CT Protocols for

Revolution™ Discovery™ CT /

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Discovery™ CT750 HD
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Copyright © 2017
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Rev: 3.0

Manufacturer:
School of Medicine and Public Health
University of Wisconsin-Madison
610 Walnut Street
Madison, WI 53726

Manufactured in USA
 University of Wisconsin-Madison CT Protocols for
Revolution™ Discovery™ CT / Discovery™ CT750 HD

Table of Contents

Page No.
Changes from Revision 2 to Revision 3 .......................................................................... 1

CT Protocol Scanner Compatibility Information ............................................................... 6

Direct Multi-Planar Reformat (DMPR) Protocols ............................................................. 7

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Introduction to University of Wisconsin-Madison CT Protocols ....................................... 9

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Design Philosophy of UW Protocols:
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Abdominal ................................................................................................................ 14
Chest........................................................................................................................ 16
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Cardiovascular ......................................................................................................... 17
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Musculoskeletal ....................................................................................................... 18
Neuroradiology ......................................................................................................... 19
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Pediatrics (including Higher Image Quality) ............................................................. 20

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Protocols
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Abdominal Protocols:
Abd/Pelvis: # 6.1/6.2/6.3 ......................................................................................... 23
High Image Quality Cancer Follow-up Abd/Pelvis: # 6.7/6.8/6.9 ............................. 26
Abd/Pelvis - R/O Hernia ........................................................................................... 29
Abd/Pelvis - Flank Pain: # 6.10/6.11/6.12 ............................................................... 31
Abd/Pelvis - Pre-IVC Filter Removal: # 6.73/6.74/6.75 ........................................... 33
Low Dose Renal Stone (including limited follow-up): # 6.13/6.14/6.15 ................... 35
Abd/Pelvis - Colonography: # 6.16/6.17/6.18 .......................................................... 38
Chest/Abd/Pelvis with IV Contrast: # 5.4/5.5/5.6 ..................................................... 43
Chest/Abd/Pelvis without IV Contrast: # 5.7/5.8/5.9 ................................................ 47
Abd/Pelvis - Urography: # 6.22/6.23/6.24 ............................................................... 51
Urothelial Tumor Follow-Up: # 6.70/6.71/6.72......................................................... 55
Abd-Liver - Biphasic: # 6.25/6.26/6.27 .................................................................... 59
Abd-Liver - Triphasic: # 6.28/6.29/6.30 ................................................................... 63
Abd-Liver - Hepatocellular Carcinoma (HCC): # 6.82/6.83/6.84 ............................. 72
Abd-Adrenal Gland - Adenoma: # 6.31/6.32/6.33 ................................................... 76
Abd-Pancreas – Pancreas Cancer (Neoplasm Screening): # 6.40/6.41/6.42 ......... 80

Revolution Discovery CT / Discovery CT750 HD Rev: 3.0 / December 2017

 Abdominal Protocols (cont.):
Abd/Pelvis - Kidney Tumor: # 6.49/6.50/6.51 .......................................................... 84
CTA Abd - Renal Donor: # 6.52/6.53/6.54 .............................................................. 88
Abd-Small Bowel - Enterography: # 6.55/6.56/6.57 ................................................ 92
CTA Abd - Obscure GI Bleed: # 6.58/6.59/6.60 ...................................................... 94
CTA Abd - Mesenteric Ischemia: # 6.61/6.62/6.63 .................................................. 98
Trauma - Chest: # 5.22/5.23/5.24 ......................................................................... 101
Trauma - Chest/Abd/Pelvis: # 5.25/5.26/5.27 ....................................................... 105
Trauma - Abd/Pelvis: # 6.4/6.5/6.6 ........................................................................ 112
Cystogram: # 8.10/8.11/8.12 ................................................................................. 117
Body Pelvis: # 8.16/8.17/8.18 ............................................................................... 121

Chest Protocols:

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Chest - Standard (Routine & High-Resolution): # 5.1/5.2/5.3................................ 124

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Chest - Low Dose Follow-up: # 5.10/5.11/5.12 ..................................................... 129
Chest - Low Dose Screening: # 5.13/5.14/5.15 ..................................................... 132
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Chest - CTA for PE: # 5.16/5.17/5.18 ................................................................... 135
Chest - Dynamic 3D Airway: # 5.70/5.71/5.72 ...................................................... 138
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Cardiovascular (CV) Protocols*:

Non-Gated CTA (Chest/Abd/Pelvis): # 5.28/5.29/5.30 .......................................... 142
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Retrospectively-Gated CTA Chest: # 5.31/5.32/5.33 ............................................ 147

-Gated Chest and Non-Gated Abd/Pelvis CTA: # 5.34/5.35/5.36 ......................... 152
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Prospectively-Gated Coronary CTA: # 5.37/5.38/5.39 .......................................... 157

Retrospectively-Gated Coronary CTA: # 5.40/5.41/5.42 ....................................... 161
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TAVI CTA: # 5.43/5.44/5.45 .................................................................................. 165

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Prospectively-Gated CTA Chest (Non-Coronary): # 5.46/5.47/5.48 ...................... 169

Upper Extremity CTA: # 5.49/5.50/5.51 ................................................................ 173
Lower Extremity CTA: # 5.52/5.53/5.54 ................................................................ 177
Post-Endostent Non-Con Volume Change (Abd/Pelvis only): #5.58/5.59/5.60 ..... 182
Prospectively-Gated Left Atrial Appendage: # 5.73/5.74/5.75............................... 184
* NOTE: All non-cardiovascular chest protocols are in the Chest Protocols section.

Musculoskeletal (MSK) Protocols:

Bony Pelvis/Hips/SI/Femur/FAI (Without Metal): # 8.1/8.2/8.3 .............................. 188
Bony Pelvis/Hips/SI/Femur/FAI (With Metal): # 8.4/8.5/8.6 ................................... 193
Knee/Tibia (Without Metal): # 9.3 .......................................................................... 198
Knee/Tibia (With Metal): # 9.4............................................................................... 202
Ankle/Foot/Distal Tibia (Without Metal): # 9.1 ....................................................... 206
Ankle/Foot/Distal Tibia (With Metal): # 9.2 ............................................................ 211
Femoral Anteversion: #9.8/9.9/9.10 ...................................................................... 216
Shoulder/Humerus (With or Without Metal): # 4.1/4.2/4.3 ..................................... 222

Revolution Discovery CT / Discovery CT750 HD Rev: 3.0 / December 2017

 Musculoskeletal (MSK) Protocols (cont.):
Elbow/Forearm (Without Metal): # 4.6................................................................... 229
Elbow/Forearm (With Metal): # 4.7 ....................................................................... 235
Wrist (Without Metal): # 4.8................................................................................... 241
Wrist (With Metal): # 4.9........................................................................................ 247
Chest Wall/Clavicle/AC Joint/SC Joint/Sternum/Ribs: # 4.11/4.12/4.13 ................ 253
Soft Tissue Extremity with IV Contrast: # 9.13/9.14/9.15 ...................................... 256

Neuroradiology (Neuro) Protocols:

Brain - Routine and Pediatric NAT/Trauma (Helical Mode): # 1.1/11.1/11.2 ......... 259
Brain - Helical Scan with Angled Axial Reformations: # 1.2/11.3/11.4 .................. 264
Brain (Axial Mode): # 1.3/11.5/11.6 ....................................................................... 269
Stealth - Stereotactic Head (Whole Brain Treatment Planning): # 1.10/11.11/11.12.... 274

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Orbit - Routine: # 2.1/12.1/12.2 ............................................................................. 277

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Facial Trauma - Routine: # 2.5/12.9/12.10 ............................................................ 282
Sinuses - Diagnostic: # 2.7/12.13/12.14................................................................ 287
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Temporal Bone (without Contrast): # 2.10/12.18/12.19......................................... 292
Temporal Bone (with Contrast Only or with & without Contrast): # 2.11/12.20/12.21 .... 295
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Adult Neck - Routine: # 3.1/3.2/3.3 ....................................................................... 301
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Neck (Parathyroid Adenoma): # 3.5/3.6/3.7 ........................................................... 306

Pediatric Neck - Routine: # 13.1.1,13.2.1,13.4.1,13.6.1,13.8.1 ............................. 314
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Adult Cervical Spine (without Metal): # 3.16/3.17/3.18 ......................................... 319

Adult Cervical Spine (with Metal): # 3.19/3.20/3.21 .............................................. 324
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Adult Thoracic Spine (without Metal): # 7.4/7.5/7.6 ............................................... 329

Adult Thoracic Spine (with Metal): # 7.19/7.20/7.21 .............................................. 333
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Adult Lumbar Spine (without Metal): # 7.1/7.2/7.3 ................................................ 337

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Adult Lumbar Spine (with Metal): # 7.16/7.17/7.18 ............................................... 341

Stroke Deluxe - Total Cerebrovascular: # 1.6/1.13/11.16/11.17 ........................... 345
CTA Head Only (Stenosis, Aneurysm, Unknown Bleed): # 1.7/11.18/11.19 .......... 352
CTA Neck Only (Cerebrovascular Disease): # 3.11/11.22/11.23 .......................... 359
CT Venography: #1.9/11.24/11.25 ........................................................................ 363

Pediatric Protocols*:
Routine Abdomen/Pelvis: # 16.1.1/16.2.1/16.4.1/16.6.1/16.8.1 ............................ 368
Acute Appendicitis - Abdomen/Pelvis: # 16.1.1/16.2.1/16.4.1/16.6.1/16.8.1 ......... 371
Renal Stone/Flank Pain: # 16.1.2/16.2.2/16.4.2/16.6.2/16.8.2 .............................. 373
Triphasic Liver: # 16.1.3/16.2.3/16.4.3/16.6.3/16.8.3 ............................................ 376
Trauma Abdomen/Pelvis: # 16.1.4/16.2.4/16.4.4/16.6.4/16.8.4 ............................ 384
Chest - Standard (Routine & High Resolution): # 15.1.1/15.2.1/15.4.1/15.6.1/15.8.1 389
Peds Chest Dynamic 3D Airway: # 15.1.2/15.2.2/15.4.2/15.6.2/15.8.2 ................. 393
Chest Pectus: # 15.1.3/15.2.3/15.4.3/15.6.3/15.8.3 .............................................. 398
CTA Chest for PE: # 15.1.4/15.2.4/15.4.4/15.6.4/15.8.4 ....................................... 401

Revolution Discovery CT / Discovery CT750 HD Rev: 3.0 / December 2017

 Pediatric Protocols* (cont.):
Routine Chest/Abdomen/Pelvis: # 15.1.5/15.2.5/15.4.5/15.6.5/15.8.5 .................. 405
Trauma Chest/Abdomen/Pelvis: # 15.1.6/15.2.6/15.4.6/15.6.6/15.8.6 .................. 409
* NOTE: Neuro protocols for pediatric patients are in the Neuro Protocols section.

Pediatric Higher Image Quality (HIQ) Protocols*:

Routine Abdomen/Pelvis: # 16.1.6/16.2.6/16.4.6/16.6.6/16.8.6 ............................ 416
Acute Appendicitis - Abdomen/Pelvis: # 16.1.6/16.2.6/16.4.6/16.6.6/16.8.6 ......... 418
Renal Stone/Flank Pain: # 16.1.7/16.2.7/16.4.7/16.6.7/16.8.7 .............................. 419
Triphasic Liver: # 16.1.8/16.2.8/16.4.8/16.6.8/16.8.8 ............................................ 421
Trauma Abdomen/Pelvis: # 16.1.9/16.2.9/16.4.9/16.6.9/16.8.9 ............................ 425
Chest - Standard (Routine & High Resolution): # 15.1.8/15.2.8/15.4.8/15.6.8/15.8.8 428
Chest Pectus: # 15.1.10/15.2.10/15.4.10/15.6.10/15.8.10 .................................... 430

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CTA Chest for PE: # 15.1.11/15.2.11/15.4.11/15.6.11/15.8.11 ............................. 432

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Routine Chest/Abdomen/Pelvis: # 15.1.12/15.2.12/15.4.12/15.6.12/15.8.12 ........ 434
Trauma Chest/Abdomen/Pelvis: # 15.1.13/15.2.13/15.4.13/15.6.13/15.8.13 ........ 436
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* NOTE: Neuro protocols for pediatric patients are in the Neuro Protocols section.
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Protocol Resources
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Pediatric Bony Pelvis Protocol Selection ..................................................................... 441

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Position Tutorial........................................................................................................... 442

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Size Selection.............................................................................................................. 445

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Size Selection for Neck and C-spine ........................................................................... 446

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Instructions for Adjusting Protocols for Pediatric Extremities and Bariatric Patients .... 447
Weight-Based Contrast Instructions ............................................................................ 449
Creatinine Guidelines (with values for eGFR) ............................................................. 450
Pediatric Contrast Guidelines ...................................................................................... 451
CT Perfusion Protocol: (Specific Instructions) ............................................................. 452
Thoracic Outlet Instructions ......................................................................................... 457
Scout Ranges and Anatomical Landmarks.................................................................. 458
Window Width and Window Level ............................................................................... 459
Instructions for Avoiding the Lens of the Eye on Head Exams .................................... 460
How to Send the ECG Trace to PACS ........................................................................ 461
Frequently-Asked Questions (FAQ’s) .......................................................................... 462

Revolution Discovery CT / Discovery CT750 HD Rev: 3.0 / December 2017

Changes from Revision 2 to Revision 3
As part of our ongoing UW Madison CT protocol optimization, we have made the following changes between
the Revision 2 and Revision 3 release. All of these changes have been internally reviewed and validated by
our team of Radiologists, Physicists, and CT Technologists, thereby fulfilling The Joint Commission mandate
on protocol review. Detailed documentation of our compliance with The Joint Commission Standards
regarding the performance element for CT protocol review is posted on our website
(https://www.radiology.wisc.edu/protocols/CT/resources.php).

New Protocols Added

The following protocols are new to the Revision 3 protocol release: Neck (Parathyroid Adenoma) Adult;

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High Image Quality Cancer Follow­Up Abd/Pelvis; Urothelial tumor follow­up; Soft Tissue Extremity with IV

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Contrast; Chest Wall/Clavicle/AC Joint/SC Joint/Sternum/Ribs; Peds Chest Dynamic 3D Airway;
Prospectively­Gated Left Atrial Appendage.
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Global Changes Made to the UW Protocols
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We turned on auto voice when using smart prep. Upon interacting with users of our protocols, we realized
most users expected this feature to be turned on by default.
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Window width and window level have been standardized across all protocols. There is now a systematic
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approach to setting window width and window level, which is included in the Protocols Manual.
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Scout start and end locations have been standardized for all protocols and are documented in a new section
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of the Protocols Manual. This includes a standardization of landmarks ex: om, sn, xy, ic. The anatomical
landmarks on all non­scout series/groups have been standardized as well.

Tables for reformats have been created in all sections; previous versions lacked reformat tables for some
protocols.

The naming of all series descriptions has been standardized to soft tissue, thin soft tissue, bone, thin bone,
axial soft tissue, etc.

To optimize image quality, all reformats have been changed to set intervals at one half of the reformatted
slice thickness.

The Smart prep phase was mistakenly called a series; this is now corrected in the protocol documentation.

References made in the reformat instructions were changed from the recon number to the series description
of the source reconstruction.

All oral contrast and IV instructions were updated to be uniform with respect to their units.

Creatinine Guidelines and Pediatric Contrast Guidelines were also added to the protocol resources section of
the manual.
Revolution Discovery CT / Discovery CT750 HD 1 Rev: 3.0 / December 2017
Abdominal Protocols
To assist CT technologists in choosing the correct size protocol (small/medium/large), all medium DFOV
were changed from 36 to 40 cm. This means patients too big to be scanned as small or medium will reveal
tissue extending outside of the “blue target region” on the scout images, prompting the technologist to select
a larger­sized protocol.

The threshold for switching from small to medium was moved from a scout AP + Lateral measurement of 55
to 60cm to improve the image quality of patients on the smaller side of what could be considered a medium
patient.

All large protocols with a 50 DFOV were changed from soft to a standard algorithm to increase the
resolution and decrease the “blurry” appearance of the large protocol’s soft tissue reconstructions.

Realizing that some organizations may not have the P3T power injector option on their Bayer injector, a
weight­based contrast chart was created for non­P3T sites. This is located in the Protocol Resources Section

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of the Protocols Manual.

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To save patient dose during the smartprep phase, the monitoring delay was increased from 30 to 40 seconds
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since contrast usually never peaks before 40 seconds.

A dedicated “Oncology Cancer Follow­up” protocol was created to better visualize subtle lesions on cancer
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follow­up patients.
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DMPR was added to the without series on the Adrenal Gland Adenoma protocol, and on all three phases of
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the liver donor work­up.

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Realizing the text­based instructions provided in previous versions of the protocols were confusing for
some, an easier to use formula and pictures were created to calculate the timing for the Liver ­ Triphasic and
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liver donor protocols.

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The contrast amount was updated for Chest/Abd/Pel/Neck (100 cc contrast/50 cc chaser) and Chest/Neck
(75 cc contrast /75 cc chaser).

