CT Protocols: Emergency, Acute Medical & Acute Surgical
**Updated 2024**
Created for radiographers, radiology registrars and JMOs involved in requesting/protocolling CT scans
CT Protocols vary based institution, please check with your institution
Table of Contents
Part 1: Introduction & Neuro Protocols
Part 2: MSK/Spine & Chest CT Protocols
Part 3: Abdomen & Pelvis CT Protocols
Part 4: CT Protocol Summary Cheat Sheet
CT Protocols vary based institution, please check with your institution
Premedication for IV contrast allergy (please check with your institution)
Emergency setting: 200mg hydrocortisone IV every 4 hrs + 15mg Promethazine slow IV 1 hr before scan
Inpatients / Outpatients: Prednisolone 50mg PO (approx. 13 hrs, 7 hrs & 1 hr) + Fexofenadine 180mg PO 1 hr before
Anaphylaxis IV contrast is an absolute contraindication to IV contrast
|
INDICATION |
PROTOCOL |
|
TRAUMA
|
CT Brain + CT Cervical Spine non contrast CT Chest, Abdomen and Pelvis (arterial and PV) |
|
MSK |
|
| ?Fracture | As per body part (non-contrast imaging) |
| Multiple myeloma | CT Skeletal survey non-contrast |
|
BRAIN |
|
| Fall with headstrike, head trauma meeting Canadian CT brain criteria, reduced GCS with unclear cause, ?intracranial haemorrhage | CT Brain non contrast |
|
Seizures with reduced GCS, first episode seizures with unclear cause, ?Brain metastases/tumour |
CT Brain pre and post IV contrast |
| ? Venous sinus thrombosis | CT brain non contrast + Venogram phase (IV contrast) |
| Stroke Call | CT Brain pre and post IV contrast, CT Carotid Angiogram and COW, CT Perfusion |
| ? Dissection, aneurysm rupture, AVM, dAVF | CT Brain pre and post IV contrast, CT Carotid Angiogram and COW (up to vertex) |
| Facial trauma ? fracture | CT Facial Bones non contrast |
| Orbital cellulitis | CT Orbits post IV contrast |
| Conductive hearing loss, cholesteatoma, otitis/mastoiditis | CT Petrous Temporal Bones non-contrast |
| Rhinosinusitis, sinonasal tumour | CT Paranasal Sinuses non-contrast |
|
NECK |
|
| Clinician unable to clear C-spine clinically | CT Cervical Spine non-contrast |
| Concerns re: rapidly spreading deep space infection, tonsillar or peritonsillar abscess, retropharyngeal collection, septic thrombosis of neck vessels. | CT Soft Tissue Neck post IV contrast |
| Fish bone / foreign body | CT Soft Tissue Neck non-contrast |
| Parathyroid Adenoma | 4D CT Parathyroid Protocol (non-contrast, arterial & delayed phase) from base of neck to mediastinum |
|
CHEST |
|
| ?PE | CT Pulmonary Angiogram (IV contrast) |
| Massive haemoptysis / ?bronchial artery bleed | CT Thoracic Angiogram with non contrast, arterial phase and delayed phase (IV contrast) |
| ? thoracic aortic dissection, aneurysm rupture, penetrating ulcer, intramural haematoma, acute aortic syndrome |
Low risk & to exclude dissection: CT Thoracic Aortogram (ECG gated non contrast arch then arterial phase thoracic Aortogram) (IV contrast) High risk / known dissection: CT Aortogram ((ECG gated non contrast arch, then arterial phase + portal venous phase of arch to femoral arteries) |
|
Pulmonary abscess or mass, Rib fractures, pulmonary mass |
CT Chest post IV contrast CT Chest non-contrast |
| ?lung fibrosis, interstitial lung disease | HRCT Chest non contrast (supine inspiratory and expiratory, prone views) (non-contrast) |
| SVC, brachiocephalic or subclavian vein thrombosis/obstruction | CT Chest venogram phase (IV contrast) (put IVC in non-affected side arm) |
| Intermediate Chest Pain |
CT Coronary Angiogram (ECG gated non contrast + ECG gated CTCA) – no caffeine for 24hrs, HR 60-70bpm, large cannula >18G If prior CABG, scan from clavicles down to include CABG graft |
| Atrial/ventricular thrombus, mass or valvular lesion. Post pacemaker placement ?myocardial perforation | CT Cardiac Chambers (arterial phase to assess left heart, delayed phase to assess right heart chambers) |
|
ABDOMEN AND PELVIS |
|
| Hollow viscus perforation, overwhelming sepsis with likely abdominal source | CT Abdomen and Pelvis (IV contrast only). Oral contrast may be given if clinician requests however will delay scan by 1-1.5hrs to allow time oral contrast to pass through to colon |
| ?renal tract obstruction with renal function derangement or urosepsis. | CT Renal Tract (prone position) (non-contrast) |
| Active GI bleed, PR bleeding/melaena | CT Mesenteric Angiogram (non contrast, arterial and delayed phases) – no oral contrast!!! Scan ASAP when they start bleeding or you may miss the bleed |
| Suspected intestinal ischaemia, elevated lactate | CT Mesenteric Angiogram (arterial and portal venous phases) (IV contrast) |
| ?hepatocellular carcinoma or other liver mass | CT Multiphase Liver (non contrast, arterial, portal venous and delayed phase) |
| ?choledocholithiasis ?bile leak | CT Cholangiogram (bilirubin < 30, IV biliscopin given as IV infusion with nurse) (no IV contrast) |
| Adrenal mass assessment | CT Adrenal Multiphase (non-contrast, portal venous, 15 minute delayed) – stop scan if adrenal lesion <10 HU on non-contrast phase |
|
VASCULAR |
|
| Acute lower limb ischemia, vascular injury | CT Angiogram Leg Run off (arterial phase) +/- delayed phase below knee (IV contrast) |
| Upper limb ischemia or vascular injury | CT Brachial Angiogram (arterial phase) (IV contrast) +- delayed phase to assess for active bleeding |
| Abdominal Aortic Aneurysm assessment/?endoleak | CT Abdominal Aortogram (non-contrast, arterial and portal venous phase) – some CTs have dynamic/4D imaging – check with your institution |