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VCUHS Radiology

VCUHS Radiology. MSK CT PROTOCOLS May 2010 Revision. MSK-01: MSK Chest Wall Protocols. MSK-01 Basic Protocol. Sternum SC Joints Clavicle Axilla Ribs Chest Wall. Indications: (-) trauma (+) mass, infection Use MSK-01 Basic protocol FOV Mark abnormality if present

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VCUHS Radiology

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  1. VCUHS Radiology MSK CT PROTOCOLS May 2010 Revision

  2. MSK-01: MSK Chest Wall Protocols MSK-01 Basic Protocol • Sternum • SC Joints • Clavicle • Axilla • Ribs • Chest Wall

  3. 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 Joints

  4. MSK-01A: Sternum, SC JointsPlanes for Reformatted Images

  5. Example Images: Sternum, SC Joints Sagittal Sternum Coronal Manubrium and SC joints Coronal Sternum

  6. Indications: trauma Use MSK-01 Basic protocol FOV Cor, sag reformats MSK-01B: Clavicle

  7. 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-01C: Axilla, Ribs, Chest Wall (-,+)

  8. MSK-02: Shoulder/Arm (at side)* MSK-02 Basic Protocol • 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.

  9. 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

  10. MSK-02A: Shoulder / ScapulaPlanes for (bone lesion) Reformatted Images C A B 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

  11. MSK-02B: Shoulder Arthrogram Shoulder Arthro Modified Protocol • Indications: post arthrogram • FOV • Use Use MSK-02 Basic protocol with changes in red at right • Other arm above head • Paracor/parasag reformats

  12. 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)

  13. Shoulder Arthrogram: Example Images

  14. 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

  15. 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

  16. 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

  17. 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

  18. MSK-02F: Wrist/Hand (-,+) Wrist / Hand Modified Protocol • 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

  19. 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)

  20. MSK-03: Arm (Over Head) MSK-03 Basic Protocol • Elbow • Forearm • Wrist • Hand • DRUJ study

  21. 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

  22. 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.

  23. MSK-03A: Example Images

  24. 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

  25. MSK-03C: Wrist/Hand (-,+) High Res Hand / Wrist Modified Protocol • 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

  26. MSK-03C: Hand / WristPlanes for Reformatted Images

  27. 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

  28. MSK-04: Pelvis/Hips MSK-04 Basic Bony Pelvis Protocol • Pelvis (bone) • Hips (bilateral) • Hip (unilateral) • Acetabular dysplasia study

  29. 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

  30. MSK-04B: Hips (-) • Indications: • trauma • FOV (legs straight as possible) • Use MSK-04 Basic Protocol • Sag/cor reformats • Hardware: use 140 kV, 400 ma

  31. 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

  32. MSK-04D: Hip (unilateral) • Indications: • post arthrogram • Bony tumor • FOV (legs straight as possible) • Sag/cor reformats • Use MSK-04 Basic Protocol

  33. MSK-04D: Hip Planes for Reformatted Images A C B 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)

  34. MSK-05: Lower Extremity MSK-05 Basic Lower Ext Protocol • Femurs (unilateral, bilateral) • Knee • Tib/fib (unilateral, bilateral) • Ankle/Hindfoot/Calcaneus • Foot • Entire leg • Miscellaneous • “Version” study • Patellar tracking study

  35. 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

  36. 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

  37. MSK-05C: Entire Leg (unilateral) (+) Entire Leg Modified Protocol • 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

  38. 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

  39. MSK-05D: Knee: Planes for Reformatted Images A C B 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)

  40. 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

  41. MSK-05E: Tib/Fib Planes for Reformatted Images A B C 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

  42. MSK-05F: Ankle/Hindfoot Ankle/Hindfoot Modified Protocol • 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

  43. MSK-05F: Ankle/Hindfoot/Calcaneus Planes for Reformatted Images A B C 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

  44. 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

  45. MSK-05G: Foot Planes for Reformatted Images C B A 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.

  46. MSK-05H: Patellar Tracking Study Modified MSK-05: Patellar Tracking Protocol • 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 *Send thin images and recons for 1st (extended) position

  47. MSK-05I: Femoral Anteversion Study Modified MSK-05: 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

  48. MSK-06. Ortho Spine • C-spine (-,+) • T-spine (-,+) • L-spine (-,+) • Post-Discogram (C, T, or L)

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