The “exam split” feature is now utilized on the Chest/Abd/Pelvis protocols (both the with and without
contrast), which allows multiple sections to read different body regions (i.e., the Chest section reads the
chest portion of the exam and the Abdominal section reads the Abd/Pelvis portion of the exam). The DMPRs
on the chest portion of the Chest/Abd/Pelvis protocol were also updated.

Trauma ­ Chest exams are now started at the bottom of the spleen to improve visualization of any arterial
injuries in that organ.

The Trauma ­ Cystogram protocol, which was scanned at a trauma­level dose, was removed. This protocol
was found to be unnecessary since no spine reconstructions were performed with that protocol. For trauma
cases, the Cystogram (Non Trauma) protocol is now recommended, which includes a without contrast, a
with contrast, and a delay phase. For trauma patients, the without phase is skipped.

In the Trauma ­ Chest/Abd/Pelvis protocol, recon #10 was changed to a thoracic/lumbar spine instead of
the bony pelvis.

Revolution Discovery CT / Discovery CT750 HD 2 Rev: 3.0 / December 2017

The Abd/Pelvis ­ Urography protocol has been changed to a 115 second delay. The scan and injection should
be started at the same time and the delay is built in to the protocol. In this protocol, the need to do manual
oblique sagittal reformats was removed, as well as the advice to have a radiologist check mid scan for any
age; instead, all patients get the entire exam.

The Abd/Pelvis – R/O Hernia protocol has been removed from the scanner. Instead use the routine
Abd/Pelvis protocol and follow the clinical instructions in this manual regarding the request to the patient
to bear down (Valsalva maneuver).

The Pancreas protocols (pre­op and screening) were combined into a single protocol now called “Pancreas
Cancer”.

Chest Protocols
DMPR coronal and sagittal reformats were added on the Chest protocols (including the Trauma – Chest from
the Abdominal protocols).

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The oblique sagittal MIP reformat (i.e., “the candy cane view”) was removed in the Trauma ­ Chest.
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The large patient contrast volume in the CTA for PE protocol was updated to use Isovue 370 instead of a 300
mgI/cc strength agent.
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An axial image of the heart was added to the PE protocol to show the smartprep location (i.e., we point out
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the location of the left ventricle).

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Cardiovascular (CV) Protocols

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For sites without the Bayer Medrad P3T PA option, a weight­based chart for Isovue 370 is available in the
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Protocol Resources section of the Manual.

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All CV reformats were changed to mimic the routine chest reformats.

If your scanner has the option, it is recommended that you turn on MARS to the run off protocol (i.e., lower
extremity CTA) to mitigate metal artifacts from orthopedic implants. This is a selectable box on the
reconstruction options tab on your scanner.

A lung recon was added to coronaries (this uses a boneplus reconstruction kernel).

If your scanner has the option, it is recommended that you turn on MARS for CTA Chest/Abd/Pel to reduce
artifact from stents and other high­contrast implanted devices.

Retro/Prospective Coronary CTA breathing instructions were updated for all phases to now be consistent
with each other; before the instructions varied between the timing bolus and the CTA.

It is recommended to send ECG trace information on gated studies to PACS. This will facilitate
troubleshooting when the study does not come out as intended. Instructions for doing this are included in
the Protocols Manual.

The Upper and Lower Extremity CTA protocols have been changed from using a timing bolus to using a
smart prep.
Revolution Discovery CT / Discovery CT750 HD 3 Rev: 3.0 / December 2017
Thoracic Outlet instructions are provided in the Protocol Resources section of the Manual. This indication is
commonly scanned using MRI when available. A CT version is included here for sites who do not have access
to MRI.

Musculoskeletal (MSK) Protocols

New reformats for FAI (i.e. femoralacetabular impingement) were created as part of the routine bony pelvis
protocol. FYI, “Femoral Anteversion” is a separate protocol.

For patients unable to raise their arms, instructions have been added throughout the MSK protocols for how
to scan an extremity protocol with arms down at their sides.

If your scanner has the option, it is recommended that you turn on MARS for the metal extremity protocols.

Neuroradiology (Neuro) Protocols

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To make it easier to understand the reformat needs of the Neuro protocols, tables for CTA head and neck
reformats have been added throughout the Neuro Protocols.
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The injection rate was changed to 4 cc/sec for the CTA head/neck protocols.
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The Brain (Axial Mode) protocol was changed from 20 mm to 10 mm beam collimation. This was done to
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lessen the slab­to­slab artifact that sometimes occurs when doing angled axials scanning.
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Pediatric axial heads were changed to be scanned at 5mm slice thickness.

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Sagittal reformats were added for all routine head without scans throughout the Neuro Protocols.

The ASiR percentage on the Neuro protocols was changed to 60% on 5mm and 80% on 1.25mm soft tissue
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reconstructions. This change affects the majority of the Neuro non­spine and non­angio protocols.

If your scanner has the option, it is recommended that you turn on smart MARS for any Spine with metal,
CTA Head, CTA head/neck, routine neck, and maxiface protocols. This will help with artifacts from
coils/clips/stents etc.

The Adult Routine Neck protocol was changed to scan top down, and the injection timing and contrast
amount were changed from 110 mls to 100 mls.

The Cervical, Thoracic, and Lumbar Spine protocols were changed from standard to soft recon for the soft
tissue reconstructions.

The University of Wisconsin Madison uses RAPID (iSchemaView Inc, Redwood City, CA) software for
perfusion map processing and we reference this in our protocol’s networking section.

The CTA stroke deluxe CTA upper thorax/neck/head CTA phase was changed from 20 to 40mm beam
collimation to speed up the scan and avoid venous contamination.

We added instructions to the neck protocol to use the small version (lower dose) on any sized patient that is
being scanned as a follow up for lymphoma.

Revolution Discovery CT / Discovery CT750 HD 4 Rev: 3.0 / December 2017

The slice thickness on the pediatric temporal bone protocol was changed to be the same as the adult.

The pediatric stereotactic head was changes from a 1 second to a 0.5 second rotation.

Pediatric Protocols
MSK guidance for pediatric scanning (i.e., how to change the protocol to lower the dose) was created based
on the adult MSK protocols and is included in the Protocol Resources section of the Manual. In addition,
guidance for scanning pediatric bony pelvis and bony pelvis with spica cast was also created and can also be
found in that section.

The indications in the Pediatric Chest With and Without IV Contrast protocols were updated, and the two
protocols were combined to match the Adult Chest protocol.

The expiration phase hi­res chest without was updated to match the adult routine chest protocol.

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Guidance and criteria for pediatric contrast administration was added to the Manual in the Protocol

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Resources Section, including IV access, needle, gauge, flow rate, etc.
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The Pediatric Trauma Head and the Pediatric Routine Head were combined. Detailed instructions for the
special reformats needed for trauma cases (3D NAT) have been provided in the Brain ­ Routine and Pediatric
NAT/Trauma (Helical Mode) Protocol.
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Revolution Discovery CT / Discovery CT750 HD 5 Rev: 3.0 / December 2017

Scanner Compatibility Revolution Discovery
HD750
Introduction:
Listed below are the minimum scanner options required to use this set of protocols on your Revolution™
Discovery™ CT or Discovery™ CT750 HD scanners. The protocols in this document have been validated on a
scanner compatible with the requirements listed below. The portability of UW protocols to scanners with
different specifications may be possible with the proper assistance from your institution’s CT protocol
optimization team, but should no longer be considered validated UW protocols.

As with any protocol “restore” operation, the existing “user” protocols will be deleted when these UW
protocols are loaded onto your scanner. We therefore recommend you save and export a copy of your
existing protocols to a CD prior to loading the UW protocols. The exported file can be used as a reference to

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aid in manually adding a single protocol to the UW protocol set under your “user” tab.

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Protocols can be exported to CD from the Tool Chest or from Dose Check. The CD can then be viewed on a PC
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and converted to Excel format.

IMPORTANT—The following two rules should always be followed when restoring protocols: 1)
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protocols must only be transferred between scanners of the same model, and 2) protocols must only
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be transferred from another scanner with a software version that is older or equal in revision
number, but not newer.
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These protocols were built using software version number 11MW44.11.V40_PS_HD64_G_GTL. You should
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contact your service engineer to receive a software upgrade if your current software version is older than
this.
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Scanner Compatibility List:

ASiR with 64 slices acquisition at 0.625 mm

Cardiac Options: SmartScore Pro, CardIQ SnapShot, CardIQ SnapShot­Cine

Tube rotation times (helical mode, non­cardiac): 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 1.0 second

mA limits/kV for large focal spot (except pediatric body and pediatric head): 715 mA at 140 kV, 835 mA at
120 kV, 800 mA at 100 kV, and 700 mA at 80 kV

mA limits/kV for small focal spot: 490 mA at 140 kV, 570 mA at 120 kV, 680 mA at 100 kV, and 620 mA at 80
kV

mA limits/kV for pediatric head and pediatric body: 210 mA at 140 kV, 250 mA at 120 kV, 300 mA at 100 kV,
and 375 mA at 80 kV

Revolution Discovery CT / Discovery CT750 HD 6 Rev: 3.0 / December 2017

Direct Multi­Planar Reformat (DMPR) Protocols
Introduction:

A Direct Multi­Planar Reformat (DMPR) is a process set up and is executed as part of the scan protocol. It can
use the same protocol that might be used in a General Reformat. In DMPR, the user defines the reformat
protocols to be executed and sets as an Automated Batch mode or a Manual Batch mode. It is then executed
on the ExamRx desktop.

Reformat is available on the Image Works Desktop and requires manual loading of the data once the scan is
completed.

DMPR Protocols:

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A reformat protocol must be created to be selected for use in protocols with DMPR enabled. For DMPR to
work with the UW protocols, reformat protocols will need to be built with the same names as those used in
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the protocols. To build reformat protocols, you need to select images from an exam already performed to
create the initial same­name reformat protocol. Reformat protocols created for use in DMPR must be single­
step protocols and can only be created in the axial, sagittal, or coronal viewports. Reformat protocols for use
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in DMPR need to be saved in the General category if using Volume Viewer. You must create the DMPR
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reformat protocol on images from the body part that the protocol will be used for (i.e., a Pediatric DMPR
protocol must be created on images for a Pediatric case and an Adult DMPR protocol must be created on
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images for an adult case).

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UW­specific DMPR reformat protocol names are identified below with window width and level values for
use with UW Protocols:
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CHEST ­ WW/WL 450/50

BODY ­ WW/WL 450/50
(created off of a C/A/P study) CHEST ­ WW/WL 1500/­700 off bone+ images
CO BODY
SA MIPS
SA BODY
CO
PEDS BODY ­ WW/WL 550/100 PEDS CHEST ­ WW/WL 550/100 PEDS CHEST ­ WW/WL 2100/­450
CO PEDS SA PEDS CHEST PEDS CO CHEST
SA PEDS CO PEDS CHEST PEDS SA CHEST

All slice thickness and intervals can be found in the actual protocols.

How to Create a Reformat Protocol for Use in a DMPR Session:

1. Load thin slices (make your reformat 0.625/1.25) into Reformat selected on the Image Works desktop.
2. Select Batch Reformat.
3. Set the slice thickness, interval, FOV and mode to the values for the protocol it will be used with.
4. Define the overage (number of images) for the reformat protocol according to the anatomical area for
the protocol.
5. At the bottom of the Batch screen, click ADVANCED.
6. Click SAVE AS PROTOCOL.
7. Enter the Protocol Name* and click SAVE.

Revolution Discovery CT / Discovery CT750 HD 7 Rev: 3.0 / December 2017

*The exact name listed above must be used in the naming of the protocol so DMPR will use the appropriate
reformat protocol, which has been predefined in each of the protocols that use DMPR. Once you create these
reformat protocols, you will not need to do it again.

Should you decide not to use these suggested reformat protocol names, slice thicknesses, or intervals, you
will need to create your own reformat protocols and modify all protocols using DMPR with your selections;
otherwise, DMPR will fail to output reformatted series.

Refer to the User Manual for detailed instructions for creating Batch Reformat Protocols.

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Revolution Discovery CT / Discovery CT750 HD 8 Rev: 3.0 / December 2017

Introduction Document
University of Wisconsin ­ Madison CT Protocols
Introduction:

We are pleased to provide you with the University of Wisconsin­Madison Computed Tomography (CT)
Protocols as part of your GE CT scanner purchase. We hope you take the time to learn and understand our
protocol philosophy. For some of you it will be a significant change from your current practice.

Today's imaging literature and bulletins from imaging associations are full of directives to decrease patient
dose. Unfortunately we are not given much detail, and the burden of executing these changes falls on our
shoulders. For many of us, it has been a long time since our physics training and few of us have really kept

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up on our physics skills. Most of us hire a physics consultant, and they come in and help us get our protocols

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to qualify for ACR accreditation and ensure the X­ray equipment is properly calibrated, but not much more.
With the unique relationship between medical physics and radiology at the University of Wisconsin­
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Madison, we combined our expertise and developed a very robust set of CT protocols. The technical
parameters have been fine­tuned specifically for this scanner and then validated using a rigorous
management system based on the ISO 9001 standard.
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With the help of our physicists, we juggled all technical parameters that could be modified on this scanner
with careful attention to not only how each individual parameter affects image quality, but the interplay of
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parameters. This was a complicated task aided by specially­written software that allowed us to model the
effects on dose and quality.
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We anticipate that most of you will find that these protocols generate acceptable image quality. A few of you
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may be more evolved and may be tolerant of slightly noisier images. It is likely that some of you will find
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these images noisy and possibly difficult to work with initially. We would like to discourage you from
modifying our protocol settings. By changing one or more parameters, you defeat the purpose of balancing
the effects of all parameters on image quality and dose. Please give your eye some time to accommodate
before you make changes.

If you find that you would like to change some of the acquisition or reconstruction parameters in our
protocol documents, please realize some modifications may drastically change the image dose and noise
level. All changes should be reviewed by your medical physicist, GE application specialists, and/or your
institution’s CT protocol optimization and quality control team. In many cases, CT acquisition parameters
are linked to reconstruction parameters in our protocols.

For example, halving the slice thickness for the first reconstruction, while keeping the same noise index, will
increase the dose by a factor of two! There is interplay between the automatic exposure control setting and
the slice thickness that needs to be understood in order to make proper protocol changes. In addition, we
have done our best to ensure that the mA does not “max out” for large patient sizes (or for low noise studies
which require extra dose) by monitoring the effective mAs used at our institution over a wide range of
patient sizes. To maintain diagnostic image quality at the lowest doses, the kV, noise index, pitch, and tube
rotation times all change for different protocols and different patient sizes within each protocol.

Revolution Discovery CT / Discovery CT750 HD 9 Rev: 3.0 / December 2017

Other seemingly trivial changes like switching from a pitch of 0.516 to 0.969, changing from the “plus” to
“full” recon option, or changing from “boneplus” to “bone” reconstruction types may also have significant
negative impacts on image quality and patient dose due to special characteristics of these parameters in
addition to those that are most obvious to the user. Changes of any individual protocol parameter must be
performed while taking into account all of the parameters making up a single protocol. Therefore, we urge
you to only make protocol changes after discussing them with your institution’s CT protocol optimization
team or seeking expert advice from GE application specialists.

We recognize these protocols are not complete. There are some deficiencies. We hope to correct them with
future releases. We encourage your feedback. We will be reaching out to radiologists, physicists, and
technologists for feedback. Hopefully, with your input, we can create an industry­wide standard for CT
protocols. These protocols will be reviewed on an annual basis, which should satisfy the ACR requirement.

Networking:
We have provided guidance in the "Networking" section of each protocol on what images to send to PACS. In

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some cases, all images should be sent to PACS. In many cases, however, thin reconstructions are not

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required to be sent to PACS. Thin reconstructions are primarily used for creating reformatted volumes.
"ALI_Store" is the name we use to refer to sending images to PACS. "ALI_Source" is where we send thin
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images that are not routinely read by the radiologists. For studies requiring 3D lab work, we instruct you to
send the images to "CTAW1", which refers to a GE Advantage Workstation. Note: if you send all thin images
to PACS, this may slow down your network transfer times and the time needed for a reviewing radiologist to
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open the study. This is why our protocols have a networking section for each protocol that gives guidance on
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when thin images are needed for radiologist review.

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Networking for "Series Auto Transfer":

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Some reconstructions in our protocol set have "Series Auto Transfer" turned on. They refer to networking
names as listed above. If you want to avoid having to re­map your networking locations for every protocol,
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you can make a single change to your scanner's host table. You need to change the host table name of your
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PACS to "ALI_Store" and of your 3D lab (if used) to "CTAW1". We do not auto transfer the thin series. If you
wish to auto transfer them, you can send them to your regular PACS.

AutoVoice and Breathing Lights Selection:

Like the protocols, if you download AutoVoice to your scanner from a UW disc, you will loose any pre­
recorded AutoVoice options. The only custom non GE default AutoVoice recordings include: English cardiac
coronaries (retro and prospective). All other UW protocol references to an AutoVoice option are to default
GE recordings.

