CT Renal Mass Protocol

Last Updated: 2026-01-01 Author:

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• 1. Clinical Summary

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  Acquisition SummaryClinical Indications

  Series	Phase	Coverage
  Non-Contrast	Non-contrast	Top kidneys to Iliac crests
  Corticomedullary	Contrast (20 sec delay)	Top kidneys to Iliac crests
  Nephrographic/IVP	Contrast (90-120 sec from 2nd injection delay)	Top kidneys to Pubic symphysis

  • Renal mass characterization
  • Renal cell carcinoma staging
  • Complex cyst evaluation

• 2. Patient Prep

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  • Position: Supine with arms raised
  • NPO Status: NPO 4 hours

• 3. IV Contrast & Injection

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  Injection ParametersLab Requirements

  Parameter	Value
  Agent	Isovue 370
  Volume	Split bolus: 1st injection 1.1 mL/kg + 2nd injection 0.4 mL/kg
  Flow Rate	3-4 mL/s
  Duration	18-22s + 20-30s
  Timing	Split bolus technique

  Full dose if eGFR > 30. Split bolus technique

• 4. Special Notes

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  Technologist NotesNursing NotesRadiologist NotesTips & Tricks

  • COMPLEX protocol: 1) NC 2) 1st contrast injection 3) Arterial 20s after 1st 4) WAIT 5-7 min 5) 2nd injection + saline 6) IVP/nephrographic 90-120s after 2nd
  • Additional Recons: Compare NC vs arterial vs nephrographic. Measure HU in mass. MIP urogram

  • 18-20G IV. Explain split bolus technique and delay

  Safety First

  • Renal Function: Verify eGFR > 30
  • Allergy: Check allergy history

  • NC: fat/calcification. Arterial: vascular anatomy and hypervascular masses. Nephrographic/IVP: delayed enhancement and collecting system

  • Split bolus timing critical. 5-7 min wait between injections

Series AcquisitionPost-Processing

Series Name	Start Location	End Location	Delay	Slice Thickness	Notes
Scout	Diaphragm	Iliac crests	N/A	N/A	AP
Non-Contrast	Top kidneys	Iliac crests	N/A	2.5 mm	Baseline - detect fat/calcium
Corticomedullary	Top kidneys	Iliac crests	20 sec	1.25 mm	Arterial/nephrographic
Nephrographic/IVP	Top kidneys	Pubic symphysis	90-120 sec from 2nd injection	1.25 mm	Delayed enhancement + collecting system

Plane	Acquisition	FOV	Thickness/Increment	Kernel	IR Strength	Notes
Axial	Non-contrast	Kidneys	2.5 mm/2.5 mm	Standard	3	Characterize mass
Axial	Corticomedullary	Kidneys	1.5 mm/1.5 mm	Standard	3	Vascular and cortical enhancement
Axial	Nephrographic	Kidneys to pelvis	2 mm/2 mm	Standard	3	Mass enhancement + urinary opacification
Coronal	All phases	Kidneys	2.5 mm/2.5 mm	Standard	3	Compare enhancement phases