3T BODY PROTOCOLS (Updated July 15, 2018)

Transcription

1 General Guidelines 3T BODY PROTOCOLS (Updated July 15, 2018) NEVER hesitate to reach out to a radiologist for guidance! Siemens / GE terminology, other abbreviations: o HASTE / SSFSE HASTE TR 1600, no less than 1400 o Vibe / Lava o TruFisp / Fiesta o Breath Hold (BH) Abdominal Contrast full dose by weight, 3ml/sec, following by 20ml normal saline flush o Arterial phase is most crucial with liver imaging. Care bolus series should be positioned just inferior to right side diaphragm & immediate post initiated when contrast is seen in descending aorta. o Delayed post to be performed at minimum of 5 minutes post injection. Always perform T1 FS Axial Pre, even if not contrasting. Careful of tight FOVs with the use of ipat, the combination of the two can lead to artifacts. o If using ipat, must have at least two coil elements on in the phase direction. Dixon do not send non-fs series to PACS. Sedation o MRCP can sedate, but do not give patient oral contract agent. o Enterography do not sedate o Defecography do not sedate ABDOMEN T2 Spair Cor (free breathing) T2 HASTE Axial (7x2) T1 FS Dixon Axial pre (3mm) *In/out of phase to PACS T1 FS Dixon Axial immediate T1 FS Dixon Axial 2 min post trigger T1 FS Dixon Axial delayed post Send the in & out of phase from the T1 FS Dixon Axial Pre ONLY, to Synapse. Do not send post in/out of phase series, WS images or the respective subtractions to PACS. Send the subtracted FS posts to Synapse. Do not send the WS subtractions to PACS. Send Care Bolus to PACS. ABDOMEN WITHOUT CONTRAST T2 Spair Cor (free breathing) T2 HASTE Axial (7x2) trigger T1 FS Dixon Axial (3mm) *in/out of phase to PACS Send the in & out of phase from the T1 FS Dixon Axial Pre ONLY, to Synapse. Do not send post in/out of phase series, WS images or the respective subtractions to PACS.

2 ABDOMINAL WALL T1 vibe Axial T1 vibe Cor T1 vibe Sag T2 FS Cor T2 FS Sag Contrast, if needed: T1 FS Axial pre & post with subtraction. Additional post plane beneficial. Always place skin marker. Run phase direction to best minimize motion artifact. May use STIR for poor FS. Must have optimal FS in region of interest through entire abdominal wall. ADRENALS INITIAL EXAM T2 HASTE Axial T1 Axial in & out of phase (2.5x2.5mm) T1 Cor in & out of phase T1 FS Dixon Axial pre CONTRAST FULL DOSE T1 FS Dixon Axial post T2 fs Axial trigger T1 FS Dixon Axial delayed post Subtract the T1 FS Dixon Axial vibe pre with the posts & all sequences to Synapse. ADRENALS KNOWN MASS Contrast not required, unless order states otherwise. Only cover adrenals for known mass. T2 HASTE Axial (5x0, 24 slices) T1 Cor vibe in & out of phase T1 Axial vibe in & out of phase (2.5mm, ~44 slices) T1 FS Dixon Axial vibe pre (3mm) OPTIONAL - CONTRAST FULL DOSE: Only on initial exam, not for F/U exams T1 FS Dixon Axial vibe post trigger T1 FS Dixon Axial delayed post Subtract the T1 FS Dixon Axial vibe pre with the posts & all sequences to Synapse.

