SOMATOM Volume Zoom Routine VA40

sSOMATOM Volume Zoom Application Guide Routine protocols Software Version A40 From the Editor Dear SOMATOM Volume Zoom user, With the release of the new software (VA 40), we would like to inform you about “What’s new?” • Pediatric scan protocols A complete set of pediatric scan protocols has been created under a new folder called “Children” (fig.1). They are numbered according to the body regions, i. e. from head to extremities (fig. 2).The Head and Neck scan protocols are defined according to age (fig. 3), and the scan protocols for the other body regions are defined according to the body weight (fig. 4). • Dose information CTDIw value is provided with each scan protocol. And the Effective Dose values are provided for most of the scan protocols. Please refer to “General” chapter for details. • Low dose Topogram for children In all pediatric scan protocols, the Topograms are defined with 80 kV and 50 mA, which is the lowest dose that can be achieved with the scanner. In comparison to 120 kV and 50 mA, the dose reduction is about 2/3. • Scan protocols with dose reduction Some of the scan protocols have been modified according to the clinical feedback. E. g., scan protocols in the region of “Thorax” and “Head” are now defined with 120 kV instead of 140 kV. This gives a dose reduction of ~38% in the routine head scan protocols, and ~46% in the routine body scan protocols. We express our sincere gratitude to the many customers who contributed valuable input. Special thanks to Children’s Hospital of Wisconsin, U.S.A., for its valuable contribution to the development of pediatric scan protocols. Special thanks to Ernst Klotz, Christoph Suess, Joachim Wildberger, Dieter Manthey, Loke-gie Haw and Stefan Schaller for their important assistance. From the Editor Fig 1: Children folder Fig 2: Scan protocols under children folder are numbered from head to Extremity. Fig 3: Head and neck protocols are defined according to the age. Fig 4: Scan protocols for body regions are defined according to the body weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 1 . . . .Overview General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Thorax . . . 51 Neck . . . . . . . . . . . . . . . . 06 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Pelvis . . . . . . . . . . . . . . . . 111 Spine . . . . . . 17 Head . 71 Shoulder . . . . . . 83 Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Extremities . . . . . . . . . . . . . . . . . s CarotidCTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s AbdPelRoutine . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . s Airway . . . . . . . s InnerEarUHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contrast medium IV injection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s NeonateBody . . . . s ExtremitySpiral . . . . s SpineSpiral . .. . . . . . . . . . . . . . . . . . s NeckRoutine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s Effective mAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postprocessing . . . . . . . . . . . . . . . . . . .. . . . s Dose information . . . . . . . . . . 06 s s s s s s Concept . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . s HeadAngio . . . . . . . . s ExtremityUHR . . . . . . . . . . . . . . . . . . . . . . . . . s ThoraxSeqHR . . . . . . . . . 17 19 23 25 26 27 29 31 32 33 35 37 39 40 41 43 45 46 47 49 50 2 . . . Scan and reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s AbdCTA . . . . . . . . s Hints in general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s HeadSeq . . . . . . . . s HeadSpi . . . . . . . . . . . . . . . . . . . . . . . . s SinusRoutine . . 17 s Overview . . . . . . . . . . . s SinusMPR . . . . . . . . . . . . . . . . How to create your own scan protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 07 07 10 11 11 14 14 Children . . . Scan set up . . . . . s ChestRoutine . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .Contents General . . . . . s ChestCombi . . . . . . . . . . . . . . . . . . . . . . . . . . s SpineMPR . . . . . . . . . . . . . . s Overview . . . . . . . . . . . . . . . . . . . . . . . Neck . . . . . . . s Overview . . s NeckRoutine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s Overview. s AngioCarotid . . . . . . . . . . . . . . . s Hints in general. . . . . . s Hints in general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shoulder . . . . .. . . . . . . . . . . . . . s HeadSpi . . . . . . . . . . . . . . . . . . . . . . . . . . s AngioHead0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s ThinSliceSpi . s InnerEarSeq . . . 51 51 52 53 55 57 59 61 63 65 67 69 71 71 72 73 75 77 79 79 80 81 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s ShoulderSpi . . . . . . . . . . . . . . . . . . . . . s AngioHead . . . . . . . . . . . . . . . . .5 . . . . . . . . . . s OrbiSinusSpi . . . . . . . . . . . . . . . . . . . . . s HeadCombi . . . . . . . . . . . . . . . . . . . . . . . . . . . . s Hints in general. . . . . . . . . . . . . . . . . . . . .Contents Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s InnerEarSpi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s HeadSeq . . . . . . . . . . . . . . . . . . . . . . . . . s HeadFastSeq . . . . . . . 105 s AngioRoutine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s LungLowDose . . . . . . . . 83 83 84 85 87 89 91 93 95 Abdomen . . . . . . . . . . . . . . . . . . . . . s ThoraxCombi . . . . . . . . . . . . . . . . . . . 98 s AbdRoutine . . . . . s ThoraxSeqHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s ThoraxHires . . . . . . . . . . s Hints in general.Contents Thorax . . . 97 s Hints in general. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 s AbdFast . . . . . . . . 107 s AngioFast . . . . . 103 s AbdThinSlice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 s Overview . . . . . . . . 101 s AbdCombi . . . . . . . . . . . . . . . 109 Pelvis . . . . . . . . . . . . . . . . . . 111 112 113 115 4 . . . . . s Hints in general . . . . . . . . . . . . s Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 s Overview . . . . . . . . s HipSpi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s ThoraxFast . . . . . . . . . . . . . . s ThoraxRoutine . . . . . . . . . s PelvisRoutine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 s ThinSliceSpi . . . . . . 118 s RoutineSeq . . . . . . . . . . . . . . . .Contents Spine . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Extremities . . . . . . s CombiSpi . . . . . . . . . . . . . . . . . . . . s AngioRunOff . . . . . . . . . . . . . . . . . . . . . . . 119 s ObeseSeq . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 s Hints in general . . . . . . . . . . . . . . . . . . . . . . . . s UHRSpi . . . . . . . . . . s Hints in general. . . . . . . . . . . . . . 117 s Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 s SpineSpi . . . . . . 123 124 125 127 129 5 . . . . . . . . . 123 s Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . special applications are defined under “special” (Please refer to the Application Guide for special applications). Abdomen.5 mm slice collimation for routine studies.75 s or more for High-resolution studies. • “UHR”: uses a 2 x 0. g. “Spi” stands for “Spiral” E. Remarks The collimations of “2 x 8 mm and 2 x 10 mm” are not recommended in the spiral scan protocols since 4 x 5 mm has the most Z-coverage per rotation. the head.5 mm as slice collimation. • “Seq”: stands for Sequence. Extremities. Thorax. Shoulder. “HeadSeq” means the sequence mode for the head. 6 . Neck.75 s or more and a scan FOV of 250 mm for ultra-high resolution studies. and images can be reconstructed as 8 or 10 mm if desired. • “ThinSlice”: uses 4 x 1 mm slice collimation for thin slice studies. • “HiRes”: uses 4 x 1 mm slice collimation and rotation time of 0. • “Combi”: uses 4 x 1 mm as slice collimation and reconstruct images as both thinner slice width for HiRes or CTA and thicker slice width for soft tissue studies. a rotation time of 0. E.General s Concept The scan protocols for adult are defined according to body regions – Head. The 500 ms rotation time is recommended in general. g. “HeadSpi” means the spiral mode for . but except for the HiRes and UHR modes where a higher number of projections are required. Spine. • “Routine”: uses 4 x 2. Pelvis. The pediatric scan protocols are defined under the folder “Children” The protocols for . The general concept is as follows: • “Fast”: uses 4 x 5 mm slice collimation for fast acquisition. it. 4 x 5 mm). In multislice CT. you do not need to care about the algorithm any more. this is divided by the number of active detector channels (e. . There are two lists of possible combination of slice collimation and slice width. which determines the Z-coverage per rotation. To repeat any mode. you select the slice collimation together with the slice width desired. select “cut” Each chronicle is rewriteable before . i. Slice width is the true thickness of the reconstructed image. With the SOMATOM Volume Zoom. e. 7 . To activate (Fig. use the checkbox “Narrow” which stands for “narrow collimation” . 2) them.General s Scan set up Scans can be simply set up by selecting a predefined scan protocol. Multiple ranges can be run either automatically with “auto range” or seperately with a pause in between. the slice width is independent of pitch and algorithm. g. what you select is always what you get. the software does it for you. just click the chronicle with the right mouse button for “repeat” To delete . 1) or deactivate (Fig. Actually. s Scan and reconstruction Slice collimation and Slice width Slice collimation is the slice thickness collimated by the tube and detector collimators. “load” . 10 mm 6. 2: Deactivate checkbox “Narrow” . 1. 5.25. 6.75. 1. 4.General Fig. 7.5. Slice collimation 2 x 0. 7. 1. 0. 1: Activate checkbox “Narrow” .0. 8. 3. 4. 1. 2 1.25.5.5.5 mm 4 x 5 mm Slice width 0. 8. 6. 1. Fig. 7. 2. 8. The following table shows you the possibilities of image reconstruction in spiral scanning.5 mm 4 x 1 mm 4 x 2. 5. 10 mm 8 . 