 (include S1), include entire sacrum if requested by provider |
| DFOV | 200mm (Larger if necessary to include entire Lumbar spine anatomy.) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 22G or larger, antecubital |
| IV Contrast- Adult | 100mL OMNI 300 @ 2.0mL/sec |
| IV Contrast- Pediatric | 2mL/kg OMNI 300 @ 1.0-2.0mL/sec,100mL MAX |
| Contrast Delay | 70 seconds from start of injection |
| Reconstructions | |
|---|---|
| Axial Bone | 2mm x 2mm |
| Coronal Bone | 2mm x 2mm |
| Sagittal Bone | 2mm x 2mm |
| Axial Soft Tissue | 3mm x 3mm |
| Position / Landmark | Level of Hips |
| Scan Start | Level of T12 (includeT12) |
| Scan End | Level of S1 (include S1), include entire sacrum if requested by provider |
| DFOV | 200mm (Larger if necessary to include entire Lumbar spine anatomy.) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | none |
| IV Contrast | none |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Axial Bone | 2mm x 2mm |
| Coronal Bone | 2mm x 2mm |
| Sagittal Bone | 2mm x 2mm |
| Axial Soft Tissue | 3mm x 3mm |
| Position / Landmark | Level of Umbilicus |
| Scan Start | Level of C12 (include C12) |
| Scan End | Level of L1 (include L1) |
| DFOV | 200mm (Larger if necessary to include entire Thoracic spine anatomy.) |
| Breath Hold | none |
| PO Prep | none |
| IV Access | 22G or larger, antecubital |
| IV Contrast- Adult | 100mL OMNI 300 @ 2.0mL/sec |
| IV Contrast- Pediatric | 2mL/kg OMNI 300 @ 1.0-2.0mL/sec,100mL MAX |
| Contrast Delay | 70 seconds from start of injection |
| Reconstructions | |
|---|---|
| Axial Bone | 2mm x 2mm |
| Coronal Bone | 2mm x 2mm |
| Sagittal Bone | 2mm x 2mm |
| Axial Soft Tissue | 3mm x 3mm |
| Position / Landmark | Level of Umbilicus |
| Scan Start | Level of C12 (include C12) |
| Scan End | Level of L1 (include L1) |
| DFOV | 200mm (Larger if necessary to include entire Thoracic spine anatomy.) |
| Breath Hold | None |
| PO Prep | None |
| IV Access | None |
| IV Contrast | None |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Axial Bone | 2mm x 2mm |
| Coronal Bone | 2mm x 2mm |
| Sagittal Bone | 2mm x 2mm |
| Axial Soft Tissue | 3mm x 3mm |
Chest protocols
| Position / Landmark | Supine centered above the lung apices |
| Scout Start | Lung apices |
| Scout End | Through lung bases |
| DFOV | Based on body habitus. Include skin surface if possible. |
| Breath Hold | Inspiration |
| PO Prep | None |
| IV Access | None |
| IV Contrast | None |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Mediastinal | 1.0 mm x 0.5 mm |
| Lung Axial | 1.0 mm x 0.5 mm |
| Coronal Lung | 1.0 mm x 1.5 mm |
| Lung Axial MIP | 10 mm x 5 mm |
| Cor Lung MIP | 10 mm x 5 mm |
| Sag Bone | 3 mm x 1.5 mm |
Indications: cancer, pain, staging
| Position / Landmark | Supine centered above the lung apices |
| Scout Start | Above lung apices |
| Scout End | To include entire liver/mid abdomen |
| DFOV | Based on body habitus. Include skin surface if possible. |
| Breath Hold | Inspiration |
| PO Prep | None |
| IV Access | 18g -22g, Location: No lower than 2” below the AC crease of the elbow, pressure approved TLC, PICC lines, (NOTE: For PV IV flush with the arm in the position it will be for the scan) |
| IV Contrast- Adult | Omnipaque 350 125mL @ 2-3ml/sec |
| IV Contrast- Pediatric | Omnipaque 300 2mL/kg max 125mL |
| Contrast Delay | 60 sec |
| Reconstructions | |
|---|---|
| Mediastinal | 3 mm x 1.5 mm |
| Lung Axial | 3 mm x 1.5 mm |
| Coronal Lung | 3 mm x 1.5 mm |
| Coronal ST | 3 mm x 1.5 mm |
| Sag Bone | 3 mm x 1.5 mm |
Indications: pain, cancer, trauma, mass
| Position / Landmark | Supine centered above the lung apices |
| Scout Start | Above lung apices |
| Scout End | Adrenals/upper kidneys |
| DFOV | Based on body habitus. Include skin surface if possible. |
| Breath Hold | Inspiration |
| PO Prep | None |
| IV Access | 18g -22g, Location: No lower than 2” below the AC crease of the elbow, pressure approved TLC, PICC lines, (NOTE: For PV IV flush with the arm in the position it will be for the scan) |
| IV Contrast- Adult | OMNI 350 80ml |
| IV Contrast- Pediatric | OMNI 350, 1ml/kg Omni 300 @ 1.5-2ml/sec (maximum dose 125mL) |
| Contrast Delay | 60 sec |
| Reconstructions | |
|---|---|
| Mediastinal | 3 mm x 1.5 mm |
| Lung Axial | 3 mm x 1.5 mm |
| Coronal Lung | 3 mm x 1.5 mm |
| Coronal ST | 3 mm x 1.5 mm |
Indications: nodule, PNA, cough
| Position / Landmark | Supine centered above the lung apices |
| Scout Start | Above apices |
| Scout End | Adrenals/upper kidneys |
| DFOV | Based on body habitus. Include skin surface if possible. |
| Breath Hold | Inspiration |
| PO Prep | None |
| IV Access | None |
| IV Contrast | None |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Mediastinal | 3mm x 1.5mm |
| Lung Axial | 3mm x 1.5mm |
| Coronal Lung | 3mm x 1.5mm |
| Sag Bone | 3mm x 1.5mm |
| Position / Landmark | Supine centered above the lung apices |
| Scout Start | Above apices |
| Scan End | Below lung bases |
| DFOV | Based on patient size- lungs only |
| Breath Hold | Dynamic Expiration for Peds breathe out and hold it out. |
| PO Prep | None |
| IV Access | N/A |
| IV Contrast | None |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Lung | 3.0mm x 1.5mm |
Notes
CT expiration chest includes a routine chest wo contrast unless otherwise stated in the protocol by Radiologist.