3 ANAL SPHINCTER DR. ERNEST GRAVES T1 Axial (360 FOV, full pelvis, 5x1) T2 Axial (240 FOV, 5x1.5) T2 Cor (360 FOV, 5x1.5) Consult QRY Body Rad for placement of the following 2 sequences through the anal sphincter. T2 hires Axial (240 FOV, 2.5x0) T2 hires Cor (240 FOV, 2.5x0) BREAST WITH CONTRAST Select appropriate protocol according to patient size: 33, 35, 37, 39 CM. T1 3D Axial (1mm) T2 Bright Fluid Axial (4x.8) 3ML/SEC T1 Axial Dynamic Dixon (1mm, 6 consecutive measurements at ~1.29min each, with 20sec delay after 1 st measurement for contrast injection, total 9.18min with Time MIP.) Pre-menopausal: exam should be scheduled within 7-14 days of the onset of their menstrual cycle. Only with radiologist approval or a new diagnosis of breast cancer may this rule be overlooked. Do not change sequence parameters, other than # of slices if only absolutely necessary. In the event that more slices need to be added to cover the breast tissue reduce phase & slice oversampling to keep consistent sequence time of approximately 9:18min. Similarly if slices decreased, add oversampling to compensate. POST PROCESSING Rename dynamic sequences: T1, STIR, PRE, POST 1, POST 2, POST 3, POST 4, & POST 5. Time MIP, Sag MPR 3x0mm from Post 2 series. Send to CAD: T1, STIR, PRE, POST 1, POST 2, POST 3, POST 4, POST 5, do not send repeats. Send to PACS: all above sequences with respective subtractions, post processed Time MIP, Sag MPR along with repeats or any additional sequences as needed.

4 BREAST IMPLANT RUPTURE WITHOUT CONTRAST *Always to be scanned as individual / free standing exam. TIRM WS Axial (4x.5mm) TIRM WS Cor (4x.5mm) Right TIRM WS Sag (4x.5mm) Left TIRM WS Sag Do not send sequence to Cadstream. CHEST Entire chest, not for a chest wall study. Check with a Radiologist before performing to confirm MRI vs CT. T1 vibe Axial T1 vibe Cor T1 vibe Sag T2 FS HASTE Axial T2 FS HASTE Cor T2 FS HASTE Sag *STIR for poor FS ENTEROGRAPHY Do not scan on an Espree due to the Limited Cor FOV. Localizer (480 FOV, free breathing) T2 HASTE Cor (6x.6, mid-liver to mid-bladder) T2 Trufi Cor T2 Cor Spair 2 set compose (free breathing) T2 HASTE Axial (5x1, mid-liver to mid-bladder) T2 FS HASTE Axial T1 Axial vibe in & out of phase (3mm) T1 FS Cor vibe caipi pre (1.3mm, mid-liver to mid-bladder) 2 ND ½ GLUCAGON CONTRAST, HAND INJECT T1 FS Cor vibe caipi post T1 FS Cor vibe caipi 90sec post T1 FS Axial post (5x1, mid-liver to mid-bladder) T1 FS Cor post (6x.6, mid-liver to mid-bladder) Scan patient prone if the patient s condition allows. Give ½ of the Glucagon dose at the beginning of the exam & the other ½ prior to contrast injection. The patient is required to drink a 450ml bottle of Breeza 60/40/20 minutes prior to the exam (3 bottles total). Do not sedate.

5 KIDNEY (tuberous sclerosis) T2 Cor Spair (free breathing, entire abdomen) T1 Axial vibe in & out of phase (3mm, entire abdomen liver/kidneys) *Following sequences are through kidneys only T1 Axial (4x0) T2 HASTE Axial T1 FS Dixon caipi Axial pre (3mm) T1 FS Dixon caipi Axial immediate post T1 FS Cor vibe caipi post (3mm) trigger T1 FS Dixon caipi Axial delayed post Subtract the T1 FS Dixon caipi Axial pre with the posts & and all sequences to Synapse. Send Care Bolus to PACS. Perform routine abdomen protocol for post nephrectomy exams. LIVER HEMANGIOMA/LESION T2 Spair Cor (free breathing) T2 HASTE Axial (7x2) T1 FS Dixon caipi Axial pre (3mm) *in/out of phase T1 FS Dixon caipi Axial immediate post T1 FS Dixon caipi Axial 2 min post trigger T1 FS Dixon caipi Axial delated post Send the in & out of phase from the T1 FS Dixon Axial Pre ONLY, to Synapse. Do not send post in/out of phase series, WS images or the respective subtractions to PACS. Send the subtracted FS posts to Synapse. Do not send the WS subtractions to PACS. Send Care Bolus to PACS.

