CT Pancreas (Dual-Phase) — Dictation, Appropriateness, and Dose for Residents
1. The Pancreatic Mass Protocol: More Than Just a Mass
Stat CT from the ED. New-onset painless jaundice. Your attending wants the multiphase pancreas protocol read, and they’re not just looking for a mass. They expect a precise evaluation of vascular involvement — celiac, Superior Mesenteric Artery (SMA), portal vein — because that dictates resectability and the patient’s entire clinical course. You know the NCCN criteria exist, but recalling the exact percentages of vascular contact that define resectable vs. borderline vs. unresectable on the fly, with three other studies in your queue, is a tall order. When I was a fellow, I kept a cheat sheet taped to my monitor for this exact scan. It’s a high-stakes read where the details matter immensely. For more high-yield guides and tools, check out the residents and fellows resource hub.
2. What a CT Pancreas (Multiphase Pancreatic Mass Protocol) Covers and What Attendings Look For
The multiphase CT of the pancreas is the workhorse for evaluating suspected pancreatic masses and assessing the severity of acute pancreatitis. The protocol is designed to optimize contrast timing to differentiate pancreatic tissue from tumors and to clearly delineate the critical surrounding vascular structures. The key is the timing: a late arterial (or “pancreatic parenchymal”) phase around 40 seconds highlights the difference between the brightly enhancing normal pancreas and a typically hypoenhancing adenocarcinoma. The later portal venous phase is crucial for spotting liver metastases and assessing venous involvement.
Your attending expects a comprehensive report that addresses:
- The Pancreas: Is there a mass? Where is it located (head, body, tail)? What are its enhancement characteristics (hypoenhancing vs. hyperenhancing)? Is there upstream pancreatic ductal dilation or parenchymal atrophy?
- The Biliary System: Is there biliary ductal dilation? The combination of pancreatic and biliary duct dilation (the “double-duct sign”) is highly specific for a pancreatic head mass.
- Vascular Involvement: A clear, structured assessment of the tumor’s relationship to the celiac axis, SMA, common hepatic artery, and the portal/superior mesenteric veins. This is the core of surgical staging.
- Metastatic Disease: Careful evaluation of the liver (on the portal venous phase), regional lymph nodes, and peritoneum.
- Acute Pancreatitis: If that’s the indication, comment on parenchymal enhancement (to identify necrosis), peripancreatic fluid collections, and other signs of severity.
3. Radiology Report Template for CT Pancreas (Multiphase Pancreatic Mass Protocol)
This template provides a solid foundation. Remember to tailor it to the specific findings and clinical question for each patient.
Technique
Multiphase CT of the abdomen was performed with and without intravenous contrast. Axial images were acquired prior to contrast administration, followed by helical imaging in the pancreatic parenchymal and portal venous phases after the administration of [e.g., 125 mL of Iohexol 350] IV contrast. Coronal and sagittal reformatted images were reviewed.
Findings
Pancreas: The pancreatic head/body/tail demonstrates a [size] cm hypoenhancing/hyperenhancing mass. There is associated upstream dilation of the main pancreatic duct, measuring up to [X] mm. The parenchyma distal to the mass appears [atrophic/normal]. No evidence of pancreatic necrosis. The remainder of the pancreas is unremarkable.
Biliary System: There is dilation of the common bile duct to [X] mm and mild/moderate intrahepatic biliary ductal dilation. The gallbladder is [unremarkable/distended].
Vascular Evaluation:
– Celiac Axis: [Patent, no tumor contact / Abutted (<180 degrees) / Encased (>180 degrees)]
– Superior Mesenteric Artery (SMA): [Patent, no tumor contact / Abutted (<180 degrees) / Encased (>180 degrees)]
– Common Hepatic Artery: [Patent, no tumor contact / Abutted / Encased]
– Portal Vein / Superior Mesenteric Vein (SMV): [Patent, no tumor contact / Abutted (<180 degrees) / Abutted with contour deformity (≥180 degrees) / Occluded]
Liver and Spleen: The liver demonstrates [no suspicious metastatic lesions / multiple hypoenhancing lesions consistent with metastases, largest in segment X measuring Y cm]. The spleen is unremarkable.
