CT CHEST ANGIO – PULMONARY EMBOLISM

INDICATIONS: Pulmonary embolism, positive D-Dimer, shortness of breath, chest pain.

“CTA: Aorta, PE. No need to do pre unless looking for acute intramural hematoma or looking at stent grafts.”

PATIENT PREP: NPO for solid foods, water only, for 4 hours prior to scan

IV CONTRAST: 100mL Isovue 370 @ 4-5 mL/second

ORAL CONTRAST: None

POSITIONING: Feet First Supine, Arms above head

TOPOGRAMS: AP. Range: Above lung apices through lung bases/costophrenic angles. 25 mA, 110 kV.

Lateral. Range: Above lung apices through lung bases/costophrenic angles. 25 mA, 110 kV.

SCAN TYPE: Spiral/Helical

NOTES: Packs Per Day X Number of Years Smoking = Pack-Years

ALARA – Keep radiation dose As Low As Reasonably Achievable.

CARE BOLUS triggered scan.

***Place Pre-Monitoring Slice at Approximately the level of the Carina to find a good slice through the Pulmonary Trunk to trigger off of.

If necessary Right click, Repeat and move Pre-Monitoring Slice to find a good slice through the Pulmonary Trunk.***

MONITORING

Scan Range
CARE BOLUS
Monitoring Location / Scan Direction
Scan Type
Number of Scans / Respiration / Threshold / Scan
Delay
Seconds / CARE
DOSE
4D / mAs / kV / Detector Configuration
Slices Per Tube Rotation / Table
Feed / InterScan
Delay
(Cycle Time)
Seconds / Scan
Time
Seconds / SFOV
(cm)
Pulmonary Artery / Craniocaudal
Sequential
30 scans / Quiet
Respiration / 120 HU / 8
Seconds / OFF / 50 / 110 / Detectors: 16 x 0.6 mm
Slices Per Tube Rotation: 1 / 0.0 mm / 1.2
Seconds / Full
0.6 Sec / 50
cm
Plane / Slice
Thickness / Interval/
Table Feed / Kernal / Window
Width/Level / DFOV
(cm)
RECON – AXIAL SOFT TISSUE / Axial / 9.6 mm / 0.0 mm / B35s
HeartView Medium / Mediastinum
400/40 / Small FOV large enough to
Cover region of interest

ARTERIAL

Scan
Range / Scan Direction
Scan Type / Respiration / Scan
Delay
(Seconds) / CARE
DOSE
4D / Quality
Reference
mAs / kV / Detector Configuration
Slices Per Tube Rotation / Pitch
Table Increment/Speed: (mm/rotation) / Rotation
Time
(Seconds) / SFOV
(cm)
Above Apices
Through
Lung Bases / Craniocaudal
Spiral/Helical / Suspended
Inspiration / CARE Bolus Tracking
(Trigger 120 HU)
Plus 6 Second Delay / ON / 70 / 110 / Detectors: 16 x 0.6 mm
Slices Per Tube Rotation: 16 / Pitch: 1.25
Table Increment/Speed: 12.0 mm/rotation / 0.6
seconds / 50
cm
Plane / Slice
Thickness / Interval / Kernal / Window
Width/Level / DFOV
(cm)
RECON – AXIAL SOFT TISSUE / Axial / 1.0 mm / 1.0 mm / B35s
HeartView Medium / Mediastinum
400/40 / FOV just beyond
patient’s body
RECON – AXIAL LUNG / Axial / 3.0 mm / 3.0 mm / B70s
Sharp / Lung
1200/-600 / FOV just beyond
patient’s body
RECON – CORONAL SOFT TISSUE MPR
Coronals Angled in Plane to Body Part / Coronals Angled in Plane to Body Part
Recon Card 3D Coronal MPR / 1.0 mm / 1.0 mm / B35s
HeartView Medium / Mediastinum
400/40 / FOV just beyond
patient’s body
RECON – SAGITTAL SOFT TISSUE MPR
Sagittals Angled in Plane to Body Part / Sagittal Angled in Plane to Body Part
Recon Card 3D Sagittal MPR / 1.0 mm / 1.0 mm / B35s
HeartView Medium / Mediastinum
400/40 / FOV just beyond
patient’s body
RECON – AXIAL MIPS
Axial MIPS / Axial MIPS
Recon Card 3D Axial MIP Thin / 10.0 mm / 2.0 mm / B70s
Sharp / Lung
1200/-600 / FOV just beyond
patient’s body
RECON - CORONAL MIPS
Coronal MIPS Angled in Plane to Body Part / Coronal MIPS Angled in Plane to Body Part
Recon Card 3D Coronal MIP Thin / 10.0 mm / 2.0 mm / B35s
HeartView Medium / Mediastinum
400/40 / FOV just beyond
patient’s body

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*The operator must check the CTDIvol before and after the scan to ensure it is within the allowed dose range. Scans performed outside of the allowed range must be

documented and reviewed by the designated radiologist and/or physicist.

Allowed CTDIvol Dose Ranges: 1 mGy – 50 mGy

XR29 Dose Notification Value (CTDIvol): 50 mGy

Approximate Values for CTDIvol
Patient Size / Weight (kg) / Weight (lbs) / CTDIvol (mGy)
Small / 50-70 / 110-155 / 4-10
Average / 70-90 / 155-200 / 8-16
Large / 90-120 / 200-265 / 14-22
Reference: AAPM

*The AAPM recommended NEMA XR29 Dose Notification Value for an adult torso is 50 mGy. Dose notification levels less than the AAPM recommended can be set. The maximum CTDIvol should match the dose notification value. Exams with CTDIvol values less than the minimum allowed range should not be performed unless approved by a radiologist.

NETWORK: Exam to PACS

12/2017 Page 2 of 2