10 mm 3. Auto filming is possible on the Recon card.5 mm and 4 x 5 mm slice collimation. g. It can be freely adapted from 1 to 4 for 2 x 0. g. table moves 20 mm per rotation. slice collimation.8 for 4 x 1 mm. you can define up to 3 reconstruction jobs with different parameters either before or after you acquire the data. and “S“ stands for Special Application. “B” stands for Body.: slice collimation = 4 x 5 mm. and then one more recon job will be available in the Recon card (Note: what you deleted is just the job from display. In case you want to add on another recon job. table moves 5 mm per rotation. The image sharpness are defined by the numbers – the higher the number. e. the smoother the image.5 mm slice collimation. and rotation time is defined. you do not need to select pitch. Recon job In the Recon card. Kernels There are 5 different kernels: “H” stands for Head. Osteo CT. Once the scan range. then pitch = 4 With the SOMATOM Volume Zoom.. all be done automatically. When you click on “Recon” they will . and 2 . In Siemens multislice CT: Pitch = table movement per rotation/single slice collimation E. simply click the little icon on the chronicle with the right mouse button and select “delete recon job” to delete the one which has been completed. g.: slice collimation = 5 mm. “U” stands for Ultra High Resolution. “C” stands for ChildHead. You can also reconstruct images for all scan modes completed at once – do not select any chronicle before you click “Recon” . 4 x 2. the lower the number. scan time. the software will adapt the table feed per rotation accordingly. the sharper the image.General Pitch In single slice CT: Pitch = table movement per rotation/slice collimation E. You can film every image or every n-th image. not the images that have been reconstructed). 9 . then pitch = 1 It can be freely selected from 1 to 3. Thus. In general. Please refer to the recommendation in this protocol. CARE Bolus (optional) or Test Bolus may be used for optimal contrast bolus timing. Keep this in mind. no more than 3 ml per kg of body weight for adults and 2 ml per kg of body weight for children should be applied. the principle is to keep contrast injection for the whole scan.General s Contrast medium IV injection* The administration of a contrast medium depends on the indication and on the delay times to be used during the examination. The patient’s weight and circulatory situation also play a role. the total amount of contrast medium needed should be calculated with the following formula**: CM = (start delay time + scan time) x flow rate. ** The scan protocol “Angio Run Off“ might be exceptional. please refer to page 97 . Please refer to the Application Guide for special protocols. single slice spiral scan. you may save contrast medium in your routine study since the multislice spiral scan can be up to 8 times faster than a 1 second. As a rule of thumb. * For more information regarding the general use of drugs and doses mentioned in this guide. For CTA study (arterial phase). the contrast medium injection should be stopped when the scan (or acquisition) is finished. 10 . such as MPR. • Select the organ region and the scan protocol name in the pop-up dialog. You can either use the same name to modify the existing scan protocol. or on the topogram routine card. 11 . increment = 1⁄2 slice width.General s Postprocessing For better postprocessing results. add new ranges etc. s How to create your own scan protocols User-specific scan protocols can be saved with the following basic procedure: • Register a test patient. or enter a new name. • Do not load the scan protocol.. • Set the table position to 0 (either at the gantry panel. at least 50% overlapping image reconstruction. • Select a scan protocol. e. i. SSD and MIP use thinner slices whenever possible and . • Select Edit/Save Scan Protocol in the main menu. change parameters. patient position must be head first-supine. • Modify the scan protocol. – You may use preceding numbers (e.General Tips: – It is recommended that you save your own scan protocol with a new name in order to avoid overwriting the default scan protocol. This list can be printed or saved on floppy (“File/Save As. “AbdomenFF” .” or “ \” within . do not save a head mode in the abdomen directory.. – Do not use special characters like “/” “. “Abdomen” change the topogram . – Don’t rename scan protocol files on NT level – this will lead to inconsistencies. This message can be avoided with user specific scan protocols: select a scan protocol. g. g.”). scan direction from “Craniocaudal” to “Caudocranial” and save the protocol under e... 12 . 1_Abdomen) for user specific scan protocols to make them appear on top of the list and to distinguish them from the Siemens defaults. message “Invalid parameters in scan protocol .. e. – System/Run offers the tool “Restore Default Scan Protocols” which allows one to remove user specific scan protocols and to restore the Siemens default settings. Change parameters or table position” will appear. g. g. – Do not mix head and body scan protocols: e. – System/Run also offers the tool “List Scan Protocols” which generates an HTML table of all available scan protocols. scan protocol names. – When a patient is scanned “feet first” with a topogram protocol which is defined as “Cranialcaudal” a warning . mAs = mAs x 4/pitch To calculate the dose on the SOMATOM Volume Zoom. The effective mAs takes into account the influence of pitch on both the image quality and dose: Eff. however when the tube load (mA) reaches its highest limitation. the dose (Dseq) applied to the patient is estimated as the product of the tube currenttime (mAs) and the CTDIw per mAs: Dseq = DCTDIw x mAs In spiral scanning. however. the applied dose (Dspiral) is influenced additionally by the pitch factor. the actual dose applied to the patient in spiral scanning will be decreased when pitch is larger than 4.Therefore. mAs/Rotation time) x (Pitch/2) You should change the mAs according to the patient size.General s Effective mAs In sequential scanning. you simply have to multiply the CTDIw per mAs with the effective mAs: Dspiral.VZ = DCTDIw x Eff. 13 . The tube current will be adapted according to: 4-slice modes: mA = (Eff. mAs/Rotation time) x (Pitch/4) 2-slice modes: mA = (Eff. mAs The Effective mAs can be selected by the user for a defined image quality and dose. the concept of Effective mAs was introduced with the SOMATOM Volume Zoom. the dose in spiral scanning has to be corrected by the pitch factor: Dspiral = (DCTDIw x mAs)/pitch To make it easier for the users. For example. independent of pitch. You should always define the scan range before you change the mAs. the “Scan Assistant” will be available to give you the possibility to adjust either the scan time or the mAs value. and increased when pitch is smaller than 4. if a multislice CT scanner (4-slice) is used. 2 . e. g. the scan range.3 mSv per year in Germany. e. the system design of individual scanner. The effective dose is expressed as a weighted sum of the dose applied not only to the organs in the scanned range.General s Dose information The dose as described by CTDIw is displayed on the user interface for the selected scan parameters. For this purpose. different exams associated with the same effective dose would have the same radiation risk for the patient. i. It also allows comparing the applied x-ray exposure to the natural background radiation. For each organ. The concept of effective dose would allow the comparison of radiation risk associated with different CT or x-ray exams. 14 1 . This dose number gives a good estimate for the average dose applied in the scanned volume as long as the patient size is similar to the size of the respective dose phantoms. It could be measured in whole body phantoms (Alderson phantom) or simulated with Monte Carlo techniques. the respective dose delivered during the CT scanning has to be calculated and then multiplied by its radiation risk factor. such as x-ray filtration and gantry geometry. The CTDI is measured in the dedicated plastic phantoms – 16 cm diameter for head and 32 cm diameter for body (as defined in IEC 60601 . the organs involved in the scanned range and the organs affected by scattered radiation. Finally the weighted organ dose numbers are added up to get the effective dose. but also to the rest of the body. Since the body size can be smaller or larger than 32 cm. The CTDIw value does not provide the entire information of the radiation risk associated with the CT examination. 2 . the CTDI value displayed can can deviate from the dose in the scanned volume. The calculation of the effective dose is rather complicated and has to be done by sophisticated programs.44). the concept of the “Effective Dose” was introduced by ICRP (International Commission on Radiation Protection). These have to take into account the scan parameters. we calculated the effective dose numbers for standard male* and female* and listed the result in the description of each scan protocol. Fig. 1: User interface of the PC program WinDose. we used the WinDose calculation and the correction factors published in “Radiation Exposure in Computed Topography”**. in which there only the conversion factors for the age of 8 weeks and 7 years old are available. The calculation was done by the commercially available program “WinDose” (Wellhoefer Dosimetry) – as shown in figure 1 . Fig. 2: A graphic interface of WinDose allows to specify the anatomical scan range. 15 .General For most of our scan protocols.3. For pediatric protocols. All parameters necessary for the effective dose calculation have to be specified. published by COCIR c/o ZVEI. Stresemannallee 19. GSF report 30/91 **Radiation Exposure in Computed Topography. Germany. 