6 LIVER WITH EOVIST CONTRAST Consult with appropriate Body Radiologist for approval, as needed. T2 HASTE Axial (7x2) T1 FS Dixon Axial vibe pre (3mm) *in/out of phase T1 3D Axial dynamic pre (5mm, 1 measurement) BOLUS DOSE 0.1ml/kg body weight T1 3D Axial dynamic post (5mm, 3 measurements) T1 FS Dixon Axial vibe immediate T1 FS Dixon Axial vibe 2 min post T1 FS Dixon Axial vibe 5 min post trigger T1 FS Dixon Axial vibe 10 min post T2 Haste Cor T2 Spair Cor (free breathing) T1 FS Dixon Axial vibe 20 min post T1 FS Cor 3D vibe 20 minute post Eovist recommended dose 0.1 ml / kg body weight. Send the in & out of phase from the T1 FS Dixon Axial Pre ONLY, to Synapse. Do not send post in/out of phase series, WS images or the respective subtractions to PACS. Send the subtracted FS posts to Synapse. Do not send the WS subtractions to PACS. MRCP / ABDOMEN WITH & WITHOUT CONTRAST T2 HASTE Cor (8x2) T2 HASTE Axial (7x2) T2 FS HASTE thick radial (80mm projection slices through biliary system, see picture protocol for instructions.) T2 Haste IR/TRIM Cor (3mm) T2 HASTE IR/TRIM Axial (4mm, biliary system through kidneys) T2 Space Cor trigger T1 FS Dixon caipi Axial pre (3mm) *in/out of phase T1 FS Dixon caipi Axial immediate post T1 FS Dixon caipi Axial 2 min post trigger T1 FS Dixon caipi Axial delayed post Specific imaging for evaluation of pancreatic or biliary ducts. Have the patient drink 12oz. of Pineapple or Blueberry (diabetic) juice minutes prior to scanning. Do not provide if sedating. Send the in & out of phase from the T1 FS Dixon Axial Pre ONLY, to Synapse. Do not send post in/out of phase series, WS images or the respective subtractions to PACS. Send the subtracted FS posts to Synapse. Do not send the WS subtractions to PACS. Send Care Bolus to PACS. Create Lateral & Tumble cut MIPs off T2 Space Cor trigger.

7 MRCP W/O CONTRAST T2 HASTE Cor (8x2) T2 HASTE Axial (7x2) T1 FS Dixon caipi Axial (3mm) *in/out of phase T2 FS HASTE thick radial (80mm projection slices through biliary system, see picture protocol for instructions.) T2 Haste IR/TRIM Cor (3mm) T2 HASTE IR/TRIM Axial (4mm, biliary system through kidneys) T2 3D Space Cor trigger Perform only with contrast / GAD contraindication. Patient must drink 12oz. of pineapple or blueberry juice minutes prior to scanning. Do not provide if sedating. Specific imaging for evaluation of pancreatic or biliary ducts. Send the in & out of phase from the T1 FS Dixon Axial Pre ONLY, to Synapse. Do not send any WS images. PANCREAS T2 Spair Cor (free breathing) T2 HASTE Axial (7x2) T1 Flair Axial (5x1) T1 FS Dixon caipi Axial pre (3mm) T1 FS Dixon caipi Axial immediate post T1 FS Dixon caipi Axial 2 min post trigger T1 FS Dixon caipi Axial delayed post Send in & out of phase Dixon along with Pre FS Axial to Synapse. Subtract the T1 FS Dixon Axial vibe pre with the posts & all sequences to Synapse. Send Care Bolus to PACS. MALE PELVIS T1 Axial (7x1, include entire bony pelvis) T2 HASTE Axial (240 FOV, 7x1) (240 FOV, 7x1) T2 FS HASTE Cor (240 FOV, 4x1) T2 HASTE Sag (240 FOV, 5x1) T1 FS Axial pre (360 FOV, 7x1, include entire bony pelvis) T1 FS Axial 2 min post With full bladder, if area of interest.

