Sequences are listed in order of their priority. If the patient is having difficulties, those listed first should be performed first, those second performed second, and so on.
MRI scanners: GE 1.5 HDX
Resources: http://www.radiology.wisc.edu/sections/msk/protocols/index.php
http://www.bone.tju.edu/protocols.htm
http://www.med.cornell.edu/mri/ http://www.gehealthcare.com/euen/mri/products/Signa-HDxt-3.0T/coils.html

TMJ
Coil: TMJ Coil.
Patient Positioning: Supine. Center the temperomandibular joint (TMJ) (just anterior to the anterior aspect of the ear) in the two surface coils.

Planes of Scanning:
Coronal: Identify a plane along the posterior aspect of the mandibular condyles and scan from through the entire TMJ.
Sagittal: Identify a plane through each mandibular condyle which is angled and parallel with the mandibular rami.

TMJ protocol
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
85/2600 2 0 mm 1 Sag T2 FSE closed mouth
2 Sag PD FSE closed
3 Cor PD FSE closed
24/2284
24/2284
2
2
0
0
24/2284 2 0 4 Sag PD FSE open
FOV
12
12
12
12
FLIP
ANGLE
MATRIX AVERAGES BW
225/224 3 20.83
256/224 3 17.86
256/224
256/224
3
3
17.86
17.86
8
8
ETL
16
8
Fat Sat TA
5:44
6:33
6:33
6:33

Cervical spine
Coil: HD CTL Spine Array
Patient positioning: Supine. Center at Adam’s apple.

Planes of Scanning:
Sagittal : Prescribe a plane along the longitudinal axis of the spine and scan parallel to this from the lateral aspect of the facets/lateral masses bilaterally.
Axial : angled parallel to a mid-cervical disc space from the middle dens distally to the mid T1 vertebral body completely through the neck.
Dens/C2 )
T1

Ortho Cervical spine
In order of priority.
1
2
SEQUENCE TR/TE
Sag T2
Sag T1
THICKNESS DIST.
FACTOR
3500/110 3
817/MF 3
1 mm
1
3 Merge
4 Sag STIR
1061.5/MF 3
2775/50
TI=150
3
0.3
1
FOV
24
24
18
24
FLIP
ANGLE
MATRIX AVERAGES BW
256/416 4
256/288 4
288/192 2
160/256 3
41.67
31.25
41.67
15.63
ETL
24
5
6
Fat Sat TA
IR
2:45
2:52
6:56
3:50

Thoracic and Lumbar Spines
Coil: HD CTL Spine Array
Position: Supine.

Planes of scanning: Thoracic Spine
Axial : Identify a plane parallel to a middle thoracic disc (e.g. T7-T8). Scan parallel to this plane from superior T1 through upper L1.
T1
T7
T8
T12
Sagittal : Identify a plane parallel to the long axis of the spine and scan from the lateral aspect of the vertebral body to the lateral aspect of the opposite side of the vertebral body. May have to widen the scanning field if there is a significant scoliosis.

Planes of Scanning: Lumbar Spine
Axial (stacked): A plane parallel to a middle lumbar intervertebral disc is selected. Scanning is from the inferior T12 distally to the anterior endplate of S1.
T12
L5
Lumbosacral junction
Axial (angled): Planes parallel to the L1 through L5 discs are selected. Scanning is performed for each disc level parallel to the selected plane from the inferior vertebral body of the level above to the superior body of the level below ensuring the neural foramina are imaged.

Sagittal : A plane parallel to the spinous processes is selected and scanning is performed from one side of the vertebral body to the other. This may have to be widened if there is a significant scoliosis.

