CT RENAL 4 PHASE

Last Updated on April 14, 2022 by Mohamad Izwan

Anatomy of Renal

Image taken from Microbe Notes

Appearance of CT Renal Images

Auto scroll of CT TAP image in axial cut.

Examination Overview

Protocol Structure

00_Renal_4Phase (Adult)

    • Topogram
    • Non Contrast (Above diaphragm to the ischial rami)

Bolus Tracking

    • Pre Monitoring
      • (At the level of diaphragm)

Contrast

    • Monitoring
      • (At the level of diaphragm)
      • Contrast triggering at the abdominal aorta
      • Triggered when achieve 100HU
    • Cortico
      • Cover entire renal
    • Nephro
      • (above diaphragm to the ischial rami)
    • Excretory 5 Minutes 
      • Full abdomen (above diaphragm to the ischial rami)

Topogram

  • Position the patient in head first supine position.
  • Align the patient in Mid-Sagittal plane of the table.
  • Position the transverse laser light beam at the level of patient’s nipple line to start the topogram.

Topogram Parameters

  • Topogram length: 512 mm
  • Slice: 0.6 mm
  • Scanning direction: Craniocoudal
  • Tube position: Top
  • Stop the topogram scanning when the scanning reach / pass over the inferior ischial ramus.

Non Contrast

  • Plan the Scan FOV (SFOV) box at topogram image.
  • Set the top line at the level of above diaphragm.
  • Set the bottom line at the level of inferior ischial ramus.
  • Ensure the lateral line to cover patient’s body outline.
  • Remind the patient before scanning as the breathing instruction will be given.

Scanning Parameters

  • kV: 100 kV
  • mAs: Tube Current Modulation (TCM)
  • Scanning Direction: Craniocaudal
  • Scan Delay: 4 s
  • Slice: 5.0mm
  • Image Comment: Non Contrast
  • Pitch: 0.6
  • Quality Reference mAs : 230

Reconstruction of Non Contrast

Recon 1Recon 2
NameNon Contrast 5.0 B30fNon Contrast 1.0 B20f
Slice Thickness5.0 mm1.0 mm
Increment5.0 mm0.7 mm
KernelB30f medium smoothB20f smooth
WindowingAbdomenAbdomen

Contrast

Type of contrast used:

    • Non-ionic iodinated contrast media
    • 300 I mg/mol

Needle Placement Test:

    • Flow Rate: 3.5 ml/sec
    • Volume of Normal Saline: 15 ml

Contrast Injection:

    • Volume of Contrast Media:
      • 100 ml (normal body type)
    • Volume of Normal Saline: 50 ml

Injector setup for Normal Body Size

Contrast Normal Saline
Flow rate3.0 ml/sec3.0 ml/sec
Contrast Volume100 ml50 ml

Bolus Tracking

Pre Monitoring

  • Set the scanning line at the level of diaphragm.

Monitoring

  • Ensure the scanning line from Pre-Monitoring is at the level of diaphragm.
  • Ensure the lateral line to cover patient’s body outline.
  • Draw ‘Triggering ROI’ on Abdominal Aorta (left-hand click on Siemens CT console).
  • Set:
    • Delay: 10 seconds
    • HU to triggered : 100HU

Post Contrast Scan Planning

Cortico

  • Plan the Scan FOV (SFOV) box at topogram image.
  • Set the top and bottom line to cover entire renal..
  • Ensure the lateral line to cover patient’s body outline.
  • Remind the patient before scanning as the breathing instruction will be given.
  • Delay after triggering: 10 seconds (enhancement of kidney outer cortex).

Reconstruction of Cortico

Recon 1Recon 2
NameCortico 5.0 B30fCortico 1.0 B20f
Slice Thickness5.0 mm1.0 mm
Increment5.0 mm0.7 mm
KernelB30f medium smoothB20f smooth
WindowingAbdomenAbdomen

Nephro

  • Plan the Scan FOV (SFOV) box at topogram image.
  • Set the top line at the upper abdomen.
  • Set the bottom line at inferior ischial rami.
  • Ensure the lateral line to cover patient’s body outline.
  • Remind the patient before scanning as the breathing instruction will be given.
  • Delay after cortico phase: 35 seconds (enhancement of renal parenchyma including medulla).

Reconstruction of Nephro

Recon 1Recon 2
NameNephro 5.0 B30fNephro 1.0 B20f
Slice Thickness5.0 mm1.0 mm
Increment5.0 mm0.7 mm
KernelB30f medium smoothB20f smooth
WindowingAbdomenAbdomen

Excretory 5 Minutes

  • Full abdomen
    • Plan the Scan FOV (SFOV) box at topogram image
    • Set the top line at the level of above diaphragm.
    • Set the bottom line at the level of inferior ischial rami.
    • Remind the patient before scanning as the breathing instruction will be given.
  • Ensure the lateral line to cover patient’s body outline.

Reconstruction of Excretory 5 minutes

Recon 1Recon 2
NameExcretory 5min 5.0 B30fExcretory 5min 1.0 B20f
Slice Thickness5.0 mm1.0 mm
Increment5.0 mm0.7 mm
KernelB30f Medium SmoothB20f Smooth
WindowingAbdomenAbdomen

Multiplanar Reconstruction (MPR)

Coronal Cortico

  • Image Thickness: 3.0 mm
  • Number of Image: 19
  • Coverage: Entire renal

Coronal Nephro

  • Image Thickness: 3.0 mm
  • Number of Image: 19
  • Coverage: Entire abdomen

Series of Images Send to PACS

  1. Topogram
  2. Non Contrast 5.0 B30f
  3. Non Contrast 1.0 B20f
  4. Cortico 5.0 B30f
  5. Cortico 1.0 B20f
  6. Nephro 5.0 B30f
  7. Nephro 1.0 B20f
  8. Excretory 5min 5.0 B30f
  9. Excretory 5min 1.0 B20f
  10. Patient Protocol
  11. COR Cortico
  12. COR Nephro

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