Liver

Priority Description
1. P1 High probability of potentially life threatening condition
2. P2 High probability of condition potentially causing significant long term harm
3. P3 Possibility of potentially life threatening condition
4. P4 Possibility of condition potentially causing significant long term harm
5. P5 Unlikely to be life threatening or cause significant long term harm

Protocol code	When to use
?Ca 2Wk	? Cancer 2ww – use as normal – scan to be scheduled within 2 weeks
Urgent	Urgent – use as normal – scan to be scheduled within 4 weeks
COVID – Semi Urgent	Examination needs performing during next few months
Routine	Do not use during Covid pandemic
COVID P5 Cancel	Examination is P5 exam and will be cancelled and re refer back to clinician
Cancel	Examination to be cancelled due to non-justification of examination only ( not due to COVID)
On hold	Use as normal

All routine are reclassified as above.

Indication	COVID Cancel	COVID Urgent	Brief description	Slice thickness and reconstruction kernel	Further details of contrast timing/explanation of what the radiographers do	Abbreviation
Cholangiocarcinoma?		X	Triple phase liver (Art/PV/5 min delayed)	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	Bolus tracked as above.	Triple phase liver (Art/PV/5 min)
Staging cholangiocarcinoma		X	Appropriate scans according to recent characterisation scan and whatever else is needed e.g. chest and pelvis
Follow up cholangiocarcinoma		X	5 min delayed liver and PV Chest, abdomen and pelvis	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	As above	CAP with 5 min delayed liver
Characterise liver lesion/HCC		X	CT triple phase liver Usually do not require pre-contrast unless possible focal fat, etc. Non contrast, arterial, PV and 5 minute delayed liver. (No pelvis required unless clinically indicated)	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	ROI placed over aorta, monitoring begins after 10 seconds and bolus tracking triggers scan at 100 HU with a delay of 12 seconds. After arterial scan 30 s delay till PV scan.	CT Quad/triple Phase Liver
Hepatocellular carcinoma staging		X	Appropriate scans according to recent characterisation scan and whatever else is needed e.g. chest and pelvis
Liver metastases		X	CT liver Depends on primary site. If colorectal only need PV phase. Breast/renal/neuroendocrine/melanoma/sarcoma/lung usually include chest	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	If colorectal, lung, squamous cell, adeno ca. (hypovascular) 65 seconds abdomen and pelvis.	CT PV liver
					Breast, melanoma, lung: Arterial chest and liver 65 seconds abdomen and pelvis	CT Art + PV liver
Haemangioma			CT triple phase liver and delayed Art, PV and 5 minute liver	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	MRI preferable (see new protocol for incidental liver lesion pick up). Bolus tracked as above.	CT triple phase liver
Post TACE		X	CT triple phase liver (arterial/portal venous/5 min delayed)	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	Bolus tracked as above.	CT triple phase liver
Post RFA		X	See either Liver metastases protocol or HCC protocol, some people want pre contrast	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	Bolus tracked as above.	See either Liver metastases protocol or HCC protocol
Post embolisation f/u of HCC		X	Aterial, portal venous and delayed phases	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	Bolus tracked as above.	CT triple phase liver
Post embolization f/u of liver metastatic deposit		X	CT arterial or arterial/PV liver	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	If colorectal, lung, squamous cell, adeno ca. (hypovascular) 65 seconds abdomen and pelvis.	CT PV liver
					Breast, melanoma, lung: 40 seconds chest and liver 65 seconds abdomen and pelvis	CT art + PV liver
Splenic lesions		X	Triple phase abdomen	1.5 mm B30f, 5 mm B30f, 1.2 mm increment.	As above	CT triple phase spleen