Ortho Thoracic spine
In order of priority.
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
1 Sag T2 2400/140 3 1 mm
2 Sag T1
3 Ax T2 stacked
534/MF 3
5450/130 6
1
1
4 Ax T1 stacked
5 Sag STIR
434/MF 5
2700/50
TI=150
4
1
1
FOV
36
36
20
20
36
FLIP
ANGLE
MATRIX AVERAGES BW
448/224 4
320/256 3
256/192 4
41.67
31.25
41.67
256/160
320/160
2
3
31.25
31.25 6
ETL
33
2
29
Fat Sat TA
2:25
3:21
5:03
IR
4:40
3:45

Orthopedic Lumbar spine
In order of priority.
If there is hardware, remove fat saturation and skip sequence 6 (below).
FOV SEQUENCE TR/TE THICKNESS DIST.
FACTOR
1 Sag T2 3384/114 4 1.2 mm 28
2 Sag T1
3 Ax T2 angled to disc
4 Ax T1 stacked
5 Sag STIR
500/MF 4
4850/130 4
350/MF 4
1.2
1
1
1.2
28
20
20
28 3300/50
TI= 145
4
350/MF 4 1 20 6 Ax T1 FS pre stacked
FOR POST-
SURGERY/
INFECTION
ADD
7 Ax T1 FS post stacked
8 Sag T1 FS post
350/MF
500/MF
4
4
1
1.2
20
28
FLIP
ANGLE
MATRIX AVERAGES BW
416/224 4
384/224 4
320/224 3
288/160 2
320/198 4
288/160 2
288/160 2
384/224 4
50
31.25
41.67
17.86
31.25
17.86
17.86
31.25
3
5
3
ETL
33
5
25
3
12
Fat Sat TA
1:37
2:58
4:23
IR
0.6
3:21
3:38
3:21
0.6
0.6
3:21
2:58

Shoulder
Coil: 3 Channel Shoulder Array Coil
Patient positioning:
Arm placed alongside and parallel to the body with the thumb pointed upward. No shoulder shrugging. Can stabilize hand with the use of sponges, tape or fingers slipped under body to reduce artifact secondary from spasm.
Internal rotation (palm down, pronated) External rotation (palm up, supinated)

Planes of scanning:
Axial: AC joint (cranial) through the glenohumeral joint (caudal).
Coronal: parallel to the supraspinatus tendon. Scan from the distal clavicle anteriorly through the infraspinatus and teres minor muscles posteriorly. If not clearly detected, as in a massive rotator cuff tear, alignment parallel to the spine of the scapula is fine.

Sagittal: parallel to the plane of the glenoid and scan from lateral to the humerus to medial at the level of the base of the coracoid process.

Routine Shoulder
3 channel coil.
In order of priority.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Ax PD FS 2450/40 4 0.5
2350/40 4 0.5 mm 2 Cor PD FS
3 Cor T1 SE
4 Sag PD FS
625/MF
2450/40
4
4
0.5
0.5
5 Ax PD FS
6 Ax 2D GRE
2450/40 4
475/18 3
0.5
0.2
FOV FLIP
ANGLE
16
16
16
16
16
16 30
MATRIX AVERAGES BW
256/192 4 25
256/192 4
256/192 2
256/192 4
25
12.5
25
256/192 4
256/160 1.5
25
10.42
8
8
8
ETL
8
Fat Sat TA
0.6 4:00
3:51 0.6
4:05
4:00 0.6
0.6 4:00
3:52

Shoulder arthrogram
3 channel coil
In order of priority.
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
1 Ax T1 1 425/MF 4
575/MF 4 1 2 Ax T1 FS
3 Sag PD FS 2450/40 4 0.5
625/MF 4 1 4 Cor T1 FS
6 Cor PD FS
7 Sag T1 FS
2350/40
750/MF
4
4
1
1
FOV
16
16
16
16
16
16
MATRIX AVERAGES BW
224 x 256 3
224 x 256 3
192 x 256 4
20.83
20.83
25
224 x 256 3
192 x 256 4
224 x 256 2
20.83
25
15.63
3
8
3
ETL
3
3
8
0.6
0.6
0.6
Fat Sat TA
3:11
0.6
0.6
4:20
4:00
4:43
3:51
3:48

Elbow
Coil: 8 Channel knee coil
Patient positioning: prone in the “Superman” position with the elbow extended and the wrist in neutral.
Taping a vitamin E marker to the site of pain is useful to insure the area is included in the study.

