Emergence CT Protocol

Indications

These are recommendations to maximize the amount of information obtained from any one examination.
The intension is to be able to give the best diagnostic answer for the clinical suspected diagnosis.
There will be times that the clinician has relevant information which may require deviation from normal practice.
However, this should be the exception and not the standard.
Deviated from a recommended protocol to save time in a non-emergent situation is not a reasonable cause to lower the diagnostic capability of the study.

Trauma

  • Head CT without contrast
  • Cervical CT without contrast
  • Chest CT with IV contrast
  • Abdomen Pelvis CT with IV contrast
  • Extremity, Lumbar Spine, Thoracic Spine without contrast

Chest CT with IV Contrast

  • Pulmonary embolism (angiogram with Coronal reconstructions)
  • Mediastinal mass
  • Loculated pleural effusion or empyema
  • Lymphadenopathy
  • Follow up known lung mass
  • Aortic dissection or aneurysm (angiogram with Coronal reconstructions)
  • Pulmonary Nodule
  • Trauma
  • Fever of unknown origin

Chest CT without IV Contrast

  • Pneumonia
  • Evaluate for emphysema (may choose High Resolution CT)
  • Pulmonary Nodule (prefer with, but not a must)
  • Routine Chest Pain
  • Follow up pneumothorax

Abdomen Pelvis CT without IV Contrast

  • Kidney stones

Dynamic CT

  1. Non contrast
  2. Early enhancement
  3. Delayed enhancement

Abdomen Pelvis CT with IV Contrast only Without Enteric

  • Trauma
  • Aortic Aneurysm

Abdomen CT with IV Contrast only Without Enteric

  • Renal Mass (dynamic CT)
  • Adrenal Mass (dynamic CT)
  • Liver Mass

Abdomen Pelvis CT with IV and Enteric Contrast

  • Generalized abdominal pain
  • Right or left lower quadrant abdominal pain
  • Diverticulitis
  • Non trauma pelvic pain
  • Fever of unknown origin
  • Metastatic disease
  • Cancer of unknown primary
  • Hernia (inguinal or ventral)
  • Pancreatic Mass (dynamic of abdomen only but need enteric if possible)
  • Pancreatitis
  • Blood in stool (also give rectal contrast)

CT Urogram

  1. Scan non contrast CT cover diaphragm through inferior urinary bladder.
  2. Inject 75% of IV contrast at 3cc/sec
  3. Inject 200 cc of Normal Saline at 3cc/sec
  4. Scan portovenous phase from inferior kidneys to dome of liver
  5. Delay 8 minutes
  6. Inject 25% of IV contrast at 3cc/sec
  7. Delay 90 seconds
  8. Scan top of kidneys through ischial tuberosities
  9. 3D reformat of the portovenous phase
  10. Coronal reconstruction on the delayed phase
  11. Coronal MIP of the delayed phase

Head CT without IV Contrast

  • Headache
  • Trauma
  • Mental Status Changes
  • Stroke
  • Intra Cranial Bleed
  • Metastatic Disease

Head CT with and without IV Contrast

  • Typically if patient has indication for MRI brain but cannot have MRI due to pace maker etc.
  • Mass or Metastatic Disease if can’t have MRI