CT protocol management is an essential element of a quality assurance (QA) program to ensure patient safety and acceptable image quality. Furthermore, the regulations for many states and accrediting bodies, such as the American College of Radiology (ACR) and the Joint Commission, require CT protocol review to be performed annually. One of the goals of CT protocol management and review is to ensure all the protocols are standardized across a fleet of CT systems at a facility. However, this task can be daunting when faced with CT systems of various models from different manufacturers with potentially different technologies. These differences can lead to inconsistent image quality and disparate radiation dose from opposing acquisition and reconstruction techniques. Additional nonuniformities can result in tissue and vascular enhancement due differences in scan delay timing for different phases, injection site, injection rates, contrast injector pressure limits, needle size, and iodine concentration during the injection of iodinated contrast agents. Finally, there are encounters of nonideal patients due to implanted devices, noncompliance leading to patient motion, and obesity where artifacts are induced and image quality compromised.
The overall objective of the presentation is to provide a better understanding and process for developing a robust CT protocol management program. There will be particular emphasis on CT acquisition and reconstruction standardization, optimization of CT injected contrast optimization, and strategies for CT imaging of the nonideal patient.
1. Understand the need for routine CT protocol management and methods for protocol standardization
2. Understand the basics of intravenous contrast dynamics and corresponding tissue enhancement and the relationship to the CT system for optimization of the contrast protocol
3. Understand how to adjust protocols to account for common artifacts related to the patient condition such as metallic implants, motion, and obesity