Manual 8 - CT - 01-30-2007
Manual 8 - CT - 01-30-2007
Manual 8
CT Scan Site
Manual of Operations
Visit 2
Version 1.0
FOREWORD
This manual is one of a series of protocols and manuals of operation for the Jackson Heart Study
(JHS). The complexity of the JHS requires that a sizeable number of procedures be described,
thus this rather extensive list of materials has been organized into the set of manuals listed
below. Manual 1 provides the background, organization, and general objectives of the JHS
Study. Manuals 2 and 4 describe the operation of the Cohort Procedures, Blood Pressure and
Events Ascertainment Components of the study. Detailed Manuals of Operation for specific
procedures, including those for Blood Pressure and Quality Assurance, make up Manuals 4 and
5. The Data Management System is described in Manual 6. The Central Laboratory and
Specimen Repository is described in Manual 7. Manual 8 is designed to provide volumetric CT
image data for measuring coronary and abdominal aortic calcified plaque as well as measuring
body composition in the abdomen.
3 Blood Pressure
5 Quality Assurance
6 Data Management
Manual 8 CT Scan
TABLE OF CONTENTS
1. Introduction ...................................................................................................................................... 1
6. CT Technologist Training................................................................................................................ 14
Appendices ............................................................................................................................................... 16
A CT Central Training Curriculum ....................................................................................... 17
B CT Scanning Worksheet .................................................................................................. 19
C The CT Technical Parameters for each CT System ......................................................... 21
D CT Technologist Training & Certification Logs ................................................................. 23
E Draft CT Technologist Electronic Training Material ........................................................... *
F CARDIA/MESA CT Methods Paper ................................................................................. *
1. Introduction
TRAINING OF TECHNOLOGISTS
Dr. Carr has performed onsite training January 1012, 2007. The training sessions included
didactic, small groups and hands on training. Following the course the technologists will complete
the certification test and observe CT scans of participants and QC procedures. They will leave
with a comprehensive understanding of the CT protocol. It is anticipated that upon completion
they will be “Provisionally Certified”. They will have knowledge and training material for the other
technologists at their site. During the pilot phase the technologists will complete the 3 certification
exams on their CT system. Each of these scans will also be rated on technical quality criteria and
immediate feedback will be provided. These exams will be reviewed by the CTRC personnel and
either further training for full certification will occur.
The JHS local investigators will arrange details of scheduling participants for the CT
exam. Scheduling details will be mutually agreed upon between the CT scanning center
and Field Center. A Field Center interviewer/scheduler will be responsible for
explaining and obtaining consent for the CT examination including pregnancy
screenings. Participants will be scheduled for a certain date and time, and escorted to
the CT scanner. The Field Center will take the participant and CT Scan Worksheet (see
Appendix B) which identifies the participant by name. The CT Technologists need to have
the individual’s real name to confirm identity. The CT Scan Worksheet provides the
detailed information required by the CT scanning sites for labeling and performing the CT
exam (See Appendix B).
Required information for the CT scheduling form includes the participant’s name (for
scheduling and greeting purposes only), participant’s weight (as recorded at the clinic
visit), and date of birth, JHS study ID and a secondary identifier called the “alpha code”
which will replace the participant’s real name.
The CT scanners to be used in this study store demographic, detailed scan technical
information and the raw image data in the standard DICOM file format. Participant
identifying information will be encrypted at each CT site for the following reasons:
Safeguard participant confidentiality.
Comply with federal requirements for medical information, Health Insurance Portability
and Accountability Act of 1996 (HIPAA).
Provide positive and redundant participant identification for CT image files now and in the
future. The data coordinating system has assigned a unique study identification number
for each participant. The exact method will be decided upon by the coordinating center
and CT scan site. Below is a method we have successfully used in prior studies.
The Jackson Heart Study study identification number (“J” + 6 digits) will be entered in
the field on the CT scanner where the local medical record numbers is typically placed.