16 1 . Frankfurt. D-60596. edited by Hans Dieter Nagel. * The Calculation of Dose from External Photon Exposures Using Reference Human Phantoms and Monte Carlo Methods. Zankl et al.General Fig. M.3: Results as output of WinDose with the organ dose readings and the effective dose according to ICRP26 (previous version) and ICRP60 (currently valid). The scan protocols for Head and Neck regions are defined according to age. e. 80 kV was used instead of 120 kV. from head to extremities.Children Overview This is a new folder. It contains 17 organ specific pediatric protocols with 2 to 5 age or weight dependant subgroups. For a few protocols. e. either to exploit the significantly higher image contrast of iodine contrast media at 80 kV or to reach a lower dose level than possible with 120 kV. and the suggested effective mAs values for the other categories are written in additional lines in the chronicle. For your convenience. As a default. g. less than 6 months in head modes. and the scan protocols for the other body regions are defined according to body weight. • HeadSeq For routine head sequential studies • HeadSpi For routine head spiral studies • SinusRoutine For routine sinus spiral studies • SinusMPR Thin slice mode for sinus spiral studies when Multi Planar Reconstructions are necessary • InnerEarUHR Ultra High Resolution mode for inner ear spiral studies • HeadAngio For head CT Angio studies 17 . the protocols are numbered according to the body regions. i. the effective mAs is set to the lowest category. Children • NeckRoutine For routine neck spiral studies • CarotidCTA For carotid CT Angio studies • NeonateBody Spiral mode for neonate studies • ChestRoutine For routine chest spiral studies • Airway Spiral mode for airway studies • ThoraxSeqHR High Resolution sequential mode for lung studies • ChestCombi Thin slice mode for combination of vascular and soft tissue studies • AbdPelRoutine For routine abdominal spiral studies • AbdCTA For abdominal CT Angio studies • SpineSpiral For routine spine spiral studies • SpineMPR Thin slice mode for spine spiral studies when Multi Planar Reconstructions are necessary • ExtremitySpiral For routine extremity spiral studies • ExtremityUHR Ultra High Resolution mode for extremity spiral studies 18 1 . Sedating this population may be a viable option for your institution. 2. adequate monitoring of the patient (pre-scan. 3. appropriate protocols need to be established at your specific institution. Please keep in mind that the children’s size can be dramatically different. Topograms: 256 mm lateral topograms are defined for the head modes. This becomes a factor especially with infants and younger children who are unable to hold still for the exam. You should press the “Hold Measurement” button whenever the range shown on the real time growing topogram is long enough. patient motion can still lead to severe motion artifacts seen on the resultant images. 19 . For instance.Children Hints in general 1. Of course. the form of administration. The proper personnel and equipment must also be readily available at your disposal in the event of a problem. and 512 mm AP topograms are defined for the body modes. during the exam and post-scan) etc. Sedation: Although the advent of the multislice scanner has enabled the user to scan through an area of interest much faster than ever. should all be taken into consideration. Warm surroundings and dimmed lighting are helpful to make children more cooperative. sometimes. in order to avoid unnecessary radiation. patient preps. In a consistent effort to reduce the total dose of an examination. all topograms of the pediatric protocols are defined at 80 kV with minimum current (50 mA). the drug of choice for specific ages/weights of these patients (taking into consideration the total time of the exam). a diluted mixture of iodine and water is used as an oral agent. The user needs to be aware of all the contraindications of any of the contrast agents they are using. 20 1 . oral contrast is recommended to opacify the intestinal tract. fruit drink mixes are but a few of these). Different substances can be added to this mixture to help reduce the bitter taste and make it more pleasing to the child (apple juice. as well as rectal contrast may be required. In general. oral contrast may or may not be given to these patients. Oral. Barium may of course be used in some cases as well. It is recommended to refer to the specific vendor’s recommendations regarding this. or when 3D reconstructions are needed. Negative contrast agents such as water are becoming more popular for delineation of stomach or bowel wall borders. Oral and rectal contrast administration: Depending on the reason for the exam/status of the patient.Children 4. Usually. as unopacified bowel can have the appearance of abdominal fluid or mass effect. These guidelines may need to be adjusted if the site is more peripheral. however.5. PIC lines and 24 guage (or smaller) lines are usually hand injected.0 . It is recommended to use CARE bolus (optional) in order to achieve optimal contrast enhancement. I. Both start delay time and injection rate are exam-/ patient-dependent.V. I. Note: these are injector guidelines based on an antecubital injection site. since the scanning can be completed in just a few seconds. 21 . please keep in mind that the total injection time should not be longer than the sum of start delay time and the scan time – do not inject contrast after the scanning is finished. 1 .5 2. injection with a power injector is recommended for all scans whenever possible.V. contrast administration: In general. Needle Size (guage) 22 20 18 Flow Rate (ml/sec) 1.Children 5.2 ml per kg of body weight should be applied. Some guidelines to follow with respect to flow rate are noted in the chart below.0 Central lines and ports may need to be hand injected or power injected at a very low flow rate (1 ml/sec).0 3. All of these protocols should be decided on by your institutions appropriate personnel. the tube voltage was set to 80 kV and the mAs values were raised by a factor of 1.5 over the reduced 120 kV values. substances with a high atomic number (such as iodine) have a significantly higher CT value (= vascular contrast). 22 . 80 kV was also used for applications when the lowest achievable mAs at 120 kV was still higher than necessary for a sufficient noise level (for technical reasons. the low tube output at 80 kV can be used to further reduce the dose to the patient. Iodine CT values at 80 kV are about 50% higher than at 120 kV. generators need to operate at a certain minimum current for stable operation). This measure roughly reduces the dose by another factor of 2.Children 6. For applications such as neonate or airway scanning. At a lower kV. Applications with 80 kV: For CTA protocols. 6 years 120 ** The conversion factor for an 8-week-old. 260 mAs and a scan range of 117 mm was used.2 ml per kg of the body weight 23 . the mAs should be adjusted according to the age of the child. e. *** The conversion factor for a 7-year-old. hydrocephalus. Sequence 120 * 4 x 2.3 years 120 3 .8*** 6 months .5 Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 . abnormalities etc.6** Female: 1.32 Effective dose (mSv) Male: 1. Age < 6 months kV 120 mAs 70 110 160 CTDIw (mGy) 15.9*** Female: 2.6** Male: 2.Children s HeadSeq Indications Sequential mode for routine head studies for children. and a scan range of 90 mm was used.89 24.97 36. g. tumors.75 s C30s ca-cr kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Direction * As written in the chronicle. . hemorrhaging.5 mm 5 mm 10 mm 0. should be scanned with an adult protocol as the skull by this time is fully grown. use kernel C60s for image reconstruction. • When bone structure is of interest. who are more than 6 years old.Children Tips • Children. 24 . Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .6** Female: 1. hemorrhaging.32 Effective dose (mSv) Male: 1.7*** 6 months . • When bone structure is of interest.97 26. g. etc.75 s C30s ca-cr kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Direction * As written in the chronicle. the mAs should be adjusted according to the age of the child. Age < 6 months kV 120 mAs 70 110 160 CTDIw (mGy) 15.89 24. should be scanned with an adult protocol.3 years 120 3 . e. use kernel C60s for image reconstruction.6** Male: 2.2 ml per kg of the body weight Tips • Children.6 years 120 ** The conversion factor for an 8-week-old and a scan range of 90 mm was used. 25 . Spiral 120 * 4 x 2. abnormalities. 260 mAs and a scan range of 110 mm was used. tumors.Children s HeadSpi Indications Spiral mode for routine head studies.8 mm 0.8*** Female: 2. hydrocephalus. *** The conversion factor for a 7-year-old. who are more than 6 years old.5 mm 5 mm 6. 5 mm 3 mm 7. sinusitis.75 s H30s/H60s 3 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. 100 mAs and a scan range of 40 mm was used. the mAs can be reduced to 20 for all age groups. 26 .2 ml per kg of the body weight Tips • Children. who are more than 6 years old.6*** Female: 0. malformations. g. e.62 Effective dose (mSv) Male: 0.5** Female: 0. • If the study is focused on bone structure only. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 . polyposis.Children s SinusRoutine Indications Spiral mode for routine studies of the paranasal sinuses and orbits. the mAs should be adjusted according to the age of the child. Spiral 120 * 4 x 2. etc.4** Male: 0. *** The conversion factor for a 7-year-old.5 mm 0. Age < 3 years 3 .5*** ** The conversion factor for an 8-week-old and a scan range of 30 mm was used.6 years kV 120 120 mAs 40 60 CTDIw (mGy) 9. should be scanned with an adult protocol.08 13. pneumatization. • The second recon job is defined with kernel H60s for the interest of bone structures. tumors. 100 mAs and a scan range of 40 mm was used. *** The conversion factor for a 7-year-old. the mAs should be adjusted according to the age of the child.6*** Female: 0.25 mm 2.6 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. polyposis.2 ml per kg of the body weight 27 . g.75 s H30s/H60s 3/0. Age < 3 years 3 .Children s SinusMPR Indications Spiral mode for the paranasal sinuses when Multi Planar reconstructions are intended. sinusitis. e.5** Male: 0.5** Female: 0.6 years kV 120 120 mAs 40 60 CTDIw (mGy) 11 16.5 Effective dose (mSv) Male: 0. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 . pneumatization. tumors etc. Spiral 120 * 4 x 1 mm 3/1. malformations.7 mm 0.6*** ** The conversion factor for an 8-week-old and a scan range of 30 mm was used. should be scanned with an adult protocol. the mAs can be reduced to 20 for all age groups. who are more than 6 years old. 28 .Children Tips • Children. • If the study is focused on bone structure only. • The second recon job is defined with kernel H60s and with an overlap for visualizing bone structures with MPR. 8** Female: 0. the mAs should be adjusted according to the age of the child. malformations of the inner ear. g. pathologies of the mastoid process. