vcuhs radiology
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VCUHS Radiology
MSK CT PROTOCOLS
May 2010 Revision
MSK-01: MSK Chest Wall Protocols
• Sternum• SC Joints• Clavicle • Axilla • Ribs • Chest Wall
1st 2nd 3rd
KVP/mAs (QRM)/Rotation time 120/350ma/1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 1.2 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 3.0 mm 3.0 mm 0.6 mm
Image Order Cr - Cau
FOV 180-200 mm
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons3X3send to PACS
Bone lesion:SAG, COR recons3X3send to PACS
Send both sets ofThin axials to PACS & Terra
MSK-01 Basic Protocol
MSK-01A: Sternum, SC Joints
• Indications:– (-) trauma– (+) mass, infection
• Use MSK-01 Basic protocol• FOV• Mark abnormality if present• Sag/Cor reformats (angle coronals to
sternum)
MSK-01A: Sternum, SC JointsPlanes for Reformatted Images
Example Images: Sternum, SC Joints
Sagittal Sternum Coronal Manubrium and SC joints
Coronal Sternum
MSK-01B: Clavicle
• Indications: trauma
• Use MSK-01 Basic protocol
• FOV• Cor, sag reformats
MSK-01C: Axilla, Ribs, Chest Wall (-,+)
• Indications:– Trauma – Mass, infection
• Use MSK-01 Basic protocol• FOV (adjust as necessary)• Mark abnormality• Sag, Cor reformats • Angled axial (along axis of
ribs) may be useful for a specific rib abnormality
MSK-02: Shoulder/Arm (at side)*
• Shoulder/scapula• Shoulder arthro• Humerus• Elbow*• Forearm*• Wrist/hand*
*For elbow and distally, only perform with arm at side if patient unable to place arm over head for more ideal scanning.
KVP/Effective mAs/Rotation time
120/300 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 1.2 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 3.0 mm 3.0 mm 0.6 mm
Image Order Cr - Cau
FOV 180-200 mm
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons3X3send to PACS
Bone lesion:SAG, COR recons3X3send to PACS
Send both sets of
Thin axials to PACS & Terra
MSK-02 Basic Protocol
MSK-02A: Shoulder/Scapula (-,+)
• Indications:
– (-) trauma
– (+) mass, infection
• Use MSK-02 Basic protocol• FOV
• Mark abnormality
• Other arm above head
• Fracture / bone lesion: Paracoronal, parasagittal reformats (see examples)
• Soft Tissue lesion (mass, infection): perform straight coronals and sagittals
• Hardware:– 140 kvp / 400 ma / 1.0 sec– Collimation: 64 X 1.2 mm– 3rd Recon: 1.2 mm X 0.6 mm
MSK-02A: Shoulder / ScapulaPlanes for (bone lesion) Reformatted Images
Ideally, planes should be specified in 3 planes, although (A) is most important for scapula and shoulder joint. (B) and (C) are important for
proximal humerus fractures
A B C
MSK-02B: Shoulder Arthrogram
• Indications: post arthrogram
• FOV
• Use Use MSK-02 Basic protocol with changes in red at right
• Other arm above head
• Paracor/parasag reformats
KVP/Effective mAs/Rotation time
120/300 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 0.75 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 3.0 mm 3.0 mm 0.5 mm
Image Order Cr - Cau
FOV 180-200 mm
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons2X2send to PACS
Bone lesion:SAG, COR recons2X2send to PACS
Send both sets of
Thin axials to PACS &
Terra
Shoulder Arthro Modified Protocol
MSK-02B: Shoulder Arthrogram Planes for Reformatted Images
Ideally, parasagittal and paracoronal images should be prescribed in all 3 planes (axis of scapula and humerus)
Shoulder Arthrogram: Example Images
MSK-02C: Humerus (-,+)
• Indications:– (-) trauma– (+) mass, infection
