Body MRI General Comments

Transcription

1 Body MRI General Comments 1. All body imaging should be performed on a 1.5 T magnet unless body habitus necessitates the larger bore of the 3 T. 2. DWI is now considered standard protocol for all solid organ or mass workup with MRI. 3. Blade or propeller techniques for T2WI should be performed whenever possible in the setting of a poor breath-holder or other movement. These techniques should not be used otherwise. 4. If not using Eovist for liver MRI, omit only the delayed hepatocyte phase. 5. Continue to contact a radiologist for female pelvis MRI protocol = "Nish Pelvis" vs. "King Pelvis". Please note that all female pelvis MRI should have a straight sagittal T2 (not FS) and a T1 FS Pre GAD. Reviewed by Dr. King 6/2017

2 Liver 1.5 T Magnet Eovist 10 ml for all patients except young peds; Call radiologist for large patients to consider dose doubling. No Eovist if Bilirubin at or above 3 mg/dl If not using Eovist, omit #9 If ordered with MRCP, must do before administration of Eovist 1. 3 Plane LOC, Non-Breath Hold 2. Coronal HASTE Localizer - (BH) - Must include superior dome of diaphragm 3. Axial In/Out - (BH) - Top of diaphragm thruogh duodenal c-loop; Use (BH) Localizer 4. *LIVER IRON QUANT IF REQUESTED* 5. ADC, DWI B50, B400 and B Axial FLASH FS, Pre GAD - Same as Series 3; Run immediately before GAD dose. ST = 4mm, no gap Post GAD FLASH (FS): Inject 1 ml/sec and 20 ml NS chaser at 2 ml/sec; Run 4 acquisitions - 1st = 20 sec delay, may need 30 sec delay if CHF/over 70 y/o; 2nd = Allow a breath then run again; 3rd = ~70 sec after injection; 4th = ~4 min after injection **Do not bolus track with Eovist. **Optimal hepatic arterial phase is when the hepatic artery is heavily contrasted and there is a trace amount of contrast in the portal vein.** 7. Axial T2 FS with TE 90 - Same coverage as Series 3; Respiratory gated; Use non-breath hold Loc; User propeller technique if possible on breathing pts, but ONLY when T2's are poor due to breathing or other 8. Axial T2 FS, long TE (TE 180) - Match Series 6 9. T1 FS Axial and Coronal - Long delays after these T2WI Sequences; Must be 20 minutes after injection; Use FA 40 degrees for these delayed images only, 1.8mm With and Mass/Lesion seen on other imaging, Increased Liver Enzymes **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

3 MRCP 1 cup of water (~8 oz) right before exam. Call radiologist if known ascites **Call radiologist if clinical statement is for infection or tumor. This may warrant contrast.** 1. 3 Plane LOC, Non-Breath Hold 2. Coronal HASTE Localizer - Navigator, center slices on liver, ensure dome is covered 3. Axial T2 HASTE FS with Nav - Cover bile ducts 4. Coronal T2 HASTE FS with Nav - Cover bile ducts 5. Coronal 3D TSE with Navigator - Cover bile ducts Comments: Send dataset to 3D Workstation (Vitrea Bridge or TeraRecon) Call radiologist for Secretin Stimulation MRCP, if needed. This is done at IMMC. Common Bile Duct Dilation, Pancreatic Duct Dilation **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

4 Renal Water Prep and IV 1. 3 Plane LOC, Non-Breath Hold 2. Coronal HASTE Localizer - (BH) 3. Axial In/Out - (BH) - Use (BH) Loc (Do not alter transmit gain) 4. Axial T2 FS with TE ~ 140. Resp Gated, use Non-Breath Hold Loc to determine superior starting location, same end as in-phase axials 5. ADC, DWI B50, B400 and B Axial FLASH FS, Pre GAD Axial FLASH, Post GAD Dynamics - 2 ml gad/sec and 20 ml saline flush at 2 ml/sec. Run 3 dynamic acquisitions T1 Axial FS - 25 seconds after injection, then at 100 seconds, then at 10 minutes 10. Coronal Post at 10 minutes Comments: (BH) = Breath Hold Do subtractions for all post-contrast acquisitions if renal mass is T1 bright. With and Mass/Cyst seen on other imaging, Decreased Kidney Function **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