Planes of scanning
Axial: Prescribe a plane parallel to the elbow joint and scan from the distal humeral metaphysis distal to the radial tuberosity.
Coronal: parallel to the line extending from humeral condyle to condyle identified on the axial images from skin to skin.

Sagittal: perpendicular to the line extending between the humeral condyles identified on the axial images from subcutaneous fat to subcutaneous fat.

Elbow Routine
In order of priority.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Cor PD FS 3100/40 3 1.5
2 Axial PD FS 2500/42 3 1.5 mm
450/MF 3 1 3 Ax T1
4 Cor 3D
SPGR
5 Sag PD FS
/Min
2500/42
2
3
-
1.5
FOV
14
14
14
12
14
10
FLIP
ANGLE
MATRIX AVERAGES BW
256/160 2 25
256/160 2 25
256/224
256/160
2
2
2
25
11.36
25
3
-
9
ETL
9
9
Fat Sat TA
0.6 1:13
0.6 1:52
3:30
Special 2:49
0.6 1:36

Elbow Arthrogram.
In order of priority.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Cor T1 FS 350/MF 3 1 mm
2 Cor PD FS 2500/40 3 1
3 Ax T1 FS
4 Ax T1
5 Sag T1 FS
450/MF 4
450/MF
550/MF
3
3
1
1
1
FOV
14
14
14
14
14
MATRIX AVERAGES BW
192 x 256 2 15.63
224 x 256 3 25
224 x 256 2
224 x 256 2
224 x 256 3
20.83
20.83
20.83
3
3
6
ETL
9
0.6
0.6
Fat Sat TA
On 4:28
0.6 3:20
3:30
3:30
3:14

Wrist
Coil: 8 channel wrist coil
Patient positioning: Patient position is prone in the “Superman” position with the elbow extended and the wrist in neutral. The coil is centered 1 cm distal to the palpated ulnar styloid. Comfort, padding and relaxed fingers are crucial.

Planes of Scanning:
Axial: Prescribe plane perpendicular to the distal radius with the scan field extending from the base of the metacarpals through the distal radial ulnar joint.
Coronal: prescribe a plane parallel through the ulnar and radial styloids and scan through the entire wrist.

Sagittal: prescribe a plane perpendicular to the coronal plane and scan through the entire wrist.

Wrist routine
In order of priority.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Cor PD FS 2500/42 3 0.5 mm
300/MF 3 0.5 2 Cor T1
3 Cor 2D GRE 480/18 1.5 0.2
4 Ax PD FS
5 Ax T1
6 Sag PD FS
2950/30 3
400/MF
2500/42
3
3
1
1
0.5
FOV
10
10
10
8
10
10
FLIP
ANGLE
MATRIX AVERAGES BW
256/192 2 20.83
30
256/192
256/192
2
2
15.63
10.42
256/192
256/192
256/192
2
2
2
25
15.63
20.83
9
8
ETL
8
0.6
1.0
Fat Sat TA
0.6 2:05
2:07
3:16
2:26
4:45
2:05

Wrist arthrogram
In order of priority.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Cor T1 FS 675/MF 3 0.5 mm
2500/42 3 0.5 2 Cor PD FS
3 Cor T1 375/MF 3 0.5
4 Ax T1 FS
5 Ax PD FS
450/MF 3
3100/30 3
0.5
1.0
FOV
12
12
12
1
8
6 Sag T1 FS 400/MF 3 1 12
FLIP
ANGLE
MATRIX AVERAGES BW
256/160 2 15.63
256/160
256/160
3
2
20.83
15.63
256/160
256/160
256/128
2
2
2
15.63
25
15.63
9
8
ETL
On
0.6
On
Fat Sat TA
On 3:37
0.6 2:35
2:01
3:43
1:58
3:31

Thumb and Finger
Coil: 8 Channel knee coil.
Patient positioning: prone in the “Superman” position with the elbow extended and the wrist in neutral.
Taping a vitamin E marker to the site of pain is useful to insure the area is included in the study.

