BETA VERSION · Cardiac CT · 64–128 slices · recommendation for clinical review, not an automated prescription.

Protocol Assistant

Cardiac CT · 64–128 slices

Patient data

Applies to single-source cardiac scanners, 64–128 slices, non-spectral. Console names are Philips (Cardiac DoseRight · Step & Shoot · iDose⁴); on other vendors, use the equivalent control. Map the proposal to your approved protocol and adjust it to the clinical context.

Heart rate and rhythmDefault HR

70bpm

30–64 · sequential if regular65–7576+ · wide

match the slider to the rate on the monitor

Rhythm· tap the one that looks like the monitornot entered

Together they set the ECG strategy. An unfavorable rhythm triggers a retrospective recommendation and a warning, not a hard stop.

HR 70II

Pick a rhythm to see a reference pattern.

Weight and heightdefaults

kg cm BMI 27.5

<100 kg + BMI<30120 zoneBMI≥40 · consider 140

BMI sets the 100, 120, or 140 kVp zone; height is needed to calculate it · weight 30–200 kg · height 120–210 cm.

IV accessnot entered

18G 20G 22G Central

Site

Antecubital / forearm Hand / wrist

gauge — validates the flow rate

Choose the study to see the suggested protocol

Everything is on this screen: every value you change in the panel recalculates the suggestion instantly. Anything missing is flagged in amber and doesn't block you.

Coronary CTA

Suggestedto review and adjust at the console

Coverageguide on the planning image

Native coronary. The highlighted band is the recommended coverage.Simplified frontal Surview: carina at roughly T5–T6, overlapping the cardiomediastinal silhouette; it varies with inspiration and positioning. Not for diagnosis.

How it's acquiredECG · tube · table · dose, on one timeline

ECG · radiation · X-ray source · table

Acquisition mode

—

full currentreduced currentactive X-ray source↻ the dot rises and falls — that's the tube rotation projected in this side viewvertical cursor = the moment shown

The animation follows the recommended protocol.

Contrastnumbers, injection over time, and IV access

At a glance: contrast first, then the saline chaser at the same flow rate; bolus tracking triggers the scan.

Advancedcurrent, pitch, medication, and console settings

Reconstructionsingle- or multi-segment · diagram · chart · self-check

See explanation · diagram · self-check

After the scan

Check the acquisition and edit the ECG

Before you pull the IV and close the exam, while the raw data are still there.

Immediate post-scan check

Extravasation? Next stepsACR 2024 · ESUR 2022

Stop the injector and disconnect; try to aspirate through the cannula (unproven benefit), then remove it. Don't reinject through that line.
Check the site, hand, and forearm: pain, swelling, paresthesias, capillary refill, pulses.
Elevate the limb and apply cold compresses; no drug has proven benefit.
Always notify the radiologist. Surgical evaluation is driven by clinical severity: progressive pain, paresthesias, vascular/skin compromise, or compartment syndrome. ACR and ESUR (key points) advise against deciding by volume; ESUR table 6 still lists >150 mL (grade C).
Document the extravasated volume, site, IV gauge, and time on the exam sheet.
At discharge: written instructions on warning signs and where to return.

The recommendation doesn't override scanner limits or the approved local protocol. If they differ, document the clinical decision and use the validated configuration.

Learnhow the assistant decides and where each explanation lives

All of this is optional. The main screen shows the suggestion; the reasoning is here for anyone who wants to read it. Each topic links to its full explanation on the page.

Recognizing the rhythm on the monitor

Regular: the peaks (R) fall at equal intervals and each one has its P wave in front.
AF: completely unequal intervals, no P waves; the baseline quivers.
Ectopic beats: a beat comes early (sometimes wide and odd-looking), followed by a pause.
Variable HR: normal beats, but the interval gradually lengthens and shortens.
Poor signal: noisy baseline or shapeless peaks; fix the electrodes and contact first.

The dot on each R is what gating uses to know where to reconstruct.

ECG and breath-hold prep

Acquisition mode and HR

kV and body size

Weight < 100 kg and BMI < 30: candidate for 100 kVp (no stent or heavy calcium).
BMI 30–39.9 or weight ≥ 100 kg: 120 kVp.
BMI ≥ 40: consider 140 kVp, as an exception and after checking the dose.
Stent or heavy calcium: don't drop to 100 kVp; a stent alone doesn't call for 140 either.
No height: 100 kVp is considered only if weight ≤ 90 kg; without a height, a BMI ≥ 40 can't be recognized.
Pre-TAVI: weight ≤ 90 kg or BMI ≤ 30 → candidate for 100 kVp; otherwise 120 (BMI ≥ 40: consider 140).
The calcium score always goes first, and always at 120 kVp.

The contrast bolus

Bypass: why the right arm is preferred

Pre-TAVI: why two passes and a single bolus

Single- or multi-segment

The explanation with your console's names, the diagram of the three cases, the interactive chart of temporal resolution vs. HR, and the 5-question self-check are in the “Reconstruction” fold of “Why these settings?”.

Scan coverage

Guides on the planning image for coronary, bypass (with the gastroepiploic extension), and the two pre-TAVI passes.

ECG editing after the scan

If the scanner mis-tagged an R, fix it at the console before closing the exam and while the raw data are still there. The 10 typical situations, with your scanner's names, are in “After the scan”.

If something fails or extravasates

The immediate post-scan check and extravasation management (ACR 2024 · ESUR 2022) are in “After the scan”.

Choose the study to see the suggested protocol

Coronary CTA

Acquisition mode

ECG editing at the console