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .75 s U80u/U90u/U90u 1/0.2 mm cr-ca * As written in the chronicle.0*** Female: 1. inflammatory changes. 100 mAs and a scan range of 40 mm was used.5/0.5 mm 1/0.Children s InnerEarUHR Indications Ultra High Resolution (UHR) Spiral mode for inner ear studies. tumorous processes of the pyramids.5 mm 0.2 ml per kg of the body weight 29 . Age < 3 years 3 . kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction Spiral 120 * 2 x 0. etc. post-traumatic changes.6 years kV 120 120 mAs 40 60 CTDIw (mGy) 19.34 Effective dose (mSv) Male: 0.56 29.0*** ** The conversion factor for an 8-week-old and a scan range of 30 mm was used. *** The conversion factor for a 7-year-old.8** Male: 1.7 mm 0. e.2/0. It is mandatory to position the patient in the center of the scan FOV. use kernel U30 for image reconstruction. • When soft tissue is of interest. 30 .Children Tips • Children who are more than 6 years old should be scanned with an adult protocol. • The 2nd and 3rd recon jobs are defined for separate image reconstruction of the left and right inner ear. • The UHR mode requires a 250 mm scan FOV. Contrast medium IV injection Start delay: 18 .Children s HeadAngio Indications Spiral mode for head CT Angiography. *** The conversion factor for a 7-year-old and a scan range of 60 mm was used. the mAs should be adjusted according to the age of the child.2 ml per kg of the body weight Tips • Children who are more than 12 years old should be scanned with an adult protocol. cerebral vascular abnormalities. kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction Spiral 80 * 4 x 1 mm 1.3 16.5*** ** The conversion factor for an 8-week-old and a scan range of 40 mm was used.4*** Female: 0.48 Effective dose (mSv) Male: 0.5 s H10f/H20f 0. 31 . • The second recon job is defined for soft tissue visualization.5** Female: 0. Age < 6 years 6 . • Images can be loaded automatically to the 3D card after reconstruction – simply save the setting in the Auto Tasking card. tumors etc.5 mm 0.25/2 mm 3. e.20 s Flow rate: dependent upon needle size/Access site Total amount: 1 .5** Male: 0.12 years kV 80 80 mAs 100 150 CTDIw (mGy) 10.6/2 mm ca-cr * As written in the chronicle. g. 12 years kV 120 120 120 mAs 40 60 90 CTDIw (mGy) 3. Age < 3 years 3 . etc. tumors. the mAs should be adjusted according to the age of the child. *** The conversion factor for a 7-year-old and a scan range of 120 mm was used. • The second recon job is defined for bone structure visualization. 32 1 .0** Male: 1.64 8.2 ml per kg of the body weight Tips • Children who are more than 12 years old should be scanned with an adult protocol.Children s NeckRoutine Indications Spiral mode for routine neck studies.75 s B30s/B60s 6/3 mm ca-cr kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle.5 mm 6/3 mm 10 mm 0.0*** ** The conversion factor for an 8-week-old and a scan range of 80 mm was used. abscesses. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .6 years 6 .76 5. g.9** Female: 1. Spiral 120 * 4 x 2.0*** Female: 1.46 Effective dose (mSv) Male: 0. e. lymphoma. 6*** ** The conversion factor for an 8-week-old and a scan range of 80 mm was used. *** The conversion factor for a 7-year-old and a scan range of 120 mm was used.6*** Female: 0.Children s CarotidCTA Indications CT Angiography of the carotid arteries.12 years kV 80 80 mAs 100 150 CTDIw (mGy) 3. the mAs should be adjusted according to the age of the child.5 5.25/5 mm 5 mm 0.5 s B20f/B30f 0.6/5 mm ca-cr kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. Age < 6 years 6 . g.8** Female: 0. e. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .2 ml per kg of the body weight 33 .25 Effective dose (mSv) Male: 0.9** Male: 0. carotid stenosis or occlusion. etc. vascular abnormalities of the carotids or vertebral arteries. Spiral 80 * 4 x 1 mm 1. • Images from the first recon job can be loaded automatically to the 3D card after reconstruction – simply save the setting in the Auto Tasking card. 34 1 .Children Tips • Children who are more than 12 years old should be scanned with an adult protocol. • The second recon job is defined for soft tissue visualization and filming. 6 mSv Female: 0. tumors. e.5 mm 6 mm 10 mm 0. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .725 mGy Male:0. Spiral 80 25 4 x 2. malformations. abscesses.2 ml per kg of the body weight 35 . etc.Children s NeonateBody Indications Spiral mode for routine neonate body studies.5 s B30f 6 mm cr-ca 0.9 mSv kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction CTDIw Effective dose* * The conversion factor for an 8-week-old and a scan range of 150 mm was used. abnormalities. g. Children Tips • You can modify the slice width for image reconstruction according to the clinical indications. 36 1 . tumors.44 kg 45 . pneumonia. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .7** Female: 0.54 kg kV 120 120 120 120 120 mAs 15 20 30 50 70 CTDIw (mGy) 1. lymphoma.Children s ChestRoutine Indications Spiral mode for routine thorax studies.41 1. metastases. g. the mAs should be adjusted according to the body weight of the child.34 kg 35 . *** The conversion factor for a 7-year-old and a scan range of 150 mm was used.82 4. e. vascular abnormalities.5** ** The conversion factor for an 8-week-old and a scan range of 100 mm was used. Spiral 120 * 4 x 2.5 mm 6 mm 12.88 2.7 6.2 ml per kg of the body weight 37 .2** Female: 1.5 mm 0.9** Male: 1.58 Effective dose (mSv) Male: 0.24 kg 25 .5 s B30f/B60f 6 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. Body Weight < 15 kg 15 . etc. 38 1 . • The first and second recon jobs are defined for visualization of the mediastinum and the lungs. respectively.Children Tips • Children who weight more than 54 kg should be examined with an adult protocol. • The second recon job is defined for the visualization of the lungs.25/5 mm 4 mm 0. bronchial stenosis or occlusion etc. 39 . g.Children s Airway Indications Spiral mode for studies of the airway. Tips • Children who are more than 6 months old should be scanned with the “ChestCombi” protocol.5 s B30f/B60f 0.4 mSv Female: 0. • Images from the first recon job can be loaded automatically to the 3D card after reconstruction – simply save the setting in the Auto Tasking card.05 mGy Male:0. Spiral 80 30 4 x 1 mm 1.6/5 mm cr-ca 1.5 mSv kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction CTDIw Effective dose* * The conversion factor for an 8-week-old and a scan range of 150 mm was used. e. 75 s B70s cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Direction * As written in the chronicle. you should practice the breathing with the patient a few times before beginning the scan.42 7.41 Effective dose (mSv) Male: 0.7** ** The conversion factor for a 7-year-old and a scan range of 150 mm was used. 40 1 . the mAs should be adjusted to the body weight of the child.6** Female: 0. so that reproducibility may better be improved.Children s ThoraxSeqHR Indications Sequence mode for High Resolution lung studies. Tips • Children who weigh more than 54 kg should be examined with an adult protocol. interstitial changes of the lung parenchyma. Sequence 120 * 4 x 1 mm 1 mm 10 mm 0.54 kg kV 120 120 mAs 30 65 CTDIw (mGy) 3. Body Weight < 35 kg 35 . e. etc. g. • If you want to acquire the patient at full inspiration or full expiration. e.2*** Female: 2.54 kg kV 120 120 120 mAs 25 45 65 CTDIw (mGy) 2.41 Effective dose (mSv) Male: 1. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 . Body Weight < 25 kg 25 . thorax studies in general and interstitial changes of lung parenchyma.5 s B30f/B60f 3 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle.5** Female: 1.Children s ChestCombi Indications Combining thin slice and routine thorax studies with one spiral scan. g.85 5.7** Male: 2. the mAs should be adjusted to the body weight of the child.44 kg 45 .6*** ** The conversion factor for an 8-week-old and a scan range of 100 mm was used.2 ml per kg of the body weight 41 . Spiral 120 * 4 x 1 mm 3 mm 6 mm 0. *** The conversion factor for a 7-year-old and a scan range of 150 mm was used.13 7. or for vascular studies such as those for the pulmonary arteries. Children Tips • Children who weigh more than 54 kg should be examined with an adult protocol. • Two recon jobs are predefined for image reconstruction of thin slice lung and routine thorax. 42 . 29 5.54 kg kV 120 120 120 120 120 mAs 20 35 55 85 120 CTDIw (mGy) 1.6** Male: 3. Body Weight < 15 kg 15 .1** Female: 4.28 Effective dose (mSv) Male: 1.Children s AbdPelRoutine Indications Spiral mode for routine studies in the region of the abdomen and pelvis. the mAs should be adjusted to the body weight of the child.2** Female: 1.5 mm 6/6/6 mm 10 mm 0. e.24 kg 25 .2** ** The conversion factor for an 8-week-old and a scan range of 100 mm was used.88 3.5 s B30f/B60f/B30f 6/6/6 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. Spiral 120 * 4 x 2. abscesses.44 kg 45 . post-traumatic changes.99 11. *** The conversion factor for a 7-year-old and a scan range of 200 mm was used. lymphoma. tumors.17 7. g. etc. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .34 kg 35 .2 ml per kg of the body weight 43 . The second one is for the reconstruction of the lungs in the upper range. and the third one with a smaller FOV is for the kidneys. • There are three recon jobs predefined. 44 .Children Tips • Children who weigh more than 54 kg should be examined with an adult protocol. 25 mm 5 mm 0.5** Female: 0.54 kg kV 80 80 80 80 80 mAs 30 50 75 110 150 CTDIw (mGy) 1. Spiral 80 * 4 x 1 mm 3/1. • The first recon job is defined for image viewing and filming.8** Male: 1.7 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle.24 kg 25 .44 kg 45 .05 1.5 s B30f/B20f 3/0. *** The conversion factor for a 7-year-old and a scan range of 200 mm was used.85 5. etc.63 3. 45 . g.9** ** The conversion factor for an 8-week-old and a scan range of 100 mm was used. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 . the mAs should be adjusted to the body weight of the child.3** Female: 1. aneurysms.Children s AbdCTA Indications For abdominal CT Angio studies.34 kg 35 . • Images from the second recon job can be loaded automatically to the 3D card after reconstruction – simply save the setting in the Auto Tasking card.75 2. e.25 Effective dose (mSv) Male: 0. vascular abnormalities. Body Weight < 15 kg 15 .2 ml per kg of the body weight Tips • Children who weigh more than 54 kg should be examined with an adult protocol. Body Weight < 15 kg 15 . the mAs should be adjusted to the body weight of the child. e. tumors.44 kg 45 . 