Last updated: 11/13/2021
General
- Brain Standard Reformations
- Axial brain 5 mm
- True Axial brain 5 mm: Reformations are parallel to the infra-orbital line and skull base
- Coronal brain 2 mm
- Sagittal brain 2 mm
- Axial bone 0.6 mm
- Dual Energy Brain Reformations
- Axial (AX) F_0.5
- True Axial (TR AX) F_0.5
- Coronal (COR) F_0.5
- Sagittal (SAG) F_0.5
- True Axial (TR AX) Bone F_0.5
- A+B A_80kV
- A+B Sn150kV
- A+B Monoenergentic Plus 190 keV
- Cervical spine “multi-spine” reformat angels the axial images to a true axial on patients with a curved spine
Brain
- Without Intravenous Contrast Indications
- Suspected intracranial hemorrhage
- Severe headache
- Follow up bleed or stroke
- ER patient with new onset seizure
- Altered mental status
- Trauma
- Hydrocephalus
- With Intravenous Contrast Indications
- Some indications with same day or recent non-contrasted CT
- Brain lab or treatment planning
- Without & With Intravenous Contrast Indications
- MRI contraindicated and
- Brain tumor or metastatic disease
- CNS infection/abscess/meningitis/AIDS
- MRI contraindicated and
- Acquisition Phases
- Brain Without: Noncontrast
- Brain With: 5 minute Delay
- Brain Without and With: Noncontrast and 5 minute Delay
- Anatomical Coverage: Skull Vertex to C1 Vertebral Body
- Reformations: Standard
- Note: MUST specify the bolded acquisition phase name above and add any additional phases needed to ensure correct phases are obtained
Brain and Face Trauma
- Indication: Head/Face Trauma
- Acquisition Phase: Noncontrast
- Anatomical Coverage: Skull Vertex through Mandible
- Brain Reformations: Standard
- Face Reformations
- Axial, coronal, and sagittal soft tissue 2 mm
- Axial, coronal, and sagittal bone 2 mm
- 3-Dimensional reconstructions
Brain CT Angiography
- Indications
- Subarachnoid hemorrhage
- Aneurysm follow-up
- Rule out vasospasm
- Acquisition Phase: Noncontrast, Arterial
- Anatomical Coverage: Skull Vertex to C1 Vertebral Body
- Reformations
- Non-contrasted axial brain 5 mm
- Non-contrasted coronal brain 2 mm
- Non-contrasted sagittal brain 2 mm
- CTA Brain axial 0.6 mm
- Axial, coronal, and sagittal MIPS 10 mm slab
- 3D: Cranial view (Circle of Willis), Bilateral lateral views (ACA), Anterior view (Carotid terminus), Posterior view (Basilar and distal vertebral arteries)
Brain Attack
- Indication: Acute stroke
- Acquisition Phases: Non-contrast, Arterial, Perfusion
- Anatomical Coverage
- Non-contrast: Skull Vertex to C1 Vertebral Body
- Arterial: Pulmonary Arteries to Skull Vertex
- Perfusion: Skull Vertex to C1 Vertebral Body
- Reformations
- Non-contrasted axial brain 5 mm
- Non-contrasted coronal brain 2 mm
- Non-contrasted sagittal brain 2 mm
- CTA Brain axial 0.6 mm
- Axial, coronal, and sagittal MIPS 10 mm slab
- Carotid canal 0.6 mm (right & left)
- Carotid bifurcation MIPs (right & left)
- 3D: Cranial view (Circle of Willis), Bilateral lateral views (ACA), Anterior view (Carotid terminus), Posterior view (Basilar and distal vertebral arteries)
- Cerebral blood flow, cerebral blood volume, mean transit time, and time to peak maps
Brain and Neck CT Angiography
- Indications
- Suspected dissection
- Vertigo/ataxia
- Syncope
- Transient ischemic attack (TIA)
- Acquisition Phases: Noncontrast, Arterial
- Anatomical Coverage: Skull Vertex to Aortic Arch
- Reformations
- Non-contrasted axial brain 5 mm
