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Page 1: MRI Body Protocols Resonance Imaging/Body/3T BODY...Last Update: 12/13/2019 1:38 PM. PROTOCOLS ... T2 3D Space Cor MRCP Trigger ~360 1.5 x 0 To include Gallbladder, biliary system

Austin Radiological Association

MRI Body Protocols Adult 3T

Questions? Last Update: 12/13/2019 1:38 PM

Page 2: MRI Body Protocols Resonance Imaging/Body/3T BODY...Last Update: 12/13/2019 1:38 PM. PROTOCOLS ... T2 3D Space Cor MRCP Trigger ~360 1.5 x 0 To include Gallbladder, biliary system

PROTOCOLS

Guidelines for Body Imaging …………………………..……………………………………………………………………………………………………………………………………………………………………………….1

Chest ……………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………2

Abdomen: Routine ………………………………………………………………………………………………………………………………………………………………………………………………………………………….3

Abdomen: Adrenals ……………………………………….……………………………………………………………………………………………………………………………………………………………………………….4

Abdomen: Kidneys ………………………………………….………………………………………………………………………………………………………………………………………………………………………………5

Abdomen: Pancreas …………….………………………………………………………………………………………………………………………………………………………………………………………………………….6

Abdomen: Wall Mass ………….…………………………………………………………………………………………………………………………………………………………………………………………………………..7

Liver: Eovist ……………………….……………………………………………………………………………………………………………………………………………………………………………………………………………8

Liver: Gaucher disease / Lipidosis. …………………………………………………………………………………………………………………………………………………………………………………………………..9

Liver: Routine …………………………….……………………………………………………………………………………………………………………………………………………………………………………………….…10

Liver: Hemochromatosis *1.5T Only ………………………………………………………………………………………………………………………………………………………………………………………………11

MRCP………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………….12

MRCP Without Contrast …………………………………………………………….……………………………………………………………………………………………………………………………………………….…13

Appendicitis during pregnancy …………………………………………………….………………………………………………………………………………………………………………………………………………..14

Enterography *3T Preferred ……………………………………………………….…………………………………………………………………………………………………………………………………………………15

Urogram …………………………………………………………………………………….………………………………………………………………………………………………………………………………………………….16

Bone Survey for Metastasis ……………………………………………………….………………………………………………………………………………………………………………………………………………….17

Pelvis: Anal Sphincter………………………………………………………………….…………………………………………………………………………………………………………………………………………………18

Pelvis: Defecography *1.5T only ………………………………………………….………………………………………………………………………………………………………………………………………………..19

Pelvis: Rectal Cancer *3T Preferred …………………………………………….…………………………………………………………………………………………………………………………………………………20

Pelvis: Rectum for Pain / Abscess / Fistula *3T Preferred …………….………………………………………………………………………………………………………………………………………………..21

Female Pelvis: Routine ………………………………………………………………………………………………………………………………………………………………………………………………………………….22

Female Pelvis: Mullerian Duct………………………………………………………..………………………………………………………………………………………………………………………………………………23

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Female Pelvis: Placenta Accreta / increta / Precreta / previa *1.5T Only…………………….………………………………………………………………………………………………………………….24

Female Pelvis: Oncology *3T Preferred……………………………………………………………………….…………………………………………………………………………………………………………………25

Female Pelvis: RTP……………………………………………………………………………………………………….…………………………………………………………………………………………………………………26

Female Pelvis: Urethral Diverticulum……………………………………………………………………………………………………………………………………………………………………………………………..27

Male Pelvis: Routine …………………..…………………………………………………………………………………………………………………………………………………………………………………………………28

Male Pelvis: Penis………………………..………………………………………………………………………………………………………………………………………………………………………………………………..29

Male Pelvis: Testicles…………………..…………………………………………………………………………………………………………………………………………………………………………………………………30

Prostate: Diagnostic *3T Preferred.. ………………………………………………………………………………………………………………………………………………………………………………………………31

Prostate: Post Prostatectomy*3T Preferred ………………………………………………………………………………………………………………………………………………………………………………….32

Prostate: Non-contrast……………………………….………………………………………………………………………………………………………………………………………………………………………………….33

Prostate: Austin Cancer Center (ACC) Therapy Planning..……………………………………………………………………………………………………………………………………………………………….34

Prostate: Cyberknife Therapy planning………………………….……………………………………………………………………………………………………………………………………………………………….35

Prostate: SpaceOAR Therapy planning………………….……………………………………………………………………………………………………………………………………………………………………….36

Prostate: Therapy planning…………………………………………………………………………………………………………………………………………………………………………………………………………….37

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General Guidelines

NEVER hesitate to reach out to a radiologist for guidance!

Siemens / GE terminology, other abbreviations:

o HASTE / SSFSE

HASTE – ideal TR 1600, no less than 1200

o VIBE / LAVA

o TruFisp / Fiesta

o FLASH/SPGR

o Breath Hold (BH)

o Free Breathing (FB)

Calculating pixel size: FOV/matrix x FOV/matrix

Abdominal Contrast – full dose by weight, 3ml/sec, following by 20ml normal saline flush

o Arterial phase is most crucial with liver imaging. Care bolus series should be positioned just inferior to right side diaphragm & immediate post

initiated when contrast is seen in descending aorta.

o Delayed post to be performed at minimum of 5 minutes post injection.