46 .44 5.34 kg 35 .3** Female: 1.3** Male: 4. • If the study is focused on bone structures only.5 mm 3 mm 10 mm 0.54 kg kV 120 120 120 120 120 mAs 26 55 90 130 200 CTDIw (mGy) 2. orthopedic indications.46 12.2 ml per kg of the body weight Tips • Children who weigh more than 54 kg should be examined with an adult protocol.75 s B30s/B60s 3 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. the mAs can be reduced up to 30% for children who weight more than 25 kg.22 18. malformations.8 Effective dose (mSv) Male: 1. post-traumatic changes. Spiral 120 * 4 x 2.24 kg 25 .17 8. etc. *** The conversion factor for a 7-year-old and a scan range of 200 mm was used.2** Female: 8. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .3** ** The conversion factor for an 8-week-old and a scan range of 100 mm was used. g.Children s SpineSpiral Indications Spiral mode for spine studies. 2** Male: 2. Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 .4** Female: 3.8** ** The conversion factor for an 8-week-old and a scan range of 100 mm was used.56 7.2 ml per kg of the body weight 47 .98 Effective dose (mSv) Male: 1. tumors.75 s B30s/B60s 0. g. *** The conversion factor for a 7-year-old and a scan range of 200 mm was used. e.Children s SpineMPR Indications Spiral mode for the spine when Multi Planar Reconstructions are intended.25 mm 5 mm 0. CT-myelography. malformations.4** Female: 2. Body Weight < 15 kg 15 . etc.54 kg kV 120 120 120 mAs 21 40 70 CTDIw (mGy) 2. post-traumatic changes.7 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle.39 4.34 kg 35 . Spiral 120 * 4 x 1 mm 1. the mAs should be adjusted to the body weight of the child. the mAs can be reduced up to 30% for children who weigh more than 25 kg. • If the study is focused on bone structures only. 48 . • Images can be loaded automatically to the 3D card after reconstruction – simply save the setting in the Auto Tasking card.Children Tips • Children who weigh more than 54 kg should be examined with an adult protocol. 2 ml per kg of the body weight 49 .34 kg 35 . e.74 1. g. the mAs should be adjusted to the body weight of the child. tumors.75 3.25/5 mm 5 mm 0. Spiral 120 * 4 x 1 mm 1.75 s B60s/B30s 0. post-traumatic changes.Children s ExtremitySpiral Indications Spiral mode for extremity studies. malformations.7/5 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the chronicle. Body Weight < 15 kg 15 .54 kg kV 120 120 120 mAs 21 35 70 CTDIw (mGy) 0.5 Contrast medium IV injection Start delay: exam dependent Flow rate: dependent upon needle size/Access site Total amount: 1 . etc. 5 mm 1 mm 0.54 kg kV 120 120 120 mAs 26 40 80 CTDIw (mGy) 5. orthopedic indications. They can be loaded automatically after the reconstruction to the 3D card – simply save this setting in the Auto Tasking card.23 17. e. It is mandatory to position the patient in the center of the scan FOV. g.5 mm 0. tumors. Spiral 120 * 2 x 0.3 mm cr-ca kV mAs Slice collimation Slice width Feed/Rotation Rotation time Kernel Increment Direction * As written in the Memo. post-traumatic changes. • When soft tissue is of interest. • The images can be used to achieve excellent MPRs. use kernel U30 for image reconstruction. the mAs should be adjusted to the body weight of the child.49 27. etc. • The UHR mode requires a 250 mm scan FOV.Children s ExtremityUHR Indications Spiral mode for Ultra High Resolution bone studies.54 Tips • Children. 50 .75 s U80u 0. who weigh more than 54 kg should be examined with an adult protocol.34 kg 35 . Body Weight < 15 kg 15 . 5 mm slice collimation • HeadSeq Sequence mode for base of the skull and cerebrum routine studies • HeadFastSeq Sequence mode for cerebrum routine studies using 4 x 5 mm slice collimation • HeadSpi Spiral mode for base of the skull and cerebrum routine studies • HeadCombi Combi mode for base of the skull and cerebrum routine studies 51 .5 For CT Angio studies using 2 x 0.Head Overview • AngioHead For CT Angio studies with 4 x 1 mm slice collimation • AngioHead0. However. cerebrum studies with contrast medium. secure head well in the head holder. arms resting against body. • InnerEarSpi Spiral mode for inner ear ultra high-resolution studies using 2 x 0.5 mm slice collimation. Patient positioning: Patient lying in supine position. Hints in general 1. For all head studies.Head • InnerEarSeq Sequence mode for inner ear ultra high-resolution studies using 2 x 0. For image reconstruction of bone structure. 2. 256 mm. use kernel H60. Start the scan after the injection is completed. Gantry tilt is available for both sequence scanning and spiral scanning.5 mm slice collimation. image reconstruction time might be longer when using gantry tilt since more data need to be calculated. it is very important for image quality to position the patient in the center of the scan field. • OrbiSinusSpi Spiral mode for orbital and sinus studies. 52 1 . 3. support lower legs. Topogram: Lateral. 6. except CTA and nasopharyx. In general. Use the lateral laser beam to make sure that the patient is positioned in the center. 4. can be performed by hand injection. 5. Rot. A range of 60 mm will be covered in 7 s. AngioHead 120 90 4 x 1 mm 1.4 mSv female: 0.0 ml/s 75 ml 53 .8 mGy male: 0. and follw up studies etc. E.Head s AngioHead Indications For cerebral CT Angio studies using 4 x 1 mm slice collimation. tumor. cerebral vascular abnormalities. g.5 mSv kV mAs Slice collimation Slice width Feed/Rot.25 mm 5 mm 0.5 s H10f 1 mm ca-cr 60 mm 24. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 18 s 3. or use manual triggering. Set the trigger threshold at 100 HU.Head Use CARE Bolus (optional) with monitoring scans positioned at the level of the basilar artery or carotid artery. 54 1 . Head s AngioHead0.5 Indications For cerebral CT Angio studies using 2 x 0.5 mm slice collimation. E. g. cerebral vascular abnormalities, tumor, and follw up studies etc. A range of 60 mm will be covered in 24 s. AngioHead0.5 120 110 2 x 0.5 mm 0.75 mm 1.3 mm 0.5 s H10f 0.5 mm ca-cr 60 mm 53.8 mGy male: 0.9 mSv female: 1.0 mSv kV mAs Slice collimation Slice width Feed/Rot. Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 18 s 3.0 ml/s 100 ml 55 Head Use CARE Bolus (optional) with monitoring scans positioned at the level of the basilar artery or carotid artery. Set the trigger threshold at 100 HU, or use manual triggering. 56 1 Head s HeadSeq Indications Sequence mode for routine head studies, e. g. stroke, brain tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc. Two ranges are predefined for the base of the skull and cerebrum. ThinSliceSeq 120 260 4 x 1 mm 4 mm 4 mm 1s 3s H40s ca-cr 39 mm 71.5 mGy male: 0.9 mSv female: 1.0 mSv RoutineSeq 120 260 2 x 8 mm 8 mm 16 mm 1s 3s H40s ca-cr 88 mm 53.3 mGy male: 1.4 mSv female: 1.6 mSv kV mAs Slice collimation Slice width Feed/Rot. Rot. time Cycle time Kernel Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 60 s 1.5 ml/s 50-60 ml 57 you can easily delete one mode by clicking the chronicle with the right mouse button. either 4 x 1 mm or 2 x 8 mm. e. 58 1 . i. and select “cut” .Head If you want to set up the scan with only one range. 5 ml/s 50-60 ml 59 . e. time Cycle time Kernel Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 60 s 1.0 mSv kV mAs Slice collimation Slice width Feed/Rot. stroke. hydrocephalus.9 mSv female: 2. etc. brain tumors. and inflammation. Rot. HeadFastSeq 120 260 4 x 5 mm 5 mm 20 mm 1s 3s H30s ca-cr 115 mm 53. cranial trauma.3 mGy male: 1. g.Head s HeadFastSeq Indications Sequence fast mode for routine head studies. cerebral atrophy. 60 1 . You could change the slice width in the Recon card before starting the image reconstruction.Head Image can also be reconstructed as 10 mm when desired. 6 mm 0. Two ranges are predefined for the base of the skull and cerebrum.6 mSv kV mAs Slice collimation Slice width Feed/Rot. etc. hydrocephalus. g.1 mSv RoutineSpi 120 260 4 x 2.5 ml/s 50-60 ml 61 . Rot.Head s HeadSpi Indications Spiral mode for routine head studies. ThinSliceSpi 120 260 4 x 1 mm 4 mm 2. cranial trauma.75 s H40s 4 mm ca-cr 40 mm 71. cerebral atrophy. and inflammation.5 mm 0. e.5 mGy male: 1.75 s H40s 8 mm ca-cr 80 mm 59 mGy male: 1.0 mSv female: 1.4 mSv female: 1.5 mm 8 mm 6. stroke. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 60 s 1. brain tumors. 5 mm. 62 1 . you can easily delete one mode by clicking the chronicle with the right mouse button.Head If you want to set up the scan with only one range i. either 4 x 1 mm or 4 x 2. and select “cut” . e. cerebral atrophy. HeadCombi 120 260 4 x 1 mm 5 mm 2. and reconstructing image as two different ranges – 5 mm slice width for the base of the skull and 8 mm slice width for the cerebrum. g.5 ml/s 50-60 ml 63 . and inflammation.6 mm 0. cranial trauma. e. Rot. hydrocephalus.75 s H40s 5 mm ca-cr 110 mm 71.Head s HeadCombi Indications Combi mode for head studies.4 mSv female: 2. stroke. This is using 4 x 1 mm slice collimation.6 mSv kV mAs Slice collimation Slice width Feed/Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose 8 mm H40s 8 mm ca-cr Contrast medium IV injection Start delay: Flow rate: Total amount: 60 s 1. brain tumors. etc. A range of 110 mm will be covered in 40 s.5 mGy male: 2. You can also use the same slice width (e.Head For 2 ranges image reconstruction with different slice width. you need to type in the table begin and table end in the Recon card. g. 64 1 . 5 mm) for the entire range of image reconstruction if you wish. cerebellopontine angle tumors. g. E.5 mm 0. use kernel U30.7 mSv female: 0. post-traumatic changes.5 mm 48. Inflammatory changes. And it is mandatory to position the patient in the center of the scan field of view. Rot.5 mm 1 mm 1s 2s U90u ca-cr 43. etc. time Cycle time Kernel Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 60 s 1. NOTE: UHR mode requires a 250 mm scan FOV.5 ml/s 60 ml For image reconstruction of soft tissue. tumorous processes of the pyramids. InnerEarSeq 120 100 2 x 0.Head s InnerEarSeq Indications Sequence mode for inner ear Ultra High-Resolution studies using 2 x 0.5 mm slice collimation.7 mSv kV mAs Slice collimation Slice width Feed/Rot.9 mGy male: 0. 