Lymph Nodes: [No pathologic retroperitoneal or mesenteric lymphadenopathy / Enlarged lymph nodes are noted at the following locations…].
Other Organs: Adrenal glands, kidneys, and bowel are unremarkable.
Bones and Soft Tissues: No suspicious osseous lesions.
Impression
1. A [size] cm hypoenhancing mass in the pancreatic head/body/tail, highly suspicious for pancreatic adenocarcinoma.
2. Associated findings include upstream pancreatic ductal dilation and common bile duct dilation (double-duct sign).
3. Vascular involvement: [Summarize the key vascular findings, e.g., “The mass abuts the superior mesenteric artery over less than 180 degrees and abuts the SMV with mild contour deformity over greater than 180 degrees.”]
4. Based on NCCN criteria, these findings are most consistent with [resectable / borderline resectable / unresectable (locally advanced)] disease.
5. [No evidence of / Evidence of] distant metastatic disease, with suspicious lesions in the liver.
4. Free Template Sources for Your On-Call Toolkit
Building your own template library is a rite of passage. But you don’t have to start from scratch. Before you spend hours creating macros, know that two great free repositories exist, curated by major radiological societies. They are excellent starting points for common and uncommon studies alike.
- RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty. (https://radreport.org/)
- Radiology Templates (AU): An excellent resource maintained by Australian radiologists, offering a clean interface and practical, well-structured templates. (https://www.radiologytemplates.com.au/home-page/)
5. The Next-Level Move: From Free-Form Dictation to a Structured Report
The challenge isn’t just finding a template; it’s populating it accurately and efficiently under pressure. You see the hypoenhancing mass, the dilated duct, and the SMV abutment. Instead of clicking through a structured report and filling in a dozen fields, you can just dictate the positive findings. This is where AI-powered tools can streamline your workflow. The GigHz Precision AI reporting assistant is designed for this exact scenario. You dictate your findings in free form—”hypoenhancing 3 cm pancreatic head mass with double-duct sign and abutment of the SMV”—and the tool generates a clean, structured report based on ACR and SIR standards. It organizes the findings, structures the vascular involvement, and helps ensure your impression directly answers the clinical question, making you look sharp and saving you time.
6. When Should You Order a CT Pancreas (Multiphase Pancreatic Mass Protocol)? ACR Appropriateness Criteria
The American College of Radiology (ACR) provides evidence-based guidelines to help clinicians choose the right test. For pancreatic imaging, multiphase CT is a cornerstone.
For a patient with suspected acute pancreatitis on their first presentation with typical symptoms and lab values, imaging within the first 48-72 hours is often not needed. However, per the ACR’s Acute Pancreatitis guidelines, if the presentation is atypical or other diagnoses like bowel perforation are possible, a multiphase CT is Usually Appropriate. The same rating applies when a patient with known pancreatitis becomes critically ill or deteriorates, as CT is essential for assessing for necrosis, a key predictor of severity. It is also Usually Appropriate for evaluating known pancreatic fluid collections that are causing symptoms more than 4 weeks after the initial onset.
When the clinical suspicion is for cancer, the ACR’s guidelines on Pancreatic Ductal Adenocarcinoma rate multiphase CT as Usually Appropriate for initial imaging in a symptomatic adult. It is also the preferred study for locoregional disease staging, pre-surgical planning, and evaluating for distant metastatic disease. While MRI is a strong alternative, especially for high-risk screening or better soft-tissue characterization, CT’s speed and vascular detail make it the frontline modality in most institutions.