Always perform T1 FS Axial Pre, even if not contrasting.

Careful of tight FOVs with the use of iPAT, the combination of the two can lead to artifacts.

o If using iPAT, must have at least two coil elements on in the phase direction.

Dixon – do not send non-FS / water image to PACS.

Sedation

o MRCP – can sedate, but do not give patient oral contract agent.

o Enterography – do not sedate

o Defecography – do not sedate

See next page

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HCA Urologist (HCA DynaCAD) Images must be sent to HCA DynaCAD, not ARA DynaCAD. o Dr. Sandeep Mistry, PA’s Dustin Fontenot & Jason Ramsdell, Leonora Brown, RN o Dr. Chris Yang o Dr. Matthew Pearson, PA Diane Warmoth o Dr. Subir Chhikara, PA’s Ashley Dufour & Terry Farley o Dr. Kouskik Shaw, NPA Alecia Zuehlke o Dr. Michael Trotter o Dr. Samantha Thiry o Dr. Lawrence Tsai o Dr. Stacy Ong

Page 6: MRI Body Protocols Resonance Imaging/Body/3T BODY...Last Update: 12/13/2019 1:38 PM. PROTOCOLS ... T2 3D Space Cor MRCP Trigger ~360 1.5 x 0 To include Gallbladder, biliary system

Chest (entire chest, not for a chest wall study)

Check with a Radiologist before performing an MR, may prefer CT

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 VIBE Ax ~360 4 x 0

T2 HASTE FS Ax (HASTE IR) if poor FS ~360 7 x 2

T1 VIBE Cor ~360 4 x 0

T2 HASTE FS Cor (HASTE IR) if poor FS 360 5 x 1

T1 VIBE Sag ~360 4 x 0

T2 HASTE FS Sag (HASTE IR) if poor FS ~ 360 7 x 2

If with contrast, T1 VIBE FS Ax Pre BH T1 VIBE FS Ax Post BH

~360 4 x 0

T1 VIBE FS Cor Post BH ~360 4 x 0

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Abdomen (Updated 12/2/19)

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES T2 HASTE Cor FB ~360 8 x 2

T2 HASTE Ax ~360 7 x 2

~24 slices To include from diaphragm through kidneys

T1 Flash Ax (If pancreas is indicated)

~360 5 x 1

T1 Dixon VIBE FS Ax Pre Care Bolus Ax T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax 2 min Post T1 Dixon VIBE FS Ax Delayed Post

~360 3 x 0 To include from diaphragm through kidneys

T2 FS Ax Trigger T2 HASTE FS Ax (if motion on TSE or trigger fail)

~360 7 x 2 Done after 2 min post

With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction images. DO NOT

send post In, Out, WS images or respective subs to PACS

Send carebolus to PACS

If study is without contrast, be sure to run T1 Dixon VIBE FS Ax Pre and T2 FS Ax Trigger must be performed

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Adrenals (Updated: 02/27/2017)

For follow-up with prior imaging of existing benign mass, IV contrast is not utilized

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES T2 HASTE Ax ~360 5 x 0

T1 VIBE In/Out Ax

~360 3 x 0

T1 VIBE In/Out Cor ~360 3 x 0

Cover diaphragm through bifurcation S-I

T1 Dixon VIBE FS Ax Pre Care Bolus Ax T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax Delayed Post

~360 3 x 0 Delayed series must be at least 5 min post injection.

T2 FS Ax Trigger T2 HASTE FS Ax (if motion on TSE or trigger fail)

~360 7 x 2 Done after the immediate Post

With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction images. DO NOT

send post In, Out, WS images or respective subs to PACS

Send carebolus to PACS

If study is without contrast, be sure to run T1 Dixon VIBE FS Ax Pre and T2 FS Ax Trigger must be performed

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Kidneys (New finding and follow up renal lesion)

(Updated 12/2/19)

Perform routine abdomen protocol if exam is follow up post nephrectomy. This is to better visualize the renal bed and surrounding organs Abdomen for tuberous sclerosis is a renal study

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor FB

~360

4 x 0 ~30 slices

Entire abdomen

T1 VIBE In/Out Ax

~360 3 X 0 Entire abdomen liver through kidneys

T1 Ax T2 HASTE Ax

~360 4 X 0 ~36 slices

Include kidneys and mass

T1 Dixon VIBE FS Ax Pre Care Bolus Ax T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax Delayed Post

~360 3 x 0 Delayed series must be at least 5 min post injection.

