NUC RAD SHARE

CARDIAC CT

 


PATIENT PREP & INSTRUCTIONS

 
                     Cardiac CT patient prep and instruction sheet       
CARDIAC CT PATIENT INSTRUCTIONS AND PREP SHEET PRE-CARDIAC CT EVALUATION GUIDELINES GUIDE TIPS       

PATIENT QUESTIONNAIRE 

 
              Cardiac CT patient questionnaire
CARDIAC CORONARY CT PATIENT QUESTIONNAIRE

64-SLICE PROTOCOL & IMAGING TIPS 

 
Cardiac CT imaging tips and protocol
64-SLICE MDCT CARDIAC CORONARY CT IMAGING PHILIPS PROTOCOL DETAILED PARAMETERS CABG STENT TRIPLE RULO OUT SHUNT MASS 
                                                                                              PHILIPS 64-SLICE MDCT PROTOCOL
                                                              64-slice cardiac CT detailed imaging protocol parameters        
CARDOAC CORONARY CT 64-SLICE IMAGING PARAMETERS PHILIPS SCOUT KVP MAS CONTRAST BOLUS TRACKING DOSE RIGHT COLLIMATION PITCH MATRIX RECON          

STEP-BY-STEP APPROACH TO CARDIAC CT 
& INTERPRETATION TIPS

 

ACQUISITION


•    Why study? Review indication for study (patient age, weight/body habitus)
•    Ok to give contrast? Contrast consent form (allergy, metformin etc) and Cr
•    ≥20G preferably in right AC
•    Vitals: EKG, HR, BP (SBP>90, otherwise raise legs and give 500cc NS IV bolus)
•    Evaluate EKG for rate, regularity, and tagging (if artifacts, consider checking/replacing electrodes)
•    Instructions: breathhold (without valsalva), hold still (calm), contrast sensation (metallic and flush)
•    Inquire: ask about outpatient PO beta blockers, meds (viagra/levitra/cialis), claustrophobia
•    Call cardiology for: beta blockers and NTG
•    Pick protocol: based on request, patient weight (BMI cutoff 30), HR (cutoff 65bpm)
•    Check injector protocol (input wt range, duration of scan, contrast concentration)
•    make sure at least 100cc (max 120-140cc) contrast and higher rate (6-8cc/s) for larger patients 
•    Setup protocol
•    Do scout (plan coverage): PA and lateral (aortic arch vs carina)
•    Plan calcium scoring 
•    Bolus tracking (4cm below top of scan, w/in desc aorta, 110HU)
•    Plan full-FOV chest CT
•    5-10mg Lopressor IV q5min for 30-50mg total (avoid if asthma, a.fib, block, hypotension, severe AS or CHF, sig ectopy) and may give 5-10mg Diltiazem IV x1
•    Do calcium scoring (make sure good coverage; if severe CAC, may abort CTA)
•    Do NS test bolus (test integrity of IV)
•    Before starting IV contrast (bolus tracking), give 400-800mcg NTG SL (check BP prior to this)—if reflex tachycardia, give additional 5-10mg Lopressor IV
•    Remind patient about breathhold and holding still
•    Check CTA: EKG editing and confirm appropriate coverage (pay attention to LAA for simulated thrombus for which 30-60s delayed scan thru ROI may be obtained)
•    Request appropriate recon phases (0 and 40% needed for functional evaluation; 20 and 30% for valvular evaluation; 40-50% if RCA motion in pts with high HR)     

INTERPRETATION

•    Check dose info (report DLP and calculate EDE)
•    Look at scout (AP and lateral)
•    Perform calcium scoring (make sure to look at calcium without threshold to differentiate calcium from stent etc)—save score report
•    Open 70, 75, 80% and compare to assess which phase is best for coronary vessel analysis
•    Open EKG: record mean HR, look for beat-to-beat HR variability, and EKG for any ectopic beats (perform EKG editing if necessary)—also determine if dose modulation was used
•    Assess sagittal view in bone window for motion (sternum) and axial view in lung window for breathing (pulmonary vessels and diaphragm)
•    Start looking at non-coronary structures (use your “search pattern”)
•    Assess auto segmentation (select “coronaries” only)
•    Extract vessels tree and save (“save results as”)—edit “centerline” or “continue” distal/proximal
•    Assess for CAD (sig stenosis should be confirmed on +/-5% phases)
•    Perform functional analysis with 0% and 40% phases (prefer Simpson method over segmentation if segmentation not accurate) and save functional report
•    Review full FOV chest
•    Save and send pertinent images to PACS
            

CARDIAC CT DICTATION TEMPLATE

 
Cardiac coronary CT dictation and reporting template worksheet
CARDIAC CORONARY CTA CT CALCIUM SCORING CABG STENT REPORTING DICTATION INTERPRETATION TEMPLATE GUIDE        

NORMAL CARDIAC VOLUMES

 
cardiac chamber size volume and ejection fraction normal values reference CT CTA