CHEST

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Contrast:100ml @ 3cc/sec    Delay: 30 seconds

Axial lung window GE:1.25 x 1.25 mm SIEMENS: 1.5 X  1.5, 1500 W, -500 L 

Axial lung window GE:3.75 X 3 SIEMENS: 3 x 3 mm, 1550 W, -500 L

 Axial soft tissue window GE:1.25 x 1.25 mm SIEMENS: 1.5 X  1.5, 400 W, 40 L

 Axial soft tissue window 3 x 3 mm, 400 W, 40 L

 Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L

 Axial MIP lung window 8 x 8 mm, 1600 W, -300 L

FOR PATIENTS THAT DO NOT QUALIFY FOR LUNG CANCER SCREENING

Axial lung window GE:1.25 x 1.25 mm SIEMENS: 1.5 X  1.5, 1500 W, -500 L 

Axial lung window GE:3.75 X 3 SIEMENS: 3 x 3 mm, 1550 W, -500 L

 Axial soft tissue window GE:1.25 x 1.25 mm SIEMENS: 1.5 X  1.5, 400 W, 40 L

 Axial soft tissue window 3 x 3 mm, 400 W, 40 L

 Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L

 Axial MIP lung window 8 x 8 mm, 1600 W, -300 L

Screening Inclusion Criteria: 

1) 50 to 80 years old 

2) Current smoker or quit within the past 15 years 

3) Minimum 20 pack-year smoking history 

4) No symptoms such as new or worsening cough, shortness of breath or chest pain 

5) Parent or sibling with lung cancer 

6) Exposure to radon, asbestos, significant second-hand smoke or other cancer-causing agents

 7) Occupational exposure

Axial soft tissue window GE: 3.75 x 3 SIEMENS 3 x 3mm, 400 W, 40L

Axial lung window GE:1.25 x 1.25 mm SIEMENS:1.5 X 1.5 , 1500 W, -500 L

Axial soft tissue window 1.25 x 1.25 mm  SIEMENS:1.5 X 1.5, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L 

Axial MIP lung window 8 x 8 mm, 1600 W, -300 L

Axial bone window 0.625 x 0.625 mm, 2000 W, -500L

 Axial lung window 3 x 3 mm, 1500 W, -500 L 

Axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L

Axial MIP lung window 8 x 8 mm, 1600 W, -300 L

#1: Perform pre-contrast acquisition of entire chest as a routine chest CT

#2: Plan scan just above and below nodule with small (200 FOV). 100 cc contrast at 2 cc/sec with images through nodule at 1, 2 , 3 and 4 minute delays

#1: Pre-contrast images from lung apices through upper abdomen to include adrenal glands

 #2: Post-contrast images only through nodule

Axial lung window 1.25 x 1.25 mm, 1500 W, -500 L

 Axial lung window 3 x 3 mm, 1550 W, -500 L 

Axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L 

Axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L Axial 

MIP lung window 8 x 8 mm, 1600 W, -300 L

Axial reconstruction with 200 FOV soft tissue window 1.25 x 1.25 mm, 400 W, 40 L Post-contrast axial with 200 FOV soft tissue window 1.25 x 1.25 mm at 1, 2, 3 and 4 minutes

Axial lung window 1.25 x 1.25 mm, 1500 W, -500 L

 Axial lung window 3 x 3 mm, 1550 W, -500 L 

Axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L 

Axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L 

Axial MIP lung window 8 x 8 mm, 1600 W, -300 L 

Coronal MIP soft tissue window 10 x 5 mm, 400 W, 40 L 

3D Rotational

*Place intravenous line in arm contralateral to symptoms

Coverage: Center at aortic arch, coverage from mid chest to elbow of abducted arm

#1: Symptomatic arm adducted, asymptomatic arm abducted and externally rotated; 90 second delay; 100 cc contrast at 4 cc/sec.

#2: Symptomatic arm abducted and externally rotated, asymptomatic arm adducted; 90 second delay; 100 cc contrast at 4 cc/sec.

Axial lung window 1.25 x 1.25 mm, 1500 W, -500 L

 Axial lung window 3 x 3 mm, 1550 W, -500 L 

Axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L 

Axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L 

Axial MIP lung window 8 x 8 mm, 1600 W, -300 L 

Coronal MIP soft tissue window 10 x 5 mm, 400 W, 40 L 

3D Rotational

Scan #1: During active inhalation (patient slowly breathes in during entire scan), do routine acquisition lung apices through upper abdomen to include adrenal glands

Scan #2: During active exhalation (patient blows out during entire scan as if slowly blowing out a candle), do helical acquisition with low dose (auto mA and 40 mAs) from thoracic inlet through the diaphragm dome

Axial lung window 1.25 x 1.25 mm, 1500 W, -500 L 

Axial lung window 3 x 3 mm, 1550 W, -500 L 

Axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L

 Axial soft tissue window 3 x 3 mm, 400 W, 40 L

 Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L 

Axial MIP lung window 8 x 8 mm, 1600 W, -300 L 

Exhalation axial lung window 1.25 x 1.25 mm, 1500 W, -500 L

Scan #1: At end inhalation do routine acquisition lung apices through upper abdomen to include adrenal glands

Scan #2: At end exhalation do helical acquisition with low dose, thoracic inlet through the diaphragm dome

Scan #3: In prone position, at end inhalation, do direct axial acquisition 1 mm sections x 10 mm , lung apices through lung bases Note: Prone imaging only for initial high resolution exam (not performed on follow-up high resolution exams)