Body:
We are aware that many facilities routinely scan patients with three sequences—1) without intravenous
(IV) contrast, 2) with IV contrast, and 3) delayed. Although such robust scanning may add a little bit of
information, it is rarely worth the additional dose. If most of your cases can be pre­protocoled to address
specific clinical concerns, we believe these protocols will provide a diagnostic study with an appropriate
number of series and at an appropriate dose.

Revolution Discovery CT / Discovery CT750 HD 10 Rev: 3.0 / December 2017

We prefer to maintain a policy of giving patients positive oral contrast for many applications. We believe it
adds diagnostic value. Although many centers are now performing studies without oral contrast to save
time, we stand by our position that the small amount of extra time required to opacify the gut and a small
inconvenience to the patient is well worth the increase in diagnostic accuracy.

For most patients, when time is not an issue, we administer iodinated contrast in water. For patients in
whom time is critical, we add dilute polyethylene glycol to help distend the lumen and accelerate transit.
With a one­hour drink, the vast majority of our Emergency Department patients have contrast in the cecum.
This facilitates the diagnosis of appendicitis.

We prefer iodinated contrast to barium suspension. In the patient with a moderate to severe bowel
obstruction, the barium eventually will flocculate and precipitate, causing a very dense artifact if further
imaging is necessary.

Chest:

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For Chest CT’s, we refrain from using IV contrast material for most indications. IV contrast adds little or no

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value to diagnosis and follow­up of most lung diseases. In some cases, the image quality of the lungs can be
hampered by streak artifact from undiluted contrast in the SVC and other mediastinal veins. Furthermore,
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subtle artifacts can occur in the lungs around contrast­filled, smaller vessels, especially with thin section
(high­resolution) technique and lower dose imaging. Thoracic indications requiring IV contrast include
acute and chronic pulmonary thromboembolism, thoracic trauma, and acute aortic pathology. IV contrast
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can be helpful for known mediastinal masses or for lung neoplasms that involve the mediastinum. Nodules,
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infections, aortic aneurysms, pleural disease, and lymphadenopathy can usually be imaged without IV
contrast.
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Cardiovascular:
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Generally, approaches to body CTA fall into two camps: 1) attempt to scan the volume along with the
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passage of the contrast bolus, and 2) opacify the vasculature throughout the imaged volume and then scan
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as fast as possible to capture a "snapshot" of the vasculature in this pseudo­steady state. The tremendous
variation in bolus transit times across patients and the technical difficulty of both assessing this transit time
and appropriately adjusting the scan parameters (rotation speed and pitch) make the former approach
difficult for CT technologists to perform consistently without direct physician supervision. We have
therefore adopted the latter approach.

Most of our body CTA protocols involve the use of SmartPrep rather than a timing bolus to trigger the
acquisition, with a diagnostic delay and overall contrast bolus intended to give consistent opacification
throughout the imaged volume during the scan. This approach is very easy for technologists to perform in a
reliable fashion without direct physician monitoring.

Revolution Discovery CT / Discovery CT750 HD 11 Rev: 3.0 / December 2017

Musculoskeletal:
CT is an excellent way to visualize bones and joints, especially when reformatted in multiple planes relative
to osseous or articular landmarks. However, the role of CT for visualizing the non­radiopaque tissues around
bones and within joints is extremely limited, and for the most part has been supplanted by Magnetic
Resonance Imaging (MRI) and/or Ultrasonography. To emphasize this, we refer to our applications as “Bone
CT” rather than “Musculoskeletal CT”, since we do not use CT to image muscles.

Appropriate applications of Bone CT can be divided into two distinct patient populations:

1. those presenting with severe acute trauma to the Emergency Department (ED), and
2. those presenting to primary care or urgent care clinics.

With regards to musculoskeletal imaging, outside of the ED, CT should never be the first study ordered.
Conventional radiographs (commonly referred to as “x­rays”) continue to be the primary modality used to
visualize the bones and joints of the extremities and spine. Indeed, the use of CT is so limited in the

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evaluation of non­acute traumatic bone or joint pain that we suggest this modality not be ordered by

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primary care providers without first consulting with their radiologists. Certainly there are some specific
indications for which scheduled outpatient CT is appropriate, but in general this is requested by specialty
care providers.
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In the ED, CT is the primary imaging modality when there is a concern for a spine fracture, especially in the
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cervical spine. (CT has been shown to be much more sensitive than radiographs for the detection of
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fractures in the cervical spine.) For other bones and joints, radiographs should be obtained whenever
fractures or dislocations are suspected. With certain acute fractures, CT is an essential secondary imaging
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modality. For example, whenever an acute fracture is detected in the bony pelvis, CT is almost invariably
obtained soon after to more fully evaluate the extent of pelvic ring disruption. In addition, orthopedic
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surgeons will often request CT for intra­articular fractures, particularly of the knee, to aid in surgical
planning.
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Bones and joints are complex 3­dimensional structures and their relationships are best demonstrated with
2­dimensional cross­sectional imaging reformatted in multiple planes. We have developed joint­specific
reformatting protocols designed to address specific clinical needs.

Visualizing bony structures adjacent to orthopedic hardware with CT can be challenging, although metallic
artifacts can be reduced by with use of 140 kV.

There are few, if any, indications for administering IV contrast for Bone CT. If there is a clinical concern for
infection, an MR should be performed. If the patient is not MR compatible, the clinical service should have a
discussion with their radiologist about the best way to answer the clinical questions.

The few indications for administering IV contrast for bone CTs, are as follows:

1. If there is a clinical concern for infection, an MR should be performed.

◾ In cases where the clinical concern is specifically to look for soft tissue gas rather than for soft
tissue abscess or osteomyelitis (e.g., necrotizing fasciitis), then CT would be the imaging
modality of choice; although IV contrast would not be necessary for gas.
2. If the patient is not MR compatible, the protocoling radiologist should have a discussion with the
clinical service about the best way to answer the clinical questions.
3. If it is agreed that CT is indeed the imaging modality of choice, the study can be performed without IV
contrast.
Revolution Discovery CT / Discovery CT750 HD 12 Rev: 3.0 / December 2017
 4. In light of the above policy, it is appropriate for the CT technologist to confirm with the protocoling
radiologist that they do indeed want to administer IV contrast.
5. Where IV contrast is deemed appropriate for a bone CT, the standard dosing guidelines should be
followed:
◾ Agent: Omnipaque 300
1. If patient has an allergy to iodinate contrast, or has renal function issues, then no IV
contrast should be administered.
◾ Dose: Per body weight (up to 100ml)
◾ Rate: As appropriate for IV access (up to 3ml/sec)
◾ Delay: 90sec

Neuroradiology:
Dose reduction is an important facet to imaging that not only radiologists, but clinicians as well, need to
keep in mind when protocoling or ordering studies. Certainly, the lowest dose study is the unnecessary one
that is not performed. With that being said, given the complex and subtle anatomy present on

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neuroradiologic examinations, dose reduction is not as readily possible to the same degree as other regions

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of the body. Decreasing dose to the point that the study is minimally or non­diagnostic should be considered
as overdosing, as the radiation delivered was essentially of no use. We have reduced the dose on our
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protocols as much as we feel is appropriate, while maintaining sufficient diagnostic quality.

We prefer to image the orbits on our head CTs because the orbit is an extension of the brain, and pathology,
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including the result of trauma, often occult, occurs there. Also, because of radiation overscan inherent in
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exam acquisition, the orbits receive radiation even on orbit sparing protocols. If your facility feels strongly
about avoiding the orbits in scanning, we have included an orbit sparing protocol. Ultimately, it is each
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individual institution’s and individual radiologist’s decision.

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Perfusion imaging is another area of some concern regarding radiation exposure. It has become important in
stroke imaging and tumor imaging to help guide treatment, as well as help assess treatment response. Our
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protocols result in a dose that is less than FDA guidelines suggest, 0.5 Gy. Rather than the typical coverage of
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approximately 3­4 cm, the GE scanner with shuttle mode doubles that amount with near whole brain
coverage. We are continuing to strive for even lower dose perfusion exams.

Pediatrics:
Ordering clinicians and radiologists should always consider whether or not alternative imaging modalities
such as ultrasound or MR could answer the clinical question as radiation exposure would be avoided. When
using CT to image children, the goal is to get diagnostic images at the lowest radiation dose possible. The
scan should be confined to the region of interest so as to expose as little of the patient’s body as possible.
Due to their smaller size and the low radiation dose, positioning is of great importance in order to obtain
adequate images for diagnosis.

Our standard pediatric CT protocols are indeed very low dose. Many of you may find these images difficult to
interpret. For you, we have included a set of protocols with only moderate dose reduction to help you
accommodate. We hope you will eventually transition to the lower­dose protocols.

Revolution Discovery CT / Discovery CT750 HD 13 Rev: 3.0 / December 2017

Design Philosophy ­ Abdominal
Protocol No. on
GE Protocol Protocol Type Design Philosophy
Scanner
This is standard abdomen pelvis protocol. It is the default protocol for
Abd/Pelvis Abdominal 6.1/6.2/6.3 the vast majority of studies. This one is useful when a general screening
protocol is needed.
This protocol is intended for the evaluation of hernias. It asks the patient
Abd/Pelvis ­ R/O (Use routine
Abdominal to perform a Valsalva maneuver during the scan to enhance the
Hernia abd/pelvis protocol)
prominence of any hernia.
Higher image quality version of the routine abdomen pelvis protocol.
This protocol is to be used for cancer follow­up on patients with
High Image Quality pathology known to be of a subtle nature. The order should specifically
Cancer Follow­Up Abdominal 6.7/6.8/6.9 ask for this version of the abdomen pelvis routine protocol at the time of
Abd/Pelvis placing the order. Typically, a determination would be made based on
age and disease process (usually dependent on whether they could have
metastatic disease to the liver).
This protocol is primarily targeted for the first­time evaluation of
obstructing renal calculus. It is a non­contrast study; therefore, not
Abd/Pelvis ­ Flank
Abdominal 6.10/6.11/6.12 optimal for imaging other causes of abdominal pain. However, it may
Pain
suffice in situations where the disease processes are not subtle. We
discourage it for appendicitis.

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This protocol is used to assess for both the position and for the presence

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Abd/Pelvis ­ Pre­IVC of clot in an IVC filter prior to removal. IV contrast is used and images are
Abdominal 6.73/6.74/6.75
Filter Removal obtained 180 seconds after contrast injection to optimize opacification of
01 ma ele the inferior vena cava and iliac veins.
This protocol is intended for follow­up of patients with known kidney
Low Dose Renal Stone stones; those status post lithotripsy; or those presenting to the
(including limited Abdominal 6.13/6.14/6.15 emergency department with typical flank pain and are known to have
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follow­up) kidney stones. Image resolution is satisfactory for identifying calculi, but
not optimal for other pathology.
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This protocol is used to screen the colon for polyps or colonic mass
disease. Patients undergo bowel preparation prior to the scan, and are
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then scanned in the supine and prone positions following colonic CO2
insufflation via rectal balloon­tipped catheter. The supine­prone
positioning is meant to displace any retained fluid and fully expose all
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Abd/Pelvis ­ parts of the colon between the two views. A right lateral decubitus view
Abdominal 6.16/6.17/6.18
Colonography can be added if distention is suboptimal in a colonic segment. The study
is performed without IV contrast and at low dose as it is used in
screening asymptomatic patients in most cases. If a patient has a known
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colon cancer and the referrer desires screening of the colon combined
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with assessment for metastatic disease, IV contrast can be administered

on the supine view.
This protocol is most commonly applied to patients with neoplasm that
Chest/Abd/Pelvis with
Abdominal 5.4/5.5/5.6 may affect the entire torso, but is not expected to affect the head and
IV Contrast
neck.
This scan is usually performed for the evaluation of tumor or other
Chest/Abd/Pelvis
Abdominal 5.7/5.8/5.9 conditions that may affect the entire torso in patients who cannot get IV
without IV Contrast
contrast due to allergy or renal failure.
Abd/Pelvis ­ This protocol is optimized for viewing the kidneys and the renal
Abdominal 6.22/6.23/6.24
Urography collecting system. The most common indication is hematuria.

Revolution Discovery CT / Discovery CT750 HD 14 Rev: 3.0 / December 2017

 This protocol will be for patients with known urothelial cancer (bladder
or ureters) and NO current evidence of or suspected metastatic disease.
Urothelial tumor Also, some of these patients will not have a bladder (so no need for those
Abdominal 6.70/6.71/6.72 to void as they will have a urostomy)
follow­up
If they have metastatic disease, routine CT A/P will suffice.

This protocol is optimized to evaluate cirrhotic patients and suspected

Abd­Liver ­ Biphasic Abdominal 6.25/6.26/6.27 liver tumors. It is also applied for the evaluation of hypervascular
metastatic disease to the liver.
This protocol is optimized for the work­up of a potential liver transplant
recipient. It has a high resolution arterial phase for precise hepatic
arterial anatomy; a late arterial phase for the detection of tumor; and a
Abd­Liver ­ Triphasic Abdominal 6.28/6.29/6.30
portal/ parenchymal phase for the demonstration of varices and other
possible pathology. Finally, a three­minute delayed phase is performed to
satisfy the UNOS requirement for HCC detection.
Abd­Liver ­ This protocol, which is used to rule out HCC, is similar to the biphasic
Hepatocellular Abdominal 6.82/6.83/6.84 liver protocol, except it includes an additional delayed phase as
Carcinoma (HCC) mandated by UNOS.
This protocol is optimized for the characterization of adrenal
Abd­Adrenal Gland ­
Abdominal 6.31/6.32/6.33 enlargement specifically for a suspect adenoma. It would not be protocol
Adenoma
of choice to rule out pheocromocytoma.

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This scan is used in patients where there is suspicion of pancreas mass.

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The first phase is scanned in the late arterial phase. Since pancreatic
adenocarcinoma is hypovascular, it is best detected at 40 seconds post
contrast when the normal glandular tissue enhances optimally and the
Abd­Pancreas ­
Pancreas Cancer Abdominal
01 ma ele6.40/6.41/6.42
hypovascular tumor does not (optimizes contrast between the lesion and
the background pancreas). The second phase is portal venous, to evaluate
(Neoplasm Screening) the solid organs, particularly the liver, for metastatic disease and for
routine evaluation of the abdomen and pelvis.
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Also for preoperative evaluation of known pancreatic neoplasm. It is
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optimized to detect vascular compromise.

Abd/Pelvis ­ Kidney This protocol is optimized to evaluate patients with suspicion or

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Abdominal 6.49/6.50/6.51
Tumor evaluation of small renal neoplasm.
This protocol is optimized to evaluate the potential renal transplant
CTA Abd ­ Renal Donor Abdominal 6.52/6.53/6.54
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donor.
Abd­Small Bowel ­ This protocol is optimized for the evaluation of the small bowel. It is
Abdominal 6.55/6.56/6.57
Enterography specifically designed for inflammatory bowel disease.
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CTA Abd ­ Obscure GI This protocol is optimized to evaluate the source of obscure
Abdominal 6.58/6.59/6.60
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Bleed gastrointestinal bleeding.

CTA Abd ­ Mesenteric
Abdominal 6.61/6.62/6.63 This protocol is optimized to evaluate for mesenteric ischemia.
Ischemia
This protocol is optimized for the emergency evaluation for aortic injury,
as well as any other sequel of trauma. This is tailored for rapid
Trauma ­ Chest Abdominal 5.22/5.23/5.24
deceleration injury. Note: Routine creatinine cut­off for IV contrast
administration does not apply in a trauma.
Emergency evaluation for aortic injury and/or organ disruption. Note:
Trauma ­
Abdominal 5.25/5.26/5.27 Routine creatinine cut­off for IV contrast administration does not apply in
Chest/Abd/Pelvis
a trauma.
Emergency evaluation for traumatic organ disruption. This is usually
reserved for a direct blow to the abdomen or low velocity MVA. Note:
Trauma ­ Abd/Pelvis Abdominal 6.4/6.5/6.6
Routine creatinine cut­off for IV contrast administration does not apply in
a trauma.
In the trauma setting, to evaluate bladder for trauma­induced leak.
(Typically performed when the standard trauma scan is inconclusive for
a bladder leak.)
Cystogram Abdominal 8.10/8.11/8.12
In the non­trauma setting, specifically for the evaluation of bladder tumor
and to evaluate for non traumatic or post operative bladder leak.

This is a standard or routine examination of the pelvis meant to assess for

Body Pelvis Abdominal 8.16/8.17/8.18
pelvic pathologies that are not hypervascular.

