CT Pulmonary Embolism
Last Updated: 2026-01-01 Author:
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1. Clinical Summary
Series Phase Coverage Pulmonary Angiogram Bolus tracked Lung apices → Adrenal glands - Suspected pulmonary embolism
- Acute dyspnea
- Chest pain with elevated D-dimer
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2. Patient Prep
- Position: Supine feet-first with arms raised
- NPO Status: NPO 2 hours recommended
- Pre-Medication:
- None required
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3. IV Contrast & Injection
Parameter Value Agent Isovue 370 Volume 1.3 mL/kg Flow Rate 5 mL/s Duration 15 - 20s Timing Method Bolus Tracking ROI Placement Main Pulmonary Artery Trigger (HU) 100 HU Use full dose if GFR > 30
If GFR < 30
Max Contrast = \(2*\left[\frac{\text{Patient Weight}}{75 \text{ kg}} * \text{eGFR}\right]\)
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4. Special Notes
- Caudocranial scan direction. Coach breath hold. ROI in main PA at level of bifurcation
- 20G or larger IV in antecubital preferred. Verify good flow before injection
Safety First
- Renal Function: Verify eGFR > 30
- Allergy: Check iodine allergy history and prior reactions
- Assess RV/LV ratio. Look for signs of right heart strain. Check for DVT in leg veins if imaged
- Arms fully raised to reduce beam hardening
| Series Name | Start Location | End Location | Delay | Slice Thickness | Notes |
|---|---|---|---|---|---|
| Pulmonary Angiogram | Lung apices | Adrenal glands | Bolus tracked | 0.625 mm | Caudocranial direction from diaphragm to apices |
| Plane | Acquisition | FOV | Thickness/Increment | Kernel | IR Strength | Notes |
|---|---|---|---|---|---|---|
| Axial | Angiogram | Chest | 1.25 mm/1.25 mm | Standard | 3 | Mediastinal window for PE assessment |
| Axial | Angiogram | Chest | 2.5 mm/2.5 mm | Lung | 3 | Lung window for parenchymal assessment |
| Coronal | Angiogram | Chest | 3 mm/3 mm | Standard | 3 | Overview of pulmonary vasculature |
| Sagittal | Angiogram | Chest | 3 mm/3 mm | Standard | 3 | Optional for clinical correlation |