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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

VCUHS Radiology

MSK CT PROTOCOLS

May 2010 Revision


Msk 01 msk chest wall protocols
MSK-01: MSK Chest Wall Protocols

MSK-01 Basic Protocol

  • Sternum

  • SC Joints

  • Clavicle

  • Axilla

  • Ribs

  • Chest Wall


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 Joints


Msk 01a sternum sc joints planes for reformatted images
MSK-01A: Sternum, SC JointsPlanes for Reformatted Images


Example images sternum sc joints
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-01B: Clavicle


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


Msk 02 shoulder arm at side
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.


Msk 02a shoulder scapula
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 scapula planes for bone lesion reformatted images
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


Msk 02b shoulder arthrogram
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


Msk 02b shoulder arthrogram planes for reformatted images
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)



Msk 02c humerus
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
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
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
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
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


Msk 02g entire arm
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
MSK-03: Arm (Over Head)

MSK-03 Basic Protocol

  • Elbow

  • Forearm

  • Wrist

  • Hand

  • DRUJ study


Msk 03a elbow
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
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 03b forearm
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
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


Msk 03c hand wrist planes for reformatted images
MSK-03C: Hand / WristPlanes for Reformatted Images


Msk 03a wrist druj study
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
MSK-04: Pelvis/Hips

MSK-04 Basic Bony Pelvis Protocol

  • Pelvis (bone)

  • Hips (bilateral)

  • Hip (unilateral)

  • Acetabular dysplasia study


Msk 04a pelvis bone
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
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
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
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
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)


Msk 05 lower extremity
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


Msk 05a femurs bilateral
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
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
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


Msk 05d knee unilateral
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
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)


Msk 05e tib fib unilateral
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
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


Msk 05f ankle hindfoot
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


Msk 05f ankle hindfoot calcaneus planes for reformatted images
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


Msk 05g foot
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


Msk 05g foot planes for reformatted images
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.


Msk 05h patellar tracking study
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


Msk 05i femoral anteversion study
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


Msk 06 ortho spine
MSK-06. Ortho Spine

  • C-spine (-,+)

  • T-spine (-,+)

  • L-spine (-,+)

  • Post-Discogram (C, T, or L)


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