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CT Chest With Contrast (Routine; Mediastinum/Nodes)

CT+ ContrastChest

Indications

Mediastinal/hilar mass or lymphadenopathy characterization
Lung cancer staging, thoracic malignancy assessment
Infection/abscess, empyema, complicated pneumonia
Vascular evaluation of mediastinum (non-PE/aorta-specific)
Pleural disease, chest wall invasion

Patient prep

Screen eGFR per contrast policy; document allergy/premedicate if indicated
IV access (18-20 G preferred for power injection)
Hold solids ~2-4 h per site policy; arms above head
Coach end-inspiratory breath-hold

Contrast

Agentiodinated (e.g. iohexol 350 or iopamidol 370)

RouteIV

Dose≈70-100 mL at 2-3 mL/s, saline flush

TimingRoutine venous/equilibrium phase ~35-45 s scan delay (fixed delay or bolus tracking); ~60 s for soft-tissue/nodal characterization

Technique

Supine, arms up; helical volume lung apices through adrenals
Single end-inspiratory breath-hold; scan in cranio-caudal direction
120 kV (100 kV smaller patients); mAs per scanner with AEC; iterative reconstruction
Reconstruct soft-tissue and lung kernels; thin sections + coronal/sagittal reformats
Bolus tracking on descending aorta or fixed delay

Series / Sequences

#	Series / Sequence	Plane	Thickness	Notes
1	Axial soft tissue/mediastinal	axial	2.5-3 mm	Standard kernel; nodes, mediastinum, pleura
2	Axial lung	axial	1-1.5 mm	Sharp kernel, lung window
3	Coronal reformat	coronal	2-3 mm	Mediastinum and lungs
4	Sagittal reformat	sagittal	2-3 mm

Key points

Routine venous-phase timing opacifies mediastinal vessels and nodes; this is NOT a PE or aortic CTA protocol (different timing)
Use standardized nodal stations for lung cancer staging; correlate with PET when staging
Add dedicated phases (e.g. arterial) only if vascular question; otherwise single venous phase suffices
Thin lung-kernel images for parenchymal/nodule assessment in oncologic patients

References

• ACR–STR Practice Parameter for the Performance of Thoracic CT
• ACR Appropriateness Criteria: Noninvasive Clinical Staging of Bronchogenic Carcinoma
• Radiopaedia: CT chest with contrast (protocol) link
• RadioGraphics: Mediastinal Lymph Node Staging

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.