vcuhs radiology msk ct protocols may 2010 revision

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



Pitch 0.75




FOV 180-200 mm

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of

Thin axials to PACS & Terra


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


120/300 ma1.0 sec



Pitch 0.75




FOV 180-200 mm

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



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 (-,+)


• 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 (-,+)


• 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


MSK-02E: Forearm (-, +)


• 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


MSK-02F: Wrist/Hand (-,+)


• **Only perform with arm at side in patients unable to raise arm above head

• Adjust MSK02 protocol with changes as noted in red


• 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



Pitch 0.75




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


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


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-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 (-,+)


• Use MSK-03 Basic Protocol


• 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 (-,+)



• 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)


VP/Effective mAs/Rotation time

120/150 ma1.0 sec

Collimation 12 x 0.6 mm


Pitch 0.75

Kernel B30 U70 B30/U70



FOV 120-150 mm

Or as indicated

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of


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


120/300 ma1.0 sec



Pitch 0.75




FOV 380 mm

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of


Terra

MSK-04 Basic Bony Pelvis Protocol

MSK-04A: Pelvis (bone) (-,+)


• 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)


• 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


120/250 ma1.0 sec



Pitch 0.75




FOV 300 mm

Or as indicated

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of


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



120/250 ma1.0 sec



Pitch 0.75




FOV 300 mm

Or as indicated

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of


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)


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) (-,+)


• 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


120/200 ma1.0 sec



Pitch 0.75




FOV 150 mm

Or as indicated

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of


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)



120/200 ma1.0 sec



Pitch 0.75




FOV 150 mm

Or as indicated

Injection Rate

Scan Delay

Care Dose4D Yes

PACS Yes Yes Yes

Notes:



Send both sets of


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


120/150 ma1.0 sec


Slice Width 3.0 mm 3.0 mm 1.2 mm*

Pitch 0.75




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


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


120/200 ma1.0 sec


Slice Width 3.0 mm 3.0 mm 1.2 mm*

Pitch 0.75




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)

vcuhs radiology msk ct protocols may 2010 revision

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