An “alpha code” (5 letters) will be entered in the name field. The participant’s weight,
dateofbirth, ordering physician (Dr. Herman Taylor, interpreting physician (Dr. Mike
Doherty), will be entered on the demographics page of the GE Lightspeed Pro 16 after
pressing the “New Exam” button.
*** It is very important that you enter your technician ID initials on this screen. This may
vary between CT vendors, but most systems have a field for entering the CT
technologists name/initials. Please type your tech ID in this location. If you do not have a
field for this on your CT scanner please call the CTRC for additional help in resolving this
issue.
3
Subjects weighing more than 350 lbs (~160 kg) will be excluded from the CT exam. This
exclusion is secondary to technical difficulties related to imaging individuals of this size
and greater.
Pregnancy Screening: The field center personnel will ask women if they have the
potential to be pregnant and complete pregnancy screening process as detailed in the
Clinic Exam procedures.
CT inclusion criteria:
Enrolled in JHS study, eligible for the CT exam with signed consent obtained.
Pregnancy screen completed if applicable
CT exclusion criteria:
The CT Tech:
1. Reviews the CT Scan Worksheet with the JHS Study ID and alpha code.
The technologist will instruct the subject on the importance of breath holding and
immobility during scanning. The technologist will attach 3 electrocardiography electrodes
under the righ and left clavicle and on the left side of the thorax near the axilla (to
maximize ECG signal) or as instructed by your equipment provider.
2.6 Positioning the Participant and Calcium QCT Phantom on the CT couch
The participants will be positioned for the study feet first. The rectangular 3 sample
calcium calibration QCT Phantom (Image Analysis, Columbia, KY) will be placed
underneath the participant and is long enough that it can extend from the top of the chest
to the sacrum (or tail bone). The phantom will not need to be repositioned between the
cardiac and abdominal CT scans. The QCT phantom will be inside the special padded
cushion to make it comfortable for participants. The long axis of the QCT phantom should
parallel the participant’s
spine. The phantom is
made of tissue
equivalent plastic with
rods of hydroxyapatite
of known radiographic
density. The density is
demonstrated in the figure
below:
The technologist performing the scan will check participant centering and position of the
Calcium CT Calibration Phantom . The technologist will then choose the start position for
just above the carina of the trachea. The end location of the volume acquisition will be
beyond the diaphragmatic aspect of the heart so that the entire coronary arterial system
will be imaged. The CT couch will be moved to the start position. The technologist will
confirm correct positioning of the calcium phantom on the scout image, correct
prescribing of the start and end scan locations and appropriate ECG gating and if all are
acceptable will then precede with scan.
5
**** One of the CT quality factors is inclusion of the phantom on the cardiac CT images – the
technologist should confirm that the entire QCT phantom (i.e. all four cylinders) are visible on
each slice – if not reconstruct the images altering the leftright or anteriorposterior positioning
while maintaining a 35 cm DFOV to include the entire phantom. ****************
Participants weighing more than 350 lbs (~160 kg) will be excluded from the CT exam. As
individuals become larger more Xray photons are stopped or attenuated by their tissue. This
means that there are fewer photons making the trip through the participant to make an image.
This results in decreased image quality. To compensate, the tube current (or mA) will be adjusted
upwards (25%) for participants who weigh more than 100 Kg (220 lbs.) at their clinic visit. This is
why clinic personnel must record weight on the CT completion form, in addition the CT tech must
append the weight after the name.
This adjustment, although imperfect, will maintain a more constant signaltonoise ratio (or photon
flux) across participants of varying weights and result in improved image quality and calcium
measurement. Note that this along with all the additional technical and demographic information
including individual time stamps for the scan, scan series and individual image is recorded in the
DICOM header which is part of each image and will be available on the CT image library of all the
JHS studies as part of our quality control procedures.
