Last Updated on January 21, 2023 by Mohamad Izwan

Anatomy of Pancreas

Courtesy to Wikipedia.org (https://en.wikipedia.org/wiki/Pancreas)

Appearance of CT Pancreas (Venous Phase)

Auto scroll of CT TAP image in axial cut.

Examination Overview

Protocol Structure

00_Pancreas_4Phase (Adult)

    • Topogram
    • Non Contrast above diaphragm to ischial rami)

Contrast

    • Late Arterial Phase 
      • (above diaphragm to ischial rami)
    • Portal Venous Phase
      • (above diaphragm to ischial rami)
    • Delayed 5 Minutes (optional)
      • Full abdomen (above diaphragm to the ischial rami)
      • Urinary Bladder (half of ilium 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 mid sternum to start the topogram.

Topogram Parameters

  • Topogram length: 768 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 mid heart
  • 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: Pre-Contrast
  • Pitch: 0.6
  • Quality Reference mAs : 230

Reconstruction of Pancreas Non Contrast

Contrast

Type of contrast used:

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

Needle Placement Test:

    • Flow Rate: 4.5 ml/sec
    • Volume of Normal Saline: 20 ml

Contrast Injection:

    • Volume of Contrast Media:
      • 100 ml (normal body type)
      • 120 ml (large body type)
    • Volume of Normal Saline: 50 ml
    • Method of injection: Contrast Injector Dual Phase

Injector setup for Normal Body Size

Injector setup for Large Body Size

Post Contrast Scan Planning

TAP IV

  • Plan the Scan FOV (SFOV) box at topogram image.
  • Set the top line at the level upper shoulder.
  • Set the bottom line at the level of iliac crest.
  • Ensure the lateral line to cover patient’s body outline.
  • Remind the patient before scanning as the breathing instruction will be given.
  • Delay: 60 seconds (to get Late Arterial Phase of Thorax and Portal Venous Phase of Abdomen and Pelvis).

Reconstruction of TAP IV

Delayed 5 Minutes (Optional)

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

Reconstruction of Delayed

Multiplanar Reconstruction (MPR)

Coronal TAP IV

  • Image Thickness: 3.0 mm
  • Number of Image: 19
  • Coverage: Anterior to Posterior of abdomen

Series of Images Send to PACS

  1. Topogram
  2. Non Contrast 5.0 B30f
  3. Non Contrast 1.0 B20f
  4. PVP 5.0 B30f
  5. PVP 1.0 B20f
  6. Delayed 15 Min 5.0 B30f
  7. Delayed 15 Min 1.0 B20f
  8. Patient Protocol
  9. COR TAP IV