Revolution Discovery CT / Discovery CT750 HD 15 Rev: 3.0 / December 2017

Design Philosophy ­ Chest
Protocol No. on
GE Protocol Protocol Type Design Philosophy
Scanner
This protocol is designed to address nearly all indications for chest CT while
maintaining very low radiation exposure levels. It includes detailed
Chest ­ Standard information on the lungs, airways, and soft tissues. High­resolution images
(Routine & High­ Chest 5.1/5.2/5.3 for evaluating the lungs are a central part of this protocol, avoiding the need
Resolution) to rescan patients who have diffuse lung disease. Although intravenous
contrast material can be administered at the discretion of the protocolling
radiologist, for the vast majority of indications, contrast is not needed.
This protocol was designed for follow­up of nodules, pleural effusions, and
Chest ­ Low Dose other abnormalities using significantly lower dose than the standard CT. For
Chest 5.10/5.11/5.12
Follow­up nearly all patients, the effective dose will be below 3 mSv, typically in the 1 ­
2 mSv range.
This protocol is designed to be used exclusively for lung cancer screening. It
Chest ­ Low Dose
Chest 5.13/5.14/5.15 meets the technical standards put forth by the American College of
Screening
Radiology and the Centers for Medicare and Medicaid Services (CMS).
This protocol is nearly identical to the routine chest CT protocol, and
reconstructed axial images are identical. Multiplanar MIPs are included to
Chest ­ CTA for PE Chest 5.16/5.17/5.18 meet CPT code requirements. The contrast injection protocol is designed to
limit the number of bolus failures and maximize opacification of the

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pulmonary vasculature.

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This protocol is designed to evaluate the central airways, particularly to
assess for tracheobronchomalacia or excessive dynamic airway collapse. In
01 ma ele addition to standard high­resolution images of the lungs, the forced
expiratory images accentuate collapsibility of the trachea and central
bronchi. This protocol includes additional reformations including minimum
intensity projections (MinIPs) and optional 3­D virtual bronchoscopic
Chest ­ Dynamic 3D
Chest 5.70/5.71/5.72 images, which referring providers might find informative. For patients who
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Airway
have a recent volumetric thin­section CT of the chest, the expiratory
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sequence of this protocol performed alone may be sufficient, minimizing

additional radiation exposure. Because the breathing technique is different
than traditional end­expiratory chest CT, proper training of technologists
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and coaching of patients with close radiologist oversight will maximize the
utility of this protocol.
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Revolution Discovery CT / Discovery CT750 HD 16 Rev: 3.0 / December 2017

Design Philosophy ­ Cardiovascular
Protocol No. on
GE Protocol Protocol Type Design Philosophy
Scanner
Non­Gated CTA Evaluate for known or suspected type “B” (descending) aortic dissection,
CV 5.28/5.29/5.30
(Chest/Abd/Pelvis) intramural hematoma (IMH), aneurysm, leak, tear, or vasculitis.
Used to evaluate the heart and great vessels (aorta and pulmonary
Retrospectively­Gated arteries) in patients with higher rates or in patients in which cardiac
CV 5.31/5.32/5.33
CTA Chest function is also being assessed. This is frequently used in patients with
congenital heart disease that have contra­indication for MRI.
Used to evaluate patients with ascending aorta aneurysm in addition
Gated Chest and Non­ thoracoabdominal aortic aneurysms. Retrospective gating is used to
CV 5.34/5.35/5.36
Gated Abd/Pelvis CTA minimize the delay between the gated chest and the non­gated abdomen
and pelvis sections.
Prospectively­Gated Used to evaluate the coronary arteries in patients with appropriate heart
CV 5.37/5.38/5.39
Coronary CTA rates.
Retrospectively­Gated Used to evaluate the coronary arteries in patients with higher rates or in
CV 5.40/5.41/5.42
Coronary CTA patients in which cardiac function is also being assessed.
Evaluation of patients being considered for trans­catheter aortic valve
replacement (TAVR). This includes a retrospectively­gated CTA of the
TAVI CTA CV 5.43/5.44/5.45 heart to evaluate the aortic root for implantation of the valve and a non­

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gated CTA chest abdomen and pelvis to evaluate the aorta and iliofemoral

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arteries to assess access.
Evaluate for ascending aortic aneurysm, dissection, or injury. Evaluate
Prospectively­Gated 01 ma ele cardiac or vascular abnormality without cardiac motion. (Note: A
CTA Chest (Non­ CV 5.46/5.47/5.48 prospectively­gated chest CTA cannot be combined with a non­gated CTA
Coronary) abdomen/pelvis. If gated chest is need along with CTA abdomen/pelvis,
use retrospective gating.)
r
To evaluate upper extremity ischemia. The scan includes vascular
Upper Extremity CTA CV 5.49/5.50/5.51
imaging from the aortic arch to the finger tips.
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For iliac occlusive disease, peripheral vascular disease, and patients with
Lower Extremity CTA CV 5.52/5.53/5.54
a “cold foot”.
1/ ev ub

Post­Endostent Non­ Measure abdominal aortic aneurysm volume after endovascular repair. If
Con Volume Change CV 5.58/5.59/5.60 the volume is stable or has decreased since the prior examination, no
(Abd/Pelvis only) hemodynamically­significant endoleak is present.
pr r p

Evaluation for left atrial thrombus, pre­op for device (Watchman (TM))
Prospectively­Gated
CV 5.73/5.74/5.75 implant. Includes two scan phases, a CTA on expiration and a 1 minute
Left Atrial Appendage
delay. Both phases are prospectively gated.
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Revolution Discovery CT / Discovery CT750 HD 17 Rev: 3.0 / December 2017

Design Philosophy ­ Musculoskeletal
Protocol No. on
GE Protocol Protocol Type Design Philosophy
Scanner
Bony This protocol is designed to examine the cortex of the pelvic ring and
Pelvis/Hips/SI/Femur/FAI acetabuli. Scans of the Bony Pelvis are most often obtained in the
8.1/8.2/8.3 and
(Without Metal) and Bony MSK setting of acute trauma, or in the evaluation of fracture, SI joints, and
8.4/8.5/8.6
Pelvis/Hips/SI/Femur/FAI prosthesis. Orthopedic surgeons may request post­operative scans to
(With Metal) assess healing, hardware, or osteolysis.
The primary indication for a knee CT is to assess the alignment and
Knee/Tibia (Without degree of displacement of fracture fragments, particularly at the
Metal) and Knee/Tibia MSK 9.3 and 9.4 articular surfaces. These can also be used to assess the integrity of the
(With Metal) bone around prosthesis. On rare occasions, a CT will be done
immediately after an arthrogram of the knee.
Ankle/Foot/Distal Tibia
There is one single scanning protocol for all ankles and feet, which is
(Without Metal) and
MSK 9.1 and 9.2 typically used to evaluate for trauma. In most cases it is desirable to
Ankle/Foot/Distal Tibia
scan both ankles/feet at the same time.
(With Metal)
This protocol is a non­contrast CT through bilateral hips, knees, and
Femoral Anteversion MSK 9.8/9.9/9.10 ankles (excluding the femur, tibia, and fibula shafts) to allow for
measurement of the version angles of the femora and, if desired, tibiae.

al e
A routine shoulder CT (non­arthogram) is used to evaluate for
fractures of the scapula and/or proximal humerus, dislocation,

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Shoulder/Humerus (With shoulder prosthesis, or masses/infection in a patient who is not MR
MSK 4.1/4.2/4.3
or Without Metal) compatible. The primary indication for a shoulder arthrogram CT is to
01 ma ele evaluate the rotator cuff and labrum in a patient who is not MR
compatible.
Elbow/Forearm (Without This primary indication is to evaluate for fracture, dislocation, or
Metal) and osteochrondritis. The elbow is the most difficult joint to scan as it is
MSK 4.6 and 4.7
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Elbow/Forearm (With usually difficult to optimally position the elbow, particularly when it is
Metal) in a cast.
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This scan is used to evaluate for wrist fracture, and similar to the
Wrist (Without Metal) and
MSK 4.8 and 4.9 elbow, it is important to position the arm over the head, with the arm
Wrist (With Metal)
1/ ev ub

as straight as possible.
This protocol is used for detection or characterization of mass or
Soft Tissue Extremity with
MSK 9.13/9.14/9.15 infection. Bony detail is not important for these scans which use a dose
IV Contrast
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level similar to an extremity CTA.

Detection or characterization of fractures, evaluation of treated
Chest Wall/Clavicle/AC fractures to evaluate the progress of osseous healing or adequacy of
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Joint/SC MSK 4.11/4.12/4.13 fracture fixation. Also for the evaluation of arthritis, mineralized bone
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Joint/Sternum/Ribs and soft tissue lesions, and to evaluate osteoarthritis. For infection,
contrast will likely be needed.

Revolution Discovery CT / Discovery CT750 HD 18 Rev: 3.0 / December 2017

Design Philosophy ­ Neuroradiology
Protocol No. on
GE Protocol Protocol Type Design Philosophy
Scanner
Brain ­ Routine and For routine head imaging and emergent imaging including trauma,
Pediatric hemorrhage, hydrocephalus, tumor, and preliminary stroke screening.
Neuro 1.1/11.1/11.2
NAT/Trauma May need to add contrast for more sensitive evaluation of tumor or
(Helical Mode) infection.
Use this protocol when the head cannot be properly positioned for a
routine helical head scan. Example: when you cannot move the patient’s
Brain ­ Helical Scan
head into proper position (trauma, cervical collar, rigid neck). For routine
with Angled Axial Neuro 1.2/11.3/11.4
head imaging and emergent imaging including trauma, hemorrhage,
Reformations
hydrocephalus, tumor, and preliminary stroke screening. May need to add
contrast for more sensitive evaluation of tumor or infection.
Helical mode should be used routinely for adult head CT scans. Only use
axial mode when you cannot move the patient’s head into proper position
Brain (Axial Mode) Neuro 1.3/11.5/11.6 (trauma, cervical collar, rigid neck), and do not wish to perform a helical
scan with angled axial reformats. This axial mode can also be used in
unstable patients in the ED when the CT scan time must be expedited.
This is a protocol which delivers thin section images for use in whole brain
Stealth ­ Stereotactic
radiation treatment planning, intraoperative neuronavigation, and
Head (Whole Brain Neuro 1.10/11.11/11.12
cranioplasty planning. Image requirements for the software associated

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Treatment Planning)
with these uses varies, and verification of compatibility is recommended.

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For evaluation of infection, inflammatory, or neoplastic processes may add
contrast as needed to increase sensitivity. May also be used for trauma,
Orbit ­ Routine Neuro 01 ma ele2.1/12.1/12.2 blunt or penetrating, localized to the orbit. Not to evaluate diffuse facial
trauma or infection/inflammatory processes, as this requires a CT
maxillofacial.
Maxillofacial CT done for evaluation of facial trauma, blunt or penetrating,
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facial infections or inflammation, as well as assessment of congenital
Facial Trauma ­
Neuro 2.5/12.9/12.10 abnormalities. Contrast may be added for sensitivity, particularly in
Routine
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infection, as warranted. 3D reconstructions may be performed if requested

by clinical service.
1/ ev ub

For evaluation of routine sinus inflammatory disease, assessment of bone

involvement from infectious, inflammatory, or neoplastic processes, and
Sinuses ­ Diagnostic Neuro 2.7/12.13/12.14 sinonasal neoplasms. May add contrast as needed typically for non­routine
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sinus inflammatory disease. Not for evaluation of facial trauma or orbital

processes.
For evaluation of hearing loss, congenital abnormalities, infection, trauma,
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Temporal Bone and neoplasms. Contrast may be added as needed for infection or
Neuro 2.10/12.18/12.19
(without Contrast) neoplasms. Used in conjunction with MRI to evaluate neoplasms typically
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unless contraindication to MRI.

This protocol adds contrast to the standard CT temporal bone, for use in
Temporal Bone (with cases of inflammation / infection or concern for sigmoid sinus
Contrast Only or with Neuro 2.11/12.20/12.21 compromise. This protocol is also used for cases in which there is a
& without Contrast) concern for a cerebellopontine angle mass causing sensorineural hearing
loss.

Revolution Discovery CT / Discovery CT750 HD 19 Rev: 3.0 / December 2017

 For evaluation of head and neck cancer (pre and post treatment),
Adult Neck ­ Routine Neuro 3.1/3.2/3.3 infection, soft tissue trauma, or inflammatory processes. Not for
evaluation of cervical spine trauma or suspected vascular injury.
This is an age­specific protocol designed to give a diagnostic and
appropriately low dose examination through the neck. This
Pediatric Neck ­ protocol is for evaluation of cervical lymphadenopathy,
Neuro 13.1.1/13.2.1/13.4.1/13.6.1/13.8.1
Routine developmental anomalies (such a branchial cleft cysts), as well
as infectious, and inflammatory conditions within the pediatric
neck.
Indications include hypercalcemia, parathryoid adenoma
(suspected or confirmed), and parathyroid surgical planning. On
early arterial and delayed contrast enhanced images the
Neck (Parathyroid enhancement of parathyroid adenomas can be confused with the
Neuro 3.5/3.6/3.7/13.1.9/13.1.10
Adenoma) Adult intrinsically CT hyperdense thyroid gland. This protocol includes
an additional non contrast phase to enable more confident
detection and discrimination of parathyroid adenomas from the
adjacent thyroid tissue.
Adult Cervical Spine
For evaluation of spine trauma, degenerative disease, infection,
(without Metal) and 3.16/3.17/3.18 and
Neuro and bone tumors. May add contrast as needed. Not for primary
Adult Cervical Spine 3.19/3.20/3.21
evaluation of soft tissues.
(With Metal)
Adult Thoracic Spine

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(without Metal) and For evaluation of trauma, degenerative disease, infection, and
Neuro 7.4/7.5/7.6 and 7.19/7.20/7.21
Adult Thoracic Spine bone tumors. May add contrast as needed.

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(with Metal)
Adult Lumbar Spine
(without Metal) and
Adult Lumbar Spine
Neuro
01 ma ele
7.1/7.2/7.3 and 7.16/7.17/7.18
For evaluation of trauma, degenerative disease, infection, and
bone tumors. May add contrast as needed.
(with Metal)
For evaluation of stroke, vascular trauma, aneurysm, vasospasm,
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Stroke Deluxe – Total
Neuro 1.6/1.13/11.16/11.17 and atherosclerotic disease. Requires administration of IV
Cerebrovascular
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contrast.
CTA Head Only
For evaluation of intracranial stenosis, aneurysm, vascular
(Stenosis, Aneurysm, Neuro 1.7/11.18/11.19
1/ ev ub

malformation, unknown bleed, vasospasm.

Unknown Bleed)
CTA Neck Only Assessment of atherosclerotic disease, trauma with suspected
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(Cerebrovascular Neuro 3.11/11.22/11.23 vascular injury, or vascular neoplasms. Requires administration

Disease) of IV contrast.
This protocol consists of a slightly delayed phase of vascular
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CT Venography Neuro 1.9/11.24/11.25 imaging, for use in cases of suspected venous sinus thrombosis
or occlusion..
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Revolution Discovery CT / Discovery CT750 HD 20 Rev: 3.0 / December 2017

Design Philosophy ­ Pediatrics
GE Protocol Protocol Type Protocol No. on Scanner Design Philosophy
For evaluation of nonspecific abdominal pain, abscesses in
postoperative patients or acutely ill inflammatory bowel
16.1.1/16.2.1/16.4.1/16.6.1/16.8.1 ­­­
Routine disease patients, fever of unknown origin, as well as for
Peds for Higher Image Quality:
Abdomen/Pelvis appendicitis in outpatients. Additionally used for initial
16.1.6/16.2.6/16.4.6/16.6.6/16.8.6
diagnosis and follow­up of abdominal neoplasm when
concurrent chest CT imaging is not indicated.
A low dose protocol for patients in whom the only clinical
16.1.1/16.2.1/16.4.1/16.6.1/16.8.1 ­­­
Acute Appendicitis ­ concern is to rule out appendicitis. This will not image the
Peds for Higher Image Quality:
Abdomen/Pelvis lung bases and will minimally image the inferior aspects of
16.1.6/16.2.6/16.4.6/16.6.6/16.8.6
the solid organs.
This protocol aims to evaluate patients with renal colic or
16.1.2/16.2.2/16.4.2/16.6.2/16.8.2 ­­­
Renal Stone/Flank hematuria in whom renal and bladder ultrasound has been
Peds for Higher Image Quality:
Pain unable to identify a source for the symptoms or on whom
16.1.7/16.2.7/16.4.7/16.6.7/16.8.7
renal and bladder ultrasound cannot be performed.
This protocol should only be ordered by surgeons for liver
16.1.3/16.2.3/16.4.3/16.6.3/16.8.3 ­­­ tumor evaluation prior to surgical resection in order to fully
Triphasic Liver Peds for Higher Image Quality: assess the tumor’s relationship to the hepatic arteries,
16.1.8/16.2.8/16.4.8/16.6.8/16.8.8 portal veins, and hepatic veins. This will also assess for
variant arterial or venous anatomy.

