[Intl_DxMedPhys] Dynamic CT Myelogram Protocol - What's a reasonable DLP?

[Tyler Fisher]

Hi Everyone,
A site that I recently began consulting for has a new physician who wants
to perform Dynamic CT Myelograms.  The goal of the procedure is to look for
CSF leaks in the spine.  The protocol that the physician provided and put
on the scanner, simplified, is below:

   1. Patient in Right lateral decubitus position.
   2. Prep the skin and advance a 22 gauge spinal needle under serial CT
   guidance.
   3. Inject 10 mL of Omnipaque-300.
   4. Perform 3 continuous passes from sacrum to skull base, then skull
   base to sacrum, and then sacrum to skull base.
   5. Rotate the patient to left lateral decubitus and do another single
   pass from sacrum to skull base.

The acquisition parameters for the 4 passes is 140 kVp, 250 mA, 0.625 mm
slices.  They're using a GE Revolution scanner.

This protocol was loaded and they did a patient.  The total exam DLP was
7,871.89 mGy-cm.  The techs promptly freaked out and have since refused to
perform the procedure.

So, for the group, what is a reasonable DLP limit for a case like this?
Are any of your sites doing this procedure and what doses are you seeing?
140 kVp seems like the wrong kVp for optimizing iodine contrast - what kVp
are you using for the passes?

Thanks in advance for the wisdom I'm sure someone has out there.

Tyler Fisher
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://lists.osu.edu/mailman/private/intl_dxmedphys_wd_osu_list/attachments/20260213/d6b34c58/attachment.html>