T1 VIBE FS Cor post ~360 3 x 0 scanned after immediate post

T2 FS Ax Trigger T2 HASTE FS Ax (if motion on TSE or trigger fail)

~360 7 x 2 Entire abdomen, liver through kidneys Done after VIBE fs COR post

With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction

images. DO NOT send post In, Out, WS images or respective subs to PACS, Send carebolus to PACS Austin Kidney Associates: reserve exams for 3D lab to process for total kidney volume. If study is without contrast, be sure to run T1 Dixon VIBE FS Ax Pre and T2 FS Ax Trigger must be performed

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Liver Gaucher disease or Lipidosis (Updated: 08/6/15)

This study does not need contrast, If contrast is ordered, add pre/post dynamic sequences from routine liver study Include both liver and spleen

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE T1 Cor

~360 8 x 2

T1 In/Out Ax T2 HASTE Ax T2 FS Ax T2 Heavy TE Ax (TE>200)

~360 7 x 2

T2 HASTE FS Ax ~360 10 x 0

This sequence is usually used for volume measurement

If contrast is given, use any VIBE series without motion artifact for measurement Volume measurement is normally done by 3D technologist. Reserve study in pending 3D folder in PACS, e-mail * 3DPostprocessing

[email protected] with details If 3D post processing is down, measurement is done using ROI tool in viewer of the MR console. Using ROI tool, trace around the liver on each image in

which the liver is seen. Save these images in a new series and send to PACS. Add the area(in square centemeters) of the ROI of each image together and enter this information into the notes in PACS

Repeat measurement process for spleen

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Liver Routine / Hemangioma / Lesion (Updated 12/2/19)

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES T2 HASTE Cor FB ~360 8 x 2

T2 HASTE Ax

~360 7 x 2 ~24 slices

T1 Dixon VIBE FS Ax Pre Care Bolus Ax T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax 2 min Post T1 Dixon VIBE FS Ax Delayed Post

~360 ~3 x 0 Begin immediate post when contrast is visualized in the aorta, take into consideration of breath hold instructions.

T2 FS Ax Trigger T2 HASTE FS Ax (if motion on TSE or trigger fail)

~360 7 x 2 Done after the 2 min Post

With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction images. DO NOT

send post In, Out, WS images or respective subs to PACS

Send carebolus to PACS

If study is without contrast, be sure to run T1 Dixon VIBE FS Ax Pre and T2 FS Ax Trigger must be performed

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Liver Hemochromatosis *1.5T only (iron deposits / overload)

(Updated )

Do not perform on GE

TR must remain consistent on T1 Axials with varying TEs, Do not adjust parameters

Include T1 FS Ax on all abdomens without contrast

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES T2 HASTE Cor ~360 8 x 2

T1 In/Out Ax T2 HASTE Ax T2 FS Ax

~360 7 x 2 ~24 slices

T1 Ax FLASH (TE 2.38) T1 Ax FLASH (TE 4.76) T1 Ax FLASH (TE 7.14)

~360 7 x 2 ~24 slices

T2* Multi Echo Gre ~360 3 slices

Post Processing T2* Maps

T1 VIBE FS Ax Pre Care Bolus Ax T1 VIBE FS Ax Immediate Post T1 VIBE FS Ax 2 min Post T1 VIBE FS Ax Delayed Post

~360 3 x 0 Delayed series must be at least 5 min post injection.

Send care bolus and subtractions to PACS

Post Process the T2* Maps for the testing sequence and send to PACS

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MRCP on patients who cannot get IV contrast (Updated: 07/11/17)

Have the patient drink 12oz. of Pineapple or Blueberry (if diabetic) juice 10-15 minutes prior to scanning. Do not provide if sedating.

Specific imaging for evaluation of pancreatic or biliary ducts. MRCP is usually ordered for the evaluation of the biliary system however if pancreatic cysts or duct is of interest, then that should be the focus when scanning.

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor ~360 8 x 2

T1 Flash Ax (If pancreas is indicated)

360 5 x 1

T2 HASTE Ax T2 FS Ax Trigger T2 HASTE FS Ax (if motion on TSE or trigger fail

~360 7 x 2 ~24 slices

Include-Liver, GB, pancreas, spleen, biliary system and duodenum

T1 Dixon VIBE FS Ax Pre

~360 3 x 0

Radial thick slab MRCP 250 40 - 80 mm

Scan 1 image per location with the angles similar to what is pictured. Radial projection through biliary system.

T2 HASTE IR Cor hires 300 3 x 0 Include pancreas and biliary system as shown in the image

- continued on next page -

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T2 HASTE IR Ax hires 300 4 x 0 Include right and left main hepatic ducts through pancreatic head and duodenum. Including the kidneys might be necessary to include the duodenum. (A common mistake is to clip the duodenum)

T2 3D Space Cor MRCP Trigger ~360 1.5 x 0

To include Gallbladder, biliary system and pancreas

T1 Ax BH (only if MRCP is for a pancreatic indication)

~360 5 x 1 Entire pancreas

Create Lateral & Tumble cut MIPs off T2 3D Cor MRCP trigger With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. If study is without contrast, be sure to run T1 Dixon VIBE FS Ax Pre and T2 FS Ax Trigger must be performed

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MRCP / Abdomen with and without contrast (Updated: 10/6/15)

Have the patient drink 12oz. of Pineapple or Blueberry (if diabetic) juice 10-15 minutes prior to scanning. Do not provide if sedating.