65 . Head 66 1 . 5 mm 0. 67 .5 mm slice collimation. tumorous processes of the pyramids.5 ml/s 50 ml For image reconstruction of soft tissue.5 mm 1 mm 1s U90u 0. Inflammatory changes. Rot. post-traumatic changes. etc. use kernel U30.5 mm ca-cr 40 mm 48. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 60 s 1.Head s InnerEarSpi Indications Spiral mode for inner ear Ultra High-Resolution studies using 2 x 0. E. InnerEarSpi 120 100 2 x 0. NOTE: UHR mode requires a 250 mm scan FOV. g. cerebellopontine angle tumors.8 mSv kV mAs Slice collimation Slice width Feed/Rot.9 mGy male: 0.8 mSv female: 0. And it is mandatory to position the patient in the center of the scan field of view. Head 68 1 . 5 mGy male: 0. e. mucocele.5 mSv kV mAs Slice collimation Slice width Feed/Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose 1.Head s OrbiSinusSpi Indications Spiral mode for orbita and paranasal sinuses studies.0 ml/s 75 ml 69 . sinusitis. Two recon jobs are predefined for image reconstruction of the soft tissue and bone structure. Rot.25 mm H60s 1 mm ca-cr Contrast medium IV injection Start delay: Flow rate: Total amount: 45 s 2.g. OrbiSinusSpi 120 100 4 x 1 mm 4 mm 3.5 mm 0. tumor.75 s H20s 4 mm ca-cr 40 mm 27. corrections etc. polyposis. pneumatization.5 mSv female: 0. the patient should be told to keep his/her eyes closed. you can delete it by clicking the icon of the recon task on the chronicle with the right mouse button and select “delete recon task“ You should . you can reduce the mAs to 20. 70 1 . do this before you start the reconstruction. If one of them is not required. This will reduce the possibility of small streak artifacts from eye movement. If the study is focused on bone structure only.Head In this protocol. When performing Orbit studies. two recon tasks are predefined for image reconstruction of both soft tissue and bone structure. Neck Overview • AngioCarotid For CTA studies • NeckRoutine For routine soft tissue studies • ThinSliceSpi For soft tissue thin slice studies 71 . the study should be performed in the caudal-cranial direction in order to follow the flow of the contrast. 72 1 . 4. do not swallow. 2. 3. Set the ROI for monitoring scan in the jugular vein at the lower level of the neck with triggering threshold of 100 HU. 6. and select “Repeat” . In case of SSD study only. Use kernel B10 and 50 % overlapping for image reconstruction. Patient respiratory instruction: do not breathe. simply .Neck Hints in general 1. For routine neck studies with contrast. Topogram: Lateral. For image reconstruction of bone structure. 5. click on the chronicle with right mouse button. hyperextend neck slightly. 256 mm. or use manual triggering. use kernel B60. CARE Bolus (optional) may be used to optimize the bolus timimg. When scanning with IV contrast. secure head well in head cradle. Patient positioning: Patient lying in supine position. the mAs value can be reduced by 50 %. 7 For multiple ranges of cervical spine studies. 5 mm 5. AngioCarotid 120 100 4 x 1 mm 1. A range of 20 cm including the aorta arch will be covered in 20 s. and slice width 5 mm. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount*: 15 s 3.5 s B20f 1 mm ca-cr 200 mm 11.4 mGy male: 1.5 mm 0. plaques course abnormalities of the carotids and vertebral arteries.0 mSv kV mAs Slice collimation Slice width Feed/Rot. 73 . etc.5 ml/s 110 ml The data acquired can also be used for soft tissue image reconstruction – select kernel B30.9 mSv female: 2.Neck s AngioCarotid Indications Noninvasive angiography of carotid stenosis or occlusions. Rot. Neck CARE Bolus (optional) may be used to optimize the bolus timimg. Set the ROI for monitoring scan in the aorta arch with triggering threshold of 100 HU, or use manual triggering. 74 1 Neck s NeckRoutine Indications For soft tissue studies in the cervical region. E. g. tumors, lymphoma, abscesses etc. A typical range of 20 cm will be covered in 13 s. NeckRoutine 120 150 4 x 2.5 mm 5 mm 13.8 mm 0.75 s B30s 5 mm ca-cr 200 mm 14.1 mGy male: 2.4 mSv female: 2.5 mSv kV mAs Slice collimation Slice width Feed/Rot. Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 45 s 3.0 ml/s 110 ml 75 Neck Patient positioning is very important for artifact-free images.The thoracic girdle should be positioned as far as possible in the caudal direction.This can be done using a strap with a permanent loop or Velcro fastener at its ends. The ends of the strap must be attached to the patient’s wrists.Then the strap must be wrapped around the patient’s feet with his legs extended and under tension. The entire thoracic girdle is thus pulled toward the patient’s feet. 76 1 6 mm for performing MPRs.4 mSv female:2. E. ThinSliceSpi 120 150 4 x 1 mm 2 mm 5.1 mGy male: 2.75 s B30s 2 mm ca-cr 160 mm 17.0 ml/s 110 ml This protocol can also be used in case of tumor suspicious of the hypopharynx and larynx.6 mSv kV mAs Slice collimation Slice width Feed/Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 45 s 3. A typical range of 16 cm will be covered in 24 s. This would help differenciate tumor lesions from normal pharyngeal mucosa.Neck s ThinSliceSpi Indications Spiral mode using thin slice for soft tissue studies. and reconstruct the images with 1. the functional study of the throat. Rot.25 mm and increment of 0. g.5 mm 0. 77 . It is recommended to acquire the images in E-phonation. Neck 78 1 . Shoulder Overview • ShoulderSpi Spiral mode for HiRes bone studies 79 . If only one side is under investigation. the injured arm placed flat against his body. 3. 256 mm. the uninjured arm placed above the head. Patient positioning: Patient lying in supine position. Topogram: AP.Shoulder Hints in general 1. 2. 80 1 . it is advisable to enter the side in the comment line. If only one side is examined. position this side in the center and support the other side with a Bocollo pillow. 1 mSv kV mAs Slice collimation Slice width Feed/Rot.Shoulder s ShoulderSpi Indications Spiral mode for HiRes bone studies.5 mm 4 mm 1. g. E. A scan range of 15 cm will be covered in 60 s. orthopedic indications etc. Rot.5 s B60s 1.3 mSv female: 5.5 mm cr-ca 150 mm 24.8 mGy male: 4. trauma. evaluation of joint cavities. dislocations. masses. time Kernel Increment Direction Scan range CTDIw Effective Dose 81 . ShoulderSpi 140 150 4 x 1 mm 1. mAs value can be reduced by 50%. and slice width 5 mm. 82 1 .Shoulder In case of 3D study only. Chose kernel B10 and increment 0.7 mm for overlapping image reconstruction. Use raw data to review a target region if necessary. The data acquired can also be used for soft tissue image reconstruction – select kernel B30. e. early detection of lung cancers 83 .Thorax Overview • ThoraxRoutine For routine thorax studies • ThoraxFast Fast mode for thorax studies • ThoraxCombi For the combination of thin slice lung and routine thorax studies • ThoraxHires For thorax HiRes studies • ThoraxSeq HR Sequence mode for HiRes lung studies • LungLowDose Spiral mode with very low dose for special lung studies. g. Also. CARE Bolus (optional) may be used to optimize the bolus timimg. or use manual triggering. For contrast study. Patient positioning: Patient lying in supine position. 5. 3. Topogram: AP 512 mm.Thorax Hints in general 1. 2. scan directions recommended as caudo-cranial in order to avoid the scattered artifact in the region of the aortic arch or the subclavian vein. use kernel B30. . arms positioned comfortably above the head in the head-arm rest. Patient respiratory instruction: inspiration. if the patient cannot hold his/her breath for the duration of the entire scan. 84 1 . breathing motion will be less apparent in the apex than in the lower lobes. For image reconstruction of mediastinum. 4. lower legs supported. Set the ROI for monitoring scan in the aorta at the level of the diaphragm with triggering threshold of 100 HU. e. Rot. A typical thorax study in a range of 30 cm will be covered in 11 s. g.5 mGy male: 3.5 mm 7 mm 15 mm 0.4 mSv female: 4. vascular anomalies etc. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 25-30 s 2. screening of tumors. metastases.4 mSv kV mAs Slice collimation Slice width Feed/Rot.Thorax s ThoraxRoutine Indications Routine studies for the region of thorax.0 ml/s 50-80 ml 85 . lymphonodes. ThoraxRoutine 120 90 4 x 2.5 s B40f 5 mm ca-cr 300 mm 8. lymphoma. E. this protocol can be combined with protocol “Neck Routine” . For lung cancer staging. 86 1 .Thorax You could repeat the same protocol simply by clicking the chronicle with the right mouse button for “repeat“ . when both non-contrast and contrast studies are required. g. 0 ml/s 50-80 ml 87 . A typical thorax study in a range of 30 cm will be covered in 6 s. Rot.Thorax s ThoraxFast Indications For thorax studies when scan time has to be short. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 25-30 s 2.3 mSv female: 4. g.7 mGy male: 3. e.5 s B40f 5 mm ca-cr 300 mm 7.2 mSv kV mAs Slice collimation Slice width Feed/Rot. ThoraxFast 120 90 4 x 5 mm 7 mm 30 mm 0. patient has difficulty of holding breath. Thorax You could repeat the same protocol simply by clicking the chronicle with the right mouse button for “repeat“ . E. when both non-contrast and contrast studies are required. 88 1 . g. E. simply change the increment before image reconstruction. g. thorax studies in general and interstitial changes in the lungs. Two recon jobs are predefined for image reconstruction of thin slice lung (with gaps) and routine thorax. 89 . time Kernel Increment Direction Scan range CTDIw Effective Dose 5 mm B30f 5 mm Contrast medium IV injection Start delay: Flow rate: Total amount: 20-25 s 2.2 mSv kV mAs Slice collimation Slice width Feed/Rot. Rot.0 mSv female: 5. ThoraxCombi 120 90 4 x 1 mm 2 mm 7 mm 0.5 s B50f 10 mm ca-cr 300 mm 10.0 ml/s 80-100 ml If you want to reconstruct thin slices in every 2 mm or 15 mm instead of 10 mm as predefined.Thorax s ThoraxCombi Indications Combining thin slice lung and routine thorax studies with one spiral scan.3 mGy male: 4. A range of 30 cm will be covered in 23 s. or use manual triggering.Thorax This protocol can also be modified for central pulmonary emboli studies: • Scan range: above the aortic arch up to the tip of the sternum. 