imaging in pregnancy algorithm revised may 2014€¦ ·  · 2015-07-06hida! suspected pancreatitis...

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IMAGING NONOBSTETRIC EMERGENCIES IN PREGNANT PATIENTS CT AbdPel Fetal Dose Range is approximately 1530 mGy Use lead shielding over abdomen & pelvis only for Head, Neck or Chest CT Technique for Abdominal & Pelvic CT: SCANNER Detector Config kVp Noise Index / Ref mAs Routine CT mA Range Noise Index / Ref mAs Stone CT mA Range ASIR SAFIRE Pitch Rot Time (sec) GE16 16 x 1.25 120 18 (@ 5.0 mm) 100360 22 (@ 5.0 mm) 50300 N/A N/A 1.38 0.6 GE64 64 x 0.62 120 40 (@ 1.25 mm) 100360 48 (@ 1.25 mm) 50300 70% (5 mm) N/A 0.98 0.5 Siemens 64 24 x 1.2 120 140 N/A 100 N/A N/A Strength 2 0.8 0.5 Siemens 128 32 x 1.2 120 140 N/A 100 N/A N/A Strength 2 0.8 0.5 All abdominal CT’s should only be single phase scans Avoid scanning unnecessary territory Acute Abdomino-Pelvic Syndromes Acute Abdomino- Pelvic Pain (without localization) US Abd-Pel or CT Abd-Pel w/ Contrast Suspected Ureteral Stone US of Kidneys & Bladder (include resistive indices & ureteral jets) CT Abd-Pel w/o Contrast Suspected Appendicitis US of Right Lower Quadrant MR of Right Lower Quadrant CT Abd-Pel w/ Contrast If still inconclusive or suboptimal MR or contraindication to MR Fever of Unknown Origin (localizing signs to abdomen or pelvis) US Abd-Pel or CT Abd-Pel w/ Contrast Suspected Cholecystitis US of Right Upper Quad HIDA Suspected Pancreatitis Lab Tests CT Abd Only w/ Contrast Suspected Bowel Obstruction Supine Radiograph Abdomen MR Abd/Pel or CT Abd-Pel w/ IV & Oral Contrast (3 hr PO Prep) No delayed scan Suspected Ovarian Torsion US of Pelvis Suspected Ruptured Splenic Aneurysm CTA Abd-Pel Trauma Fast Scan US CT Abd-Pel w/ Contrast (No Delays) Plain film at 15-30 min. if collecting system injury is suspected Conventional Cystogram if bladder injury is suspected

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Page 1: Imaging in Pregnancy Algorithm Revised May 2014€¦ ·  · 2015-07-06HIDA! Suspected Pancreatitis Lab Tests! CT Abd Only ... Microsoft Word - Imaging in Pregnancy Algorithm _Revised_May

IMAGING  NON-­‐OBSTETRIC  EMERGENCIES  IN  PREGNANT  PATIENTS    

 

 

CT  Abd-­‐Pel  Fetal  Dose  Range  is  approximately  15-­‐30  mGy  

Use  lead  shielding  over  abdomen  &  pelvis  only  for  Head,  Neck  or  Chest  CT  

Technique  for  Abdominal  &  Pelvic  CT:  

SCANNER   Detector  Config   kVp   Noise  Index  /  Ref  mAs  

Routine  CT   mA  Range   Noise  Index  /  Ref  mAs  Stone  CT   mA  Range   ASIR   SAFIRE   Pitch   Rot  Time  

(sec)  GE-­‐16   16  x  1.25   120   18  (@  5.0  mm)   100-­‐360   22  (@  5.0  mm)   50-­‐300   N/A   N/A   1.38   0.6  GE-­‐64   64  x  0.62   120   40  (@  1.25  mm)   100-­‐360   48  (@  1.25  mm)   50-­‐300   70%  (5  mm)   N/A   0.98   0.5  Siemens  64   24  x  1.2   120   140     N/A   100   N/A   N/A   Strength  2   0.8   0.5  Siemens  128   32  x  1.2   120   140     N/A   100   N/A   N/A   Strength  2   0.8   0.5    

All  abdominal  CT’s  should  only  be  single  phase  scans  

Avoid  scanning  unnecessary  territory  

Acute Abdomino-Pelvic Syndromes

Acute Abdomino-Pelvic Pain

(without localization)

US Abd-Pel or

CT Abd-Pel w/ Contrast

Suspected Ureteral Stone

US of Kidneys & Bladder (include resistive indices &

ureteral jets)

CT Abd-Pel w/o Contrast

Suspected Appendicitis

US of Right Lower

Quadrant

MR of Right Lower

Quadrant

CT Abd-Pel w/ Contrast

If still inconclusive or suboptimal MR or

contraindication to MR

Fever of Unknown

Origin (localizing signs to abdomen or

pelvis)

US Abd-Pel

or CT Abd-Pel w/ Contrast

Suspected Cholecystitis

US of Right Upper Quad  

HIDA  

Suspected Pancreatitis

Lab Tests  

CT Abd Only w/ Contrast  

Suspected Bowel

Obstruction

Supine Radiograph Abdomen

MR Abd/Pel or

CT Abd-Pel w/ IV & Oral Contrast

(3 hr PO Prep) No delayed scan

Suspected Ovarian Torsion

US of Pelvis

Suspected Ruptured Splenic

Aneurysm

CTA Abd-Pel

Trauma  

Fast Scan US  

CT Abd-Pel w/ Contrast

(No Delays) Plain film at 15-30 min. if collecting system injury is

suspected  

Conventional Cystogram if

bladder injury is suspected  

Page 2: Imaging in Pregnancy Algorithm Revised May 2014€¦ ·  · 2015-07-06HIDA! Suspected Pancreatitis Lab Tests! CT Abd Only ... Microsoft Word - Imaging in Pregnancy Algorithm _Revised_May

IMAGING  NON-­‐OBSTETRIC  EMERGENCIES  IN  PREGNANT  PATIENTS    

 

 

Contrast  Volume  for  all  CT  exams:  100  ml  only                       Ramit  Lamba,  MD;  Director  of  CT  

Ver  1.4    May  21,  2014  

Acute Neurologic Syndromes

Headache

CT Head w/o Contrast

Acute Infarct or HIE

CT Head w/o Contrast

MR Brain w/o Gad

Cranio-Facial Trauma

CT Head / Facial Bones

w/o Contrast

Vertebral Dissection

CTA Neck

C.Spine Trauma

C.Spine x-ray’s or CT C.Spine

w/o contrast

Cord Compression

MR Spine w/o Gad

Non-compressive Cordopathy

MR Spine w/o Gad

Siuns Thrombosis

CTA/V Head  

Aneurysmal Rupture

CTA Head  

Acute Chest Syndromes

Suspected Pulmonary Embolism

CTPA

Suspected Arotic Dissection

CTA Chest Real time review by Radiologist at

CT console No base scan

Extend to L-4 if dissection seen

Trauma

CTA Chest

Fever of Unknown Origin (localizing to chest)

CXR

CT Chest w/ Contrast