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This protocol is designed to evaluate patients who have

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suffered from blunt or penetrating trauma for possible
internal injuries. Delayed images may be required at the
01 ma ele radiologist’s discretion to evaluate for active bleeding, but
16.1.4/16.2.4/16.4.4/16.6.4/16.8.4 ­­­ the field of view should be limited to the area of concern
Trauma
Peds for Higher Image Quality: only so as to keep radiation dose as low as possible. This
Abdomen/Pelvis
16.1.9/16.2.9/16.4.9/16.6.9/16.8.9 protocol should always be done following administration of
IV contrast as evaluation for solid organ injuries, and to a
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lesser extent bowel/mesenteric injuries is significantly
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limited on non­contrast examinations. This is especially

true in pediatric patients with little mesenteric fat.
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Revolution Discovery CT / Discovery CT750 HD 21 Rev: 3.0 / December 2017

 This non­contrast protocol is performed to evaluate the
lung parenchyma for evidence of interstitial lung disease,
Chest ­ Standard 15.1.1/15.2.1/15.4.1/15.6.1/15.8.1 ­­­ for
bronchiectasis, or aspiration. As pediatric patients have
(Routine & High­ Peds Higher Image Quality:
little mediastinal fat, evaluation for mediastinal or hilar
Resolution) 15.1.8/15.2.8/15.4.8/15.6.8/15.8.8
lymphadenopathy, as well as mediastinal pathology in
general, would be limited.
This protocol is designed to further evaluate patients with
chest infections such as pneumonia with or without
empyema, neoplasm, fever of unknown origin, vascular
rings and slings, as well as mass lesions such as congenital
Chest with IV Contrast Peds XXX ­­­ for Higher Image Quality: xxxxx
cystic adenomatoid malformation and sequestration.
Additionally, this could be used in evaluation of patients
who have suffered blunt or penetrating trauma to the
chest only.
Technique for the pectus excavatum protocol was
15.1.3/15.2.3/15.4.3/15.6.3/15.8.3 ­­­ for
optimized for evaluating the bony thorax. These images
Chest Pectus Peds Higher Image Quality:
allow for precise calculation of the Haller and correction
15.1.10/15.2.10/15.4.10/15.6.10/15.8.10
indices, as well as for pre­surgical planning.
15.1.4/15.2.4/15.4.4/15.6.4/15.8.4 ­­­ for
This protocol is designed to evaluate patients who are
CTA Chest for PE Peds Higher Image Quality:
suspected of having pulmonary embolism.
15.1.11/15.2.11/15.4.11/15.6.11/15.8.11
This protocol is intended to initially diagnose and follow­

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15.1.5/15.2.5/15.4.5/15.6.5/15.8.5 ­­­ for
Routine up malignancy and to evaluate for infection/fever of
Peds Higher Image Quality:
Chest/Abdomen/Pelvis unknown origin in patients with nonspecific symptoms or

8 nu as
15.1.12/15.2.12/15.4.12/15.6.12/15.8.12
who are immunocompromised.
This protocol is designed to evaluate patients who have
01 ma ele suffered from blunt or penetrating trauma for possible
internal injuries. Delayed images may be required at the
radiologist’s discretion to evaluate for active bleeding, but
the field of view should be limited to the area of concern
15.1.6/15.2.6/15.4.6/15.6.6/15.8.6 ­­­ for
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Trauma only so as to keep radiation dose as low as possible. This
Peds Higher Image Quality:
Chest/Abdomen/Pelvis protocol should always be done following administration
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15.1.13/15.2.13/15.4.13/15.6.13/15.8.13
of IV contrast as evaluation for vascular and solid organ
injuries, and to a lesser extent bowel/ mesenteric injuries
1/ ev ub

is significantly limited on non­contrast examinations. This

is especially true in pediatric patients who have little
mediastinal and mesenteric fat.
pr r p

This protocol is designed to evaluate the central airways,

particularly to assess for tracheobronchomalacia or
excessive dynamic airway collapse. In addition to standard
high­resolution images of the lungs, the forced expiratory
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images accentuate collapsibility of the trachea and central

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bronchi. This protocol includes additional reformations

including minimum intensity projections (MinIPs) and
15.1.2/15.2.2/15.4.2/15.6.2/15.8.2 ­­­ No optional 3­D virtual bronchoscopic images, which
Peds Chest Dynamic 3D
Peds higher image quality version of this referring providers might find informative. For patients
Airway
protocol who have a recent volumetric thin­section CT of the chest,
the expiratory sequence of this protocol performed alone
may be sufficient, minimizing additional radiation
exposure. Because the breathing technique is different
than traditional end­expiratory chest CT, proper training
of technologists and coaching of patients with close
radiologist oversight will maximize the utility of this
protocol.

Revolution Discovery CT / Discovery CT750 HD 22 Rev: 3.0 / December 2017

Pages 23-440 are not a part of this manual preview. The full manual, along with an
accompanying disc for your CT scanner come with new CT scanner purchases from
GE or can be ordered for your current scanners. Contact your apps or salesperson with
questions on this process.

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Peds Bony Pelvis Protocol Selection
If you get an order for a pediatric bony pelvis:

No Is the pediatric a teen/obese Yes

with an AP + LAT size over 55
cm?
Is the order for a
Use the pediatric Use the appropriate
spica casting for
chest pectus adult protocol
developmental Yes
protocol but (probably the adult
dysplasia of the hips
change the small without metal)

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(probably on a kid <

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coverage to top of
1 yo)? 01 ma ele the illiac crests to Why use a chest
No the lesser protocol on the
trochanters pelvis? This is
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our lowest dose

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pediatric
1/ ev ub

The order should be for a trauma or

protocol so it
avascular necrosis (AVN), if it is not please
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has the right

consult the pediatric attending. Use the
technique for
pediatric trauma abd/pelvis protocol with
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spica planning
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a coverage of top of the illiac crests to the

lesser trochanters

Note: you will need to adjust the scout landmark and scan ranges based on
the flow chart above to cover the desired anatomy.
Note: please provide the radiologist with 3 mm by 3 mm coronal and
sagittal reformats using a boneplus recon.

Revolution Discovery CT / Discovery CT750 HD 441 Rev: 3.0 / December 2017

Position Tutorial
Body Positioning
◾ Particularly important for Pediatrics and Small Adults

To provide the best image quality at the lowest dose, proper patient positioning is always important. It is particularly important with
the smaller patients scanned as small adults and in pediatric imaging using low kV techniques. Positioning errors usually occur with
the patient being positioned too low. This error causes significant problems with pediatric protocols in which the patient may actually
need to be positioned a bit high to outward appearances: Ideally the most attenuating part of the patient should be centered in the
scan. To accomplish this, one should position the patient high enough so that the horizontal laser light is centered on the lumbar spine
and is just anterior to the thoracic spine. This is demonstrated in the scout images below, where the red line is the actual midpoint of
the scout image and the blue line is where the patient should have been centered on the scout. Only the scout on the upper right
shows correct positioning; the midpoint of this scout is shown as a purple line. All the rest are centered too low.

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Revolution Discovery CT / Discovery CT750 HD 442 Rev: 3.0 / December 2017

Decubitus Positioning
◾ Proper positioning for the decubitus portion of the CTC screening exam

Just as patient positioning is critical in our routine supine and prone exams, it is also critical in the decubitus portion of our virtual
colonoscopy screening exam. To provide the best image quality at the lowest dose, proper patient centering in the scanner gantry is
critically important.
You cannot simply have the patient roll to their side, this will leave their pelvis in an off center position! You must have the patient roll
and then confirm that they have shifted their pelvis back to the scanner of the couch. Roll and shift! Aim to get the patient's ilium
bones centered in the scanner.
Note, it is also possible that after proper positioning, the patient may tilt to the side before the scan. Tilting to the side is a natural
response to being placed in the decubitus position. Please watch for this and instruct the patient to return to the proper position.

Poor Position Good Position

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Bad Looking Scout 01 ma ele
Good Looking Scout
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Resulting Bad Looking Image Resulting Good Looking Image

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Revolution Discovery CT / Discovery CT750 HD 443 Rev: 3.0 / December 2017

Shoulder Relaxation
◾ Lowering the position of the shoulders is important in both allowing adequate visualization of the cervicothoracic junction and
in lowering the dose required for the exam.
◾ Fastening the CT table strap around the torso only, as compared to around the torso and arms, decreases the level of the
shoulders by one vertebral body level.
◾ Simply encouraging appropriate patients to “pull” their shoulders down has also been found to be effective.
◾ Having patients “walk” their hands down a folded bedsheet wrapped around the feet is also helpful for challenging cases.

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Examples of good and bad shoulder position relative to the neck. The techniques listed above can get a patient from having a poor
positioning of the shoulder to a good position. Note: try to recognize improper shoulder relaxation before you scout. If, however, you only
01 ma ele
notice this after you scout, there is no need to re­scout the patient after they move their shoulders.
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Revolution Discovery CT / Discovery CT750 HD 444 Rev: 3.0 / December 2017

Size Selection
Adults:Small/Medium/Large
All Adult Body Protocols are divided into Small, Medium, and Large Adult Protocols.

Small Adult Body Protocols shall be used for all patients with a combined AP plus Lateral size of 60 cm or less.

Medium Adult Body Protocols shall be used for all patients with a combined AP plus Lateral size of greater than 60 cm and less
than 80 cm.

Large Adult Body Protocols shall be used for all patients with a combined AP plus Lateral size of 80 cm or greater.

These sizes shall be measured off of the Scout image over the largest anatomy of clinical interest.

With the use of these 3 protocols, matched to patient size, there should not be any need for the CT technologist to make further
adjustments to the scan techniques when scanning any patient.

Pediatrics: Color Code

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When selecting the patient size protocol to use, the combined AP plus Lateral Size of the patient is the primary determining factor.
This sum of the AP plus Lateral dimensions of the patient should be measured off of the scout image over the largest anatomy of
01 ma ele
clinical interest. For accurate measurement, the patient must be properly centered. Also the window width must be adjusted wide
enough so that the measurements can be taken from the surface of the skin. For patients with a combined AP plus Lateral Size above
60 cm, use a Medium Adult protocol.
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The pediatric color coding scheme divides pediatric into five sizes coded by color. The approximate age of patients and size ranges are
given as follows:
1/ ev ub

Pink Newborns. Typical AP + Lateral size of 0­26 cm.

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Red/Purple 6 months­2.5 years. Typical AP + Lateral size of 27­31 cm.

Yellow/White 3­7 years. Typical AP + Lateral size of 32­37 cm.

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Blue/Orange 8­12 years. Typical AP + Lateral size of 38­43 cm.

Green/Black 13­18 years. Typical AP + Lateral size of 44­55 cm.

The 9 colors that are used in this scheme are derived from the Broselow tape scale which was originally used to color code doses of
medication given in pediatric care.

Neuro: Adult/Child/Infant
Some of the neuro protocols have scan parameters that are divided into three groups for: Adults, children (3­6 years old), and infants
(0­3 years old).

Revolution Discovery CT / Discovery CT750 HD 445 Rev: 3.0 / December 2017

Size Selection for Neck and C­spine
1. Verify that the arms are outside of the CT wrap, and that the shoulders are relaxed down toward the feet as far as possible.
Measure the width of the shoulders through the level of the mid­humeral head, as shown below.
2. Check BMI in EPIC (under SnapShot)
3. Select small, medium and large based on the table below.

NOTE ­ if the patient has lymphoma and the study is a follow­up, use the small neck protocol (regardless of the patients
actual size) since it will provide a lower dose

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Measure width through mid­humeral heads
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Small Medium Large

1/ ev ub

Shoulder width greater than 50 cm OR BMI greater than

35
Shoulder width less than 46 cm OR BMI less than 26 Shoulder Width 46 to 50 cm
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Revolution Discovery CT / Discovery CT750 HD 446 Rev: 3.0 / December 2017

Instructions for Adjusting Protocols for Pediatric Extremities
and Bariatric Patients
Pediatric Extremity Adjustments
We do not have separate pediatric protocols for extremity imaging in the MSK section of our manual. To image pediatric extremities
for patients less than 13 years old, please select the adult extremity protocol and lower the kV 1 step. These protocols are all set to
use manual mA, so decreasing the kV will decrease the patient dose by roughly 50%.

These instructions apply to the following protocols

1. Knee/Tibia (Without Metal) 9.3

2. Knee/Tibia (With Metal) 9.4
3. Ankle/Foot/Distal Tibia (Without Metal) 9.1
4. Ankle/Foot/Distal Tibia (With Metal) 9.2
5. Elbow/Forearm (Without Metal) 4.6
6. Elbow/Forearm (With Metal) 4.7

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7. Wrist (Without Metal) 4.8
8. Wrist (With Metal) 4.9

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For example, you get an order for a pediatric ankle scan. There is no metal in the field of view so you select the protocol:
01 ma ele
Ankle/Foot/Distal Tibia (Without Metal) 9.1 . When you get to the tomographic phases of the exam (helical scan series), simply
change the kV from 120 kV to 100 kV.
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kV Steps
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By 1 step, we mean the following:

1/ ev ub

If the adult is kV Then change the kV to

140 120
120 100
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100 80

Note: we do not have any MSK extremity protocols that use 80 kV for adults.
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Note: you do not have to change the kV for the scouts.

Adjustments for Bariatric PE Studies

We do not have a bariatric protocol for chest PE studies. Our large protocol is already designed to deliver a higher maximum dose
than the medium and small adult protocols, but it uses 120 kV to maximize iodine contrast. Other large adult protocols that are not
angiograms use 140 kV for large adults. Therefore, for bariatric PE patients who 1. fill the scout view or 2. max out the mA table
please increase the kV from 120 kV to 140 kV.

Note: If you know the patient is likely to max out the mA table before taking the scout, you should increase the scout kV from
120 to 140.

Revolution Discovery CT / Discovery CT750 HD 447 Rev: 3.0 / December 2017

Example of a patient filling the scout view

Example patient filling the scout AP Example patient filling the scout
view lateral view

resulting poor image quality from a

patient who fills the scout

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Revolution Discovery CT / Discovery CT750 HD 448 Rev: 3.0 / December 2017

Weight­Based Contrast Instructions
Contrast volume for users without the Medrad P3T Option (what UW uses for most routine non angio imaging)

This table assumes use of contrast strength at 300 mg I/cc and an injection rate of 3 ml/sec

Patient Weight (lbs) Contrast Volume (ml or cc)

130 and less 80 (minimum amount to load)
140 86
150 92
160 98
165 101
170 104
175 107
180 110
190 116
200 122
210 129
220 135

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230 141
240 147

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250 and larger 150 (max amount to load)

Contrast volume for users without the Medrad P3T PA Option (what UW uses for angios)
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This table assumes use of contrast strength at 370 mg I/cc and an injection rate of 5 ml/sec
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Patient Weight (lbs) Contrast Volume (ml or cc) Saline chaser Volume (ml or cc)
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150 and less 100 60

150­200 125 60
200 and higher 150 60
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Revolution Discovery CT / Discovery CT750 HD 449 Rev: 3.0 / December 2017

Creatinine Guidelines (with values for eGFR)
If a patient has 1 Kidney, partial Nephrectomy, kidney transplant, or RCC and they are borderline for our non­diabetic criteria identify
creatinine trend. If the creatinine has been stable follow our current guidelines without changing to Iodixanol.

Diabetic Creatinine eGFR

Iohexol <1.4 >50
Iodixanol 1.4­1.8 40­50
No Contrast >1.8 <40

Non­ Diabetic Creatinine eGFR

Iohexol <1.8 >40
Iodixanol 1.8­2.4 30­40
No Contrast >2.4 <30

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Revolution Discovery CT / Discovery CT750 HD 450 Rev: 3.0 / December 2017

Pediatric Contrast Guidelines
Purpose: To identify appropriate intravenous (IV) access for CT studies requiring intravenous contrast. Achieving appropriate
contrast injection rates is critical to achieving a quality diagnostic study.

◾ In order to decrease delays from injection to image acquisition, a power­injector will be used by the CT technologists.
◾ If a patient arrives for the CT and has an IV or central line that is not functioning appropriately for contrast injection at the

required rate, the patient will not be scanned until a new IV is placed.

◾ Preferably IV access should be obtained in an upper extremity.

PIV = peripheral IV

RN to Accompany to CT for
Type of Exam IV Catheter Requirements Power Injector Rate
Injection
PIV (<1 year): 22G 22G: 3mL/sec No
CT Angio Exams PIV (>1 year): 18G­20G 18G­20G: 4mL/sec No
Power injectable central catheter (tunneled or non­tunneled) Power injectable catheter: 4mL/sec No
PIV: 22G or larger > 22G: 2mL/sec No

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24G catheter (must flush well) 24G: HAND INJECT0.8­1mL/sec Yes

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Power injectable central catheter (tunneled or non­tunneled) Power injectable catheter: 2mL/sec No
Routine CT Exam
Non­power injectable central catheter (tunneled or non­
Place PIV > 22G: 2mL/sec No
tunneled): <4 Fr
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Non­power injectable central catheter (tunneled or non­
tunneled): >5 Fr
Non­power injectable catheter: HAND INJECT1­1.5 mL/sec *Yes

Hand Injection by RN: Patient’s RN must accompany patient or CT if a non­power­injectable line is to be used for hand injection of
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contrast for a CT. The RN will be in the room and inject the contrast. The CT tech can then start the scan at the appropriate time
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following contrast administration. If there are clinical concerns regarding IV/central line size or function limiting our ability to
perform a diagnostic CT scan, a discussion should be had between the patient’s attending physician and the attending pediatric
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radiologist.