Thumb planes of scanning:
Axial: Identify a plane parallel to the shaft of the first proximal phalanx and scan perpendicular to this extending from the distal tip of the distal phalanx through the first CMC joint.
Coronal: Prescribe a plane parallel to a line through bone sasamoid bone of the first MCP joint and scan parallel to this plane through the entire thumb.

Sagittal: Identify a plane perpendicular to the coronal plane and scan through the entire thumb.
Finger planes of scanning:
Axial: Identify a longitudinal plane through the phalanges and scan perpendicular through this from the tip of the distal phalanges through the MCP joints.

Coronal: Identify a plane parallel to the volar/palmar surface of the metacarpal head and scan through the entire finger parallel to this plane, including an adjacent finger for comparison.
Sagittal: Scan through the entire finger and an adjacent finger in a plane perpendicular to the coronal plane.

Finger or Thumb routine.
In order of priority
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Ax T1 SE 400/MF 3 1 mm
2950/30 3 1 2 Ax PD FS
3 Sag STIR 4000/48 3 1
500/MF 3 1 4 Cor T1
5 Sag T1
If thumb for gamekeeper’s add
6 Cor 2D GRE
500/MF 3
480/18 2
1
0.2
FOV
10
10
8
10
10
10
FLIP
ANGLE
MATRIX BW
256/128 15.63
256/160
256/192
25
15.63
256/160
256/128
15.63
15.63
30 256/160 10.42
ETL
11
2
2
2
AVERAGES Fat Sat TA
1 2:19
0.6
IR
3:06
2:01
2:48
3:04
2 4:03

Pelvis and Hip
Coils: HD Torso Array
Patient positioning: supine.

Planes of Scanning:
Axial: in a plane parallel to the acetabular roofs or the lesser trochanters scan from the acetabular roofs distally below the lesser trochanters.
Coronal: in a plane parallel to the anterior femoral heads scan from the ischium through the pubic tubercles.

Sagittal: in a plane perpendicular to the coronal plane scan from the medial wall of the acetabulum through the greater trochanter.

Osseous Pelvis
In order of priority
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
1 Ax T1 434/MF 6 mm
FOV MATRIX AVERAGES CONCATS BW
2 mm gap 38 256 x 288 2 31.25
ETL Fat
Sat
0 38 192 x 256 2 31.25 8
TA
3:45
IR 5:35 2 Cor STIR
3 Cor SE T1
4 Ax T2 fs
3350/32
TI=165
634/MF
(min
7
7 full)
3667/45 6
2
2
40
38
192 x 512
224 x 320
2
3
31.25
20.83 8 0.6
4:05
4:04
5 Sag T1*opt
6 If groin pain*, Sag
T2 FS
525/MF 5
3667/45 6
1
2
24
38
192 x 512
224 x 320
2
3
 Check with radiologist for possible “sports hernia” protocol before beginning
31.25
20.83 8 0.6
3:26
4:10

Hip Arthrogram
In order of priority
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
1 Cor STIR 3350/32 7 0
567/MF 3 1 mm 2 Cor T1 FS
3 Ax T1 FS 567/MF 3 1
567/MF 3 1 3 Sag T1 FS
5 Cor T1
6 AX T2 FS
384/MF
2200/50
3
3
1
1
FOV
38
20
18
18
20
18
MATRIX AVERAGES BW
192 x 256 2
192 x 288 3
192 x 288 3
31.25
19.23
19.23
192 x 288 3
192 x 288 3
224 x 320 3
19.23
19.23
20.83
3
3
8
ETL
8
3
3
Fat Sat TA
IR 5:35
FS 0.6 3:43
FS 0.6 3:43
FS 0.6 3:43
2:26
FS 0.6 3:09

Femur, Tibia and Fibula
Coils: 12 Channel Body Array.
Patient positioning: supine. Toes pointed up, but relaxed. Can support with cushioning or tape together to avoid spasm.

