Welcome to brand new Ask the Fish. Post your questions in different boards to get in touch with CTisus team & Dr. Elliot K. Fishman!
Our old Ask the Fish forum can be still viewed as an archive at https://ctisus.com/redesign-askfish/index.html.
We encourage all the users to register in this new forum to get answers to their questions since the posts in old forum will no longer be reviewed!
Thank you for visiting & looking forward to your feedback!

Recent Posts

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CT Scan Protocols / Re: Oral Contrast for CT: 2 Questions
« Last post by Elliot K. Fishman, MD on August 05, 2019, 03:47:15 pm »
the era of delay is over
if u get 15-20m minutes "praise the Lord"
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CT Scan Protocols / Re: Oral Contrast for CT: 2 Questions
« Last post by CharPatton on August 05, 2019, 02:44:42 pm »
Preaching to the choir, but thank you very much for sharing your expertise and maintaining such a wonderful and useful site!!!

Given the UCSF paper, what kind of time delay to you use at JHU between ingestion and scanning? Our practice is similar to the UCSF quote, but it would sure be nice to get a longer delay in there to opacify distal SB loops.
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CT Scan Protocols / Re: Special protocol for "gallbladder cancer"?
« Last post by CharPatton on August 05, 2019, 02:42:16 pm »
Tnx!
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CT Scan Protocols / Re: Special protocol for "gallbladder cancer"?
« Last post by Elliot K. Fishman, MD on August 05, 2019, 09:56:50 am »
if I was staging GB cancer I would do dual phase to try and define liver involvement by direct extension. If only one phase I would wait 70 sec
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CT Scan Protocols / Re: Oral Contrast for CT: 2 Questions
« Last post by Elliot K. Fishman, MD on August 05, 2019, 09:55:47 am »
we need oral contrast to prevent misdiagnosis.
use 500-1000 cc of Oral Omnipaue or 500-1000cc of water depending on the situation.
this is a quality of care issue
Elliot
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CT Scan Protocols / Special protocol for "gallbladder cancer"?
« Last post by CharPatton on August 01, 2019, 02:53:56 pm »
Do you do just a regular CT in portal venous phase, or do you add a 15' delay like one would for cholangiocarcinoma scans?

Thanks!!!
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CT Scan Protocols / Oral Contrast for CT: 2 Questions
« Last post by CharPatton on August 01, 2019, 02:43:29 pm »
1) Are you still holding the line at requiring/recommending oral contrast for CT in non-trauma settings?

- Most every administrator in the hospital, and many of the clinicians, are telling us that we don’t need to give it. We feel that patients benefit barring extenuating circumstances, but it’s an uphill battle to promote continued PO contrast in CT.   
- There was a 2019 Radiology article from Harvard that said, “Current oncology and American College of Radiology guidelines advocate the use of positive OCM, despite its influence on workflow”.   

2) If you are still giving PO contrast, what volume of contrast and what specific instructions do you give patients about drink timing prior to the CT scan?

- There was a 2019 AJR article from UCSF that said: “Our use of a 45- to 60-minute scanning delay after initiation of drinking of oral contrast material is common for the use of oral CT contrast material and has been our institutional protocol for decades. Nevertheless, we found incomplete opacification of the small bowel when using this protocol regardless of which type of oral contrast agent was used. “

As always, thank you so much!!!
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Please reference a case number along with anatomical region or URL of the case when asking a question about a specific case.  The case number is located at the top of the page right below the anatomical region.  Alternatively you can simply copy and paste the URL.  Otherwise it may be impossible to answer your questions.
 
Thank you!
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!! Please Read - About the Board / Re: Coronary CTA
« Last post by Elliot K. Fishman, MD on July 14, 2019, 08:15:46 pm »
you can see the protocol on CTISUS protocol section.
our rule with infants is to wait a bit longer and opacify all structures to prevent a misdiagnosis
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!! Please Read - About the Board / Re: Rules
« Last post by Elliot K. Fishman, MD on July 14, 2019, 08:14:28 pm »
Hope the rules are helpful to all
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