VCUHS Radiology
MSK CT PROTOCOLS
May 2010 Revision
MSK-01: MSK Chest Wall Protocols
MSK-01 Basic Protocol
1st
KVP/mAs (QRM)/Rotation time
•
•
•
•
•
•
Sternum
SC Joints
Clavicle
Axilla
Ribs
Chest Wall
2nd
3rd
3.0 mm
1.2 mm
120/350ma/1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
3.0 mm
3.0 mm
0.6 mm
Image Order
Cr - Cau
Yes
Yes
Bone lesion:
SAG, COR recons
3X3
send to PACS
Send both sets of
Thin axials to
PACS & Terra
FOV
180-200 mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue lesion:
SAG, COR recons
3X3
send to PACS
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
Planes 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.
MSK-02 Basic Protocol
KVP/Effective
mAs/Rotation time
120/300 ma
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
Yes
Yes
FOV
180-200 mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR recons
3X3
send to PACS
Bone lesion:
SAG, COR
recons
3X3
send to PACS
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 / Scapula
Planes for (bone lesion) Reformatted Images
A
B
C
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
Shoulder Arthro Modified Protocol
•
•
•
•
•
Indications: post
arthrogram
FOV
Use Use MSK02 Basic protocol
with changes in
red at right
Other arm
above head
Paracor/parasag
reformats
KVP/Effective
mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
3.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
3.0 mm
3.0 mm
0.5 mm
Image Order
Cr - Cau
Yes
Yes
FOV
180-200 mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
2X2
send to PACS
Bone lesion:
SAG, COR
recons
2X2
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
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 (-,+)
• 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
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 (-,+)
•
•
•
•
•
•
•
•
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 (-, +)
•
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 (-,+)
•
•
•
•
•
•
•
•
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
Wrist / Hand Modified Protocol
VP/Effective
mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
2.0 mm
2.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
2.0 mm
2.0 mm
0.6 mm
Image Order
Cr - Cau
Yes
Yes
FOV
180-200 mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
2x2
send to PACS
Bone lesion:
SAG, COR
recons
2x2
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
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 Basic Protocol
1st
•
•
•
•
•
Elbow
Forearm
Wrist
Hand
DRUJ
study
KVP/mAs(QRM)
Rotation time
2nd
3rd
3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)
1.2 mm
120/150ma/1.0 sec
Collimation
64 x 1.2 mm
Slice Width
3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)
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
Image Order
Cr - Cau
Yes
Yes
FOV
120-180 mm
as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Sag, Cor 2x2 to PACS
Send both sets of
Thin 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 (-,+)
• 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 (-,+)
• 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
High Res Hand / Wrist Modified Protocol
VP/Effective
mAs/Rotation time
120/150 ma
1.0 sec
Collimation
12 x 0.6 mm
Slice Width
2.0 mm
2.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
U70
B30/U70
Increments
2.0 mm
2.0 mm
0.5 mm
Image Order
Cr - Cau
Yes
Yes
FOV
120-150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
2x2
send to PACS
Bone lesion:
SAG, COR
recons
2x2
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
MSK-03C: Hand / Wrist
Planes 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
MSK-04 Basic Bony Pelvis Protocol
KVP/Effective
mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
3.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B60
B30/B60
Increments
3.0 mm
3.0 mm
0.6 mm
Image Order
Cr - Cau
FOV
380 mm
Yes
Yes
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
3X3
send to PACS
Bone lesion:
SAG, COR
recons
3X3
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
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 (-)
• 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 (-)
•
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
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 Basic Lower Ext Protocol
•
•
•
•
•
•
•
Femurs (unilateral,
bilateral)
Knee
Tib/fib (unilateral,
bilateral)
Ankle/Hindfoot/Calc
aneus
Foot
Entire leg
Miscellaneous
– “Version” study
– Patellar tracking
study
KVP/Effective
mAs/Rotation time
120/250 ma
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
Yes
Yes
FOV
300 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
3X3
send to PACS
Bone lesion:
SAG, COR
recons
3X3
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
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) (+)
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
KVP/Effective
mAs/Rotation time
120/250 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
5.0 mm
5.0 mm
2.0 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
5.0 mm
5.0 mm
1.0 mm
Image Order
Cr - Cau
Yes
Yes
FOV
300 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
5x5
send to PACS
Bone lesion:
SAG, COR
recons
5x5
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
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
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) (-,+)
• 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
A
B
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
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
Ankle/Hindfoot Modified Protocol
KVP/Effective
mAs/Rotation time
120/200 ma
1.0 sec
Collimation
64 x 0.6mm
Slice Width
2.0 mm
2.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
2.0 mm
2.0 mm
0.5 mm
Image Order
Cr - Cau
Yes
Yes
FOV
150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
2x2
send to PACS
Bone lesion:
SAG, COR
recons
2x2
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
MSK-05F: Ankle/Hindfoot/Calcaneus
Planes for Reformatted Images
A
B
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
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)
Hardware: use 140 kV, 300 ma
Foot Protocol
KVP/Effective
mAs/Rotation time
120/200 ma
1.0 sec
Collimation
64 x 0.6mm
Slice Width
2.0 mm
2.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
2.0 mm
2.0 mm
0.5 mm
Image Order
Cr - Cau
Yes
Yes
FOV
150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Soft tissue
lesion:
SAG, COR
recons
2x2
send to PACS
Bone lesion:
SAG, COR
recons
2x2
send to PACS
Send both
sets of
Thin axials to
PACS &
Terra
MSK-05G: Foot
Planes for Reformatted Images
A
C
B
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
•
•
•
•
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
Modified MSK-05: Patellar Tracking
Protocol
KVP/Effective
mAs/Rotation time
120/150 ma
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
Yes
Yes
FOV
Both Knees
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
*Soft tissue
lesion:
SAG, COR
recons
3X3
send to PACS
*Bone lesion:
SAG, COR
recons
3X3
send to PACS
*Send both
sets of
Thin axials to
PACS &
Terra
*Send thin images and recons for 1st (extended) position
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
Modified MSK-05: Anteversion Study
KVP/Effective
mAs/Rotation time
120/200 ma
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
Both legs
Yes
Yes
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Yes
Notes:
Send axials
To PACS
MSK-06. Ortho Spine
•
•
•
•
C-spine (-,+)
T-spine (-,+)
L-spine (-,+)
Post-Discogram
(C, T, or L)