Inhalation axial lung window 1.25x1.25 mm, 1500 W, -500 L 

Inhalation axial lung window 3x3 mm, 1550 W, -500 L 

Inhalation axial soft tissue window 1.25x1.25 mm, 400 W, 40 L 

Inhalation axial soft tissue window 3x3 mm, 400 W, 40 L 

Coronal soft tissue window 3x3 mm, 400 W, 40 L 

Sagittal soft tissue window 3x3 mm, 400 W, 40 L 

Inhalation axial MIP lung window 8x8 mm, 1600 W, -300 L 

Exhalation axial lung window 1.25x1.25 mm, 1500 W, -500 L 

Prone axial lung window 1 mmx10 mm, 1500 W, -500 L

Scan #1: At end inhalation do routine acquisition lung apices through upper abdomen to include adrenal glands

Scan #2: At end exhalation do helical acquisition with low dose (auto mA and 40 mAs), thoracic inlet through the diaphragm dome

Inhalation axial lung window 1.25 x 1.25 mm, 1500 W, -500 L 

Inhalation axial lung window 3 x 3 mm, 1550 W, -500 L 

Inhalation axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L Inhalation axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L 

Inhalation axial MIP lung window 8 x 8 mm, 1600 W, -300 L

Exhalation axial lung window 1.25 x 1.25 mm, 1500 W, -500 L

 
ROI on the carina angle with bolus tracking, 8 second delay before tracking begins, monitor every 1.2 sec Trigger at 130 HU

“Small or gentle breath in and hold.” Practice with the patient to prevent large breaths in that can result in contrast interruption.
 

Axial lung window 1.25 x 1.25 mm, 1500 W, -500 L 

Axial lung window 3 x 3 mm, 1550 W, -500 L 

Axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L 

Axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Sagittal soft tissue window 3 x 3 mm, 400 W, 40 L 

Axial MIP lung window 8 x 8 mm, 1600 W, -300 L 

Coronal MIP soft tissue window 15 x 5 mm, 400 W, 40 L

 Right and Left oblique MIP through each pulmonary artery 5 x 3 mm, 400 W, 40 L

ROI on main pulmonary artery with bolus tracking 8 second delay before tracking begins, monitor every 1.2 sec Trigger at 115 HU

RECONS SAME AS STANDARD PE PROTOCOL

Post trigger scan: 80 mAs (no dose modulation)

ROI on main pulmonary artery with bolus tracking 8 second delay before tracking begins, monitor every 2 sec Trigger at 115 HU

Restricted: 1 cm above the aortic arch to just inferior to the xiphoid process.

Phase #1: Pre-contrast-scan as routine chest

Phase #2: No known renal disease or eGFR > 30: 100 ml Omnipaque 350 @ 3-5 ml/sec

ROI on aortic arch with bolus tracking 10 second delay before tracking begins, monitor every 1.5 sec Trigger at 130 HU-

Precontrast axial lung window 1.25 x 1.25 mm, 1500 W, -500 L Precontrast axial lung window 3 x 3 mm, 1550 W, -500 L

Precontrast axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L

Precontrast axial MIP lung window 8 x 8 mm, 1600 W, -300 L Postcontrast axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L Postcontrast axial soft tissue window 3 x 3 mm, 400 W, 40 L 

Postcontrast coronal soft tissue window 3 x 3 mm, 400 W, 40 L 

Postcontrast sagittal soft tissue window 3 x 3 mm, 400 W  40L

Candy Cane 

 Phase #1: Pre-contrast Phase 

#2:   No known renal disease or eGFR >30:   100 ml Omnipaque 350 @ 3-5 ml/sec  eGFR <30: Consult radiologist  Requires 20 gauge IV

 Phase #3: No additional contrast, image through stent/graft region   only 

 Phase #1 and 2: Lung apices through upper abdomen 

Phase #3: 2 cm above and 2 cm below stent/graft region only 

Phase #2:  ROI on aortic arch with bolus tracking 10 second delay before tracking begins, monitor every 1.5 sec Trigger at 130 HU 

Phase #3: 60 seconds after phase 2 completed Coverage 

 Precontrast axial lung window 1.25 x 1.25 mm, 1500 W, -500 L

 Precontrast axial lung window 3 x 3 mm, 1550 W, -500 L  

Precontrast axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L 

 Precontrast axial lung window 1.25 x 1.25 mm, 1500 W, -500 L Precontrast axial lung window 3 x 3 mm, 1550 W, -500 L  Precontrast axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L Phase #2 axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L  Phase #3 axial soft tissue window 1.25 x 1.25 mm, 400 W, 40 L Phase #2 coronal soft tissue window 3 x 3 mm, 400 W, 40 L Phase #2 sagittal soft tissue window 3 x 3 mm, 400 W, 40 L Precontrast axial MIP lung window 8 x 8 mm, 1600 W, -300 L Phase #2 2 x 2 m

Contrast: 

A) Non-contrast coronary calcium score 

B) Dual Injection: #1: 80 cc undiluted contrast at 5 cc/sec #2: 25 cc of contrast diluted with 25 cc saline at 5 cc/sec Requires 16-18 gauge IV in right antecubital fossa vein 

Scan Delay:

A) Standard prospective ECG triggered non-enhanced coronary  calcium score 

B) ROI on left atrium with bolus tracking 5 second delay before tracking begins, monitor every 2 sec Trigger at 150 HU or manually when contrast enters left atrium 

Chest CTA:

 Axial lung window 1.25 mm q 1.25 mm  

Axial soft tissue window 1.25 mm q 1.25 mm 

Coronal soft tissue window 2.5 mm q 2.5 mm 

Sagittal soft tissue window 2.5 mm q 2.5 mm 

Axial MIP lung window 8 mm q 8 mm 

Coronary CTA:

 Axial soft tissue window 0.75 mm q 0.4 mm Curved multi-planar reformations MIPs Volume rendering 

Calcium Score