iCT workflow for Coronary CTA

Brilliance iCT v2.5

This is an application guide for Brilliance iCT on version 2.5. For more detailed information, please refer to the Philips operator or user guide.

Patient Preparation

Feet first scanning is recommended Position patient on couch, feet first supine (with cushion under knees) Ensure proper skin prep (see below) Place ECG electrodes on patient and connect ECG leads (see below) Hook patient up to the Patient Interface Module (PIM) Verify the ECG wave display on gantry (see below) Offset patient on the couch so the patients heart is in the middle of the field of view.

Skin prep

1. If body hair is present, shave the skin to ensure good electrode contract with the skin. 2. Clean the contact site with alcohol to remove excess oils. 3. Use ECG skin prep tape to abrade the skin and remove the outer layer of the dead skin cells. 4. Use the wet-gel electrodes (not dry) for better skin contact. 5. Connect the four leads to the electrodes. 6. Make sure the electrodes are not in the field of view. 7. Run the leads along the side of the patients body. 8. Make sure the leads are straight and without loops. 9. If necessary tape the electrodes to the leads for a better connection.

2008 Koninklijke Philips Electronics N.V. All rights are reserved. Philips Medical Systems Nederland B.V. reserves the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. Printed in the USA. 453567525911 - Rev.3 des 11/2008

ECG Lead Placement

Advancement of Medical Instrumentation (AAMI) Configuration International Electrotechnical Commission (IEC) Configuration

1. Have the patient assume the posture for the scan; raise the arms above the head. 2. Connect the leads to the electrodes (best if done before placing on the chest)

Verify the ECG Signal on the Gantry

1. Ask the patient to simulate a breath hold with arms above their head. 2. Observe the ECG signal during the breath hold. 3. If a clear ECG signal does not display, make sure that the electrodes are properly connected. 4. If ECG appears noisy or QRS tagging is incorrect, redo the skin prep and reposition electrodes.

Brilliance iCT v2.5 453567525911 - Rev. 3 des 11/2008

Choose the correct protocol

Rotation Time 0.33 0.27 0.27

Heart rate HR62 62<HR<72 HR72

Pitch 0.18 0.18 0.16

Select one of the Coronary CTA protocols from the above chart based on the patients heart rate during a simulated breath hold.

Coronary CTA - Scan procedure

1. Click Exam Protocol Groups. 2. In the exam protocols groups, click the Cardiac folder. The list of cardiac protocols displays. 3. Select one the three Coronary CTA protocols based on the patients heart rate. 4. Verify the Surview scan parameters. It is recommended to do a Dual Surview Scan the Surview from the manubrial notch to the mid abdomen Perform the Surview with a short inspiration 5. Plan on Surview 6. Verify the Locator scan parameters. 7. Position the Locator line one disc level below the carina.

Brilliance iCT v2.5 453567525911 - Rev. 3 des 11/2008

8. Verify the Tracker scan parameters. 9. Verify the Coronary CTA scan parameters. 10. Use the contrast injection parameters per your sites requirements 11. The default threshold for Bolus Tracking is 110 HU with a 7 8 second post threshold delay 12. If desired, turn on Cardiac DoseRight under the Cardiac Tab 13. If desired, define the coronaries and functional phases using the Edit phase option under the Cardiac tab 14. Verify the patients heart rate on the ECG viewer 15. If needed, adjust rotation time and pitch based on the patients heart rate under the advanced tab. See patient HR protocol table above. 16. Perform the Locator scan 17. Place the ROI in the descending Aorta, using the Auto ROI feature.

18. Perform the Tracker scan 19. Follow the on-screen instructions and perform and complete Coronary CTA scan with a short inspiration 20. Adjust the images and edit the ECG as needed.
1. Coronary

Note: CTA start point is placed 1 to 2 cm above the first slice where a coronary artery can be seen (slightly below the level of the carina). The end point is 1 to 2 cm below the apex of the left ventricle.
C

Brilliance iCT v2.5 453567525911 - Rev. 3 des 11/2008