Editing Liver


Priority Description<br />
1. P1 High probability of potentially life threatening condition <br />
2. P2 High probability of condition potentially causing significant long term harm <br />
3. P3 Possibility of potentially life threatening condition <br />
4. P4 Possibility of condition potentially causing significant long term harm <br />
5. P5 Unlikely to be life threatening or cause significant long term harm  <br />
<br />
{| class="wikitable"
|-
!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.

{| class="wikitable"
|-
! 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?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
|colspan="4"|
Appropriate scans according to recent characterisation scan and whatever else is needed e.g. chest and pelvis


|-
|
Follow up cholangiocarcinoma
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
|colspan="4"|Appropriate scans according to recent characterisation scan and whatever else is needed e.g. chest and pelvis


|-
|rowspan="2"|Liver metastases
|rowspan="2"| <!--Put an X after the angled bracket if COVID Cancel -->
|rowspan="2"| <!--Put an X after the angled bracket if COVID Urgent -->X
|rowspan="2"|CT liver
Depends on primary site.
If colorectal only need PV phase.
Breast/renal/neuroendocrine/melanoma/sarcoma/lung usually include chest
|rowspan="2"|
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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->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


|-
|rowspan="2"|Post embolization f/u of liver metastatic deposit
|rowspan="2"| <!--Put an X after the angled bracket if COVID Cancel -->
|rowspan="2"| <!--Put an X after the angled bracket if COVID Urgent -->X
|rowspan="2"|CT arterial or arterial/PV liver
|rowspan="2"|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
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
Triple phase abdomen
||
1.5 mm B30f, 5 mm B30f, 1.2 mm increment.
||
As above
||
CT triple phase spleen
|}