CT Scanning and Injection Protocols
More than 600 clinical cases have been processed using the
AngioVis setup. The generation of MIPs, and various forms of Curved Planar
Reformations has been used clinically at the Department of Cardiovascular and
Interventional Radiology, Medical University of Vienna, Austria, using a
16-channel Multislice CT scanner. Recently, we have been using a 64-slice
scanner at Medical University of Vienna, Austria and at
The axial CT source images are transferred to the AngioVis
workstation, where post-processing steps are performed by experienced CT
technologists. The resulting images are sent to PACS (in DICOM format), and are
then reviewed by the radiologist and vascular surgeons on any PACS viewing
station.
Routine readout usually begins with looking at the MIP images,
as they give an "angiography-like" overview. In the presence of vessel
calcifications or endoluminal stents, the assessment of the flow channel
requires the analysis of cross-sectional images. The most comprehensive tool to
read cross sections is to use multi-path curved planar reformations. In many
instances, these images provide the necessary clinical information. If necessary,
the user can also read single-path CPRs through a vessel of interest. As all
images are read on PACS workstations, all images can be magnified (zoom), and
the viewing window settings can be altered interactively. This is crucial in the
presence of calcifications/stents because too narrow window settings may cause
–pseudo-stenosis due to the blooming artifact.
The following section describes our current scanning
technique, the technique of contrast medium injection, and the routine post-processing
steps for visualizing peripheral arterial occlusive disease for diagnosis and
treatment planning, using the AngioVis programs.
Recent clinical examples with angiographic correlation will be available for practical testing at the exhibition booth.
Department of Radiology
Stanford University
Medical
Center
Stanford ,
CA
-
USA
D. Fleischmann
Lower Extremities Runoff
Scanning Protocol – Siemens S 64
Scan protocol |
RUNOFF
(Vascular Folder) |
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Topogram |
1500 mm AP;
feet first, arms up; feet still and relaxed; support with cushions/tape; |
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Range 1+2 |
Bolus
Tracking, ROI in abdominal aorta at celiac artery |
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Range 3 |
Runoff: from above the celiac trunk (D12 vertebral body)
through toes 120kV / Care dose 4D w. 250 ref-mAs) 64x0.6mm, 0.5s gantry-rotation
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Range 4 |
Runoff:
Pre-programmed
optional
second CTA acquisition to cover popliteal and crural
territories. This range is only initiated, if there is no contrast medium
opacification seen in the popliteal/crural vascular territories; |
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Breathhold |
at
inspiration |
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Scandirection |
cranio-caudal |
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Injection Protocol |
20-22G
IV line,
Isovue (iopamidol) 370
Injection Rates and Volumes
Saline flush: 40mL volume, flow-rate equal to
'Flow2' |
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Reconstruction (STh/RI) |
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Transfer |
Auto transfer of all data to PACS Transfer to ANGIOVIS workstation |
Department of
Cardiovascular and Interventional Radiology
Medical
University of
Vienna
Vienna, Austria
J.
Lammer
Lower Extremities Runoff
Scanning Protocol – Philips Brilliance 64
Indication |
Peripheral
arterial occlusive disease |
Scanprotocol |
(Vascular
Folder) |
Topogram |
1500 mm AP;
feet first, arms up; feet still and relaxed; support with cushions/tape; |
Range 1+2 |
Bolus
Tracking, ROI in abd. aorta at celiac artery |
Range 3 |
Runoff: from
above the celiac artery (D12 vertebral body) through toes
120kV / 180
eff.mAs
64
x 0.625mm
pitch 0.7 - 0.8 |
Range 4 |
Runoff:
Pre-programmed
optional
second CTA acquisition to cover popliteal and crural
territories. This range is only initiated, if there is no contrast medium
opacification seen in the popliteal/crural vascular territories; |
Breathhold |
at
inspiration |
Scandirection |
cranio-caudal |
Injection Protocol |
17-20G IV line, Iomeron (iomeprol) 400 Biphasic injection protocol Volume 1 = 25 mL, injected at 4.5 mL/s Volume 2 = 58 mL for PAOD II&III, 68mL for PAOD IV Saline flush: 40mL volume, flow rate 2.3 mL/s |
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|
Transfer |
Auto transfer of all data to PACS |
Lower Extremities Runoff
Scanning Protocol – Siemens S16
Indication |
Peripheral
arterial occlusive disease |
Scanprotocol |
RUNOFF
(Vascular Folder) |
Topogram |
1500 mm AP;
feet first, arms up; feet still and relaxed; support with cushions/tape; |
Range 1+2 |
Bolus
Tracking, ROI in abd. aorta at celiac artery |
Range 3 |
Runoff: from
above the celiac artery (D12 vertebral body) through toes
120kV / 130
eff.mAs
16 x 0.75mm
Table-feed ~14mm/s
(scantime
is ~ 45– 55s) |
Breathhold |
at
inspiration |
Scandirection |
cranio-caudal |
Injection Protocol |
17-20G IV line, Iomeron (iomeprol) 400 Biphasic injection protocol Volume 1 = 25 mL, injected at 4.5 mL/s Volume 2 = __ mL* injected at 2.3 mL/s Saline flush: 40mL volume, flow rate 2.3 mL/s |
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|
Transfer |
Auto transfer of all data to PACS |