8 MALE PELVIS TESTICULAR With empty bladder. T1 Axial (360 FOV full pelvis) T2 HASTE Axial (240 FOV) (240 FOV) T2 FS HASTE Cor (280, 4x1) T2 HASTE Sag (280 FOV) hires (200 FOV, 3x1) T2 HASTE Axial hires T1 FS Axial pre (360 FOV, full pelvis) T1 FS Axial post T1 FS Axial hires post (200 FOV, 3x1) Build up testes using a folder towel. FEMALE PELVIS With empty bladder. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) trigger (240 FOV, 5x1.5) T2 HASTE Axial (breath hold) T2 FS HASTE Cor (240 FOV, 4x1) T2 Sag (230 FOV, 3.5x.5) T2 HASTE Sag T1 FS Axial pre (minimum FOV to include entire bony pelvis, 5x1.5) T1 FS Axial post Subtract pre from post & send all to Synapse. With full bladder, if area of interest. FEMALE PELVIS RTP WITHOUT CONTRAST Head first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles. T1 Axial (3x0, ~32-48 slices) T1 FS Axial T2 3D Axial FEMALE PELVIS VAGINAL / CERVICAL CA & RTP, DR. CATHERINE WU With empty bladder & KY. Have the patient insert 20CC of KY into the vagina. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) trigger (240 FOV, 5x1.5) T2 Sag (230 FOV, 3.5x.5) T2 HASTE Sag (240 FOV, 3x.5) T2 FS Cor (240 FOV, 4x1) T2 Hires Obl Axial (160 FOV, 2.5x0, Cervical CA ONLY, true axial through long axis of cervix, **Consult with Body Radiologist for positioning.) Diffusion Axial (260 FOV, 3.6x0, ~46 slices, B Values of 0, 400, 800 & Calculated Diff) *Area of interest, consult with radiologist if needed. T1 FS Axial pre (minimum FOV to include entire bony pelvis, 5x1.5)

9 T1 FS Axial post T1 FS Sag post Subtract pre from post & send all to Synapse.

10 FEMALE PELVIS CERVICAL CA With empty bladder. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) trigger (240 FOV, 5x1.5) T2 Sag (230 FOV, 3.5x.5) T2 HASTE Sag (240 FOV, 3x.5) T2 FS Cor (240 FOV, 4x1) T2 Hires Obl Axial (160 FOV, 2.5x0, Cervical CA ONLY, true axial through long axis of cervix, **Consult with a Body Radiologist for positing Diffusion Axial (260 FOV, 3.6x0, ~46 slices, B Values of 0, 400, 800 & Calculated Diff) *Area of interest, consult with radiologist if needed. T1 FS Axial pre (minimum FOV to include entire bony pelvis, 5x1.5) T1 FS Axial post T1 FS Sag post (230 FOV, 3.5x.5) Subtract pre from post & send all to Synapse. FEMALE PELVIS ONCOLOGY (UTERINE / ENDOMETIAL CA) With empty bladder. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) trigger (240 FOV, 5x1.5) T2 HASTE Axial (breath hold) T2 FS HASTE Cor (240 FOV, 4x1) T2 Sag (230 FOV, 3.5x.5) T2 HASTE Sag Diffusion Axial (260 FOV, 3.6x0, ~46 slices, B Values of 0, 400, 800 & Calculated Diff) *Area of interest, consult with radiologist if needed. T1 FS Axial pre (minimum FOV to include entire bony pelvis, 5x1.5) T1 FS Axial post T1 FS Sag post (230 FOV, 3.5x.5) Subtract pre from post & send all to Synapse. FEMALE PELVIS MULLERIAN DUCT ANOMALIES Unicornuate, Arcuate, Bicornuate, Septate, or Didelphic Infertility With empty bladder. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) trigger (240 FOV, 5x1.5) T2 HASTE Axial (240 FOV, 5x1.5) T2 Sag (230 FOV, 3.5x.5) T2 HASTE Sag (240 FOV, 3x.5) T2 FS Cor (240 FOV, 4x1) T2 HASTE Axial loc parallel/perpendicular to long axis of uterus T2 Obl Axial (240 FOV, 4x0, parallel to long axis of uterus) * See picture protocol. Radiologist must approve sequence prior to removing patient from table. T2 Haste Cor Abd (~360 FOV, 8x2, ~26 slices)