Radiation Safety Guidelines for RNs in room during the start of CT exams:
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◾ The RN should be wearing a lead apron (wrap around type) and thyroid shield.
◾ The RN should try to stand as far as possible from the patient while still being able to administer the contrast agent during the
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time when the CT scanner is on (the scanner has a notification light on the front and back sides to show people in the room
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when it is creating x­rays).

◾ After the injection is complete, the RN should back/step away from the patient/scanner and leave the room if time allows
◾ For pregnant RN’s in the room, refer to your sites own internal policy guidelines.

Contraindications for Using the Power­Injector

◾ Tunneled catheters that are not power­injectable (silicone Hickman or Broviac catheter): Due to the inability to inject at an
appropriate rate.
◾ Patient will need to have a peripheral line placed for any CTA
◾ If the tunneled catheter is smaller than 5 French or does not flush well, a peripheral line will need to be placed
◾ Umbilical venous catheters: due to the possibility of injecting the contrast bolus directly into the liver.
◾ Patients will need to have a peripheral line placed.
◾ If no other venous access can be attained, the patient’s attending physician needs to speak with the attending pediatric
radiologist prior to the scan being performed to discuss options.

Revolution Discovery CT / Discovery CT750 HD 451 Rev: 3.0 / December 2017

CT Perfusion Protocol: (Specific Instructions)
Setup
1. Patient Supine, AP and lateral scouts, no gantry tilt
2. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of the eye and the EAC is perpendicular
to the CT tabletop (see head CT protocol).
3. Usually done in conjunction with a CT/CTA of the Head or CT/CTA of Head/Neck
4. Best to use 64 (4 cm detector coverage) slice scanners

Exam
CT Perfusion

1. Scan Type Cine

2. Cine Duration 65 seconds
3. Perfusion Area (next page)
4. Contrast Adult: 40 ml of 370 Isovue (14.8 g Iodine) with 30 ml saline chase

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Peds: 0.25 mg/kg Isovue 370 with 10 ml saline chase

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1. Injection Rate Adult: 5 ml per sec
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Peds: 3­4 ml per sec (Depends on size of needle and age of patient)

1. Prep Delay 5 seconds

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2. Perfusion Slabs Use maximum number (4­8­16) of contiguous 5 mm slabs allowed by each specific CT scanner (use
toggle/shuttle mode if possible)
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DFOV
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1. Preferred 22 cm
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Perfusion Post Processing

(see below for further details):
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1. Prospectively reconstruct the images to .5 seconds. This is found under thick/speed ­ (under recon 2).
2. When you are in recon 2, enter the RAS coordinates manually.
3. Network raw perfusion images to ALI Store

Acquisition Parameters
Cine
Adult and Child non Revolution Adult and Child Revolution
Scan Type Cine Cine
Rotation Time 1.0 1.0
Beam Collimation 40 80
Detector Rows 64 128
Detector Configuration 64 x 0.625 128 x 0.625
Scan FOV Head Head
Number of images per rotation 8i 16i
kV 80 80
Smart or Manual mA Manual mA Manual mA
Manual mA for Adults 150 200
Manual mA for Ped < 6 y/o 75 100
Cine Duration (sec) 65 65
Slice Thickness (mm) 5.0 5.0
Interval (mm) 0 0

Note: Apply 30% ASiR/ASiR­V to the perfusion recons.

Revolution Discovery CT / Discovery CT750 HD 452 Rev: 3.0 / December 2017

Shuttle
Adult and Child
Scan Type Shuttle
Rotation Time 0.5
Beam Collimation 40
Detector Rows 64
Detector Configuration 64 x 0.625
Scan FOV Head
Number of images per rotation 8i
kV 80
Smart or Manual mA Manual mA
Manual mA for Adults 400
Manual mA for Ped < 6 y/o no shuttle scans for peds
Cine Duration (sec) 65
Slice Thickness (mm) 5.0
Interval (mm) 0

Note: Apply 30% ASiR/ASiR­V to the perfusion recons.

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Revolution Discovery CT / Discovery CT750 HD 453 Rev: 3.0 / December 2017

CT Perfusion Coverage
32 and higher slice scanners (shuttle mode)
Obtain 16 contiguous 5 mm slices from EAC Upward

32 and higher slice scanners (cine mode)

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64 Channel CT Perfusion: Non­shuttle Mode (8x5 mm slice coverage)

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64 Channel CT Perfusion: Non­shuttle Mode (8x5 mm slice coverage)

Revolution Discovery CT / Discovery CT750 HD 454 Rev: 3.0 / December 2017

8­16 Slice scanners (cine mode)

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8­16 Channel CT Perfusion: (4x5 mm slice coverage)
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Revolution Discovery CT / Discovery CT750 HD 455 Rev: 3.0 / December 2017

CT Perfusion Analysis Instructions
Suggestions for ROI placement shown below

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Revolution Discovery CT / Discovery CT750 HD 456 Rev: 3.0 / December 2017

Thoracic Outlet Instructions
Indication

Evaluation for suspected unilateral thoracic outlet obstruction.

Oral Contrast

None

Pre­Scan Instructions

Two CTA scans, one with both arms down and one with affected arm up. Make sure hand in affected arm is warm. If ordered as a
bilateral scan: Do two CTA scans, (A) one with right arm down and left arm up and (B) one with right arm up and left arm down. Make
sure hands are warm.

IV Contrast Parameters

Load 135 cc contrast Isovue 370 and 80 cc saline.

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Field of View

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Same as previous study or as small as appropriate

Scan Description
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◾ Part 1
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◾ Scan Description: Arms Down
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◾ Series 1: PA and Lateral Scout

◾ Coverage:From lower neck to diaphragm on inspiration. Scan with the scouts from the routine neck protocol.
◾ Series 2: Smart Prep
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◾ Coverage: Center over the aortic arch and place the ROI on the proximal aortic arch. Starts canning at 100 HU
trigger level.
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◾ Series 2: Scan Phase CTA

◾ Coverage: From below the carina to lower neck on inspiration.
◾ IV: 50 mL IV contrast at 5 mL/sec followed by 40 mL saline at 5 mL/sec
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◾ Part 2
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◾ Scan Description: Affected Arm Up

◾ Series 3: PA and Lateral Scout
◾ Coverage: From carina through finger tips on inspiration.
◾ Series 4: Smart Prep
◾ Coverage: Center over the aortic arch and place the ROI on the proximal aortic arch. Start scanning at 100 HU
trigger level.
◾ Series 4: Scan Phase CTA
◾ Coverage: From aortic arch through finger tips on inspiration.
◾ IV: 25 mL IV contrast at 5 mL/sec followed by 60 mL IV contrast at 4 mL/sec then 40 mL saline at 4 mL/sec
◾ Part 3
◾ Scan Description: Delayed CTA (Have the patient keep their arm raised as it was in the previous series)
◾ Series 5: Scan Phase CTA
◾ Timing: This scan should be started 70 seconds after the contrast injection from the previous series.
◾ Coverage: Scan from the carina to the elbow.

Acquisition Parameters
Scan the scouts from the routine neck protocol when the arms are down and the upper extremity run off protocol when the arms are
up. Scan the tomographic portions with the upper extremity run off protocol (turn the smart prep option on).

Revolution Discovery CT / Discovery CT750 HD 457 Rev: 3.0 / December 2017

Scout Ranges and Anatomical Landmarks
The table below lists scout start and end ranges appropriate for most adults. For pediatrics, adjustment of these values should be
based on patient height.

Protocol Name/Type Anatomical Landmark Scout Start Location Scout End Location
Head (Brain), Orbits, Facial Trauma, Sinus, Temporal Bone, Stereotactic head OM S 150 I 150
CTA head, AND any of the following that need to smart prep over the aortic arch: Head
OM S 150 I 300
(Brain), Orbits, Facial Trauma, Sinus, Temporal Bone
Stroke Deluxe, Head/Neck Venography SN S 300 I 200
Neck, CTA neck, Cervical Spine SN S 200 I 200
Shoulder/Humerus SN S 150 I 150
Elbow/Forearm EJ S 150 I 150
Wrist/Hand WJ S 150 I 150
Chest, Lung Cancer Screening, Pulmonary Embolism, All Cardiac Protocols (gated/non­
SN S 50 I 350
gated), Dynamic Airway
Subclavian venogram, Pectus SN S 75 I 350
Abdomen/Pelvis (this includes all protocols starting with Abd­Pelvis unless otherwise
XY S 50 I 500
noted), Lumbar Spine
Chest Abdomen Pelvis, TAVI/TAVR, PE/Abd/Pelvis Combo, Thoracic Spine SN S 50 I 600

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Bony Pelvis, Cystogram, Body Pelvis IC S 50 I 300
MAKO Hip IC S 50 I 650

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MAKO Knee KN S 350 I 350
Knee/Tibia KN S 150 I 150
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Femoral Anteversion
Ankle Foot, Distal Tibia
IC
AJ
S 100
S 150
I 1000
I 150
Upper Extremity CTA (run off) SN S 800 I 300
Lower Extremity CTA (run off) SN S 100 I 1700*
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*Note, some scanners may only be capable of going to I1450.

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OM = orbital meatal, SN = sternal notch, EJ = elbow joint, WJ = wrist joint, XY = xyphoid process, IC = iliac crest, KN = knee, AJ = ankle
joint
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Revolution Discovery CT / Discovery CT750 HD 458 Rev: 3.0 / December 2017

Window Width and Window Level
Note: ST refers to soft tissue, ww refers to window width, wl refers to window level, PE refers to pulmonary embolism.

All scouts (CT localizer radiographs)

WW/WL = 500/50

Abdominal
Anatomy being scanned WW/WL
ST 450/50

Chest
Anatomy being scanned WW/WL
Lungs 1500/­700

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ST 450/50

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PE AX MIPS 920/125

Cardiovascular 01 ma ele
Anatomy being scanned WW/WL
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ST 450/50
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Neuro
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Anatomy being scanned WW/WL

Bone (temporal and spines) 2500/350
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Thick ST (general head/brain) 80/25

Generic ST images, CTA head and neck 450/50
Thin ST Head, Perfusion 180/25
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Neck ST 300/35
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Orbits ST 300/0

MSK
Anatomy being scanned WW/WL
Bone 2500/350
ST 450/50

Peds
Anatomy being scanned WW/WL
Chest/Body 550/80
Lung 2100/­450

Revolution Discovery CT / Discovery CT750 HD 459 Rev: 3.0 / December 2017

Instructions for Avoiding the Lens of the Eye on Head Exams
For routine head exams where one desires to avoid the lens of the eye:

1. Positioning: Tilt the patients chin toward their chest “tucked position” (or tilt gantry alternatively) to produce a scan angle that
is parallel to a line created by the supraorbital ridge and the inner table of the posterior margin of the foramen magnum
(opisthion).
2. Helical mode should be used routinely for adult head CT scans. If you cannot move the patient’s head into proper position
(trauma, cervical collar, rigid neck) then perform a helical scan with angled axial reformats or perform an axial scan with gantry
tilt.
3. Start scans at the top of the C1 lamina and scan through the top of the calvarium.
4. The figure below details the scan ranges

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Scan range for routine head imaging if the eye

lens is to be avoided (scan from yellow line to
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yellow line, the red line denotes the bony

landmarks you want to get aligned with the
scan plane)
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Revolution Discovery CT / Discovery CT750 HD 460 Rev: 3.0 / December 2017

How to Send the ECG Trace to PACS
For all gated exams (prospective and retrospective for all indications/contrast phases/body regions (non contrast chest, CTA non
coronaries, CTA coronaries, etc.) please send the ECG trace to PACS. This will help document the patients heart rate, heart rate
variability, and the presence of any irregular beats during the scan. If you perform any trigger editing, it will also document how that
editing was performed.

To send the ECG trace to PACS

1. After completing all of the needed reformats and pushing the study to PACS, open the retro reconstruction screen and select the
gated series. Do not select the smart prep or bolus tracking series if present. For coronary CTA, pick the coronary CTA, not
calcium scoring.
2. Adjust the scan reconstruction range to as small as possible (we will be doing a retro recon only to save the ECG trace, not to
actually send the images so the range doesn't matter and therefore should be as small as possible to save space on the scanner).
For example, if the scan started at S40 and ended at I250, you could just do a retro recon from S40 to S39.
3. Make sure the button that says "ECG Viewer" is selected (you should see the ECG trace when it is selected in the top right hand
corner of the screen)

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4. Hit the save icon on the ECG trace (it is in the upper right and corner of the screen and looks like a floppy disc).

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5. Name the series "Recon for ECG Trace".
6. Click confirm.
7. Two new series will show up for the patient, the one you just made named "Recon for ECG Trace" and one named "ECG Report".
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Only send the "ECG Report" to PACS.
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How the ECG report shows up on the image browser

tab
ECG trace shown on retro recon viewer

Revolution Discovery CT / Discovery CT750 HD 461 Rev: 3.0 / December 2017

Frequently­Asked Questions (FAQ's)

Critical Comments on Proper Patient Centering

1. Using the UW protocols, I sometimes find that parts of the image are too noisy, particularly towards the posterior part
of the patient. Why?
To ensure uniform image quality at the lowest dose, proper patient positioning is very important. Current scanner technology
incorporates bowtie filters. Their purpose is to decrease radiation to the periphery of the patient. This results in a sweet spot for
patient positioning. Improper positioning will result in degraded image quality. It is particularly important in pediatric imaging
and the small adults specifically, whenever the smaller bowtie filter is used relative to the selected Scan Field of View (SFOV).
The small bowtie filter is used for all pediatric SFOV’s, for the Small Body and Small Head SFOV’s on the LightSpeed VCT and the
Discovery CT750 HD; and for the Small Body and Head SFOV’s on the Revolution EVO and the Optima CT660. Proper centering
is also more important when using low kV technique.

Patients of all sizes are frequently positioned too low in the gantry, primarily because it can be difficult to correctly estimate the
AP center of the patient since part of the patient is effectively hidden by the curve of the table. Generally it is better to have the
patient centered a bit high rather than low, since it is optimal to place the most attenuating part of the patient at the center of

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the scan. The patient's center of mass is usually a bit posterior to the measured center point of the patient from skin line to skin
line. Thus, make sure that the table is properly elevated. (To accomplish this with smaller and pediatric patients, one should

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position the patient high enough so that the horizontal laser light is centered on the lumbar spine and is just anterior to the
thoracic spine. This is demonstrated by the figures on the next page.)
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If the patient is positioned too low in the gantry, several detrimental effects occur. They are most problematic when using the
smaller SFOV bowtie filter or lower kV settings. First the image noise will increase, particularly toward the posterior part of the
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patient. Second the patient dose will increase. The proper solution is NOT to avoid the use of the smaller SFOV bowtie filter or to
avoid the use of lower kV when appropriate. Rather the best solution is proper patient positioning – to obtain the best overall
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image quality at the lowest dose.

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The principals of properly centering small and pediatric patients are demonstrated in the scout images below, where the red
line is the actual midpoint of the scout image and the blue line is where the patient should have been centered on the scout. Only
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the scout on the upper right shows correct positioning; the midpoint of this scout is shown as a purple line. All the rest are
centered too low.
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Revolution Discovery CT / Discovery CT750 HD 462 Rev: 3.0 / December 2017

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Positioning Examples

General

1. Why did GE partner with the University of Wisconsin­Madison?

University of Wisconsin­Madison has one of the largest medical physics departments of any major institution offering this type
of program, and their Department of Radiology has years of experience in refining and improving CT protocols. Together, these
two departments have developed clinically relevant and technically sound CT protocols. The University of Wisconsin­Madison
and GE Healthcare have had a long­standing working relationship and strategic alliance. This is partly due to geographic
proximity.
2. When I buy a new GE scanner, must I use these protocols?
We encourage you to take the time to review the protocols and apply them as they are written. These protocols have been
refined to provide optimal imaging for a numerous set of conditions. They have been fine­tuned to each specific CT scanner and
refined for the varying size of our population. But you may choose to use your own protocols. Just please take the time to
optimize them for your new scanner. That’s the right thing to do to make sure your patients get the best scan at the safest dose.
3. Why are there so many different protocols?
The protocols are refined for certain disease states. Modifications in patient positioning, oral and intravenous contrast
administration, and timing of series acquisition can help to optimize visualization of the suspect clinical condition.
4. Will these protocols change?
It is inevitable that with further improvements in CT technology and/or a growing understanding of disease conditions, the
University of Wisconsin­Madison protocols will evolve. Our intention is to release new versions of improved protocols on an
annual basis; however, an earlier release may be provided if a major medical advance or a protocol issue comes to light.

