CT UROGRAPHY SINGLE BOLUS PROTOCOL FOR HAEMATURIA
BEFORE THE EXAMINATION
Please remember to use the terms fine tube instead of needle and give contrast instead of injection as these terms are much less "scary" for the patient.
1. Give the patient 750-1000 ml of tap water to drink during 30 min prior to examination to encourage urine flow.
2. Remove bras, belts, necklaces to avoid artifacts on reconstructions.
3. Remove patients shoes (to help patient rolling on the CT table). This is very important to promote mixing of contrast with urine for complete opacification.
4. Ask the patient to void (empty their bladder) immediately before entering the room so they are comfortable during the CT examination and do not have to void during the examination.
DURING THE EXAMINATION
5. Position the patient on CT table in supine position.
6. All series to be acquired on expiration to extend the ureter and avoid ureteric kinks which may simulate small tumours.
7. Say to the patients “Small breath in, breath out and hold”.
8. Unenhanced series from top of kidneys to below pubic symphysis.
ST=1.25 -1.5 mm, RST=0.625 - 0.7, TF=18 mm/rot, n=16. RFOV=358 mm. Supine position.
9. Give 150 ml non-ionic contrast I.V. (Iohexol or Iopamidol) (300 mg I /ml) via pump at 3 ml/s and start the digital timer.
10. Scan from the top of liver to bottom of kidneys at 100 s post-contrast administration in the supine position for nephrographic phase.
11. Move the patient off table and walk them around CT machine. This exercise is to encourage urine flow and mixing of contrast and urine.
12. At t = 8 min reposition the patient on CT table and roll them twice anticlockwise and twice clockwise. Please do not rock the patient on the table if they are unable to roll, simply place them supine and write the request form "unable to roll".
13. At t=12.5 min post-contrast injection, scan from top of diaphragm to below symphysis in the supine position for the excretory phase images.
14. If the pelvic ureters are not fully opacified turn patient prone immediately and rescan from top of iliac crests to below symphysis. Make sure all of the bladder is included in the scan.
AFTER THE EXAMINATION
15. Reconstruct images for reporting: SW=1.5mm, RI=0.7mm, RFOV=358 mm, reconstruction kernel B31F. (RFOV = PS x matrix).
16. Send images to PACS for reporting