Reconstruction Parameters:
The following technical parameters should be entered into a memorized protocol on each CT
system, which should greatly facilitate protocol compliance. All series will be performed using the
large scan fieldofview. This may also be referred to as the “body” as opposed to the “head” scan
fieldofview. The technologist will reconstruct using a display or reconstruction fieldofview of 35
cm (or 350 mm). Why are we scanning the heart with a 35 cm fov? By reconstructing with a 35
cm fov we insure that the QCT phantom is included in the reconstructed images. It is very
important when prescribing the scan to make sure that the anteriorposterior center is
such that the entire phantom is included in the image. You will have to center AP behind
the heart on individuals with very large chest. If while reviewing your images you see that
the phantom is partially clipped off, reconstruct the series with the appropriate AP offset.
Be sure to check this on all studies and if necessary reconstruct to include the phantom
on the images. The standard reconstruction kernel will be used for the two cardiac series. For
the cardiac series, the 240 degree (cardiac CINE) segmented scan reconstruction algorithm will
be used.
Additional Reconstructions: Two additional reconstructions of the same scan data will be
made for measurements of surrounding tissues.
2. “Max 50 cm Recon”. These images can be used along with the scout in
future studies to obtain information about body composition with attention
directed to the chest wall, muscles and fat.
All CT scan sequences will be performed with suspended respiration and a single breath
hold. The cardiac scan series will require participants to suspend respiration a variable
amount of time, ranging from 10 to 15 seconds, depending upon the combination of heart
rate and heart length. The technologist will instruct the participant as described above
and then a standardized digitally recorded voice will provide breathing instructions.
Breathing will be suspended at end inspiration to depress the diaphragm and liver for
improved imaging of the heart.
Though total imaging time will be less than 15 seconds, it will require about 5 to 7 minutes
to complete.
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Helical Scan Acquisition of the Abdominal Aorta: The abdominal aortic scan will be
prescribed graphically based on the location of L3 and S1 vertebra from the lateral scout image.
Why are we using S1 as at landmark? The Lumbosacaral junction is the most easily identifiable
and consistent landmark identified in the abdomen/pelvis. Our objective is for you to scan the
entire aspect of the two lowest lumbar vertebra, typically L4 and L5. The protocol is designed to
avoid imaging the true pelvis where in females the ovaries are located. We performed a study
and have determined that 150 mm superior to S1 is above the renal arteries in all participants in
our sample population. Other landmarks like the top of the diaphragm and counting the vertebral
levels are variable between people and we believe are less reproducible. The CT scanners will be
set at the technical parameters specified in the table below. Like in the cardiac scan we will adjust
up the mA for those individuals that weigh more than 220 lbs.
Abdominal Aorta CT scan series will be acquired in the helical mode, full or 360° recon mode with
a 2.5 mm slice collimation and a scan pitch of 3:1 or 0.75:1 depending upon the definition of pitch
chosen by the CT scanner manufacturer for a particular system. A detailed definition of pitch is
provided in the note below the table on technical factors. The CT Reading Center will confirm
through the quality assurance scans performed on phantom objects that all protocol parameters
are set appropriately. Human and software will check each pilot and participant scan for the key
technical parameters related to image quality and radiation exposure to insure protocol
compliance. Scans will be obtained during suspension of breathing. Technologist should instruct
participants and use the same breathing script as used for the heart 1 and heart 2 series.
The technologist will use the 35 cm field of view and the standard reconstruction kernel
at 2.5 mm slice thickness. In addition, a retrospective reconstruction into a 500 mm
(50cm) display fov will be performed so that we include the entire body in this set of
images and an additional reconstruction at the 35 cm DFOV will be made using 1.25 mm
slice thickness. Because of significantly reduced motion of the abdominal aorta relative
to the coronary arteries, the full or 360 degree reconstruction rather than the partial scan
reconstruction algorithm will be used for the aorta scans. Cardiac gating is not required
and will not be used in imaging the abdominal aorta. The images will be obtained with
participant’s holding their breath and using the standard breathing instructions
(autovoice).