Revolution Discovery CT / Discovery CT750 HD 463 Rev: 3.0 / December 2017

 5. Is there a reason why Dose Reduction Guidance is not used in the protocols?
1. When the Dose Reduction Guidance is used, there is a limit imposed on the min mA allowed, which poses a problem for
our protocols.
2. Dose Reduction Guidance is not available on the Discovery CT750 HD scanner, and we wished to be consistent in our
protocols across GE CT platforms.
3. Our radiologists have approved the use of a certain percent ASiR for the different exams and do not want to have it altered
by the Dose Reduction Guidance.
6. These protocols incorporate oral contrast. How do we use the protocols if our institution has gotten away from using
oral contrast in our emergency department?
The University of Wisconsin­Madison firmly believes that imaging of certain disease states is enhanced by the addition of oral
contrast. If your institution is comfortable with scanning the abdomen in the absence of oral contrast, that's fine. However, you
are encouraged to consider one unique aspect of the oral contrast cocktail that we recommend. The University of Wisconsin­
Madison routinely adds polyethylene glycol (PEG) to the oral contrast mix. This accelerates transit through the intestine. When
our patients drink this contrast mixture for one hour, we routinely see opacification of the gut to the level of the cecum. This
significantly increases confidence and interpretation, especially for enteric conditions.
7. I just scanned a small patient and the image quality is not very good. Why?
Patient centering is critically important to achieve uniform image quality. Please refer to the Proper Patient Centering in this
section for more information.
8. Why do you use Smart mA instead of Auto mA or Manual mA?

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The UW protocols always rely on the Smart mA function when the Auto mA is turned on. We do not see any situation in which it
would be advantageous to turn the Smart mA function off. Smart mA includes both mA modulation as the patient attenuation

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changes along the length of the patient and also mA modulation as the tube rotates around the patient. This is always
advantageous and is essential in areas of the anatomy where patient size / attenuation varies dramatically with direction, such
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as the shoulders and pelvis. It is even useful in scanning the head, since the AP and lateral dimensions of the head are not the
same.
9. Why don’t the protocols use Dynamic Transition on Smart Prep?
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Dynamic Transition triggers the scan automatically when IV contrast enhancement in the selected region of interest reaches a
predetermined HU value. Some patients, however, are startled by the influx of contrast and may move or breathe differently.
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This could shift the region of interest and result in an attenuation spike which may prematurely trigger the scan to start before
optimal contrast opacification.
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Abdominal CT Protocols
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1. Why are there two flank pain protocols?

The standard dose flank pain protocol is appropriate for the patient presenting for the first time to the emergency room with
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suspicion of renal calculi or appendicitis (although we encourage oral contrast for suspect enteric pathology). The low­dose
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flank pain protocol is more appropriate for the follow­up of patients with known kidney stones who are receiving numerous
scans. It is tailored to provide a level of resolution good enough to visualize renal calculi, but not to characterize other renal
abnormalities.
2. Why is there an hepatocellular carcinoma protocol in addition to the biphasic CT?
The United Network for Organ Sharing (UNOS) has mandated that prior to listing a patient for transplantation, the CT scan
evaluating the possibility of neoplasm must include a delayed phase. Therefore, a special protocol was created to accommodate
this mandate. The biphasic CT, however, is preferred for evaluation of hypervascular metastases to the liver.
3. Why are there so many reformatted images on a trauma study?
The University of Wisconsin­Madison trauma CT of the chest is performed with angiographic technique. However, many centers
do not provide in­house 3­D services off­hours. Therefore this protocol includes an oblique MIP reconstruction of the great
vasculature. It provides a candy cane projection of the aortic arch, ideal to rule out aortic injury.
4. Why do you scan the trauma chest from bottom up?
By the time the scan arrives at the apex of the chest, most of the intravenous contrast has been washed out of the veins of the
upper thorax by the saline chaser. This decreases the streak artifacts from veins. If scanned top down, these veins would be
filled with very dense contrast as it is being actively injected at the time of acquisition.
5. The dose for the trauma chest abdomen pelvis appears relatively high compared to a standard chest abdomen pelvis
study. Why is that so?
A trauma study routinely results in additional reformatted images of the spine. To obtain appropriate resolution for imaging of
fractures, the technique must be relatively robust. This is major reason why trauma imaging is performed at a higher dose than
standard body imaging.
6. Why is a 0.5xx:1 pitch used?
University of Wisconsin­Madison uses the 0.5xx:1 pitch for several reasons: (1) it provides optimized helical reconstructions,
compared to higher pitches; and (2) for the same image noise, it produces a 20% lower dose than does the 0.9 pitch (which is
why that pitch is avoided). University of Wisconsin­Madison uses 0.4s or 0.5s rotation times when possible to reduce scan times
Revolution Discovery CT / Discovery CT750 HD 464 Rev: 3.0 / December 2017
 with the lower pitch. When that is not sufficient, as in PE studies, the pitch is increased to 1.375. The use of a lower pitch is
possible with the GE 64­slice scanners because of the wider beam collimation of 40mm compared to 20mm, which doubles the
table speed for any particular pitch and rotation time. This also allows the scanning of larger patients without hitting max mA
and degrading image quality.

Chest CT Protocols

1. Please explain why Bone Plus (thin cuts) are prescribed in Recon4?
Bone Plus is used as a “lung algorithm”. We prefer its diagnostic image quality compared to the “Lung” or “Bone” algorithm. Thin
cuts for both soft tissue and lung images are performed to create the Sagittal and Coronal reformatted images.
2. Why is a 0.5xx:1 pitch used except for PE studies?
See same question under "Abdominal CT Protocols.

CV CT Protocols

1. Why is a separate non­contrast scan included with the CTA studies?

It allows us to differentiate contrast from calcium when looking for extravasation or a leak. Also, the non­contrast scan is
essential for detection of intramural hematoma in acute aortic syndrome.

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2. Why is the time­of­arrival of the timing bolus measured at the popliteal arteries during run­offs instead of in the aorta?
There are 2 general approaches to performing extremity CTA run­off studies

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1. The first attempts to scan at roughly the same rate as the contrast bolus passes through the extremity in order to "follow"
the bolus from the aorta through the distal extremity. Before the advent of multidetector fast scanners, this was the only
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real option. However, the tremendous variability in the contrast bolus transit time through the extremity, especially in the
presence of atherosclerotic disease, made timing difficult.
2. The second approach (which the University of Wisconsin­Madison has adopted) aims to opacify all of the larger arteries of
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the extremities and then scan as quickly as possible. Since the contrast transit time varies markedly among patients, using
arteries in the extremity (e.g., popliteal arteries for lower extremity runoffs) enables better determination of the
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appropriate delay between injection and scan. Performing an immediate repeat of the very distal extremity (beginning at
the knees or elbow) also helps ensure that the distal arteries are adequately evaluated.
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3. Why doesn’t University of Wisconsin­Madison use prospective gating on the chest portion of a combined CTA
chest/abdomen/pelvis in which gating is needed in the chest?
GE scanners are not currently able to combine a prospectively gated chest with a non­gated abdomen/pelvis in a single
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acquisition. Therefore, when it is essential to use ECG­gating on the chest portion of a CTA chest/abdomen/pelvis, retrospective
gating must be used.
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MSK CT Protocols

1. Why does the wrist/elbow need to be over the head?

This positioning eliminates both exposure to and scatter from the rest of the body.
2. When positioning the patient with their arm over their head, does it matter if they are prone, supine, or decubitus?
No. Use whatever position makes the patient most comfortable.
3. When scanning ankles/feet, why are both ankles/feet included in the scanning FOV?
Because there is no appreciable scatter from the normal contralateral side, and sometimes it is useful to have the contralateral
side for comparison.
4. If, when scanning a knee/ankle/foot, there is metal in the contralateral side, what should be done?
The contralateral knee should be bent to move the metal knee/ankle/foot out of the scanning FOV.
5. How should the arm be positioned when there is a cast in place?
The ideal position for scanning the elbow/forearm/wrist is with the arm and elbow straight so that the arm is perpendicular to
the CT gantry. When there is a cast across the elbow, then the forearm should be positioned so it is oblique to the CT gantry.
6. Why shouldn't the patient be positioned with the forearm parallel to the CT gantry?
This creates an unacceptable amount of streaking along the length of the forearm due to greatly increased x­ray attenuation.
The forearm should be positioned perpendicular (preferred) or oblique to the CT gantry.
7. Why are some of my bone images too blurry, especially those of the shoulders?
There are two important requirements to retain the image sharpness that can be provided by the sharper image algorithms
such as “bone”, “bone plus”, “edge”, and “ultra”. The first requirement is the use of a small DFOV, ideally of less than 20 cm. This
produces a pixel size that is capable of reproducing the full resolution of the sharp algorithms. The larger pixel size that results
with the use of larger DFOV’s will limit the resolution of which the sharp algorithms are capable.

The second requirement is that the anatomy for which you need high resolution be positioned close to the center of the scan
field of view. Due to the effects of focal spot size and detector size, the maximum limiting resolution degrades significantly as
Revolution Discovery CT / Discovery CT750 HD 465 Rev: 3.0 / December 2017
 you move farther from the center of the scan field. For example, when using any of the sharp algorithms, the actual resolution
near the outer edge of the scan field can degrade to that of a “soft” algorithm. To avoid this blurring, the best policy is to position
the anatomy within a central area with a diameter of 15 cm or less.

Another recommendation, which will increase size of this central sharp area a bit, is to use a small focal spot. To make sure that
the scanner is actually using a small focal spot, the mA in manual mA mode must be no more than a value that depends on the
kV setting and that can be found in the Technical Reference Manual for the scanner being used. In auto or smart mA mode the
maximum mA setting must be limited to no more than that same value. Here are example values for the Revolution EVO/Optima
CT660 and for the Revolution Discovery CT/Discovery CT750 HD, indicating the maximum mA allowed for the small focal spot:

Revolution EVO/Optima CT660 mA limits for small focal spot Revolution Discovery CT/Discovery CT750 HD mA limits for small focal spot
kV Normal Scan Mode Normal/Hi Res Scan Mode
80 300 mA 620/610 mA
100 240 mA 650/490 mA
120 200 mA 540/405 mA
140 170 mA 460/350 mA

As you can see from the above table, the Revolution Discovery CT/Discovery CT750 HD scanners have an additional scan mode­­“Hi
Res”. This allows an even greater increase in the size of the sharp central “sweet spot” in the scan. This scan mode can be used with
either the large or small focal spot, but the greatest advantage is with the use of the small focal spot. Please note that to take

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advantage of this benefit of using the “Hi Res” scan mode, you DO NOT need to use the additional “HD” reconstruction algorithms that
are available when using this scan mode. In fact, you may prefer the normal, non­HD algorithms since the HD algorithms may cause an

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unacceptable increase in image noise and artifacts. The HD algorithms used in the Hi Res scan mode can produce a resolution limit in
the center of the scan field that is up to 50% greater than achievable with the normal scan mode, but this greater resolution is seldom
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needed or desirable considering the increase in image noise and artifacts that can result.

Neuro CT Protocols
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Adult Brain
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1. Why is helical mode used?

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1. Helical scanning allows recon intervals at less than the slice thickness. The best z­resolution, along with the fullest display
of the clinical information obtained in the scan, is obtained at recon intervals of one­half of the actual slice thickness. The
source images that are used for any reformatted images must be thin slices (1.25 mm for soft tissue and 0.625mm for
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bone) with recon intervals of one­half the slice thickness for optimal image quality. The nearly isotropic voxel volumetric
data that this provides can then be used to generate axial images at any angle through the brain or straighten the images
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through the brain if the patient is not properly positioned. It also allows for the ability to create 2­D reconstructions.
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2. When the patient’s head can be positioned and angled properly for the scan, use helical mode and the axial images can be
read without reformatting.
3. A helical scan mode followed by angled recons can be used when one cannot adequately position the patient’s head (e.g.,
cervical collar).
2. Why is axial mode used?
This is used when the patient’s head cannot be positioned properly and also when helical scans would produce artifact from
metal projecting over the posterior fossa.
3. Why not use an even lower dose than what’s in the protocol?
This would result in decreased contrast resolution and a worse signal­to­noise ratio making subtle lesions imperceptible. Grey­
white matter differentiation would also become more difficult.
4. Do you scan the head CT to include orbits or tip the head down to exclude orbits?
The head is scanned to include the orbits since we consider it to be an important part of the exam. It is acknowledged that some
facilities do not wish to image the orbits because of fear of inducing cataracts. Many of these facilities may not realize that by
just missing the orbits, they are still exposing them to the radiation beam. University of Wisconsin­Madison does not believe
that the very small level of possible risk for inducing cataracts is sufficient to exclude the diagnostic information obtained in this
method of imaging.
5. Why is Auto/Smart mA used on heads?
Auto mA or Smart mA is used to optimize image quality at the lowest dose. The brain is not a uniform cylinder—obviously it is
smaller toward the top and its cross­section is oval and not circular. Head attenuation is also not the same for all patients (bone
density and thickness). Thus there is definitely an advantage to using Smart mA, and it does not cause any imaging problems.
When the axial mode is used to perform head scans, then Manual mA is used. The problem here is the noticeable change in noise
texture between axial slabs if the mA were to change. This problem is not seen with helical scanning. Helical scanning allows
one to reconstruct at intervals of ½ the actual slice thickness, which improves diagnostic information in the axial scans and
improves Sagittal and Coronal reformats.

Revolution Discovery CT / Discovery CT750 HD 466 Rev: 3.0 / December 2017

 6. Why is the noise index different between the adult brain routine and adult brain helical scan with angled axial
reformats?
Effectively they are the same. One noise index is set for an initial slice thickness of 5.0mm while the other is set for a slice
thickness of 1.25mm and therefore needs to be twice the setting used for 5.0mm.

Adult Orbit

1. When is intravenous contrast used?

IV contrast is useful in suspected or known tumor, infection, or vascular malformation.
2. Why is the bone plus algorithm utilzied?
This helps in assessing bony changes from tumor (e.g., smooth remodeling versus aggressive destruction) or infection.
3. Why can’t one simply use soft tissue algorithm with bone windows?
This would have diminished bony detail compared to true bone plus algorithm, and subtle destructive lesions could be
obscured.
4. Why use Auto/Smart mA?
Except for scanning using the axial mode, for all standard scanning helical mode is used with Smart mA. This includes the
protocols for the orbit, sinus, facial bones and temporal bones. Using Smart mA simply gives more consistent image quality at
the lowest dose and does not produce any image quality problems. We are unaware of any situation in which it would be
advantageous to turn the Smart mA function off when using Auto mA.

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Adult Maxillofacial
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1. Do I need to scan the mandible, as well as the face?
Yes. Up to 10% of patients with facial trauma will have coexistent mandibular fractures.
2. Why do I need 0.625 mm slices?
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This slice thickness is needed for isotropic voxel resolution allowing for high quality multiplanar reconstructions.
3. Why isn’t a lower dose used?
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Soft tissue evaluation is also mandatory with facial trauma and higher dose is needed for adequate soft tissue imaging.
4. Why do I need so many different reconstructions?
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Different planes may better demonstrate subtle fractures, allowing for more accurate diagnosis.
5. Do I need to do soft tissue reconstructions in facial trauma patients?
Facial trauma also affects the soft tissues of the orbit and face. These lesions will not be adequately visualized on the bone
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algorithm images.
6. Why use Auto/Smart mA?
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See same question under 'Adult Orbit' subsection of "Neuro CT Protocols".

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Adult Sinuses

1. When is contrast needed?

For evaluation of suspected tumors, atypical infections, suspected extra­sinus spread of infections, or possible vascular lesions.
2. Is CT as good as MRI for evaluating the sinuses?
It depends on the problem that is being evaluated. They are often complimentary studies, especially for assessment of sino­
nasal masses, and both may be required in some instances.
3. Why use Auto/Smart mA?
See same question under 'Adult Orbit' subsection of "Neuro CT Protocols".

Adult Temporal Bone

1. What is the optimal slice thickness?

For temporal bone imaging, in general, the thinner the slice, the better.
2. When is contrast needed?
For evaluation of infection or inflammatory processes. In addition, it can be used in evaluation of possible tumors in patients
who cannot have an MRI, although it is not typically as sensitive as MRI. Please note that adequate mAs must be utilized for soft
tissue resolution.
3. Why aren’t direct coronal images obtained?
If adequate slice thickness (i.e., 0.625 mm) is obtained, then multiplanar reconstructions will be comparable in quality without
the additional patient dose. It saves a great deal of time and shortens the exam considerably. The coronal plane can be correct
for each patient and not limited by tilt or ability to position patient in direct coronal position.
4. Why use Auto/Smart mA? See same question under 'Adult Orbit' subsection of "Neuro CT Protocols".
Revolution Discovery CT / Discovery CT750 HD 467 Rev: 3.0 / December 2017
Adult Neck

1. Why is 140 kV used?

This higher kV is needed for adequate penetration of the shoulders. The use of a lower kV setting would result in streaking
artifacts through the shoulders and reduced image quality including increased image noise.
2. Why is the scan started at the aortic arch?
1. The scan follows the contrast bolus.
2. Needed for evaluation of left true vocal fold palsy.
3. Allows assessment of mediastinal nodal disease, which is often present in head and neck cancer.
4. Allows for evaluation for the lower limit of retropharyngeal pathology.
3. Why is only a 0.5xx:1 pitch used for a CTA neck?The low pitch reduces helical artifacts, particularly when the anatomy is
changing so rapidly as in the neck/shoulder region. Also, the low pitch avoids reaching the scanner’s maximum mA value in the
lateral direction through the shoulder, which would compromise the image quality.
4. Please explain the rationale for 140 kV and 0.5xx:1 pitch.
140 kV is used to assure proper penetration through the shoulders, which can otherwise be an annoying source of noise and
artifact. The 0.5xx:1 pitch is to minimize artifacts due to the substantial attenuation changes from the transitions from the
shoulders and to allow enough effective mAs to penetrate the shoulders. For the same image noise the dose is lower using the
0.5xx:1 pitch compared to the 0.9xx:1 pitch on the GE 64­slice scanners, as noted previously.