• Use Basic MSK-02 protocol• FOV (adjust as indicated)• Mark abnormality• Other arm above head• Cor/sag reformats (angle to
bone)• Hardware:
– 140 kvp / 400 ma / 1.0 sec– Collimation: 64 X 1.2 mm– 3rd Recon: 1.2 mm X 0.6 mm
MSK-02C: Hummers (at Side)Planes for Reformatted Images
For humerus, prescribe planes along long axis of humerus (A,B) and in plane of elbow joint (C) to give ideal coronal and sagittal view of humerus and upper arm
MSK-02D: Elbow (-,+)
• Indications:– (-) trauma– (+) mass, infection
• Use Basic MSK-02 protocol• **Only perform with arm at side in
patients unable to raise arm above head
• FOV (adjust FOV as necessary to cover abnormality)
• Other arm above head• Sag/cor reformats (angle to long
axis of humerus)• For large Pt and/or arm across
abdomen, may require max technique
• Hardware:– 140 kvp / 400 ma / 1.0 sec– Collimation: 64 X 1.2 mm– 3rd Recon: 1.2 mm X 0.6 mm
MSK-02E: Forearm (-, +)
• Indications:– (-) trauma– (+) mass, infection
• Use Basic MSK-02 protocol• **Only perform with arm at side in
patients unable to raise arm above head• FOV (adjust FOV as necessary to
cover abnormality)• Other arm above head• Sag/cor reformats (angle to long axis
of ulna)• For large Pt and/or arm across
abdomen, may require max technique
• Hardware:– 140 kvp / 400 ma / 1.0 sec– Collimation: 64 X 1.2 mm– 3rd Recon: 1.2 mm X 0.6 mm
MSK-02F: Wrist/Hand (-,+)
• Indications:– (-) trauma– (+) mass, infection
• **Only perform with arm at side in patients unable to raise arm above head
• Adjust MSK02 protocol with changes as noted in red
• FOV (adjust FOV as necessary to cover abnormality)
• Other arm above head• Sag/cor reformats • For large Pt and/or arm
across abdomen, may require max technique
• Hardware:– 140 kvp / 400 ma / 1.0 sec– Collimation: 64 X 1.2 mm– 3rd Recon: 1.2 mm X 0.6
mm
VP/Effective mAs/Rotation time
120/300 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 2.0 mm 2.0 mm 1.2 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 2.0 mm 2.0 mm 0.6 mm
Image Order Cr - Cau
FOV 180-200 mm
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons2x2send to PACS
Bone lesion:SAG, COR recons2x2send to PACS
Send both sets of
Thin axials to PACS &
Terra
Wrist / Hand Modified Protocol
MSK-02G: Entire Arm (+)
• Indications: mass, infection• Use Basic MSK02 protocol• FOV (mark mass, adjust FOV as
necessary to cover abnormality, elbow straight as possible)
• Other arm above head• Slice thickness of 5mm x 5mm• Sag/cor reformats (angle to long
axis of humerus)
MSK-03: Arm (Over Head)
• Elbow• Forearm• Wrist• Hand• DRUJ
study
1st 2nd 3rd
KVP/mAs(QRM)Rotation time
120/150ma/1.0 sec
Collimation 64 x 1.2 mm
Slice Width 3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)1.2 mm
Pitch 0.75
Kernel B30 B70 B30B70
Increments 3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)0.6 mm
Image Order Cr - Cau
FOV 120-180 mm as indicated
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes: Sag, Cor 2x2 to PACS
Send both sets ofThin axials to PACS & Terra
MSK-03 Basic Protocol
MSK-03A: Elbow
• Indications:– (-) trauma– (+) infection, mass
• Use MSK-03 Basic Protocol• FOV (adjust FOV as necessary to
cover abnormality, elbow straight as possible)
• Mark abnormality if present• Sag/cor reformats (angle to long
axis of humerus)• This protocol may be use for
isolated humerus abnormality• Hardware: use 140 kV, 250 ma
MSK-03A: Elbow (Fx)Planes for Reformatted Images
Planes must be prescribed carefully and in 3 planes in order to achieve true axial (A), coronal (B), and sagittal (C) images.