7. How Much Radiation Does a CT Pancreas (Multiphase Pancreatic Mass Protocol) Deliver?
A multiphase CT pancreas protocol delivers an estimated effective radiation dose of 10-20 mSv. This places it in a moderate dose tier for diagnostic CT scans. To put this in perspective, this dose is equivalent to several years of natural background radiation that we are all exposed to annually. While we should always be mindful of radiation, especially in younger patients or those requiring serial imaging, the diagnostic value in staging cancer or assessing severe pancreatitis almost always outweighs the risk. Modern CT scanners employ dose reduction techniques like automated tube current modulation to keep the dose as low as reasonably achievable (ALARA) without compromising image quality.
| Scan/Exposure | Typical Effective Dose (mSv) |
|---|---|
| Natural Background Radiation (1 year) | ~3 mSv |
| Chest X-ray (PA/LAT) | ~0.1 mSv |
| CT Pancreas (Multiphase) | 10-20 mSv |
8. CT Pancreas (Multiphase Pancreatic Mass Protocol) Imaging Protocol — Phases, Contrast, and Reconstructions
The success of a pancreatic mass protocol hinges on precise timing and high-quality reconstructions. The goal is to capture the peak enhancement difference between the normal pancreatic parenchyma and a potential tumor, followed by optimal opacification of the portal venous system for staging. A typical protocol involves a non-contrast series (especially if pancreatitis is a concern), a pancreatic parenchymal phase, and a portal venous phase.
| Phase | Timing (Post-Injection) | Key Purpose | Slice Thickness |
|---|---|---|---|
| Pre-contrast | N/A | Baseline density, calcifications, hemorrhage | 3-5 mm |
| Pancreatic Parenchymal | ~40 seconds | Peak pancreas enhancement; optimal for detecting hypoenhancing adenocarcinoma and hyperenhancing PNETs | 1-2 mm |
| Portal Venous | ~70 seconds | Liver metastases, portal/SMV involvement, venous anatomy | 1-2 mm |
Contrast: 100-125 mL of an iodinated agent (e.g., Iohexol 350) is injected at a high rate of 4-5 mL/sec to achieve a tight bolus for the arterial phase.
Reconstructions: Thin-slice (1-1.5 mm) reconstructions are essential for creating high-quality multiplanar reformats (MPRs). At the workstation, creating curved planar reformats along the course of the pancreatic duct and major vessels can be invaluable for assessing invasion.
9. The 3-Months-Free Offer for Radiology Residents and Fellows
3+ months free for radiology residents and fellows
Look like a rockstar on your reports — dictate positive findings in free form, and the AI generates a structured report using ACR + SIR templates with the appropriate clinical decision support firing automatically. All we ask is feedback so we can keep improving the product for trainees.
Signup is simple. No credit card, no long forms. To get set up, just provide these three items:
- Your PGY year (e.g., PGY-2, PGY-4)
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- Your training program / hospital name
Ready to give it a try? Apply for the residents free-access program here.
10. Frequently Asked Questions
Is GigHz Precision AI HIPAA-compliant?
Yes. The platform is designed for de-identified workflows by default. It operates on the anonymized text of your dictated findings, not on patient-identifiable images or electronic health record data, ensuring compliance with privacy standards.
Do I need my hospital’s IT department to set this up?
No. It’s a browser-based tool that requires no local software installation or special permissions. It works on any modern computer, including the workstations in the reading room or your personal laptop or iPad at home.
How does this work with PowerScribe or other dictation systems?
It works alongside your existing dictation system, not as a replacement. You can dictate your findings as you normally would, then paste the text into the AI assistant to generate the structured report. You then copy the structured output back into your final report in PowerScribe.
Can I use this on my phone or iPad?
Yes, the tool is web-based and responsive, making it accessible on tablets like the iPad, which is great for reviewing cases or preparing reports away from a dedicated workstation.
Can I customize the templates?
Yes. While the system comes pre-loaded with ACR and society-standard templates, you can customize them to match the specific formatting and phrasing preferences of your attendings or institution.
What happens after I finish my residency or fellowship?
The free access program is specifically for trainees. After graduation, you would have the option to transition to a paid plan designed for practicing radiologists. There’s no automatic roll-over or obligation.
Free GigHz Tools That Pair With This Article
Three free tools that complement the material above:
- ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
- GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
- GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.
Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026