- Non-contrasted coronal brain 2 mm
- Non-contrasted sagittal brain 2 mm
- CTA Brain axial 0.6 mm
- Axial, coronal, and sagittal MIPS 10 mm slab
- Carotid canal 0.6 mm
- Carotid bifurcation sagittal 3 mm bilaterally
- 3D: Cranial view (Circle of Willis), Bilateral lateral views (ACA), Anterior view (Carotid terminus), Posterior view (Basilar and distal vertebral arteries)
Neck CT Angiography
- Indications
- Trauma with suspected vascular injury
- Vascular anomaly
- Arterial Stenosis
- Acquisition Phase: Arterial
- Anatomical Coverage: Mid Orbits through Aortic Arch
- Standard CTA Reformations
- Axial soft tissue 0.6 mm
- Carotid canal 0.6 mm (right & left)
- Carotid bifurcation sagittal 3 mm bilaterally
- 3D Vascular
- Trauma CTA Reformations
- Axial soft tissue 0.6 mm
- Coronal and sagittal soft tissue 2 mm
- Axial, coronal, and sagittal bone 2 mm
- 3-Dimensional Vascular
- Notes
- Must specify CTA Neck vs Trauma CTA Neck to ensure correct reformations are performed
- Either performed as a true CTA (CTANNWWO) or as a trauma CTA neck (CNNTRAUMAW)
- Almost always perform as the true CTA (not trauma) due to better image quality
- Trauma CTA Neck is most commonly performed when the trauma team orders a “Single Pass” trauma CT
Soft Tissue Neck
- Without Intravenous Contrast Indications
- Subglottic stenosis
- Thyroid pathology in patients who cannot receive iodinated contrast (reaction vs plan for treatment)
- With Intravenous Contrast Indications
- Malignancy/Mass
- Infection
- Acquisition Phases
- Soft Tissue Neck Without: Noncontrast
- Soft Tissue Neck With: 90 second delay
- Anatomical Coverage: Frontal Sinuses through Aortic Arch
- Reformations
- 3 mm axial, coronal, and sagittal soft tissue
- 3 mm axial, coronal, and sagittal bone
- Laryngology patients also get 1 mm soft tissue axial through larynx
- Notes
- MUST specify the bolded acquisition phase name above and add any additional phases needed to ensure correct phases are obtained
- If the order is for without and with, look to see if it’s for a parathyroid abnormality and if so use that specific protocol. Otherwise, both without and with contrast is not performed.
Cervical Spine
- Without Intravenous Contrast Indications
- Spinal canal stenosis and MRI contraindicated
- Trauma, compression fracture
- Osseous metastatic disease
- Post myelogram
- With Intravenous Contrast Indications
- Metastasis and MRI contraindicated
- Epidural tumor and MRI contraindicated
- Intraspinal abscess
- Surgical planning (vertebral artery)
- Acquisition Phase
- Cervical Spine Without: Noncontrast
- Cervical Spine With: 60-70 second delay (basically same as PVP)
- Anatomical Coverage: Skull Base to T1 Vertebral Body
- Reformations
- 2 mm axial, coronal, and sagittal soft tissue
- 2 mm axial, coronal, and sagittal bone
- Note
- MUST specify the bolded acquisition phase name above and add any additional phases needed to ensure correct phases are obtained
- Never perform without and with contrast
- “Multispine”: Angles the axial images to the true axials on patients with curved spines
Face
- Without Intravenous Contrast Indication: Trauma
- Sinus CT (does not cover mandible): sinusitis (see below for sinus protocol)
- Face CT (does cover the mandible): trauma
- Face With Intravenous Contrast Indications
- Malignancy
- Infection (Invasive sinusitis, cellulitis, abscess, etc.)