MSK-03A: Example Images
MSK-03B: Forearm (-,+)
• Indications:– (-) trauma– (+) mass, infection
• Use MSK-03 Basic Protocol
• FOV (adjust FOV as necessary to cover abnormality)
• Mark abnormality, elbow straight as possible
• Sag/cor reformats (angle to long axis of ulna)
• Hardware: use 140 kV, 250 ma
MSK-03C: Wrist/Hand (-,+)
• Indications:– (-) trauma– (+) mass, infection
• Use MSK-03 Basic Protocol
• For High Res study, see modifications at right (must be isocenter)
• FOV (adjust FOV as necessary to cover abnormality, wrist and fingers straight as possible)
• Sag/cor reformats (angle to long axis of radius)
• Hardware: use 140 kV, 250 ma
VP/Effective mAs/Rotation time
120/150 ma1.0 sec
Collimation 12 x 0.6 mm
Slice Width 2.0 mm 2.0 mm 0.75 mm
Pitch 0.75
Kernel B30 U70 B30/U70
Increments 2.0 mm 2.0 mm 0.5 mm
Image Order Cr - Cau
FOV 120-150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons2x2send to PACS
Bone lesion:SAG, COR recons2x2send to PACS
Send both sets of
Thin axials to PACS &
Terra
High Res Hand / Wrist Modified Protocol
MSK-03C: Hand / WristPlanes for Reformatted Images
MSK-03A: Wrist- DRUJ Study
• Indications:– Distal Radio-ular joint
(DRUJ) abnormality• Use MSK-03 Basic Protocol
(high res may be necessary for one of the three scans)
• FOV• Scan BOTH wrists
separately in the arm overhead position
• Scan in 3 positions:– Neutral– Full pronation– Full supination
• Be sure to label R/L and which position for each series
• Use High-Res technique with Sag/Cor recons for neutral position only
MSK-04: Pelvis/Hips
• Pelvis (bone)• Hips (bilateral)• Hip (unilateral)• Acetabular
dysplasia study
KVP/Effective mAs/Rotation time
120/300 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 1.2 mm
Pitch 0.75
Kernel B30 B60 B30/B60
Increments 3.0 mm 3.0 mm 0.6 mm
Image Order Cr - Cau
FOV 380 mm
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons3X3send to PACS
Bone lesion:SAG, COR recons3X3send to PACS
Send both sets of
Thin axials to PACS &
Terra
MSK-04 Basic Bony Pelvis Protocol
MSK-04A: Pelvis (bone) (-,+)
• Indications:– (-) trauma– (+) mass, infection
• Use MSK-04 Basic Protocol• FOV (legs straight as possible)• Sag/cor reformats • Hardware: use 140 kV, 400 ma
MSK-04B: Hips (-)
• Indications:– trauma– FOV (legs straight as
possible)
• Use MSK-04 Basic Protocol
• Sag/cor reformats • Hardware: use 140
kV, 400 ma
MSK-04C: Acetabular Dysplasia Study (-)
• Indications:– suspected acetabular
dysplasia• Use MSK-04 Basic Protocol• FOV (legs straight and symmetric
as possible, toes straight up and together)
• Sag/Cor and 3-D reformats
MSK-04D: Hip (unilateral)
• Indications: – post arthrogram– Bony tumor
• FOV (legs straight as possible)• Sag/cor reformats • Use MSK-04 Basic Protocol
MSK-04D: Hip Planes for Reformatted Images
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Additional angling in the long axis of the femur (off the sagittal) yields nice images of femur (C)
A
B
C
MSK-05: Lower Extremity
• Femurs (unilateral, bilateral)
• Knee
• Tib/fib (unilateral, bilateral)
• Ankle/Hindfoot/Calcaneus
• Foot
• Entire leg
• Miscellaneous
– “Version” study
– Patellar tracking study
KVP/Effective mAs/Rotation time
120/250 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 1.2 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 3.0 mm 3.0 mm 0.6 mm
Image Order Cr - Cau
FOV 300 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons3X3send to PACS
Bone lesion:SAG, COR recons3X3send to PACS
Send both sets of
Thin axials to PACS &
Terra
MSK-05 Basic Lower Ext Protocol
MSK-05A: Femurs (bilateral)
• Indications: – mass, infection
• Use MSK-05 Basic Protocol• FOV (legs straight as possible)• Sag/cor reformats • Hardware: use 140 kV, 400 ma
MSK-05B: Femur (unilateral) (+,-)
• Indications: – (-) trauma– (+) mass, infection
• Use MSK-05 Basic Protocol• FOV (legs straight as possible)• Sag/cor reformats, angle along
long axis of femur • Hardware: use 140 kV, 350 ma
MSK-05C: Entire Leg (unilateral) (+)
• Indications:
– Mass, infection
• Use modified protocol at right
• FOV (legs straight as possible)
• Sag/cor reformats (angle along long axis of femur
• Hardware: use 140 kV, 300 ma
KVP/Effective mAs/Rotation time
120/250 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 5.0 mm 5.0 mm 2.0 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 5.0 mm 5.0 mm 1.0 mm
Image Order Cr - Cau
FOV 300 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons5x5send to PACS
Bone lesion:SAG, COR recons5x5send to PACS
Send both sets of