3.1 Introduction
The CT exam involves the use of ionizing radiation (Xrays) to generate images of the
participants, which are then analyzed to provide quantitative information for scientific
investigation. The level of exposure utilized in the CT exam is on the same magnitude as that
typically used in diagnostic imaging. The next section describes the potential risks of exposure to
low levels of radiation and how this exposure compares to the average natural exposure of 3.6
mSv annually. The radiation exposure in this CT exam is well below the threshold for any
observable direct dose related effects of ionizing radiation. Therefore the concerns of lowlevel
radiation exposure for participants are the potential for (1) hereditary defects, (2) developmental
defects for exposure of a fetus/embryo in utero and (3) cancer induction. The CT Exam is
designed to minimize or eliminate these potential risks. Specifically the following steps have been
implemented:
1. To reduce the risk of any radiation induced hereditary effects, the gonads (testes and
ovaries) are not directly irradiated in the CT exam.
2. To, in all likelihood, eliminate the potential risk of any radiation induced developmental
defects to an embryo/fetus as a result of a research CT exam, female participants who
have the potential to be regnant (i.e. functioning ovaries and uterus) will be required to
have a pregnancy test prior to being eligible for an research CT exam. In addition, the
true pelvis which contains the uterus and ovaries receives negligible exposure related
only to scatter photons since it is not directly imaged in the CT protocol.
3. To further reduce the low risk of any radiation induced cancer, we are using as low a
radiation exposure scan as possible to obtain the information necessary to accomplish
the goals of this research.
Participants in this study will receive a onetime exposure of less than 6.6 mSv. This level of
radiation exposure is equivalent to less than two years of average annual background exposure
(secondary to natural and manmade sources of radiation), less than the 7 mSv annual exposure
of residents of Denver, Co, and much less than the 50 mSv annual exposure allowed for radiation
workers.
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As specified in the preceding sections of this MOP, participants will have a CT exam that consists
of the following components:
The heart scan is comparable to those currently in use in both the NHLBIfunded CARDIA and
MESA studies. The lower abdomen scan is less coverage and thus lower exposure than the scan
of the abdomen that is used in the NHLBI MESA, FHSSCAN and Framingham Heart Studies.
1. Peak radiation dose of approximately 2.5 rad (25 mGy) at the peripheral position
(essentially the skin) of the patient.
2. Highest doses to radiosensitive organs are approximately 0.65 rad or 6.5 mGy) to the
lungs and slightly less than the skin dose (1.25 rad or 12.5 mGy) to the female breast.
3. An estimate of effective dose would be 3.5 to 3.9 mSv for the entire CT exam and is
itemized by scan series below:
Note: Dr. McNittGray, expert in medical physics and imaging states that the radiation exposure
related to the low energy scouts / topograms are inconsequential in dose compared to the above
series, as a result they are not detailed in the above table.
These estimates of effective dose can be compared to the annual average effective dose from
background radiation, which is 3.6 mSv/year and the annual whole body effective dose that a
radiation worker (medical personnel, nuclear chemist or other radiation worker) is allowed on an
annual basis (50 mSv/year).
Exam description
The CT exam will consist of the series of scans described above with repeat series (total of 2)
through the coronary arteries using standard techniques.
Estimated radiation dose (CTDI) is reported below using the technical factors described above for
each sequence. These values were calculated based on measured values using a standard test
object (CTDI 32 cmdiameter body phantom) in comparable scanners (GE LightSpeed) at UCLA:
For one prospectively ECG gated low dose heart scan the peak dose is 12.5 mGy (1.25 rad).
Effective Dose is the sum of the weighted absorbed doses for all irradiated tissues, where the
weighting factors represent the different risk of each tissue to mortality from cancer and
hereditary effects. These weighting factors are higher for the gonads and lower for less sensitive
organs (such as the extremities).