Specific imaging for evaluation of pancreatic or biliary ducts. MRCP is usually ordered for the evaluation of the biliary system however if pancreatic cysts or duct is of interest, then that should be the focus when scanning.

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor ~360 8 x 2

T1 Flash Ax (If pancreas is indicated)

~360 5 x 1

T2 HASTE Ax T2 FS Ax Trigger-done after post 2min T2 HASTE FS Ax (if motion on TSE or trigger fail

~360 7x 2

Include-Liver, GB, pancreas, spleen, biliary system and duodenum

Radial thick slab MRCP ~250 40-80 thick ~6 slices

Scan 1 image per location with the angles similar to what is pictured. Radial projection through biliary system.

T2 HASTE IR Cor hires ~300 3 x 0 Include pancreas and biliary system as shown in the image

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T2 HASTE IR Ax hires ~300 4 x 0 Include right and left main hepatic ducts through pancreatic head and duodenum. Including the kidneys might be necessary to include the duodenum. (A common mistake is to clip the duodenum)

T2 3D Cor MRCP Trigger ~380 1.5 x 0

To include Gallbladder, biliary system and pancreas Respiratory coaching might be necessary.

T1 Ax BH (only if MRCP is for a pancreatic indication)

~360 5 x 1 Entire pancreas

T1 Dixon VIBE FS Ax Pre Care Bolus Ax T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax 2 min Post T1 Dixon VIBE FS Ax Delayed Post

~360 3 x 0 Include liver, GB, pancreas, spleen, biliary system and duodenum Delayed series must be at least 5 min post injection.

Create Lateral & Tumble cut MIPs off T2 3D Cor MRCP trigger With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction

images. DO NOT send post In, Out, WS images or respective subs to PACS Send carebolus to PACS If study is without contrast, be sure to run T1 Dixon VIBE FS Ax Pre and T2 FS Ax Trigger must be performed

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Liver Eovist (Updated 12/13/19)

Eovist studies have to be approved by a body radiologist if a previous ARA study does not recommend Eovist.

GFR testing is necessary if patient has kidney disease, diabetes, hypertension, multiple myeloma, solid organ transplant, severe hepatic disease, or ordered by an oncologist

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Ax ~360 7 x 2

T1 Dixon VIBE FS Ax Pre T1 Vibe in/out Ax

~360 3 x 0

T1 3D Ax FS Dynamic pre ~360 5 x 0 1 measurement 5-6 second scan

Care Bolus Ax Begin immediate post when contrast is visualized in the aorta

T1 3D Ax FS Dynamic post ~360 5 x 0 3 measurements in one breath-hold, 15-18 seconds

T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax 2 min Post T1 Dixon VIBE FS Ax 5 min Post T1 Dixon VIBE FS Ax 10 min Post T1 Dixon VIBE FS Ax 20 min Post

~360 3 x 0 Copy everything from pre.

T2 FS Ax Trigger T2 HASTE FS Ax (if motion on TSE or trigger fail

~360 7 x 2 Done between 5 &10 min or 10 & 20 min post Dixon series

T1 VIBE FS Cor 20 min Post ~360 3 x 0

T2 HASTE SPAIR Cor FB T2 HASTE Cor BH

~360 8 x 2 Done between 5 &10 min or 10 & 20 min post Dixon series

Subtract the dynamic series from its respective post series, send the resulting 7 sub series to PACS

Send care bolus to PACS

With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction images. DO NOT send post In, Out, WS images or respective subs to PACS

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Pancreas (Updated 12/2/19)

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor FB ~360 8 x 2

T2 HASTE Ax T2 FS Ax Trigger (done after 2 min post) T2 HASTE FS Ax (if motion on TSE or trigger fail

~360 7 x 2

T1 Flash Ax

~360 5 x 1 Entire pancreas

T1 Dixon VIBE FS Ax Pre Care Bolus Ax T1 Dixon VIBE FS Ax Immediate Post T1 Dixon VIBE FS Ax 2 min Post T1 Dixon VIBE FS Ax Delayed Post

~360 3 x 0

Delayed series must be at least 5 min post injection.