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Adult Cervical Spine

1. Why is 140 kV used? 01 ma ele

This higher kV is needed for adequate penetration of the shoulders. The use of a lower kV setting would result in streaking
artifacts through the shoulders and reduced image quality including increased image noise.
2. Why are images so grainy in the lower cervical spine with soft tissue windows?
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The exam is obtained with a noise index, which allows for good visualization of the bones for fractures and adequate evaluation
of most significant soft tissue pathology with this dose. Adjustments can be made for dosing per preference.
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3. Why are soft tissue reconstructions obtained in trauma?

These are used to detect additional trauma such as soft tissue hematomas, epidural or subdural hematoma, traumatic disc
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herniation, and possible spinal cord injury.

4. Why are 2­D multiplanar bone reformations obtained?
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Because 1) some fractures may be more adequately seen in different planes than others; and 2) multiplanar 2­D reformations
allow for improved visualization of subluxation.
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Pediatric Routine Cervical Spine

1. Why use 0.8s rotation time on a child, age 3 to 6 years?

To avoid reaching the scanner’s maximum mA in the lateral direction through the shoulder, which would compromise the image
quality.

Adult Thoracic Spine

1. Why are reformats created on trauma CT chest/abdomen/pelvis?

1. This option can be used with unstable patients who need multiple body parts to be quickly scanned and there is not
adequate time to obtain standard thoracic spine CT images.
2. Additionally, in patients with low likelihood of trauma, this helps to reduce radiation dose. If there is a high likelihood of
significant thoracic spine fracture, a dedicated thoracic spine CT should obtained.
2. Why are the axial soft tissue reconstructions and sagittal 2D reformatted thoracic spine images that are obtained from
secondary reconstructions of trauma CT chest/abdomen/pelvis studies so grainy?
A lower mA is utilized with this option to limit radiation dose. If there is a high likelihood of thoracic spinal injury, a dedicated
thoracic spine study should be performed. Individual institutions may also increase the dose per preference.

Vascular CTA

1. Why are images obtained cranial to caudal with a head and neck CT angiography protocol?
This is designed to reduce venous contamination intracranially, allowing for improved sensitivity for aneurysm detection.
2. Why is smart prep used instead of a timing bolus?
Less contrast is utilized. Venous contamination is also avoided.
Revolution Discovery CT / Discovery CT750 HD 468 Rev: 3.0 / December 2017
 3. Why are so many reconstructions obtained?
This allows for improved pathology detection. Individual institutions may modify the reconstructions created per preference.

Intracranial Perfusion

1. Can I modify the radiation dose?

The FDA has strict regulations regarding dose with perfusion imaging, and therefore, it is not recommended. Future updates to
these protocols may utilize even lower dose parameters.
2. Why is VolumeShuttle mode used?
This increases the area of brain that can be covered.

Axial vs. Helical Pediatric Head

1. In pediatric protocols for the head, does the University of Wisconsin­Madison use Manual mA or Automatic Exposure
Control? If Automatic Exposure Control, is the max mA listed in the protocols too high for a 3­6 year old compared to
that listed for a 0­3 year old?
The University of Wisconsin­Madison uses Smart mA for all scans performed with helical scanning. In the unusual circumstance
that Manual mA is used, the scan parameters are selected to give a comparable dose and image quality as compared to the

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helical scanning. With helical scanning, the Noise Index is slightly higher with the 0­3 year old protocol compared with the 3­6
year old protocol, but the image quality is similar since the 0­3 year old protocol is performed using a lower kV (better

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contrast). In protocols that use Manual mA, the mA settings are adjusted to give comparable image quality with a lower kV,
reducing dose and increasing image contrast for the 0­3 year old protocol compared to the 3­6 year old protocol.
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Pediatric CT Protocols
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1. Why are there only five different size­based protocols from the University of Wisconsin­Madison whereas GE has nine?
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GE has set up nine separate protocols based on the Broselow color­based system. This system is predominantly used for the
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purposes of emergent medication dosing and equipment selection such as catheter and endotracheal tube size during pediatric
resuscitation. There is not enough difference between each of these nine categories in terms of scan parameters and dose to
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warrant this many gradations. University of Wisconsin­Madison uses AP + lateral measurements to place the pediatric patients
into 5 categories, correlating with approximate ages of newborn (Broselow pink); 6 months­2.5 years (Broselow red and
purple); 3­7 years (Broselow yellow and white); 8­12 years (Broselow blue and orange); and 13­18 years (Broselow green and
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black).
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2. The University of Wisconsin­Madison pediatric protocols have doses that are actually higher than what our institution
has been using lately. What is the rationale behind the pediatric parameters?
We at the University of Wisconsin­Madison applaud your dose reduction in pediatric imaging. As these protocols are being
introduced they are going to a wide spectrum of imaging centers, some of which have not yet reduced pediatric CT dose. In
order to provide imaging quality to the unaccustomed eye of a radiology group scanning at a higher dose, we have provided two
different sets of pediatric protocols. One set contains the relatively low dose protocols that we use at the University of
Wisconsin­Madison. A second set contains higher image quality, higher dose protocols for those more comfortable with this
image quality level. If you would like to continue using your existing pediatric protocols, we encourage you to confirm that they
are at an appropriately low dose with adequate image quality, across the spectrum of pediatric sizes.
3. Why are some pediatric images so noisy?
It is mandatory to keep the dose low for pediatric patients. However, image quality should be interpretable. If you are
intermittently having poor quality pediatric studies, we encourage you to reevaluate patient centering in the gantry. In our
experience, it is the most frequent cause of poor image quality. Proper centering is critical to image quality in small patients.
4. Why is the protocol different for outpatients versus ER patients in the evaluation of appendicitis?
Outpatients are generally not as sick. They are less likely to have appendicitis, but may be more likely to have another reason for
their abdominal pain, thus we should image the entire abdomen and pelvis rather than decrease the FOV to include only the
lower abdomen and pelvis where the appendix lives.
5. Why is there no protocol for pediatric patients with bowel obstruction?
The most common cause of bowel obstruction in a child is intussusception, for which ultrasound is the appropriate test to
perform. Unlike adults, most children have not had surgery and therefore do not have adhesions causing obstruction. If a child
has had prior surgery, then the routine abdomen and pelvis protocol should be used.
6. Why do pediatric CTA’s not include a non­contrast enhanced set of images?
These most often do not provide additional information in children and only add to the total radiation dose.
7. When evaluating the chest for metastatic disease in patients with osteosarcoma, why do you not give contrast?
Osteosarcoma metastases often calcify, making them easy to detect. Unlike other types of tumors, osteosarcoma does not
Revolution Discovery CT / Discovery CT750 HD 469 Rev: 3.0 / December 2017
 metastasize to lymph nodes, so contrast is not necessary to delineate normal mediastinal structures from abnormal lymph
nodes.
8. When evaluating for infection and/or empyema in a child, why is contrast given?
Contrast is helpful in evaluation of pleural thickening and septations. Additionally, the presence or absence of enhancement in
the involved lung is helpful in determining the presence of necrotizing pneumonia.
9. Why is there a separate protocol for non­contrast chest CT in evaluation of pectus excavatum?
A routine non­contrast CT of the chest does not include the entire rib cage. Additionally, since the concern is only about the
osseous structures, dose can be reduced even farther.
10. Why is a routine chest CT with contrast performed rather than a CTA when evaluating patients with clinical suspicion
of a vascular ring?
Vascular rings can involve the aortic arch or pulmonary veins, so both need to be opacified during image acquisition. Performing
a CTA would only opacify the aorta and branch vessels. Additional scans might be required to evaluate for pulmonary sling,
adding to the total radiation dose.
11. Why is a 0.5xx:1 pitch used on the 13­18 age group?
This allows sufficient mA range with the fastest rotation time. The 0.5xx:1 pitch provides the best helical image quality and also
a lower dose than the 0.9xx:1 pitch at a given image quality.

Physics/Technical Comments on Scan & Reconstruction Parameters

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1. Is there a reason why Dose Reduction Guidance is not used in the protocols?

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1. When the Dose Reduction Guidance is used, there is a limit imposed on the min mA allowed, which poses a problem for
our protocols.
2. Dose Reduction Guidance is not available on the Discovery CT750 HD scanner, and we wished to be consistent in the
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protocols across GE CT platforms.
3. Our radiologists have approved the use of a certain percent ASiR for the different exams and do not want to have it altered
by the Dose Reduction Guidance.
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2. Why do you use Smart mA instead of Auto mA or Manual mA?
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The UW protocols always rely on the Smart mA function when the Auto mA is turned on. We do not see any situation in which it
would be advantageous to turn the Smart mA function off. Smart mA includes both mA modulation as the patient attenuation
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changes along the length of the patient and also mA modulation as the tube rotates around the patient. This is always
advantageous and is essential in areas of the anatomy where the patient size / attenuation varies dramatically with direction,
such as the shoulders and pelvis. It is even useful in scanning the head, since the AP and lateral dimensions of the head are not
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the same.
3. Why use Auto/Smart mA?
Except for scanning using the axial mode, for all standard scanning helical mode is used with Smart mA. This includes the
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protocols for the orbit, sinus, facial bones and temporal bones. Using Smart mA simply gives consistent image quality at the
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lowest dose and has not produced any image quality problems. Also, no situation has been identified in which it would be
advantageous to turn the Smart mA function off when using Auto mA.
4. Why is a 0.5xx:1 pitch used for most of the UW protocols?
University of Wisconsin­Madison uses the 0.5xx:1 pitch for several reasons: (1) it provides optimized helical reconstructions,
compared to higher pitches; and (2) for the same image noise, it produces a 20% lower dose than does the 0.9 pitch (which is
why that pitch is avoided). University of Wisconsin­Madison uses 0.4s or 0.5s rotation times when possible to reduce scan times
with the lower pitch. When that is not sufficient, as in PE studies, the pitch is increased to 1.375. The use of a lower pitch is
possible with the GE 64­slice scanners because of the wider beam collimation of 40mm compared to 20mm, which doubles the
table speed for any particular pitch and rotation time. This also allows the scanning of larger patients without hitting max mA
and degrading image quality.
5. Why do you use a Helical Scan Type instead of Axial for nearly all your protocols?
The use of Helical scanning has several advantages over Axial. Faster area coverage, with less chance of patient motion during
the scan, is an obvious advantage. Helical scanning decreases the effects of cone­beam artifacts with multi­slice scanning. One
great advantage of helical scanning is the ability to prescribe Recon Intervals at less than the slice thickness. The best
z­resolution, along with the fullest display of the clinical information obtained in the scan, is obtained at intervals of one­half of
the actual slice thickness. In addition, the source images that are used to create any reformatted images must be thin slices
(1.25mm for soft tissue and 0.625mm for bone) with recon intervals of one­half the slice thickness for optimal image quality.
This is an advantage of helical scanning that is often not utilized.
6. Why do you consistently use a Recon Interval that is smaller than the slice thickness? Doesn’t a Recon Interval equal to
the slice thickness provide all the available clinical information?
The University of Wisconsin­Madison uses a reconstruction Interval that is half of the actual slice thickness because using a
Recon Interval equal to the slice thickness does not in fact provide all the available clinical information from the patient scan.
Both mathematics and clinical experience show that the full display of the clinical information obtained in the scan is obtained
Revolution Discovery CT / Discovery CT750 HD 470 Rev: 3.0 / December 2017
 by using intervals of one­half of the actual slice thickness. You DO NOT want to waste any information obtained from the
radiation exposure of a patient.
7. Why do you not use the Pediatric Scan Field of View (SFOV) for any of your pediatric protocols?
The Pediatric Head and Body protocols substantially limit the maximum allowed mA that can be used in manual or Auto/ Smart
mA modes. At 140, 120, 100, and 80 kV, the maximum mA is limited to 210, 250, 300, and 375, respectively. The rationale is to
limit the dose to pediatric patients. However, the actual result is to limit the use of faster rotation times or higher pitches that
will allow a faster exam with less motion artifact. Thus we avoid the use of the pediatric SFOV’s for this reason. We would prefer
to obtain a given patient dose and image quality with a higher mA and shorter rotation time.
8. Why are some of my bone images too blurry, especially those of the shoulders?
See same question under "MSK CT Protocols".
9. Why do you tend to use a fast rotation time with a low pitch? Would not a pitch of 0.9xx:1 and a rotation time of 1.0 s be
equivalent to a pitch of 0.5xx:1 and a rotation time of 0.5 sec?
While it is true that a pitch of 0.9xx:1 and a rotation time of 1.0 s would produce an exam time essentially equal to a pitch of
0.5xx:1 and a rotation time of 0.5 s, and would also require about the same mA values, it would NOT result in the same image
quality. The 0.5xx:1 pitch will have less helical artifact than the 0.9xx:1 pitch and the 0.5 s rotation time will have less motion
artifact than the 1.0 s rotation time. Additionally, the 0.5xx:1 pitch is about 20% more dose efficient in the GE 64 slice scanners
than the 0.9xx:1 pitch. For these reasons a pitch of 0.5xx:1 and a rotation time of 0.5 sec is much preferable to a pitch of 0.9xx:1
and a rotation time of 1.0 s. With scanners that have this option, we even prefer to use the shortest rotation time of 0.4 s when
possible.

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For obese patients, the use of a 0.5xx:1 pitch allows an appropriate technique to be used to obtain a satisfactorily diagnostic
image. If needed, the rotation time can be increased up to 1.0 s for these patients.

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10. When is a pitch higher than 0.5xx:1 used and why is the 1.375 pitch then generally used instead of a pitch of 0.9xx.1?
University of Wisconsin­Madison principally uses the 0.5xx:1 pitch for several reasons: (1) it provides optimized helical
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reconstructions, compared to higher pitches; and (2) for the same image noise, it produces a 20% lower dose than does the
0.9xx.1 pitch (which is why that pitch is avoided). University of Wisconsin­Madison uses 0.4s or 0.5s rotation times when
possible to reduce scan times with the lower pitch. When that is not sufficient, as in PE studies and others requiring a very short
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exam time, the pitch is increased to 1.375. This is often preferred to the 0.9xx:1 pitch because of better dose efficiency at the
1.375 pitch. The use of a lower pitch is possible with the GE 64­slice scanners because of the wider beam collimation of 40mm
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compared to 20mm, which doubles the table speed for any particular pitch and rotation time. This also allows the scanning of
larger patients without hitting max mA and degrading image quality.
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11. What is your strategy for selection of kV?

The selection of optimal kV is dependent on the patient size and the importance of the visualization of iodine contrast in the
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images. As an example, for abdominal non­contrast scans the kV will vary from 80 for the small pediatric patient to 140 kV for a
very obese patient. If the visualization of iodine contrast is important in the imaging, such as for angiography, the same range of
patient size will have a kV variation of 80 to 120 kV. 140 kV is never optimal for visualizing iodine contrast, even in the largest
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patients.
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12. Why do you consistently use a “Plus” Recon Option for Helical Scanning instead of “Full”?
The “Plus” Recon Option provides better image quality than “Full” by reducing Helical artifacts in the images. It also reduces
image noise by about 10% by increasing the actual slice thickness by about 20% from the nominal slice thickness. If a specific
noise index is used, then a change from “Full” to “Plus” will reduce patient dose by about 20%. The following table provides
approximate changes in actual slice thickness in ”Plus” mode:

Normal Slice Thickness Actual Slice Thickness using "Plus" Recon Option Optimal Recon Interval
5.0mm 6.0mm 3.0mm
3.75mm 4.5mm 2.25mm
2.5mm 3.0mm 1.5mm
1.25mm 1.5mm 0.625mm
0.625mm 0.8mm 0.312mm

The 20% increase in slice thickness generally has little negative clinical effect compared to the advantages of using the “Plus” option.
In fact, it is possible to improve z­resolution even with the greater slice thickness by using a reconstruction interval that is one­half of
the actual slice thickness, as shown in the table above. The reconstruction interval for the 1.25 and 0.625 mm nominal slice thickness
remains at half of the nominal slice thickness. This allows the use of “IQ Enhance” to further improve image quality by reducing helical
artifacts in thin slices.

Revolution Discovery CT / Discovery CT750 HD 471 Rev: 3.0 / December 2017