These estimates were obtained by finding the average dose to each radiosensitive organ (based
on the phantom radiation dose measurements described above and anatomical coverage for
each sequence). The weighting factors were then applied according to the description in the
International Council on Radiation Protection Report 60. These estimates were performed for
each sequence and then summed to obtain the results for the entire exam. The results are
summarized in table 2 above.
For each coronary scan, the estimated effective dose is estimated to be 1.5 mSv (150 mrem) for
men and 1.9 mSv (190 mrem) for women. The difference is that the breast is irradiated in this
scan, and because the breast dose carries a weighting factor of .05 of the total effective dose, the
effective dose is higher for women. A similar effective dose was calculated for the abdominal
scan used in FHSSCAN and MESA studies of 2.7 mSv for both women and men is noted since
neither gender’s gonads are directly irradiated. In this protocol the majority of the abdomen was
imaged. In the Jackson Heart Study we are reducing the scan coverage by 30% and removing
the liver, kidneys and marrow of the upper spine from the imaged region. Thus the a conservative
estimate of the effective dose for this more limited scan area is 2.0 mSv.
11
For the entire exam, the estimates of effective dose range 3.5 mSv for men to 3.9 mSv for
women. These values would compare with 3.6 mSv annual background exposure in the U.S to
radiation and the 50 mSv whole body exposure annual limit for radiation workers.
Therefore, the total effective dose from these scans for an average Jackson Heart
Participant is significantly less than that allowed for radiation workers on an
annual basis and is equivalent to about 1.1 times annual background exposure.
However, because these estimates are based on population averages, these
estimates should not be taken to provide an estimate of risk for any individual
patient.
To provide participants with a concise and understandable explanation of the radiation involved
with the CT exam we have chosen to present the effective dose. The effective dose estimates the
exposure by organ irradiated and allows the values to be compared directly with the annual
exposure to natural sources of radiation (3.6 mSv) and the annual allowance for radiation
workers(50 mSv). We believe that the alternatives of (1) simply providing a number out of context
or (2) comparing the dose to other medical procedures, while informative to scientists and
healthcare professionals, is less informative to the lay public. The following language is
recommended to the field centers for informed consent concerning the CT exam. Local
requirements or standard language may require modifications as appropriate.
Recommended Language for Informed Consent
The estimated amount of radiation (effective dose) the average participant in this
study will receive is less than 4 mSv. This amount of radiation exposure can be
compared to the amount of radiation exposure you get each year from natural and
man made sources which is 3.6 mSv (average annual background exposure to
radiation in the U.S.). The actual amount you receive for the whole CT exam
depends on several factors such as how big you are and if you are a man or
women. People who have jobs in which they work with radiation have a yearly limit
of 50 mSv. This CT exam is about 8% of the yearly amount of radiation exposure a
worker is allowed to receive each year.
We believe the above language accurately and conservatively presents the information related to
radiation exposure with the research CT exam and will allow our participants and potential
participants to make an informed decision about involvement in this study.
The investigators are aware that local review and approval of the CT protocol, as for other
aspects of the study, must be made through the appropriate local Investigational Review Boards
(IRB). In some cases additional review by radiation safety committees may be required. The CT
Reading Center will provide assistance and the material contained in the manual of operation to
the field center principal investigator and imaging investigator to facilitate and enhance the
process as requested.
4.0 CT Scan Site Procedures for Secure Networking of CT image to Wake Forest
University CTRC
The JHS CT Data Acquisition Center is located in the Jackson Medical Mall. The specific CT
system is a GE Healthcare Lightspeed 16 Pro. The standardized protocol has been stored on the
CT system during Dr. Carr’s training visit and this protocol includes automatic routing from the CT
scanner to the Wake Forest Univ. CTRC using secure networking protocols over the internet. The
system uses Medical Imaging Resource Center (MIRC) software developed with support from the
Radiological Society of North America (http://www.rsna.org/mirc/) in an open source environment.
