Name Abdul Shakoor Khan

Reg no Mid02163110
Assignment Topic Protocol of Abdomen
Submitted to DR Hasham
PROTOCOL OF CT ABDOMEN
Scanning Patient Contrast Oral
Protocol Positioning Medium Preparation

Renal Colic Arrested None None

Expiration

Renal Arrested Iopamidol 100ml None

Malignancy/ Expiration 300
Hematuria (inspiration
If chest
Scanned

Liver, HCC, Arrested Iopamidol 100ml None

FNH, Expiration 300
Cholangio-
Carcinoma

Abdomen/ Arrested Iopamidol 100 ml 2GG

Oncology Expiration 300 over 1 h
Follow-u
Sepsis

Abdomen Arrested Iopamidol 100ml None

Angiogram Expiration 300
Coeliac axis
Etc

Pancreas/ Arrested Iopamidol 100ml Water+1GG

Pancreatitis Expiration 300 30 min
Pseudocyst before
Scanning Patient Contrast Oral
Protocol Positioning Medium Preparation

Pancrease Arrested Iopamidol 100ml 1GG+Water

Tumor/ Expiration 300
Tumor
Staging

Pancrease Arrested Iopamidol 100ml 1GG+Water

Insulinoma/ Expiration 300
Vascular
Mapping

Oesophagus Arrested Iopamidol 100ml Water only

Gastric cancer Respiration 300
Staging

Colon Arrested Iopamidol 100ml 4GG

Standard Respiration 300 over 36 h

Colon Arrested Iopamidol 100ml NO GG

Colonoscopy Respiration 300

Supine to pubic Picolax

Symphysis buscopan

Prone Pelvis Iopamidol 100ml None

Adrenals/ Arrested 300
Adenoma Inspiration

ABDOMEN (routine protocol)

KV / effective mAs /  120 / 200 / 0.5 seconds
rotation time

Detector collimation  1.5 mm

Slice Thickness  3.0 mm

Pitch  0.75

Kernel  B30f

Increment   3.0 mm

Image order  Cranial to caudad. Image from above

diaphragm to greater trochanters. One
acquision.

Oral Contrast  INPATIENTS: 250cc’s of water mixed with 7cc

of Gastroview = 1 dose.
     1 Dose given orally every ½ hour for two
hours prior to exam
 OUTPATIENTS: 1 bottle of Redicat taken
orally two hours before exam. ½ bottle of
     Redicat given 45 minutes prior to exam.
Last ½ of 2nd Redicat bottle given on
     the CT table.
Intravenous Contrast  100 cc Isovue 300 at 3 cc/sec.
 18 – 22 ga IV needed preferably in the AC.
Scan Delay  75 seconds

Reconstruction  Oral contrast on table.

 Second recon: kernel 80 lungs only.
INDICATIONS
 Evaluation of abdominal, flank, or pelvic pain, including evaluation
of suspected or known urinary calculi and appendicitis

 Evaluation of known or suspected abdominal or pelvic masses or

fluid collections.

 Evaluation of primary or metastatic malignancies.

 Evaluation of diffuse liver.

 .Assessment for recurrence of tumors following surgical resection.

 Detection of complications following abdominal and pelvic

surgery.

 Evaluation of abdominal or pelvic inflammatory processes,

including inflammatory bowel disease, infectious bowel disease
and its complications, without or with CT enterography.

 Assessment of abnormalities of abdominal or pelvic vascular

structures.

 Evaluation of abdominal or pelvic trauma.

 Clarification of findings from other imaging studies or laboratory

abnormalities.
 Evaluation of known or suspected congenital abnormalities of
abdominal or pelvic organs.
 Evaluation for small bowel or large bowel obstruction.

Guidance for interventional or therapeutic procedures within the

abdomen or pelvis.
 Treatment planning for radiation and chemotherapy and
evaluation of tumor response to treatment.

 Pre- and post-transplant assessment.

CONTRAINDICATIONS
 Due to the relatively high radiation dose involved in CT scans, it is
important to avoid scanning patients who are pregnant.

 Radiation exposure to a fetus can cause developmental problems.

Thus, CT should only be performed for pregnant patients in critical
situations and only after discussion of the potential risks

 Patients who have an allergy to the IV contrast media (IVCM) used

in CT scans should not be referred for scans where IVCM is
required to attain a diagnosis. These tests include CT angiograms
and most abdominal and chest scans

 Renal impairment may also prohibit your patient from having

IVCM. You should check the patient’s creatinine and eGFR prior to
referral.