11 FEMALE PELVIS PRE/POST UFE With empty bladder. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) trigger (240 FOV, 5x1.5) T2 FS HASTE Cor (240 FOV, 4x1) T2 FS Cor (240 FOV) T2 Sag (230 FOV, 3.5x.5) T1 FS Axial pre (minimum FOV to include entire bony pelvis, 5x1.5) T1 FS Axial post T1 Sag post (230 FOV, 3.5x.5) T2 FS HASTE Axial (240 FOV, 5x1.5) T2 HASTE Axial bh If the patient has a fibroid that extends superiorly out of the pelvic cavity, increase the FOV and/or slice coverage to include in on all sequences. Subtract pre from post & send all to Synapse. PELVIS URETHRAL DIVERTICULUM Consult with a Radiologist if the patient is male. T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5) T2 FS Hires Sag (140 FOV, 2.5x0, 24 slices) T2 FS Hires Axial T2 FS Hires Cor T1 FS Hires Axial pre T1 FS Hires Axial post Subtract pre from post & send all to Synapse. PROSTATE RTP WITHOUT CONTRAST Head first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles. T1 Axial (3x0, ~32-48 slices) T1 FS Axial T2 3D Axial PROSTATE RTP WITHOUT CONTRAST, DR GARZA / DR. MARK RUFUS Head first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles. Coverage is 10cm superior & 6cm inferior to prostate. T1 Axial (3x0, ~32-48 slices) T1 FS Axial T2 3D Axial T2 Axial (140 FOV, 3x0, include from top of seminal vesicles through urogenital diaphragm) * Add the following sequence if the patient is post prostatectomy (140 FOV, 3x0, include from top of seminal vesicles through urogenital diaphragm)