- Acquisition Phases
- Face Without: Noncontrast
- Face With: 60-70 second delay (basically same as PVP)
- Anatomical Coverage: Frontal Sinuses through Mandible
- Reformations
- 2 mm axial, coronal, and sagittal soft tissue
- 2 mm axial, coronal, and sagittal bone
- Notes
- MUST specify the bolded acquisition phase name above and add any additional phases needed to ensure correct phases are obtained
- Face includes mandible (vs sinus)
- Never perform without and with contrast
- Also have a noncontrast “Face/Sinus Brain Lab” protocol which includes 1 mm soft tissue and bone reformations and is used for surgical planning
Parathyroid
- Indications
- Suspected parathyroid lesion
- Abnormal parathyroid glands
- Acquisition Phases: Noncontrast, Arterial (25 seconds from injection), Delay (80 seconds from injection)
- Anatomical Coverage: Frontal Sinus through Carina
- Reformations
- 2 mm axial noncontrast phase
- 2 mm axial, coronal, and sagittal soft tissue arterial and delayed phases
- Note: Should be ordered and coded as CT neck without and with
Sinus
- Indication: Non-invasive sinusitis
- Acquisition Phases: Noncontrast
- Anatomical Coverage: Frontal through Maxillary Sinuses
- Reformations
- 2 mm axial, coronal, and sagittal soft tissue
- 2 mm axial, coronal, and sagittal bone
- Notes
- Sinus CT’s are not performed with contrast. If the indication needs contrast, then a Face CT should be performed instead
- Sinus doesn’t include mandible (vs face)
- Also have a noncontrast “Face/Sinus Brain Lab” protocol which includes 1 mm soft tissue and bone reformations and is used for surgical planning
Orbit/Sella
- Without Intravenous Contrast Indication: Trauma
- With Intravenous Contrast Indications
- Intra-orbital tumor
- Infection
- Acquisition Phases
- Orbit/Sella Without: Noncontrast
- Orbit/Sella With: 60-70 second delay (basically same as PVP)
- Anatomical Coverage: Frontal through Maxillary Sinuses
- Reformations
- 2 mm axial, coronal, and sagittal soft tissue
- 2 mm axial, coronal, and sagittal bone
- Notes
- MUST specify the bolded acquisition phase name above and add any additional phases needed to ensure correct phases are obtained
- Never perform without and with contrast
Temporal Bone
- Without Intravenous Contrast Indications
- Trauma
- Conductive or sensorineural hearing loss
- Semicircular canal dehiscence
- Surgical planning for mastoidectomy and cochlear implant placement
- With Intravenous Contrast Indication
- Neoplasms (e.g. Glomus tympanicum or jugulare)
- Infection (Ear/Mastoid, Rule out Bezold’s abscess)
- Acquisition Phases
- Temporal Bone Without: Noncontrast
- Temporal Bone With: 60-70 second delay (basically same as PVP)
- Anatomical Coverage: Mastoid air cells
- Without Reformations (All bone window and bilateral)
- Axial 0.6 mm (Bilateral and individual coned down)
- Coronal 0.6 mm (Bilateral and individual coned down)
- Oblique Poschl and Stenvers 0.6 mm
- With Reformations
- Axial bone 0.6 mm (Bilateral and individual coned down)
- Coronal bone 0.6 mm (Bilateral and individual coned down)
- Oblique bone Poschl and Stenvers 0.6 mm (Individual coned down only)
- Axial 0.6 mm soft tissue (Bilateral only)
- Coronal soft tissue 0.6 mm (Bilateral and individual coned down)
- Notes
- MUST specify the bolded acquisition phase name above and add any additional phases needed to ensure correct phases are obtained
- Never perform without and with contrast
- Bilateral= wider field of view able to see both sides
- Individual= smaller field of view focused in on either the right or left side
- Remind techs to send soft tissue reconstructions on the “with contrast” exams