Femur Planes of Scanning:
Same as pelvis extended distally from the acetabulum to the knee.
Tibia and Fibula Planes of Scanning:
Coronal: in a plane parallel to a line through the posterior cortices of both tibias scan from the proximal to the distal tibial metaphyses.

Axial: scan from the proximal to the distal metaphyses (upper and lower arrows, respectively on the left image).
Sagittal: in a plane perpendicular to the coronal plane, scan from the proximal to the distal metaphysis of the leg of interest.

Long Bone: Femur and Tibia/Fibula
Ax T2 fs to identify mass, then follow with sag T1 if mass/abnormality is anterior or posterior, or cor T1 if mass/abnormality is medial or lateral. If unsure, use coronal.
Align coronal and sagittal images with long axis of femur.
SEQUENCE TR/TE FOV MATRIX AVERAGES BW ETL Fat Sat TA
4417/60
THICKNESS DIST.
FACTOR
5 1 mm 22 160 x 256 2 31.25 8 FS 0.6 4:39 1 Ax T2 FS
(unilateral)
2 Cor
(bilateral) or sag T1
(unilateral)
3 Cor or sag
STIR
(unilateral)
4 Ax T1
(bilateral)
734/MF
417/MF
5
4600/50/145 5
7
1
1
1
44
22
(coronal) or 44
44
192 x 512
224 x 352
1.5
2
2
31.25
41.67
31.25
14
7
IR
3:42
5:41
3:30
FOR MASS/
INFECTION
ADD
5 Ax T1 FS
(unilateral)
6 Ax T1 FS post
(unilateral)
7 Cor/sag T1
FS post
(unilateral)
467/MF
467/MF
367/MF
7
7
7
1
1
1
22
22
44
192 x 256
192 x 256
160 x 256
2
2
2
31.25
31.25
31.25
7
7
8
FS=
0.6
FS=
0.6
FS=
0.6
4:32
4:32
2:17

Knee
Coil: 8 Channel knee coil.
Patient positioning; supine with toes up. Ankle and leg supported with cushioning to prevent spasm.

Planes of scanning:
Coronal: Prescribe a plane parallel to the posterior femoral condyles.
Axial plane: From the distal quadriceps tendon distal to the patellar tendon attachment.

Sagittal: Scan perpendicular to the coronal plane from the medial to the lateral femoral condyle.

Routine Knee (8 channel)
In order of priority
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Sag PD FS 2150/22 3 1 mm
2 Sag PD 1000/MF 3 1
3 Cor PD FS
4 Ax PD FS
5 Sag 3D
SPGR
3000/42 4
3000/22
MF/ flip angle 30
4
2
0.5
0.5
FOV
16
16
16
16
16
MATRIX AVERAGES BW
224 x 256 2 31.25
192 x 256 1 10.42
224 x 256 2
192 x 256 3
160 x 256 1
31.25
31.25
12.5
6
8
ETL
6
0.6
0.6
ON
Fat Sat TA
0.6 3:09
3:40
3:06
3:06
3:16

Routine Knee (4 Channel)
In order of priority
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Sag PD FS 2417/22 3 1 mm
2 Sag PD 934/MF 3 1
3 Cor PD FS
4 Ax PD FS
5 Sag 3D
SPGR
3484/42 4
2900/22
MF/30 deg flip angle
4
2
0.5
0.5
FOV
16
17
16
16
16
MATRIX AVERAGES BW
224 x 256 2 20.83
192 x 256 1 10.42
224 x 256 2
192 x 256 3
160 x 256 1
20.83
20.83
12.5
8
8
ETL
8
0.6
0.6
Fat Sat TA
0.6 2:19
3:18
3:21
3:32
3:16