The software has been specifically designed to meet the needs of clinical trials and has been
incorporated in the National Cancer Institute’s CABIG project. Dr. Carr has collaborated in the
development of the clinical trials software applications. A computer with the MIRC Field Center
software has been installed in the CT control room at the Jackson Medical Mall. Upon completion
of each exam the images are automatically networked to the MIRC PC. The MIRC Field Center
System is set up to receive DICOM images from imaging modalities and forward these images to
Wake Forest University’s research PACS. In order to ensure HIPPA compliance, this system is
configured to deidentify patient health information before forwarding the images. Furthermore,
the forwarding mechanism is based on the secure HTTP protocol using SSL networking. The
cryptographic keys use the RSA/DES3 algorithms and are 2048 bits long and provide industrial
strength security. The CTRC can receive images continuously and simultaneously from the JHS
CT scanner 24 hours a day, 7 days a week. In addition the images are archived redundantly to
prevent lose of image data during the transfer (CT scanner holds a temporary copy, UMMC
sends the images to two independent PACS archives, the MIRC field center applications
maintains a copy of all images until received successfully at WFU CTRC and once received we
have extensive backup procedures detailed in the CTRC MOP.
The CT Scanners will complete a certification process prior to the pilot exam. During this process
measurement of scan quality will be obtained concerning spatial resolution and contrast
resolution with particular attention directed to the calibration of CT numbers.
CT Certification Process:
1. CT images will be sent to the CTRC to provide format of DICOM header and additional
CT scanner specific information.
2. CTRC will ship the Cardiac CT phantom (QRMGermany) to the site and a series of
scans of this phantom will be obtained (This was completed on Jan. 11, 2006). .
3. The QCT phantom & torso phantom to be used throughout the exam will be scanned
according to protocol (This was completed on Jan. 11, 2006).
The purpose of the CT scanner certification process is to validate the CT scanners ability to
measure the known amounts of simulated calcified plaque contained in the standard QCT
phantom (Image Analysis, Columbia, KY). We will then use this information to finetune the CT
protocol for the CT system. It will also allow us to ensure comparability to other CVD disease
research studies that use CT such as MESA and the Framingham Heart Study.
CT Calibration
Calibration to Air (Baseline, then daily) An initial baseline followed by daily scans will be
obtained. This calibration is part of the daily scanner startup routine. These procedures will follow
the manufacturer’s recommended procedure.
Some common sources that cause poor results include: inappropriate table height (TORSO plug
should be at isocenter when scanned); malpositioning of the phantom; old or improper CT
calibrations; use of improper scan parameters.
CT protocol training material will be provided for all technologists from each field site. The
curriculum for the CT Training is presented in Appendix A and a draft of the electronic
education material is in Appendix D.
The instructional material will provide the technologist who will perform the CT studies an
overview of the study objectives, study organization and an introduction to the CT Reading
Center personnel. It will detail the study protocol and quality control procedures. It will
complement this manual of operation and provide pictures to facilitate learning the CT protocol.
The experience in MESA and CARDIA with CT technologists is that in some cases multiple
technologists at each site are performing protocol exams as part of their work schedule.
Although it is desirable to minimize the number of technologists involved, this is, in most
cases, outside the ability of investigators to designate. The WFU Reading Center has
designed a program to accomplish the following:
1. Identify the technologist performing each CT study
2. Train and maintain skills of each CT technologist
a. Train a “Master” technologist from each site at WFUHS
CTRC
b. Provide precertification material and exam for each
technologist
c. Provide Preliminary Certification until completion and
review of the 3 studies on protocol.
