Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

ORAL CONTRAST

“General” abdo-pelvic CT

Gastroview 3%.
Routine: 1000 ml in 250 ml aliquots starting 2 hours prior to scan.

NB: Patients with suspected or known Crohn's disease (excluding those with acute obstruction
– see below): 1000 – 1500 ml water starting 1 hour prior to scan

Acute Bowel Obstruction

No oral contrast

Blunt Abdominal Trauma

No oral contrast

Liver CT (limited to upper abdo / lesion characterisation or follow-up)

500 ml water starting 20 minutes prior to scan

Liver / Abdo for metastasis screen

As for “General” CT

Renal Colic

No oral contrast

Other renal (masses etc)

As for “General” abdo-pelvic CT

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 1 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

CT cholangiography

2 glasses water prior to scan

Staging Oesophageal carcinoma

500-750 ml water starting 20 minutes prior to scan

Gas forming agent immediately prior

Staging gastric carcinoma

500-1000 ml water starting 30 minutes prior to scan

Gas forming agent immediately prior

Pancreas protocol

500 –1000 ml water starting 20-30 minutes prior to scan

Adrenal CT

500 ml 3% Gastroview starting 30-45 min prior to scan

CT Urography

No oral contrast

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 2 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

RECTAL CONTRAST

Rarely needed.
Dilute Gastroview (2-3%) via rectal tube on CT table if leak suspected from rectal anastomosis.
Rectal water (or air) may be required for rectal cancer staging.

IV CONTRAST

Please note that the injection rates indicated in the following protocols are for guidance only.

Individual patients (based on age, nature of venous access, etc) may require lesser rates.

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 3 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

“GENERAL PURPOSE” ABDO-PELVIC CT

Oral contrast:
Gastroview 3%.
Routine: 1000 ml in 250 ml aliquots starting 2 hours prior to scan.
IV Contrast: Approx 4ml / sec.
NB: if the scan is a Chest + Abdomen, reduce rate of injection (say to 3 ml/sec)
Scans: PV phase

Staging Oesophageal Cancer

Oral contrast:
500-750 ml water starting 20 minutes prior to scan
Gas forming agent immediately prior
IV Contrast: 3-4ml sec
Patient supine
Arterial Phase Chest
PV Phase diaphragm to bottom of liver
Additional Scans may be required:
Gastro-oesophageal junction tumours --- right side up decubitus through ROI
Mid-oesophageal tumours --- prone scan through ROI

Staging Gastric cancer

Oral contrast:
500-1000 ml water starting 30 minutes prior to scan
Gas forming agent immediately prior
IV Contrast: 3-4 ml / sec
Patient supine
Arterial phase chest and upper abdo (late arterial, thin collimation)
PV phase whole abdo
Additional scans may be required:

Dependent on site of tumour in stomach. Position patient so ROI is non-dependent. ? give

more IV contrast and scan ROI in late arterial phase

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 4 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

LIVER CT

Metastasis Screen

Oral Contrast:
Gastroview 3%.
Routine: 1000 ml in 250 ml aliquots starting 2 hours prior to scan.

IV contrast: 4 –5 ml / sec

PV Phase

(Non-contrast, arterial and PV phase if following primary tumours:

renal, phaeochromocytoma, insulinoma / islet cell tumour of pancreas,
carcinoid, melanoma, thyroid)

Known liver lesion for characterisation

Oral Contrast:
500 ml water starting 20 minutes prior to scan

IV Contrast: 4-5ml / sec

Scans: Upper abdo only

Non-contrast
Arterial phase (early, 30 sec and late, 45 sec)
PV phase

Selected patients (?haemangioma, cholangiocarcinoma, some FNH) will need

delayed images (2,3,5 minutes) through ROI.

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 5 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

Hepatocellular carcinoma (HCC) Screen)

Oral Contrast:
500 ml water starting 20 minutes prior to scan

IV Contrast: 4-5ml / sec

Scans:Upper abdo only

Non-contrast
Arterial phase (early, 30 sec and late, 45 sec)
PV phase

ACUTE SMALL BOWEL OBSTRUCTION

Oral Contrast: None

IV Contrast: 4-5 ml /sec

Scan:
Supine
Post-contrast PV phase

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 6 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

ACUTE LARGE BOWEL OBSTRUCTION (SUSPECTED)

Oral Contrast: None

Rectal Contrast: None

IV Contrast: 4-5 ml / sec

Scans:
60-70 secs post-contrast

Post-contrast
Patient supine, then review images:

If ? transition point:

In recto-sigmoid/ distal sigmoid: do prone scans

In prox sigmois / descending colon/ splenic flexure: do left-side up decubitus
In ascending colon / hepatic flexure : do right-side up decubitus
In transverse colon: no further scans

If no transition point:

Usually no further scans indicated. (Occasionally prone scans for clarification)

NB: these additional scans can be performed using a low-dose protocol

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 7 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

PANCREAS PROTOCOL

Oral contrast:

500 –1000 ml water starting 20-30 minutes prior to scan

IV contrast: 4 – 5ml /sec

Scans:
Non-contrast: Upper abdo only

Post-contrast:
Parenchymal phase: approx 35 sec. Upper abdo only

PV phase: Whole abdo (first scan) or upper abdo only (follow-up of benign disease, other
selected patients)

NB. Follow-up patients for benign disease: Usually single scan late arterial / early PV phase.

BLUNT ABDOMINAL TRAUMA

Oral Contrast: Usually none

IV contrast: 4-5 ml / sec

Scans:
PV phase.

+ Delayed (2-3 minutes) if indicated to assess renal tract (NB: Clamp

urinary catheter prior to starting scan)

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 8 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

ADRENAL MASS – for characterisation

Oral Contrast:
Gastroview 3%.
Routine: 1000 ml in 250 ml aliquots starting 2 hours prior to scan.

IV Contrast: 4-5 ml / sec

Scans:

Non-contrast: upper abdo

Arterial phase: ROI only

PV phase: Large field to iliac crests

Delayed 15 minutes: ROI only

RENAL COLIC

Oral contrast: None

IV Contrast: None

Scans:

Non-contrast: Minimise dose!

Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 9 of 10
 Division of Imaging Services CT Protocol

Code: 3CLP31
Title: CT ABDOMEN PROTOCOLS
Category: Appropriateness

RENAL MASS

Oral contrast:
Gastroview 3%.
Routine: 1000 ml in 250 ml aliquots starting 2 hours prior to scan.

IV Contrast: 4-5ml / sec

Scans:

Non-contrast: Kidneys only

Nephrographic phase (80secs): Whole abdomen

Pyelographic phase (10-15 mins): Kidneys only.

Scout (KUB): After pyelographic phase

NB: Delayed CT Urogram:(whole renal tract, delayed 10-15mins, normal dose)May be

requested instead of scout and pyelographic phase.

NB: For staging renal cell cancer, CT of Chest may also be required

CT UROGRAPHY for urothelial lesion

Oral Contrast: Usually none

IV Contrast: 3 ml /sec; Infuse 250 ml normal saline IV following IV contrast

Scans:
Patient supine
Non-contrast: low-dose renal tract
Nephrographic phase (80 sec post contrast): Kidneys only
Pyelographic phase: (10-15 min delay) – whole renal tract
NB: Delayed CT Urogram:(whole renal tract, delayed 10-15mins, normal dose)
Responsibility References
Protocol Owner: CT Supervising MIT
Endorsed By: EQuIP 1.3 Appropriate care and services are provided to
First Compiled: consumers/patients
Last Amended: February 2008
Review Date: February 2009 33397524.doc
Division of Imaging Services CT Protocol Page 10 of 10