Send care bolus to PACS With Pre Dixon VIBE, only send to PACS the In, Out, and FS images and NOT the WS. With Post Dixon vibe only send to PACS FS and respective subtraction

images. DO NOT send post In, Out, WS images or respective subs to PACS

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Enterography

Do not scan on an Espree scanner due to limited Head to foot FOV. Include mid liver to mid bladder Administer ½ of the Glucagon dose at the beginning of the exam and the other ½ prior to contrast injection Have patient use restroom before MR to avoid any disruptions during study Scan patient in prone if possible The patient is required to drink 1 full bottle of Breeza 60, 40, & 20 minutes prior to the exam Do not sedate Arterial phase or No delay imaging is required

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor Trufi Cor

~380 6 x 0.6

T2 HASTE SPAIR Cor FB 360 6 X 0.6 Tim planning to compose upper and lower

T2 HASTE Ax T2 HASTE FS Ax

~360 5 x 1

Vibe In/Out Ax

~360 4 x 0

T1 VIBE FS Cor Pre (administer gluc and gad) T1 VIBE FS Cor Immediate Post T1 VIBE FS Cor 90 second Post

~380 1.3 x 0

T1 FLASH FS Cor Post ~380 6 x 0.6

T1 FLASH FS Ax Post ~360 5 x 1

Include T1 Vibe FS Cor on all Enterography studies without contrast

Send Subtractions to PACS

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Abdominal Wall

For certain indications, this study does not require contrast Always use a skin marker Run phase direction to best minimize motion artifact Breath-held scans are used to avoid motion artifact

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 VIBE Ax

~320 3 X 0

T2 HASTE FS Ax(HASTE IR) if poor FS

6 x 1

T1 VIBE Cor

~320 3 X 0

T2 FS Cor (HASTE IR) if poor FS 6 x 1

T1 VIBE Sag

~320 3 X 0

T2 FS Sag(HASTE IR) if poor FS 6 x 1

(continue if study is with contrast) T1 VIBE FS Ax Pre T1 VIBE FS Ax Post

~320 3 X 0

T1 VIBE FS Cor or Sag (best plane) Post

~320 3 X 0 See above

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Appendicitis during Pregnancy *1.5T only (Updated 11/4/19)

Include from mid-upper abdomen through pubic symphysis on all scans

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor T2 HASTE FS Cor

~360 (adjust FOV as

needed)

4 x 1

T2 HASTE Ax T2 HASTE FS Ax T1 FLASH Ax (In phase)

~360 4 x 1

T2 HASTE Sag ~360 4 x 1

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Anal Sphincter (Routine & Dr. Ernest Graves) (Updated 11/4/19)

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax

~360 (include

full pelvis)

5 x 1.5

T2 Ax

240 5 x 1.5

T2 Cor ~360 (include

full pelvis)

5 x 1.5

T2 Ax Obl Hires 240

(include anal

sphincter)

2.5 X 0

T2 Cor Obl Hires 240

(include anal

sphincter)

2.5 x 0

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Bone Survey for Metastasis

Only performed at MID, QRY, & CIC

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Cor Upper STIR Cor Upper

~480 (include orbits to

diaphragm)

8 x 0

T1 Sag Upper STIR Sag Upper

~480 (spine only,

include orbits to

diaphragm)

6 x 0

T1 Cor Lower STIR Cor Lower

~480 (include

diaphragm to femoral

heads )

8 x 0

T1 Sag Lower STIR Sag Lower

~480 (spine only,

include diaphragm to femoral

heads )

6 x 0

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Male Pelvis (Updated 12/6/19)

With full bladder, if area of interest

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax

~360 (minimum FOV to

include entire boney pelvis)

7 x 1

T2 HASTE Ax T2 FS Ax

240

7 x 1

T2 HASTE Cor 240 4 x 1

T2 HASTE Sag ~240 5 x 1

T1 DIXON FS Ax pre T1 DIXON FS Ax Post (2 minute delay)

~360 (minimum FOV to

include entire boney pelvis)

3 x 0

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Male Pelvis for Testicles (Updated 12/6/19)

With empty bladder Build up testes using a folded towel. Tape penis to pelvis

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax

~360 (minimum FOV to include entire pelvis and testes)

7 x 1

T2 HASTE Ax T2 FS Ax

~240 (Include Pelvis and testes)

7 x 1

T2 HASTE Cor 280 4 x 1

T2 HASTE Sag ~280 5 x 1

T2 FS Ax Hires T2 HASTE Ax Hires

~200 3 x 1

T1 DIXON FS Ax pre T1 DIXON FS Ax Post (2 minute delay)

~360 (minimum FOV to include entire pelvis and testes)

3 x 0

T1 FS Ax Hires Post ~200 3 x 1

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Male Pelvis for Penis (Updated 11/4/19)

With empty bladder Allow anatomy to remain in natural position

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax

~340 (minimum FOV to

include entire pelvis, penis and testes)

7 x 1

T2 Sag hires ~200 2.5 x 0.5

or

T2 Ax hires ~200 2.5 x 0.5

T2 Cor hires

~180 2.5 x 0.5

T1 DIXON VIBE FS Obl Ax Pre T1 DIXON VIBE FS Obl Ax Post

~240 2 x 0

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Female Pelvis (Updated 12/6/19)

With empty bladder. If bladder is area of interest, then image with full bladder This protocol is done for routine, adenomyosis, endometriosis, adnexal mass, uterine fibroids, Pre/Post uterine fibroid embolization (UFE), etc. Increase FOV and/or slice coverage to include uterus with any fibroids in its entirety on both sagittal and coronal views, i.e., do not images as cor upper and

cor lower. This is so that the rads can provide an accurate measurement of uterus and tumors.