d. Timelimited certification for 6 months
3. Provide feedback to CT technologist on an individual and by site
basis
4. Identify protocol variances / violations /and violations impacting
participant safety
a. Retrain / enhanced training as needed
b. Stop CT exams if needed to resolve problem
The training material will consist of a CD with a PowerPoint presentation, this CT manual of
operations and a precertification exam. Technologists will be required to read the
PowerPoint training material and answer the precertification exam. Hypertext links will allow
the technologist to link directly to the relevant material in the MOO. The precertification exam
will allow the Reading Center to assign a unique technologist identification which will be
entered on every scan performed by the technologist. After successful precertification, the
next three exams will be performed in conjunction with the Master technologist. After these
have been reviewed and accepted, the technologist will be given full certification for 6
months. Every 6 months the Reading Center will create a new training presentation in
PowerPoint focusing on core issues and any potential problems identified across all scan
sites in the study. A brief questionnaire directed at these issues must be completed by each
technologist and returned to the Reading Center to maintain certification. If problems are
identified at a specific site, additional training by Dr. Carr may be required. He will review
selected studies completed to date and discuss issues related to protocol compliance.
Feedback will be provided to the technologists concerning their scan technique for the heart.
Questions and issues they may have will be discussed and resolved as appropriate. These
visits will take one working day each and will concentrate on obtaining adequate and optimal
scan images using the CT scanning protocol.
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Appendices
17
Appendix A
Wednesday, January 10
2:00 – 3:30 p.m. Meet with Data Acquisition Center, CC & EC Staff
JHS Library
Thursday, January 11
8:00 – 9:00 a.m. Prep meeting with Data Acquisition Center Staff
JMM CT Station
Friday, January 12
*NOTE: Since the CT Scan Protocol had not been approved by the UMMC IRB, Pilot Testing was
replaced with the use of 3 volunteers, who are not JHS participants, to allow Dr. Carr to train
technologists on body positioning and related skills. UMMC Radiology Department will conduct
Pilot Testing after IRB approval of the CT Scan protocol.
19
DR. H. TAYLOR
Dr. M. DOHERTY
To Be Completed by CT Technologist
Series Description: Series Number: Number of Images
Scout
Heart: 35 cm FOV @ 2.5 mm
Heart Retrorecon: 27 cm FOV @ 1.25
mm
Heart Retrorecon: 50 cm FOV @ 2.5
mm
Aorta: 35 cm FOV @ 2.5 mm
Aorta Retrorecon: 27 cm FOV @ 1.25
mm
Aorta Retrorecon: 50 cm FOV @ 2.5
mm
Table Height:: 150 or mA: 400 or 515 (if > 220 lbs) (circle
one)
Exam Number: Local Archive: Tech ID#
Comments:
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Appendix C
Appendix C: The CT Technical Parameters for each CT system
Note: The Siemens and Philips systems will enter mAs values while the GE systems will
enter mA values. The appropriate value has been made bold in the above table.
CT Technical Parameter for the Abdominal Aorta Scan:
Appendix D:
CT Technologist Training and Certification Procedures:
The WFU CT Reading Center will coordinate with FC personnel for the training of CT
technologists. The process will consist of:
1) precertification training material
2) precertification test
3) detailed review and successful completion of three complete CARDIA CT exams
4) quarterly recertification test completion
A lead technologist at each Field Center along with as many as possible participant technologists
will be trained during Dr. Carr’s site visit and course scheduled for December 2006, exact date
TBD. This visit provides an opportunity for handson training and relationship building for the CT
exam. During this visit a lead CT tech for the project is designated and trained. Detailed training is
provided by an animated and graphical PowerPoint course provided by the CTRC. This course is
based on the manual of operations(MOO) but includes actual CT exam images and pictures
documenting critical aspects of the CT exam and quality control procedures. A written exam must
be completed. Following the successful completion of the precertification exam the RC will issue
a technologist ID number and preliminary certification. The RC will then review each exam by the
Technologist and provide full certification once three exams have been completed with complete
protocol adherence. Written quarterly recertification will be required to maintain skills.