90 1 .0 ml/s • Total amount: should be calculated as (start delay + scan time) x flow rate • Slice width: 3 mm • Kernel: B30 * CARE Bolus (optional) may be used to optimize the bolus timimg. Set the ROI for monitoring scan in the main pulmonary trunk with triggering threshold of 100 HU. • Start delay: 12-15 s* • Injection rate: 3. 0 mSv female: 5.3 mGy male: 4. Rot.75 s B70s 1. E. you should reconstruct images with kernel B30. interstitial changes in the lungs.2 mSv kV mAs Slice collimation Slice width Feed/Rot. or peripheral emboli. and use mediastinum window for image display. 91 . Spiral 120 90 4 x 1 mm 1. contrast medium is not necessary. This injection protocol applies for peripheral emboli studies.0 ml/s 120 ml * With studies of interstitial changes in the lungs. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection* Start delay: Flow rate: Total amount: 20-25 s 3.2 mm ca-cr 300 mm 10. In this case.25 mm 6 mm 0.g. A range of 30 cm for the complete thorax will be covered in 39 s.Thorax s ThoraxHires Indications HiRes lung studies. 92 1 .Thorax If the scan time is not realistic. or simply use the ThoraxCombi protocol which applies faster rotation time. you could either adjust the scan range. Thorax s ThoraxSeqHR Indications Sequence mode for HiRes lung studies. Spiral 120 90 4 x 1 mm 1 mm 15 mm 0. E. Rot. g. time Kernel Direction Scan range CTDIw Effective Dose 93 .0 mSv female: 1.3 mSv kV mAs Slice collimation Slice width Feed/Rot. interstitial changes in the lungs.75 s B70s cr-ca 285 mm 10. Images are acquired in 15 mm intervals.3 mGy male: 1. 94 1 . simply change the Feed/Rotation before load the mode.Thorax If you want to reconstruct thin slices in every 10 or 20 mm instead of 15 mm as predefined. A typical thorax study in a range of 30 cm will be covered in 10 s. Rot.Thorax s LungLowDose Indications Lung studies with low dose setting.3 mGy male: 0. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 25-30 s 2. early detection of lung cancers.1 mSv kV mAs Slice collimation Slice width Feed/Rot.5 s B50f 5 mm cr-ca 300 mm 2. LungLowDose 120 20 4 x 1 mm 5 mm 7 mm 0. e.0 ml/s 50-80 ml 95 .9 mSv female: 1.g. when both non-contrast and contrast studies are required. For lung cancer staging. this protocol can be combined with protocol “Neck Routine” .g.Thorax You could repeat the same protocol simply by clicking the chronicle with the right mouse button for “repeat“ . 96 1 . E. Abdomen Overview • AbdRoutine For routine abdominal studies • AbdFast Fast mode for abdomen studies • AbdCombi For combination of CTA and two phases soft tissue studies • AbdThinSlice For abdomen thin slice studies • AngioRoutine For CTA routine studies • AngioFast For long-range CTA studies 97 . 512 or 768 mm. arms positioned comfortably above the head in the head-arm rest.Diluted barium suspension (1% . Note: • In general. g. for abdominal studies such as liver.250 ml) 1st cup to drink 30 minutes before exam 2nd cup to drink 15 minutes before exam 3rd cup to drink 5 minutes before exam Abdomen-Pelvis: Minimum 1000 ml of contrast divided into 4 cups 1st cup to drink 1 hour before exam 2nd -4th cups every subsequent 15 minutes Start exam 5 minutes after the 4th cup is administered. Upper abdomen: Minimum 600 ml of contrast divided into 3 cups (approximately 200 . 4.Water soluble agent (2% . • For patients with bowel obstruction. Barium suspension is contraindicated. EZCAT . Topogram: AP. 5. Oral administration of contrast medium: For abdominal studies. only water or water-soluble contrast can be used. gastrointestinal studies. Timing of the oral contrast administration is important to ensure its even distribution in the bowels. Water is more effective than positive oral contrast agent in depicting the linings of the stomach & intestines in post enhancement studies. Various types of bowel opacifying agents can be used: .Water itself as a negative contrast agent. pancreas.2%) e. abdominal masses & abscesses. Gastrografin .Administration of an IV CM injection in such cases may trigger a hypertensive crisis! 98 1 . In addition. it is sufficient to use just water. 3. focal lesion of the kidneys and CTA studies. Patient respiratory instruction: inspiration.Abdomen Hints in general 1.4%) e. 2. lower legs supported. the use of water will not obscure the blood vessels thus allowing CTA processing to be performed easily afterward. gall bladder (query stones). Patient positioning: Patient lying in supine position. Be careful when examining pheochromocytoma patients. it is necessary to delineate the bowels from other structures such as lymph nodes. g. screening. follow-up examinations etc.Abdomen s AbdRoutine Indications All routine studies in the region of abdomen. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 50-60 s 4-5 ml/s 100-120 ml 99 . AbdRoutine 120 165 4 x 2. e. in a range of 50 cm will be covered in 21 s.0 mSv female: 13. Rot.8 mSv kV mAs Slice collimation Slice width Feed/Rot. and a typical liver scan in a range of 20 cm will be covered in 9 s. A complete abdomen/pelvis scan.5 mm 0.5 mm 5 mm 12.5 s B30f 5 mm cr-ca 400 mm 15. g.5 mGy male: 9. 100 1 . g. E.Abdomen You could repeat the same protocol simply by clicking the chronicle with the right mouse button for “repeat“ . when both non-contrast and contrast studies are required. and a typical liver scan in a range of 20 cm will be covered in 5 s.9 mSv female: 12.5 s B30f 5 mm cr-ca 400 mm 13. AbdFast 120 155 4 x 5 mm 7 mm 25 mm 0. A complete abdomen scan in a range of 50 cm will be covered in 11 s.3 mGy male: 7. when a patient has difficulty with breathhold.g.Abdomen s AbdFast Indications Fast spiral mode for abdominal studies. Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 50-60 s 4-5 ml/s 100-120 ml 101 . e.0 mSv kV mAs Slice collimation Slice width Feed/Rot. 102 1 .Abdomen You could repeat the same protocol simply by clicking the chronicle with the right mouse button for “repeat“ . Quiet respiration can also render good results.g. E. especially on a patient who cannot hold his/her breath. when both non-contrast and contrast studies are required. 5 mGy male: 5. Rot.25 mm/5 mm 5 mm 0.5 mm 0. and 5 mm for soft tissue enhancement. image reconstructed in 5 mm for soft tissue only.5 mm acquisition in 11 s for venous phase.25 mm for MIP/SSD/MPR postprocessing.5 mm 0.5 s B30f 5 mm ca-cr 200 mm 14. image reconstructed in 1.g.5 mm 5 mm 12.5 s B30f/B30f 1 mm/5 mm cr-ca 200 mm 16.6 mSv female: 5. Same range followed by a 4 x 2. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: 20-25 s (arterial phase) 50-75 s (venous phase) Flow rate: 4-5 ml/s Total amount: 100-120 ml 103 . Native 120 155 4 x 2.7 mSv Arterial phase 120 145 4 x 1 mm 1.1 mSv female: 6. E.Abdomen s AbdCombi Indications Combination of CTA and soft tissue studies.5 s B30f 5 mm cr-ca 200 mm 14.2 mSv Venous phase 120 155 4 x 2.6 mGy male: 4.7 mSv kV mAs Slice collimation Slice width Feed/Rot.6 mGy male: 4.5 mm 5 mm 12.6 mSv female: 5. pancreas and kidney: arterial phase acquired with 4 x 1 mm in 25 s. a range of 24 cm including liver. 104 1 . Use water instead if necessary. as this impairs the editing of MIP/SSD images.Abdomen Do not administer oral contrast medium. g. pancreas or kidneys will be covered in 26 s. E. and thicker slice reconstruction for soft tissue.1 mSvv kV mAs Slice collimation Slice width Feed/Rot.8 mSv female: 7. Rot.8 mGyy male: 5. time Kernel Increment Direction Scan range CTDIw Effective Dose 5 mm B30f 5 mm Contrast medium IV injection Start delay: Flow rate: Total amount: 50-65 s 4-5 ml/s 100-120 ml 105 . Two recon jobs are predefined: thinner slice reconstruction used for post-processing.5 s B20f 1 mm cr-ca 200 mm 18. AbdThinSlice 120 165 4 x 1 mm 1.25 mm 4 mm 0. a range of 20 cm for liver.Abdomen s AbdThinSlice Indications Thin slice scan for soft tissue studies. E. when both non-contrast and contrast studies are required. repeat the same protocol as mentioned below. the thin slice reconstruction can also be used for postprocessing.g.Abdomen If you want to use this protocol for a two phases study. But do not administer oral contrast medium. as this impairs the editing of MIP/SSD images. 106 1 . Water could be used instead if necessary. and chose start delay time for arterial phase as 20-25 s. In this case. You could repeat the same protocol simply by clicking the chronicle with the right mouse button for “repeat“ . Rot.0 ml/s 100-120 ml * CARE Bolus (optional) may be used to optimize the bolus timing.9 mSv kV mAs Slice collimation Slice width Feed/Rot. E.3 mSv female: 6. Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan range with triggering threshold of 100 HU. AngioRoutine 120 130 4 x 1 mm 1.Abdomen s AngioRoutine Indications For abdominal CTA studies.: a typical study of renal arteries in a range of 18 cm will be covered in 16 s. or use manual triggering.25 mm 6 mm 0.5 s B20f 1 mm cr-ca 250 mm 14. 107 . g.8 mGy male: 5. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 20-25 s* 3. Abdomen Do not administer oral contrast medium. as this impairs the editing of MIP/SSD images. 108 1 . 9 mSv kV mAs Slice collimation Slice width Feed/Rot. 109 . time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 20 s* 3. g. Rot.0 ml/s 120-140 ml * CARE Bolus (optional) may be used to optimize the bolus timimg.Abdomen s AngioFast Indications Long range CTA studies.5 mm 3 mm 15 mm 0.1 mSv female: 15. Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan range with triggering threshold of 100 HU. or use manual triggering.2 mGy male: 14. E. AngioFast 120 130 4 x 2.: a typical study of the whole aorta including its branchiocephalic trunk and iliac arteries in a range of 80 cm will be covered in 28 s.5 s B30f 3 mm cr-ca 800 mm 12. 110 1 . The data acquired can also be used for soft tissue image reconstruction. select smaller increment for overlapping image reconstruction. e. For better MIP/SSD/MPR images.Abdomen Do not administer oral contrast medium. 1.5 mm. as this impairs the editing of MIP/SSD images. Select slice width as 5 or 7 mm. g. Pelvis Overview • PelvisRoutine Spiral mode for routine pelvis studies • HipSpi Spiral mode for HiRes bone studies 111 . lower legs supported. since respiration does not negatively influence this region. 2. Rectal contrast medium administration: Rectal contrast media is usually required to delineate the rectum and sigmoid colon. if lower pelvic mass or pathology is suspected. 