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax

~360 Pixel Area ≤ 2.4 mm²

5 0 x 1.5* ACR: must include entire boney pelvis

T2 HASTE Ax T2 FS Ax Trigger

~240 Pixel Area ≤ 1.0 mm²

5 x 1.5* ACR: must include vaginal introitus through iliac crests & pelvic sidewalls

T2 HASTE Cor ~240 (increase fov if

need)

4 x 1

T2 Sag T2 HASTE Sag (if motion on tse sag)

~200 Pixel Area ≤ 1.0 mm²

(increase fov if

needed)

3.5 x 0.5*

example of a giant uterine mass in one fov)

T1 Dixon FS Ax Pre T1 Dixon FS Ax Post

~360 Pixel Area ≤ 2.4 mm²

3 x 0 ACR: must include entire boney pelvis

T1 Sag Post (If for fibroids or pre/post UFE)

~200

3.5 x 0.5

Send subtractions to PACS

Sag post is only needed for fibroids and pre/post UFE studies * ACR Requirements – Do not adjust parameters.

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Female Pelvis RTP

With empty bladder, unless specified otherwise by oncologist Include entire anatomy in the FOV, skin to skin RTP for Dr. Wu is oncology pelvis

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 3D Space Ax T2 FS Ax T1 Ax T1 FS Ax If contrast is needed T1 FS Ax Post

include entire soft

tissue pelvis, skin to skin from side to

side and front to back

3 x 0 ~32-48 slices

Acquire enough slices to cover abnormality fully

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Female Pelvis Mullerian Duct (Updated 11/4/19)

Infertility, Unicornuate, Arcuate, Bicornuate, Septate, or Didelphic With empty bladder

SEQUENCE FOV (mm) SLICE (mm) IMAGES COMMENTS

T2 HASTE Cor - abdomen ~360 8 x 2 *renal agenesis is sometimes associated with mullerian duct anomalies

T1 Ax ~340 5 X 1.5

T2 HASTE Ax BH T2 FS Ax Trigger

~240 5 X 1.5

T2 Sag T2 HASTE Sag (if motion on tse sag)

~200 3.5 X 0.5

T2 FS Cor ~240 4 x 1

T2 HASTE Obl Ax loc (short axis) A haste *3-plane loc positioned parallel/perpendicular to uterus should be ran before this sequence for better planning of the Oblique scans.

~240 4 x 1

T2 Obl (long axis - parallel to long axis to uterus)

~200 4 X 0

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Female Pelvis for Placenta Accreta, Increta, Precreta and Previa (Updated 11/4/19)

Encourage a full bladder to accurately assess for placenta percreta FOV and slices to cover entire uterus to below the bladder Need for IV contrast will be determined by the radiologist on a case by case basis Using a second coil(flex/torso) can help with signal Being on their back, Patients will get tired quickly. Imaging fast and words of encouragement will help complete the exam

SEQUENCE FOV (mm) SLICE (mm) OMMENTS IMAGES

T2 HASTE Ax T1 In/Out AX

~360 (adjust FOV as

needed)

7 x 2

T2 HASTE Cor BH

~380 5 x 1

T2 HASTE Sag BH T2 HASTE FS Sag BH TrueFisp/Fiesta Sag BH

~380 5 x 1

Placenta Accreta- placenta grows too deeply into the uterine wall

Placenta Increta- attaches even deeper into the uterine wall and penetrate into the uterine muscle

Placenta Percreta- placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder

Placenta Previa-When the placenta covers the opening in the mother's cervix

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Female Pelvis Oncology (Uterine, Endometrial, Cervical, Vaginal Ca and Dr Wu RTP) (Updated 12/2/19)

With empty bladder If ordering physician is Dr. Catherine Wu, have the patient apply 20 cc of KY jelly into the vagina

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax ~340 (minimum FOV to

include entire bony pelvis)

5 x 1.5

T2 FS Ax Trigger T2 HASTE Ax

240 5 x 1.5

T2 Sag tse T2 Sag HASTE(If T2 Sag tse has any motion)

200 3.5 x 0.5

T2 HASTE Cor 240 4 x 1

T2 Obl Ax Hires (If for cervical cancer)

160 2.5 x 0 (True axials

through long axis of cervix)

Consult with body rad for positioning

Diffusion Ax (B0, B400, B800 Values, 1400calc)

260 3.6 X 0, ~46 slices

Cover area of interest, consult with rad if needed

T1 DIXON Ax Pre T1 DIXON Ax Post

~340 (minimum FOV

to include entire bony

pelvis)

3 x 0

T1 FS Sag Post 200 3.5 x 0.5

Send subtractions to PACS

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Female Pelvis Urethral Diverticulum (Updated 12/2/2019)

Patient should be told to hold still and relax the pelvic muscles during imaging Phase oversampling will need to be increased on larger patients to avoid/reduce wrap around artifact

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax ~340 (minimum FOV

to include entire bony

pelvis)

