Protocol: Hip Arthrogram

Patient Identification:

Protocol Information

Scanning Technologist:

Accession #:

Plane Sequence name FOV Siemens name 1. 3-Plane Scout 24 flash_r 2. Coronal PD Coro fs (TE mid 40s) 15 tse fs 3. Coronal T1 Coro fs 15 tse fs 4. Axial T1 Ax no fs 15 tse 5. Axial PD Ax fs (TE mid 40s) 15 tse fs 6. Sagittal T2 Sag fs (TE mid 60s) 15 tse fs 7. Sag Oblique PD Obl Sag (along fem neck) 15 tse _________________________TIPS______________________________ - Optional coronal truFisp for cartilage evaluation - Optional FABER (femoral abduction external rotation) positioning - Optional FADIR (femoral adduction internal rotation) positioning

Reviewing Radiologist:

Patient in FABER position Morrison, et al. Use of Femoral Abduction External Rotation (FABER) Positioning for the Diagnosis of Acetabular Labral Tear During MR Arthrography Proc. Intl. Soc. Mag. Reson. Med. 11 (2003)

Optional Oblique Axial prescr from coronal plane Shindle et al., Magnetic resonance imaging of cartilage in the athlete: current techniques and spectrum of disease. J Bone Joint Surg Am. 2006;88 Suppl 4:36.)

Oblique Sagittal (A) prescribed from coronal plane and (B) resulting images Newman JS and Newberg AH, MRI of the Painful Hip in Athletes Clin Sports Med 25 (2006) 613-33

Contrast : 0.1 mmol/kg of contrast

Comments

Dose (cc):

Agent:

John A. Carrino, M.D / T1908 Last updated 3/14/11

Time Out

Patient ID verified with two identifiers/ Wristband

Verify correct Patient and exam on scanner and RIS

All required screening forms completed and singed

Images Sent

Ordered under correct dept. (i.e. MBV, MKM, etc)

Correct Protocol confirmed

Confirm Patient, exam, and special instructions

Relay info such as location of Pt. family/ valuables

Tech Hand Off

Technologist Signature/ Date and Time

Confirm Patient tracked in RIS and ICD-9 Coded

MSK DepartmentCharge: RT = 8200 LT = 8201