 All scanners will have weight limits that are specified by the
manufacturers. Newer scanners have higher limits than their
predecessors with some able to accommodate 220kg

 Despite these weight recommendations, there may be limitations

to the patient’s size. The gantry of the scanner is a fixed diameter
and if the patient cannot fit through the gantry, the scan cannot
be performe

 A common diameter is about 70cm.

Patient Positioning
The technologist begins by positioning you on the CT exam table,
usually lying flat on your back. Straps and pillows may be used to
help you maintain the correct position and remain still during the
exam
Many scanners are fast enough that children can be scanned
without sedation.
In special cases, sedation may be needed for children who cannot
hold still. Motion will cause blurring of the images and degrade the
quality of the examination the same way that it affects
photographs.
If contrast material is used, depending on the type of exam, it will
be swallowed, injected through an intravenous line (IV) or, rarely,
administered by enema.
Next, the table will move quickly through the scanner to determine
the correct starting position for the scans. Then, the table will
move slowly through the machine as the actual CT scanning is
performed. Depending on the type of CT scan, the machine may
make several passes.
You may be asked to hold your breath during the scanning. Any
motion, including breathing and body movements, can lead
to artifacts on the images. This loss of image quality can resemble
the blurring seen on a photograph taken of a moving object.
When the exam is complete, you will be asked to wait until the
technologist verifies that the images are of high enough quality for
accurate interpretation.
The CT examination is usually completed within a few minutes.
However, if you are required to drink oral contrast you will be
asked to arrive approximately two hours prior to your scan time or
begin drinking the contrast at home prior to arriving.
Patient Preparation
PRECAUTIONS:
 If you are pregnant or think you may be pregnant, please
check with your doctor before scheduling the exam.
 Other options will be discussed with you and your doctor.

CLOTHING:
 You may be asked to change into a patient gown. If so, a
gown will be provided for you.
 A locker will be provided to secure personal belongings.
Please remove all piercings and leave all jewelry and
valuables at home.

CONTRAST MEDIA:
CT scans are most frequently done with and without a contrast
media. The contrast media improves the radiologist's ability to
view the images of the inside of the body.

 Some patients should not have an iodine-based contrast

media.

 If you have problems with your kidney function, please

inform the access center representative when you schedule
the appointment.

 You may be able to have the scan performed without

contrast media or have an alternative imaging exam.

 You will be asked to sign a consent form that will detail the
risks and side-effects associated with contrast media
injected through a small tube places in a vein called an
intravenous (IV) line.
  The most common type of CT scan with contrast is the
double contrast study that will require you to drink a contrast
media before your exam begins in addition to the IV contrast.

 The more contrast you are able to drink, the better the
images are for the radiologist to visualize your digestive
tract.

ALLERGY:
 Please inform the access center representative when you
schedule your CT scan if you have had an allergic reaction
to any contrast media.

 IV contrast will not be administered if you have had a severe

or anaphylactic reaction to any contrast media in the past.

 If you had mild to moderate reactions in the past, you will

likely need to take medication prior to the CT scan. These
plans will be discussed with you in detail when you schedule
your exam.
Any known reactions to a contrast media should be discussed
with your personal physician.

 EAT/DRINK:

 If your doctor ordered a CT scan without contrast, you can

eat, drink and take your prescribed medications prior to your
exam. \
 If your doctor ordered a CT scan with contrast, do not eat
anything three hours prior to your CT scan.
  You are encouraged to drink clear liquids. You may also take
your prescribed medications prior to your exam.
DIABETICS:
 Diabetics should eat a light breakfast or lunch three hours
prior to the scan time. Depending on your oral medication for
diabetes, you may be asked to discontinue use of the
medication for 48 hours after the CT scan.
.
MEDICATION:
o All patients can take their prescribed medications as
usual.

o Based on your medical condition, your doctor may

request other specific preparation.

Side effects of an abdominal CT

scan
The side effects of an abdominal CT scan are most often
caused by a reaction to any contrast used. In most cases,
they’re mild. However, if they become more severe, you
should call your doctor right away.

Side effects of barium contrast can include:

 abdominal cramping
 diarrhea
 nausea or vomiting
  constipation

Side effects of iodine contrast can include:

 skin rash or hives
 itching
 headache

If you’re given either type of contrast and have severe

symptoms, call your doctor or go to the emergency room
right away. These symptoms include:

 trouble breathing
 rapid heart rate
 swelling of your throat or other body parts