In adult radiology a PAN scan includes 

• C- Head

• C- Cervical Spine

• C+ Chest, Abdomen and Pelvis

This type of scan is routinely performed on all adult trauma patients. 

As a way to reduce dose to our patients, we only image what areas are necessary and relevant to the patient's symptoms and the mechanism of injury.

No "PAN" scans unless deemed clinically justified. All scans must be discussed with the radiology fellow/consultant 

 eg, If the patient has no neurological deficient and are cleared by neurology, we shouldn't be imaging the head. If the patient has no abdominal tenderness, no signs of trauma to the abdomen and is cleared by surgery, then we shouldn't be imaging the abdomen. 

Occasionally after non-contrast imaging we may need to add on extra scans to help answer the clinical question.

For example, you image a C- head and there is a large bleed. The team want to add on a CTA neck and head, then continue on for the chest, abdomen, pelvis scan. Your patient is 70kg. What do we do?

If possible, we want to limit contrast exposure to the patient so only use 1 injection.

Contrast Volumes and rates

• CTA Head and Neck would only need 60mls, quickly (4ml/s)

• CT CAP will need 100mls, slower (2ml/s)

Injection 

• 100mls contrast at 4ml/s (volume for CAP, speed for CTA)

Delays for scan

• Carotids likely to trigger around 15-20s (caudo-cranial)

  • Move arms up in between if possible to reduce artifact on the chest

• CT Chest: 30s (15s post carotids) (Cranio-caudal)

• CT Abdomen: 75s (45s post chest) (Cranio-caudal)

• Can also manually trigger these while watching the timer on injector

Now think about these examples while trying to use the 1 bolus of contrast?

1. CTA Chest + PV Abdomen

2. Leg run off + CAP

3. C- head + Venogram + CAP

• What are the timings for each scan?

• How much contrast do they need?

• What flow rate is required?

• What direction of scanning is needed?

• Do we need to try change patient position between the scans?

• What is the length of the scans (A CTA legs can take up to 20s)

• Do we do the CAP as a one range or two range (30s Chest and 75s Abdo)

Chat with your CT senior and have a go yourself at building the protocol for all of the above.