| Position / Landmark | Supine, centered above the lung apices, Arms down |
| Scout Start | Above apices |
| Scout End | Below lung bases |
| DFOV | Based on patient size- chest only |
| Breath Hold | Maximum inspiration |
| PO Prep | None |
| IV Access | N/A |
| IV Contrast | None |
| Contrast Delay | N/A |
| Reconstructions | |
|---|---|
| Mediastinal | 3 mm x 1.5 mm |
| Thin ST | 1 mm x 0.8 mm (512x512 matrix) |
| Lung | 3 mm x 1.5 mm |
| Coronal Lung | 3 mm x 1.5 mm |
| Sag Bone | 3 mm x 1.5 mm |
Notes
Thin data set must be at 512 matrix with a maximum image count of 690 (or less) to load into the Super D system.
| Position / Landmark | Supine, centered above the lung apices |
| Scout Start | Lung apices |
| Scout End | Below lung bases |
| DFOV | Based on patient body habitus- chest only |
| Breath Hold | Stop Breathing |
| PO Prep | None |
| IV Access | 18g -20g or larger, Location: No lower than 2” below the AC (crease of the elbow, pressure approved TLC, PICC lines, (NOTE: For PV IV flush with the arm in the position it will be for the scan) |
| IV Contrast | OMNI 350 mixed volume 60ml (80% contrast & 20% saline) with a saline flush. |
| IV Contrast- Pediatric | Peds < or = 17 yrs., 2mL/kg with a max of 120mL OMNI 300 |
| Bolus Tracker Location/HU Trigger | Pulmonary Artery/ 150 HU |
| Contrast Delay | 6 sec. post threshold delay |
| Reconstructions: | |
|---|---|
| Mediastinal | 2 mm x 1 mm |
| Coronal ST | 2 mm x 1 mm |
| Lung | 3 mm x 1.5 mm |
| Coronal Lung | 3 mm x 1.5 mm |
| MIP Obliques | 12 mm x 3 mm |
Notes
Coach patient on proper breathing instructions prior to scan. Patient should not bear down and stop breathing when the scanner prompts them to.
Toshiba Notes: Save a snapshot of your bolus tracker location by pressing F7 and send it to pacs.
Body protocols
| Position / Landmark | Supine (Diaphragm - pubis) |
| Topogram Direction | Top Down, Dual Scout (with arms up for correct dose modulation) |
| Respiratory Phase | Inspiration |
| Scan Type | Helical |
| Kv / mA / Rotation time (sec) | 120kVp |
| Pitch / Speed (mm/rotation) | 0.4 rotation |
| Noise Index | Dose right index 15 |
| Detector width x Rows = Beam Collimation | |
| Average Tube Output |
| First Helical Set | Non-Contrast Scan 5 x 2.5 |
|---|---|
| Slice Thickness / Spacing | 3 x 3 |
| Algorithm | STD (B) IDose 3 |
| Recon Destination | Coronal and Sagittal 5 x 2.5 |
| Second Helical Set | Hepatic Arterial 5 x 2.5 (**Diaphragm to the iliac crest**) 30 Sec delay |
|---|---|
| Slice Thickness / Spacing | 3 x 3 |
| Algorithm | STD (B) IDose 3 |
| Recon Destination | Coronal and Sagittal 5 x 2.5 |
| Third Helical Set | Portal Venous phase 5 x 2.5 (Diaphragm through the pubis) 90 sec delay |
|---|---|
| Slice Thickness / Spacing | 3 x 3 |
| Algorithm | STD (B) IDose 3 |
| Recon Destination | Coronal and Sagittal 5 x 2.5 |
| Scan Start / End Locations | See each phase above |
| DFOV | Accurate per the patient habitus |
| IV Contrast Volume / Type / Rate | Omnipaque 350 / 100mL @ 5-6 mL/sec |
| Scan Delay | Noncontrast / 30 sec / 90 sec |
| 2D / 3D Technique Used | 2D = Coronal and Sagittal, 3D = Hepatic arterial anatomy to include the celiac and all branches and the proximal SMA and any hepatic arterial variants. |
Notes
ROI in the aorta at the level of the hepatic artery on the wo images.