Thin axials to PACS &
Terra
Entire Leg Modified Protocol
MSK-05D: Knee (unilateral)
• Indications: – trauma (-) – mass, infection (+)
• Use MSK-05 Basic Protocol• FOV (knee straight as possible)• Mark mass if present• Sag/Cor reformats (angle to
posterior femoral condyles if possible)
• Hardware: use 140 kV, 300 ma
MSK-05D: Knee: Planes for Reformatted Images
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Use posterior femoral condyles to prescribe coronal and sagittal reformats (A, thick red line)
A
B
C
MSK-05E: Tib/Fib (unilateral) (-,+)
• Indications:– (-) trauma– (+) mass, infection
• Use MSK-05 Basic Protocol• FOV (knee straight as possible)• Mark abnormality if present• Sag/Cor reformats (angle to
long axis of tibia) • Hardware: use 140 kV, 300 ma
MSK-05E: Tib/Fib Planes for Reformatted Images
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Use posterior femoral condyles or midline of proximal tibia (A, thick red line) to prescribe coronal and sagittal reformats
A
B C
MSK-05F: Ankle/Hindfoot• Indications:
– (-) trauma– (+) mass, infection
• Use modified MSK-05 Basic Protocol on right
• FOV (foot at 90 degrees if possible)• Sag/Cor reformats (angle to approx
axis of foot) • Hardware: use 140 kV, 300 ma
KVP/Effective mAs/Rotation time
120/200 ma1.0 sec
Collimation 64 x 0.6mm
Slice Width 2.0 mm 2.0 mm 0.75 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 2.0 mm 2.0 mm 0.5 mm
Image Order Cr - Cau
FOV 150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons2x2send to PACS
Bone lesion:SAG, COR recons2x2send to PACS
Send both sets of
Thin axials to PACS &
Terra
Ankle/Hindfoot Modified Protocol
MSK-05F: Ankle/Hindfoot/Calcaneus Planes for Reformatted Images
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Use approximate long axis of calcaneus (A, thick red line) to prescribe coronal and sagittal reformats
A
B C
MSK-05G: Foot (-,+)• Indications:
– (-) trauma– (+) mass, infection
• Use Modified MSK-05 Protocol (same as Ankle/Hindfoot
• FOV (foot at 90 degrees if possible)
• Sag/Cor reformats (angle to long and short axes of metatarsals – see red lines at left)
• Hardware: use 140 kV, 300 ma
KVP/Effective mAs/Rotation time
120/200 ma1.0 sec
Collimation 64 x 0.6mm
Slice Width 2.0 mm 2.0 mm 0.75 mm
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 2.0 mm 2.0 mm 0.5 mm
Image Order Cr - Cau
FOV 150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
Soft tissue lesion:SAG, COR recons2x2send to PACS
Bone lesion:SAG, COR recons2x2send to PACS
Send both sets of
Thin axials to PACS &
Terra
Foot Protocol
MSK-05G: Foot Planes for Reformatted Images
Prescribe in sagittal (B) and coronal (C) planes off the short axis plane (A). For midfoot, use axis of 2nd-5th MT’s (A, thick red line) to prescribe coronal and sagittal reformats. Depending upon positioning of patient in scanner, short axis plane (A) may need to be derived from original images as well.
A B
C
MSK-05H: Patellar Tracking Study
• Indications:– Patellar
tracking abnormalities
• FOV (legs symmetric as possible)
– Scan in four positions: 0, 15, 30, 45 degrees of flexion
• Use Modified MSK-05 Basic Protocol (Rt)
• Archive thin sections from 1st position only
KVP/Effective mAs/Rotation time
120/150 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 1.2 mm*
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 3.0 mm 3.0 mm 0.6 mm
Image Order Cr - Cau
FOV Both Knees
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes:
*Soft tissue lesion:SAG, COR recons3X3send to PACS
*Bone lesion:SAG, COR recons3X3send to PACS
*Send both sets of
Thin axials to PACS &
Terra
*Send thin images and recons for 1st (extended) position
Modified MSK-05: Patellar Tracking Protocol
MSK-05I: Femoral Anteversion Study
• Indications:– lower extremity
alignment abnormalities
• Use Modified MSK-05 Basic Protocol (Rt)
• Keep FOV the same for all 3 scans
• Legs straight as possible
• Must not move between scans
• AP scout from top of femur to ankle joint (need to be able to measure limb lengths)
• Axials only
KVP/Effective mAs/Rotation time
120/200 ma1.0 sec
Collimation 64 x 1.2mm
Slice Width 3.0 mm 3.0 mm 1.2 mm*
Pitch 0.75
Kernel B30 B70 B30/B70
Increments 3.0 mm 3.0 mm 0.6 mm
Image Order Cr - Cau
FOV Both legs
Injection Rate
Scan Delay
Care Dose4D Yes
PACS Yes Yes Yes
Notes: Send axials
To PACS
Modified MSK-05: Anteversion Study
MSK-06. Ortho Spine
• C-spine (-,+)
• T-spine (-,+)
• L-spine (-,+)
• Post-Discogram (C, T, or L)
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