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.
Step 1
Before opening the protocol
Three checks before you choose the acquisition.
View critical safety items
No history of a severe or anaphylactic reaction to iodinated contrast — if there is one, follow the local risk plan.
Possible pregnancy assessed per site policy.
Renal function and clinical stability compatible with contrast, per local thresholds.
Contraindications to beta-blocker and nitroglycerin reviewed if they are being considered.
Patent IV line, adequate gauge/site, and connection ready for high flow and pressure.
View ECG and breath-hold prep
Good electrode contact and a usable tracing during a practice breath-hold.
Practice the breath-hold several times with the patient before the scan.
Use the same breathing instruction for scout, score/test, and angiography.
Comfortable inspiration, no Valsalva; watch whether the breath-hold changes HR or rhythm.
Arms up whenever possible and heart centered at isocenter.
IV line in place:gauge — validates the flow rate
Site:hand IVs drop the flow rate to the diagnostic minimum
Scanner:optional — unlocks the single-beat alternative when HR ≤ 60 with a regular rhythm
If something's not ideal: the final recommendation will flag it. Don't compensate by improvising pitch, rotation, mAs or contrast.
What study are you running?
Pick the main route — you'll only see the options that modify it.
HR ≤ 60, regular rhythm and a high-pitch scanner: the whole heart in one cycle, prospective. The switch needs sign-off from the person in charge; Step & Shoot stays the department standard.
Dose: the lowest of all modes; sub-mSv achievable.
No ventricular function: one phase only. If the order asks for function or valves, don't use it.
No safety net: there are no other phases — artifact means a repeat. HR has to hold steady during the practice breath-hold, or stay with the standard mode.
Contrast · proposed plan, pending confirmation
At a glance: contrast first, then the saline chaser at the same flow rate; bolus tracking triggers the scan.
Why the right arm for bypass casesA preference, not a rule: a good right-arm IV usually means less dense contrast at the left venous crossing. If you end up using the left arm, adjust and watch for artifact per local protocol.Advanced · gI/s · duration · constants
Console essentials
Advanced parameters and checks
Visual guide
Native coronary. The highlighted band is the recommended coverage.Simplified frontal scout: the carina sits around T5–T6 and overlaps the cardiomediastinal shadow; it shifts with inspiration and positioning. Not for diagnostic use.
Acquisition 1 · full chest. Retrospective ECG-gated helical. Keep diagnostic tube current at least through systole (20–40 % R-R as a guide) and enough signal outside that window, per the validated card.Acquisition 2 · Vascular access CT angiography, non-gated. From the diaphragm to below the lesser trochanters to include both common femoral arteries. Run it immediately after the chest.
Single bolus if the local sequence is validated. Factor in the pause to reposition the table and change parameters so arterial enhancement holds through the second acquisition.
ECG · radiation · X-ray source · table
Acquisition mode
—5 × ≈40 mm · exampleafter · vascular access
full currentreduced currentcontinuous helical coveragenon-gated continuationactive 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.
Immediate post-scan check
Extravasation? — management (ACR 2024)
Stop the injector and disconnect; don't pull the IV yet (aspiration hasn't proven useful).
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 if: progressive pain, paresthesias, vascular/skin compromise, or large volume (>150 mL, ESUR).
Document the extravasated volume, site, IV gauge, and time on the exam sheet.
At discharge: written instructions on warning signs and where to return.
ECG editing at the console
Full library · 10 lessonsWhen editing won't help · golden rules
If the radiologist isn't present: show them this screen or read out mode · kVp · contrast before scanning.
The recommendation does not replace scanner limits or the approved local protocol. If they differ, document the clinical decision and use the validated configuration.