This document outlines the protocol for performing CT angiography (CTA) from the cerebral arteries to the lower limbs. It discusses indications for CTA including aneurysms, stenosis, dissections, and more. The preparation, positioning, and scanning protocols are provided for CTA of the head to lower limbs as well as the subclavian arteries. Pediatric protocols are also summarized. The document concludes with examples of CTA findings and references.

3. Indications

4. Contraindication

5. Preparation

6. Protocol

7. Cerebral to lower limb

8. Subclavian

9. Pediatric patient

11. Carotid arteries

12. Subclavian arteries

13. Thoracic & abdominal aorta

14. Renal vasculature

15. Abdominal viscera vasculature

17. Stenosis

18. Dissection of aorta

19. Atherosclerosis

20. A-V fistula

21. A-V malformation

22. Thrombosis

23. Pulmonary embolism

24. Guide to implanting or evaluating stents.

25. Thoracic Outlet Syndrom

26. Pregnancy

27. unstable vital signs

28. Allergic patient

29. Kidney problems

31. A 20-year old male pt . Known to have thoracic aortic aneurism post endovascular aortic repair.

32. Left lower limb ischemia. Complete occlusion of the left popliteal artery

34. Not severly allergic or asthmatic

35. Recent Renal function test(RFT) must be normal;

36. 1 week inpatient.

37. 3 month diabetic patient

38. 6 month non diabetic patient.

39. Explain procedure

40. Signed consent form

42. We will present:

44. Head first in the gantry.

45. The arms are raised above the head.

46. Scanning from head to lower limb, as ordered.V center (height center): mid of the body (mid of the axilla ). H center: mid of the head.

50. Scan parameters: Note: scan delay time is used if we don’t have smart prep.

51. Cont. Filming: No print out; PAC system is used. Windowing: Reformatting: 2DD must be done

52. Reformatting: 2DD 2D sagital 3D 2D coronal

54. No injector machine.

55. to avoid extravasations.

57. Watch the patient for possible adverse contrast reactions.

58. Pt. can eat and drink as normal.

61. Stenosis

62. Dissection of aorta

63. Atherosclerosis

64. A-V fistula

65. Thrombosis

66. Pulmonary embolism

67. Guide to implanting or evaluating stents

68. Pregnancy

69. unstable vital signs

70. Allergic patient

71. Kidney problems

72. Severe diabetes

74. TOS symptoms: pain in the arms, shoulder and neck, can turn blue.

75. Caused by nerve or BV compression.3D reconstructed image of RT subclavian artery compressed at costo-clavicular level.

76. Differ than the previous technique in the following…

78. To avoid the artifact caused by the thick CM in the subclavian artery of the injected arm.

79. Volume: 160 ml80 ml for rest 80 ml for stress

80. Axial slices Start location: half of carotid a. or neck. End location: down to mid chest (bifurcation). FOV is adjusted to as small as possible; but include shoulder. Carotid arteries

81. Axial slices Start location: half of carotid a. or neck. End location: down to mid chest (bifurcation). FOV is adjusted to as small as possible; but include shoulder. Carotid arteries

83. Thin slices are needed or overlapped slices are needed.

84. Auto Bone subtraction, or any other unwanted soft tissue structure is subtracted.

86. Cases 20 yr old male with hypertension, CT Renal Angiography showed Renal Artery Stenosis. 50 yr old asymptomatic male. CT Thoracic Angio shows a twisted dilated descending aorta with celiac artery aneurysm.

87. Thank U No thing is impossible, the word itself says “I’m possible”

88. References: King Khalid Universal Hospital, CT Department Protocol. Explained by Mr. Kamal, the supervisor of CT department. Some of the CT angiographic images were taken from websites.