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)
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 )
- Late Arterial Phase
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
| Recon 1 | Recon 2 | |
|---|---|---|
| Name | Pancreas NC 5.0 B30f | Pancreas NC 1.0 B20f |
| Slice Thickness | 5.0 mm | 1.0 mm |
| Increment | 5.0 mm | 0.7 mm |
| Kernel | B30f Medium Smooth | B20f smooth |
| Windowing | Abdomen | Abdomen |
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
- Volume of Contrast Media:
Injector setup for Normal Body Size
| Contrast A | ContrasB | Normal Saline | |
|---|---|---|---|
| Flow rate | 3.5 ml/sec | 2.5 ml/sec | 3.0 ml/sec |
| Contrast Volume | 80 ml | 20 ml | 50 ml |
Injector setup for Large Body Size
| Contrast A | Contrast B | Normal Saline | |
|---|---|---|---|
| Flow rate | 3.5 ml/sec | 2.5 ml/sec | 3.0 ml/sec |
| Contrast Volume | 100 - 130 ml | 20 ml | 50 ml |
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
| Recon 1 | Recon 2 | Recon 3 | Recon 4 | |
|---|---|---|---|---|
| Name | Thorax IV 5.0 B31f | Lung IV 5.0 B70f | TAP IV 5.0 B30f | TAP IV 1.0 B30f |
| Slice Thickness | 5.0 mm | 5.0 mm | 5.0 mm | 1.0 mm |
| Increment | 5.0 mm | 5.0 mm | 5.0 mm | 0.7 mm |
| Kernel | B31f medium smooth | B70f Very Sharp | B30f Medium Smooth | B30f Medium Smooth |
| Windowing | Mediastinum | Abdomen | Lung | Abdomen |
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
| Recon 1 | Recon 2 | |
|---|---|---|
| Name | DELAY 5.0 B30f | Delay 1.0 B20f |
| Slice Thickness | 5.0 mm | 1.0 mm |
| Increment | 5.0 mm | 0.7 mm |
| Kernel | B30f Medium Smooth | B20f Smooth |
| Windowing | Abdomen | Abdomen |
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
- Topogram
- Non Contrast 5.0 B30f
- Non Contrast 1.0 B20f
- PVP 5.0 B30f
- PVP 1.0 B20f
- Delayed 15 Min 5.0 B30f
- Delayed 15 Min 1.0 B20f
- Patient Protocol
- COR TAP IV