12 PROSTATE CYBERKNIFE THERAPY PLANNING WITHOUT CONTRAST, DR. GHAFOORI Feet first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles. T1 FS Axial (2x0, ~54 slices) PROSTATE WITHOUT CONTRAST, DR HSU T2 Axial (150 FOV, 3x1, 30 slices) T2 Sag (200 FOV, 3x1, 30 slices) T2 Axial (400 FOV, 100%, 3x0, 38 slices, skin to skin, no angles) T1 Axial (minimum FOV to include entire bony pelvis, 5x1.5, 40 slices) Diffusion Axial (200 FOV, 3.6x0, 33 slices, include from top of seminal vesicles through urogenital diaphragm) PROSTATE DIAGNOSTIC 3T ONLY T2 Sag (160 FOV, 2.5x, 36 slices) Diffusion Axial (200 FOV, 3.6x0, 33 slices, include from top of seminal vesicles through urogenital diaphragm, split the images of each B-Value into its own series by loading into the Viewer & saving as a new series as B0 Value, B400 Value, B800 Value) T2 Axial (180 FOV, 3x1, 25 slices, include from top of seminal vesicles through urogenital diaphragm) T1 Axial (360 FOV, 5x1.5, 40 slices, full pelvis) T2 Cor (180 FOV, 3x1, 22 slices) T1 TWIST Axial Dynamic Perfusion (180 FOV, 3mm, 60 measurements, include from top of seminal vesicles through urogenital diaphragm, ~6 minute scan time, injected at 3ml/sec after 2 measurement is completed) T2 Axial best image quality required, repeat for motion, etc. Send the following sequences to Synapse: T2 Sag, T2 Axial, T1 Axial, T2 Cor, diffusion axial ADC map, diffusion axial calculated b value 1400, T1 TWIST Dynamic Axials, renamed B0 Value, B400 Value, and B800 Value. Send the following sequences to ARA DynaCAD or HCA DynaCAD: T2 Sag, T2 Axial, T1 Axial, T2 Cor, diffusion axial ADC map, diffusion axial calculated b value 1400, T1 TWIST Dynamic Axials. HCA Urologist (HCA DynaCAD) Images must be sent to HCA DynaCAD, no ARA DynaCAD. o Dr. Sandeep Mistry, PA s Dustin Fontenot & Jason Ranfdell, Leonora Brown, RN o Dr. Chris Yang o Dr. Matthew Pearson, PA Diane Warmoth o o o o Dr. Subir Chhikara, PA s Ashley Dufour & Terry Farley Dr. Kouskik Shaw, NPA Alecia Zuehlke Dr. Michael Trotter Dr. Samantha Thiry If contraindicated for 3T, may perform on 1.5T: MID, QRY, VIL, CP, GTN, RCP. 4-6 week waiting period post biopsy applies to all patients, even with positive biopsy. Exception without radiologist approval can be made if referring absolutely needs exam for treatment purposes. Must document biopsy date in Tech Notes.

13 PROSTATE POST PROSTATECTOMY 3T ONLY T2 Sag (160 FOV, 2.5x, 36 slices) Diffusion Axial (200 FOV, 3.6x0, 33 slices, include from top of seminal vesicles through urogenital diaphragm, split the images of each B-Value into its own series by loading into the Viewer & saving as a new series as B0 Value, B400 Value, B800 Value) T1 Axial (360 FOV, 5x1.5, 40 slices, full pelvis) T1 Axial (200 FOV, 3x1, 25 slices, include from top of seminal vesicles through urogenital diaphragm) T2 Axial T1 TWIST Axial Dynamic Perfusion (180 FOV, 3mm, 60 measurements, include from top of seminal vesicles through urogenital diaphragm, ~6 minute scan time, injected at 3ml/sec after 2 measurement is completed) Send the following sequences to Synapse: T1 Axial, T2 Sag, T1 Axial, T2 Axial,, diffusion axial ADC map, diffusion axial calculated b value 1400, T1 TWIST Dynamic Axials, renamed B0 Value, B400 Value, and B800 Value. RECTUM RECTAL CANCER 3T ONLY Straight, do no angle to anal canal. T1 Axial (minimum FOV to include entire bony pelvis, 6x1) T2 Cor (240 FOV, 5x1.5, 40 slices) T2 Sag (160 FOV, 2.5x, 36 slices) T2 Axial (240 FOV, 2.5x0, L5 through the ischium) T1 FS Dixon Axial vibe pre (240 FOV, 2mm, 72 slices/slab) CONTRAST FULL DOSE T1 FS Dixon Axial vibe post immediate Diffusion Axial (260 FOV, 3.6x0, 46 slices) Symptom of rectal bleeding will likely use this protocol, may need to verify diagnosis with referring or radiologist. Subtract pre from post & send all to Synapse. No delay post biopsy required. RECTUM FOR PAIN/ABSCESS/FISTULA/ETC. 3T ONLY Be sure to completely scan through the patient s pathology, extending the scan through the buttocks inferiorly is frequently needed. T1 Axial (minimum FOV to include entire bony pelvis, 6x1) T2 FS Sag (160 FOV, 2.5x0, 36 slices, S/I joint to S/I joint to cover the rectum) T2 Obl Cor (240 FOV, 2.5x0, 76 slices, parallel to anal canal) T2 Obl Axial (240 FOV, 2.5x0, perpendicular to anal canal) T2 FS Obl Axial T1 FS Dixon Obl Axial pre (240 FOV, 2mm, 72 slices/slab) CONTRAST FULL DOSE T1 FS Dixon Obl Axial post Subtract pre from post & send all to Synapse.