3.The use of a vaginal tampon may be helpful in adult female patients with suspected pelvic pathology.Pelvis Hints in general 1. Patient positioning: Patient lying in supine position. A breathing command is not necessarily required for the pelvic spiral. 4. Topogram: AP. 256 mm. arms positioned comfortably above the head in the head-arm rest. 112 1 . In some cases. air may be substituted for a positive contrast agent. wait at least 3 minutes following IV administration of the contrast medium. PelvisRoutine 120 178 4 x 2. urinary bladder.Pelvis s PelvisRoutine Indications Spiral mode for routine pelvis studies. rectum. 113 . processes of the prostate. g. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay*: Flow rate: Total amount: 50 s 2-3 ml/s 120 ml * If the examination performed requires a full urinary bladder. E.5 s B30f 3 mm cr-ca 200 mm 16.5 mm 5 mm 10 mm 0. gynecological indications etc.7 mSv female: 8. Rot. A typical range of 20 cm will be covered in 11 s.3 mSv kV mAs Slice collimation Slice width Feed/Rot.7 mGy male: 5. Pelvis 114 1 . dysplasia. trauma. Rot. g. time Kernel Increment Direction Scan range CTDIw Effective Dose 115 . congruence evaluations. masses.5 mm 5 mm 1.0 s B60s 1. evaluation of joint cavity.5 mm cr-ca 100 mm 24. E. orthopedic indications etc.8 mGy male: 4.7 mSv female: 4.3 mSv kV mAs Slice collimation Slice width Feed/Rot. necrosis of the head of the hip. Spiral 140 150 4 x 1 mm 1. A typical range of 10 cm will be covered in 22 s.Pelvis s HipSpi Indications Spiral mode for HiRes bone studies. Use raw data to review the target region. images should be reconstructed with 50 % overlapping and kernel B10. 116 1 . In case of 3D study only. and slice width 5 mm. mAs can be reduced up to 50 %. it is advisable to enter the side in the comment line. If only one side is examined.Pelvis The data acquired can also be used for soft tissue image reconstruction – select kernel B30. Spine Overview • RoutineSeq Sequence mode for routine spine studies • ObeseSeq Sequence mode for studies of obese patients • SpineSpi Spiral mode for spine studies • ThinSliceSpi Thin slice spiral mode for spine studies 117 . use kernel B60. it is a good idea to roll the patient once. Also. use the protocols in the region of “Neck” . mAs value can be reduced by 50 %. In case of SSD study only. arms positioned comfortably above the head in the head-arm rest. This will prevent the contrast from pooling posterior to the spinal cord. or scan in a prone position. For cervical spine study. Use kernel B10 and 50 % overlapping image reconstruction. formed within 4-6 hours of the injection. 4. 5.Spine Hints in general 1. 2. the contrast density in the spinal canal will be too high to obtain artifact-free images. 7 The CT scan following myelography must be per. 3. For lumbar studies. This will reduce the curve in the spine and also make the patient more comfortable. 118 1 . Patient positioning: Patient lying in supine position. For image reconstruction of bone study. 6. Topogram: Lateral. Any possible injuries to the spinal column should be determined before beginning the examination and taken into account when repositioning the patient. place a cushion under the patients’ knee. otherwise. lower legs supported. 512 mm. if possible. Spine s RoutineSeq Indications Sequence mode for spine studies. Sequence 120 360 4 x 2.0 s 2s B30s cr-ca 17. degenerative changes. Rot.0 mSv kV mAs Slice collimation Slice width Feed/Rot.8 mGy male: 0. g.9 mSv female: 1. tumors etc. e. time Cycle time Kernel Direction Scan range CTDIw Effective Dose 119 .8-0.4-3. trauma. prolapse.5 mm 2.5 mm 33.5 mm 10 mm 1. Spine s ObeseSeq Indications Sequence mode for spine studies of the obese patients when higher dose are needed, e. g. prolapse, degenerative changes, trauma, tumors etc. kV mAs Slice collimation Slice width Feed/Rot. Rot. time Cycle time Kernel Direction Scan range CTDIw Effective Dose Sequence 140 450 4 x 2.5 mm 2.5 mm 10 mm 1.5 s 2s B30s cr-ca 17.5 mm 61.7 mGy male: 1.4-1.6 mSv female: 2.5-5.4 mSv 120 1 Spine s SpineSpi Indications Sequence mode for spine studies, e. g. prolapse, degenerative changes, trauma, tumors etc. A range of 40 cm will be covered in 43 s. kV mAs Slice collimation Slice width Feed/Rot. Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose Spiral 120 300 4 x 2.5 mm 3 mm 7.5 mm 0.75 s B20s 3 mm cr-ca 300 mm 28.2 mGy male: 11.8 mSv female: 19.9 mSv 121 Spine s ThinSliceSpi Indications Thin slice spiral mode for spine studies when high resolution for fine structure is required. ThinSliceSpi 120 330 4 x 1 mm 2 mm 2.5 mm 0.75 s B20s 2 mm cr-ca 200 mm 37.6 mGy male: 8.9 mSv female: 17.9 mSv kV mAs Slice collimation Slice width Feed/Rot. Rot. time Kernel Increment Direction Scan range CTDIw Effective Dose 122 1 123 .5 mm slice collimation. • CombiSpi Combination for HiRes bone and soft tissue studies. • AngioRunOff For long range CTA studies.Extremities Overview • UHRSpi Spiral mode for bone ultra high-resolution studies using 2 x 0. bind feet together. c) For ankle and feet scan: Patient lying in supine position. feet first. Use kernel B10 and 50 % overlapping image reconstruction. The only exceptions are extremely light patients. feet first. a) For wrists scan: Patient lying in prone position. Patient positioning: Depends on the region of examination.Extremities Hints in general 1. d) UHR mode requires a 25 cm scan FOV as a maximum. 124 1 . promote relaxation by placing Bocollo pillows between knees and feet. Both wrists should be examined together when necessary. Topogram: AP 128/256 mm for joint studies. 3. ankles supported with a pad. The latter can remove the leg not being examined from the gantry by bending it 90° at the hip and the knee and placing the bottom of the same foot against the gantry casing. b) For knee scan: Patient lying in supine position. Bind both ankles together if necessary to assure the AP position of both feet. 2. hands stretched above the head and lying flat on a Bocollo pillow. . Use CombiSpi mode when a scan FOV > 25 cm is necessary. mAs can be reduced up to 50 %. In case of SSD study only. you should always try to position the patient evenly whenever the patient can comply. In general. for bilateral studies. Special positioning is not necessary since the real time MPR could simulate any view of secondary reconstruction. 1024 mm for CTA. E. g.Extremities s UHRSpi Indications Spiral mode for ultra HiRes bone study.5 mm 1 mm 0.1 mGy male: 0. time Kernel Increment Direction Scan range CTDIw Effective Dose* * These were calculated based on a CT exam of the ankel. NOTE: UHR mode requires a 250 mm scan FOV. trauma.01 mSv kV mAs Slice collimation Slice width Feed/Rot.5 mm 0.75 s U90u 0. 125 . and it is mandatory to position the patient in the center of the scan field.3 mm cr-ca 60 mm 20. UHRSpi 120 100 2 x 0. orthopedic indications etc. Rot.01 mSv female: 0. 126 1 . It is not recommended to use this protocol for 3D studies.Extremities This protocol is used for ultra high-resolution studies. For image reconstruction of soft tissue. use kernel U30. 127 .75 s B60s 1 mm cr-ca 150 mm 34.25 mm 4 mm 0. trauma. disorders of the joint etc. CombiSpi 120 90 4 x 1 mm 1. time Kernel Increment Direction Scan range CTDIw Effective Dose* 5 mm B30s 5 mm cr-ca * These were calculated based on a CT exam of the Knee. Rot.Extremities s CombiSpi Indications Combination for HiRes bone and soft tissue studies. g.04 mSv kV mAs Slice collimation Slice width Feed/Rot.1 mGy male: 0. E. masses.06 mSv female: 0. Extremities 128 1 . A range of 100 cm will be done in 35 s. record the table position of the desired scan range while positioning the patient.5 s B20f 3 mm ca-cr 900 mm 12. AngioRunOff 120 130 4 x 2.5-3 ml/s 150 ml If Topo length 1024 mm is not long enough. Rot.2 mGy male: 5. and type them into the routine card as “table begin” and “table end” .9 mSv female: 4.5 mm 3 mm 15 mm 0.3 mSv kV mAs Slice collimation Slice width Feed/Rot. 129 .Extremities s AngioRunOff Indications For CTA studies. time Kernel Increment Direction Scan range CTDIw Effective Dose Contrast medium IV injection Start delay: Flow rate: Total amount: 25-30 s 2. 130 1 . The data acquired can also be used for image reconstruction of soft tissue – select kernel B30.Extremities Position the patient as feet first. and slice width 5 mm. Bend the feet together if necessary. Notes 131 . Text The information presented in this application guide is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Martin Heuschmid* David Bradley *University Hospital Tuebingen. This material does not substitute for that duty and is not intended by Siemens Medical Solutions Inc. training and expertise in dealing with their individual patients. We assume no responsibility whatsover for the correctness of this information.. The treating physician bears the sole resposibility for all of the parameters selected. +49-91 91-18 99 98 eMail: ct-application. Variations may prove necessary for individual patients. Xiaoyan Chen Dr. to be used for any purpose in that regard. The pertaining operating instructions must always be strictly followed when operating the SOMATOM Volume Zoom. Please contact us: CT Application Hotline: Tel. Any health care practitioner reading this information is reminded that they must use their own learning.hotline@med. suggestions and comments. The statutory source for the technical data are the corresponding data sheets. Germany.de Author: Dr. 132 1 . no. +49-9191-18 80 88 (outside Germany) 01 30-18 53 91 (in Germany) Fax no. To improve future versions of this application guide.siemens. we would highly appreciate your questions. The drugs and doses mentioned herein were specified to the best of our knowledge. Siemens reserves the right to modify the design and specifications contained herein without prior notice.com Order No. Please contact your local Siemens Sales Representative for the most current information. A91100-M2100-A265-1-7600 Printed in Germany CC 63265 BA 11015. Germany Corporate Headquarters: Berlin and Munich Siemens AG. D -80333 München. D-91301 Forchheim. Siemens AG. original images always lose a certain amount of detail when reproduced. Germany Internet: SiemensMedical. . Medical Solutions Computed Tomography Siemensstrasse 1. Wittelsbacher Platz 2. Note: Of necessity.