5 x 1.5

T2 Sag Hires

180 2.5 X 0 24 slices

T2 FS Ax Hires T2 Ax Hires

180 2.5 X 0 24 slices

T2 Cor Hires 180 2.5 X 0

24 slices

T1 FS Ax Hires Pre T1 FS Ax Hires Post

180 2.5 X 0

Send subtractions to PACS

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Prostate Diagnostic (Updated 8/26/19)

If 3T is contraindicated, MRI may be performed on 1.5T at MID, QRY, VIL, CP, GTN, or RCP Patients with recent positive prostate biopsy can have their MRI immediately and don’t have to wait 4-6 weeks for the inflammation to do down

Empty bowels and bladder before beginning exam. T2 Axial-best image quality required. Repeat for motion

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 Sag

160 2.5 x 0

Diffusion Ax (B 0, 400, 800 Value) Calculated 1400

~200 3.6 x 0 (~33 slices)

include from top of seminal vesicles through urogenital diaphragm

Split and save B-Values into its own series

T2 Ax ~180 3 x 1 include from top of seminal vesicles through urogenital diaphragm

T1 Ax ~360 5 x 1.5 Cover entire bony pelvis(L5-lesser trochanter)

T2 Cor

~180 3 x 1 Include seminal vesicles

T1 TWIST Ax Dynamic Perfusion Pre/Post

~180 3 x 0

include from top of seminal vesicles through urogenital diaphragm

Scan time is approximately six minutes

60 total measurements

Begin contrast injection after the second measurement is completed

Inject at 3ml/sec

HCA Urology studies will go to HCA CAD, see General Guidelines or Provider Comments in MI for HCA CAD instructions

Send to PACS-T2 Sag, T2 Ax, T1 Ax full pelvis, T2 Cor, Diff ADC map, T1 TWIST Axials, renamed B0 Value, B400 Value, B800 Value, any repeats

Send to HCA or ARA CAD- T2 Sag, T2 Ax, T1 Ax full pelvis, T2 Cor, Diff ADC map, T1 Vibe Axials

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Prostate Post Prostatectomy

If 3T is contraindicated, MRI may be performed on 1.5T at MID, QRY, VIL, CP, GTN, or RCP Empty bowels and bladder before beginning exam. T2 Axial-best image quality required. Repeat for motion

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 Sag

160 2.5 x 0

Diffusion Ax (B 0, 400, 800 Value) 1400 calculated

~200

3.6 x 0 (~33 slices)

include from top of seminal vesicles through urogenital diaphragm

Split and save B-Values into its own series

T2 Ax T2 Ax FS T1 Ax

~200 3 x 1 include from top of seminal vesicles through urogenital diaphragm

T1 Ax ~360 5 x 1.5 Cover entire bony pelvis(L5-lesser trochanter)

T2 Cor

Include seminal vesicles

T1 VIBE Ax Dynamic Perfusion Pre/Post

~180 3 x 0

include from top of seminal vesicles through urogenital diaphragm

Scan time is approximately six minutes

60 total measurements

Begin contrast injection after the second measurement is completed

Inject at 3ml/sec

Send to PACS-T2 Sag, T2 Ax, T2 Ax FS, T1 Ax, T1 Ax full pelvis, T2 Cor, Diff ADC map, T1 Vibe Axials, renamed B0 Value, B400 Value, B800 Value, any repeats

To CAD - No image is sent to CAD

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Prostate Austin Cancer Center Therapy Staging-ACC Protocol

Include patient’s entire anatomy in the FOV, skin to skin

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax T1 FS Ax T2 FS Ax T2 3D Ax

~400-500 3 x 0

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Prostate Cyberknife therapy planning Dr. Ghafoori

Feet first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles, No contrast

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 FS Ax T2 FS Ax If contrast is needed T1 FS Ax

~400-500 2 x 0 ~54 slices

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Prostate Therapy planning Dr. Rufus Mark

Feet first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles, No contrast

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax T1 FS Ax T2 FS Ax T2 3D Ax

~400-500 3 x 0 ~54 slices

10 cm above prostate to 6 cm below prostate

T2 Ax ~140 3 x 0 Scan from top of seminal vesicles through urogenital

diaphragm

T2 FS Ax (if post prostatectomy)

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Prostate RTP without Contrast Space-OAR Procedure, Dr. Garza

Head first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles, Cover from top of seminal vesicles through urogenital diaphragm. No contrast, keep hands on chest to avoid them wrapping around.