14 AORTIC DISSECTION MRA Include from above aortic arch through bifurcation. T1 Axial T1 FS Axial T2 HASTE Axial T2 HASTE Cor 3D Sag Volume pre 3D Sag Volume post (arterial phase) 3D Cor Volume post 3D Axial Volume post ANGIOGRAM & VENOGRAM CONVENTIONAL IMAGING MRA UPPER EXTREMITY Confirm coverage with referring and/or INTV radiologist. T1 Cor TWIST Cor Multi Station: T1 Sag Aorta localizer 3D Volume Cor pre start scan when contrast is seen in descending aorta at level of aortic arch 3D Volume Cor post Humerus: must include arch through elbow joint. Entire upper extremity: must include arch through wrist joint, if possible include through finger tips, multi station (approx. 20 seconds each), two bolus injections. For example 1.5ml/sec, second injection 1.5ml/sec followed by 20ml saline. Subtract 3D Volume pre from post; use resulting subtraction for MIP's. MRA RENAL T1 fl2d Cor (~360 FOV, 5x1, entire kidneys) (entire kidneys) T1 Sag Aorta localizer 3D Volume pre CONTRAST 3D Volume post Subtract pre from post, use resulting subtraction for post processing. o Cut Lateral MIP o Cut Tumble MIP o Axial 2x0mm MPR, ~220 FOV

15 MRA PELVIS WITHOUT CONTRAST Consult radiologist for protocol for use of QISS. 2D TOF MRV LOWER EXTREMITY FSPGR / Turbo-Flash Axial T1 Axial 2D TOF Axial 3D Volume pre 3D Volume post 30 Second delay 3D Volume (run 3 times consecutively) Subtract the arterial phase from the best venous phase. Subtract pre images from first subtraction & use resulting subtraction for MIP's. MRV PELVIS FSPGR / Turbo-Flash Axial (360 FOV, 5x1.5) T1 Axial 2D TOF Axial (above bifurcation to femoral heads) 3D Vibe Volume pre 3D Vive Volume post with 30 second (run 3 times consecutively) Subtract the arterial phase from the best venous phase & use resulting subtraction for MIP s.

16 QISS / NON-CONTRAST MRA QISS ABDOMEN OR PELVIS ECG gating. Adjust number of slabs for coverage. Select appropriate RR interval >/< 800ms QISS Trufi Ax QISS RUN-OFF ECG gating. FOV bifurcation through ankle joint. Select appropriate RR interval >/< 800ms QISS Trufi Ax QISS POPLITEAL ARTERY ENTRAPMENT (PAE) ECG gating. FOV mid-thigh to mid-calf. Select Appropriate RR interval >/< 800ms QISS Trufi Ax Dorsiflexion QISS Trufi Ax Neutral QISS Trufi Ax Plantarflexion Right T1 Axial (7x1, ~47 slices) Left T1 Axial

17 RENAL MRA WITHOUT CONTRAST - NATIVE Only available at M18 Skyra. Localizers Axial & Cor Native Space 3D NATIVE / NON-CONTRAST MRA LOWER EXTREMITY MRA WITHOUT CONTRAST - NATIVE Only available at M18 Sykra. Only perform from the knee down, not available in pelvis or upper leg. Localizers Axial, Cor Cine TD Scout Native Space 3D Upper & Lower Composed UPPER EXTREMITY MRA WITHOUT CONTRAST - NATIVE Only available at M18 Sykra. Only perform from the elbow down, not available in chest or upper arm. Localizers Axial & Cor Cine TD Scout Native Space 3D