Ankle and Foot
Coil: 8 channel Foot Ankle Coil
Patient position: Supine with ankle flexed to 90 deg and the toes pointed up. Use cushioning to avoid spasm

Planes of Scanning for Ankle:
Axial: Plane is parallel to the long axis of calcaneus with scan obtained from the distal tibia through the plantar fascia into the subcutaneous tissues.
Coronal: Plane is perpendicular to the plane of the calcaneus or axial plane from the base of the metatarsals through the entire calcaneus.

Sagittal: prescribe a plane parallel to the long axis of the calcaneus and scan through the entire foot.

Planes of Scanning for the Foot:
Short axis plane: identify the plane parallel to the long axis of the second metatarsal and scan perpendicular to this from the navicular distal to the phalanges.
Sagittal plane : identify the plane of the second metatarsal and scan parallel to this through the entire foot.

Long axis plane: prescribe a plane parallel to the plantar aspect of the 2 nd through the 5 th metatarsals and scan from the plantar through the most dorsal aspect of the foot.

Ankle Routine
In order of priority
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Axial PD FS 3767/85 4 0.5
500/MF 4 0.5 2 Axial T1
3 Sag STIR 4000/50
TI=100
3
534/MF 3
1
1 4 Sag T1
5 Cor PD FS
6 Cor 3D
SPGR
3017/42
MF/ flip angle 20
3
1.8
1
0
FOV
14
14
16
16
16
16
MATRIX AVERAGES BW
224 x 320 2 31.25
192 x 416 2
192 x 256 2
50
15.63
224 x 416 2
224 x 320 2
224 x 288 1
41.67
31.25
31.25
3
7
3
8
ETL
8
0.6
On
Fat Sat TA
0.6 3:39
IR
3:37
3:20
2:55
3:43
3:56

Foot: Lisfranc ligament injury
Place marker: midfoot.
FOV centered on the TMT joints.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Short Axis axial T1
484/MF 3 1 mm
2
3
4
Short Axis axial T2 FS
Long Axis axial STIR
Sag T1
5150/42 3
4200/50
TI= 100
4
534/MF 3
1
1
1 mm
FOV
14
14
20
14
MATRIX AVERAGES BW
192 x 256 1 50.0
192 x 256 2
192 x 256 2
224 x 416 2
31.25
15.63
41.67
ETL
7
10
8
3
Fat
Sat
0.6
IR
TA
3:07
3:52
3:26
2:55

Foot: Mass and Osteomyelitis
Place marker: forefoot versus midfoot.
1
SEQUENCE TR/TE THICKNESS DIST.
FACTOR
Sag T1 550/MF 3 1 mm
2 4300/50 4 1
3
4
5
Sag STIR
Short Axis axial T1
Short Axis axial T2 FS
Long Axis axial T1
350/MF
3867/85
617/MF
3
4
3
1
0.5
1
6 1
FOV
14
14
14
14
Coned down to area of interest
14
7
8
Short Axis axial T1 fs
Pre
FOR MASS/
INFECTION
ADD
Short Axis axial T1 fs post
Sag T1 FS post
350/MF 3
350/MF 3
350/MF 3
1
1
14
14
FLIP
ANGLE
MATRIX AVERAGES BW
256/192 2 41.67
256/192
256/192
2
1
15.63
15.63
256/192 2
256/160 2
31.25
50.0
8
ETL
3
12
7
256/192
256/192
256/192
2
2
2
15.63
15.63
15.63
Fat
Sat
IR
0.6
On
On
On
TA
0:57
2:53
2:53
3:26
2:53
3:17
3:17
2:29