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 FS Ax T2 FS Ax

~400-500 2 x 0 ~54 slices

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Prostate WO Contrast, Dr HSU

If 3T is contraindicated, MRI may be performed on 1.5T at MID, QRY, VIL, CP, GTN, or RCP Patients with recent positive prostate biopsy can have their MRI immediately and don’t have to wait 4-6 weeks for the inflammation to do down

Empty bowels and bladder before beginning exam. T2 Axial-best image quality required. Repeat for motion

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 Sag

160 3 X 0 ~30 slices

Diffusion Ax (B 0, 400, 800 Value) 1400 calculated

~200 3.6 X 0 (~33 slices)

include from top of seminal vesicles through urogenital diaphragm

Split and save B-Values into its own series

T2 Ax ~150 3 X 1 ~30 slices

include from top of seminal vesicles through urogenital diaphragm

T2 Ax ~400 100 PFOV

3 X 0 ~38 slices

Skin to skin, no angles

T1 Ax

~340 (minimum FOV

to include entire bony pelvis)

5 X 1.5 ~40 slices

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Pelvis Defecography Explain every step of the exam to the patient before beginning. Cooperation is a key factor for this exam

Do not sedate-sedated patients might not be able to complete required functions of the procedure

Position the patient with their knees bent as much as the space within the magnet bore allows

All patients should have 240cc KY jelly in the rectum. Use a 60cc catheter tip syringe connected to 4-6” clear tube connected to enema tip to place KY jelly in rectum SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T2 FS Cor loc T2 FS Sag loc

280 6 x 0

T2 Ax

280 5 x 1

T2 Sag 240 5 x 1

T2 Trufi Sag Resting 220

10

1 slice at midline Tech to ensure good view of rectal canal before proceeding

T2 Trufi Sag Constrict (repeat 3 times)

220

10 1 slice at midline

Instruct patient to constrict their anal sphincter as much as possible. Resting between each run

T2 Trufi Sag Strain (repeat 3 times)

220

10 1 slice at midline

Instruct patient to strain but not enough to defecate KY Jelly. Again resting between each run

Instructions for the next sequence: Likely the patient will already have the urge to defecate due to the presence of the KY jelly in the rectum. Do not tell the patient to strain in order to defecate, just simply to defecate out the jelly. Confirm with patient if defecation occurred & if straining to defecate was done. In theory, a normal patient should not need to strain to defecate out the jelly, rather the patient should be able to just relax & defecate. Be sure to document in tech notes if the patient strained to defecate.

T2 Trufi Cine Sag (repeat 3-4 times)

220 10 1 slice at midline

25 measurements

Instruct patient to relax for the first 5 measurements, defecate over the next 15 measurements and relax for the remaining 5 measurements

T2 Trufi Cine Cor 240 10 1 slice

25 measurements

Instruct patient to relax for the first 5 measurements, defecate over the next 15 measurements and relax for the remaining 5 measurements position the slice through the rectum and anus. Use sag cine to set up

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Rectum Rectal cancer

Patient to follow LOSO PREP starting 24 hours prior to exam. We DO NOT prep patients with colostomies for this study Symptom of rectal bleeding will likely use this protocol, may need to verify diagnosis with referring or radiologist Scan straight, do not angle to anal canal Arterial phase or no delay post imaging is required

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax ~340 (min fov to

include entire bony pelvis)

6 x 1

T2 Cor

240

5 x 1.5 40 slices

T2 Sag 160 2.5 x 0

36 slices

T2 Ax T2 FS Ax

240

2.5 x 0 L5-ischium

T1 Dixon VIBE FS Ax Pre T1 Dixon VIBE FS Ax Post

240

2 72 slices/slab

Diffusion Ax (B0, 400, 800 with 1400 Calculated when possible)

260

3.6 x 0 46 slices

Send subtractions to PACS

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Rectum for Pain/Abscess/Fistula (Updated 10/14/2019)

Patient to follow LOSO PREP starting 24 hours prior to exam. We DO NOT prep patients with colostomies for this study Be sure to completely scan through the patient’s pathology, extending the scan through the buttocks inferiorly is frequently needed

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax ~340 (min FOV to

include entire bony

pelvis)

6 x 1

T2 FS Sag T2 Sag

160

2.5 x 0 36 slices

(SI jt-SI jt to cover rectum)

T2 Cor Obl 240 2.5 x 0 76 slices

Slices parallel to anal canal (blue line)

T2 Obl Ax T2 FS Obl Ax

240

2.5 x 0

Slices Perpendicular to anal canal

T1 Dixon VIBE FS Obl Ax Pre T1 Dixon VIBE FS Obl Ax Post

240

2 x 0 72 slices/slab

Send subtractions to PACS

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Urogram

Do not scan on an Espree due to the limited H-F FOV Administer 20 mg of Lasix IV & 1mg Glucagon IV prior to scanning

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 Ax T2 FS Ax

~340

8 x 0 ~42 slices

Scan from above kidneys through bladder

T2 HASTE Ax

~340 5 x 0 ~36 slices

Kidneys only

T2 HASTE FS Cor ~380 5 x 0 Kidneys, ureters, and bladder

T1 VIBE FS Ax Pre T1 VIBE FS Ax Post

~340 3 x 0 Kidneys only (Use care bolus to get good arterial phase imaging)

T1 VIBE FS Sag 5 minute ~380 4 x 0

~64 slices

T1 VIBE FS Cor 15 minute ~380

2.5 x 0

~64 slices

If you have any question whether enough contrast is seen in the Kidneys, Ureters, and Bladder, Check with a Radiologist prior to getting the patient off the

table.