5 Adrenal Body Array 1. 3 Plane LOC, Non-Breath Hold 2. Coronal HASTE Localizer - (BH) - Cover adrenals 3. Axial HASTE - (BH) - Use (BH) localizer to determine coverage 4. Axial In/Out - (BH) - Match series 3 5. ADC, DWI B50, B400 and B800 **Check with Radiologist Next series are optional 6. Axial T2 RT Fat Sat, Resp Gated, Use non-breath hold localizer to determine superior 7. Axial FLASH FS, Pre GAD Axial FLASH, Post GAD, First is 6-7 sec delay, then breath, then run again, then wait seconds Comments: (BH) = Breath Hold Mass seen on other imaging **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

6 Pancreas IV and water 1. 3 Plane LOC, Non-Breath Hold 2. Coronal HASTE Localizer - (BH) - Do as many slices as possible in the breath hold. 3. Axial In/Out - Cover top of diaphragm though c-loop of duodenum or bottom of the liver (whichever is lowest), use (BH) LOC 4. ADC, DWI B50, B400, B Axial T2 RT FS, RG 6. 3D MRCP, include rotating MIPS 7. Axial FLASH FS Pre-GAD THIN ST/SG 3.0/0 (no gaps), just cover pancreas Axial FLASH Post-GAD, like #5, first 25 seconds after injection, then breath and run second phase, then another phase at 70 seconds. Fourth phase at 4 minutes. Comments: (BH) = Breath Hold If bolus tracking, run first scan 8 seconds after blush in abdominal aorta. If working up pancreas cancer for metastatic disease, call radiologist. Might need liver instead. **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

7 Enterography 1. Localizer 2. T2 Coronal CINE (BH) (Trufi) sets as needed 3. Glucagon - After Cine 4. T2 Coronal (BH) (Haste) 5. T2 Coronal FS S.S.F.P. (BH) (Trufi) 6. T2 Coronal FS (BH) (TSE) 7. T2 Axial S.S.F.P. (BH) (Trufi) 8. T2 Axial S.S.F.P. FS (BH) (Trufi) 9. T2 Axial FS (BH) (TSE) 10. T1 Coronal GRE Pre (BH) FS (3D Flash) (Vibe) 11. Optional T1 Axial - Through pelvis for fistula (if needed) 12. Optional T2 Axial - Through pelvis for fistula (if needed) 13. Contrast 14. T1 Coronal FS GRE Post - 45 Seconds (BH) - (T1 Flash Vibe) 15. T1 Axial FS GRE Post - 45 Seconds (BH) - (T1 Flash Vibe) 16. T1 Coronal FS GRE Post - 2 Minutes (BH) - (T1 Flash Vibe) 17. T1 Axial FS GRE Post - 2 Minutes (BH) - (T1 Flash Vibe) 18. **If requested by Radiologist - T2 Coronal 3D (Gated - Rectal Fistula) - (Space RST) 19. Diffusion (Gated) 20. Optional T1 Axial FS - Through pelvis for fistula (if needed) Comments: (BH) = Breath Hold **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

8 of Right Sided Abdominal Pain in Pregnancy 1.5 T Phased Array Surface Coil Non Contrast Technique 1. Axial, Coronal, Sagittal T2 SSFSE (4 skip 1) - Limit FOV to right abdomen unless patient is small then may need to expand coverage. 2. Axial dual echo T1 in/out phase AND T1 Fat Sat Axial. 3. Repeat Axial SSFSE T2 with above parameters with Fat Sat. 4. **Call radiologist to review.** May need multiplanar T2 FS's, may need additional imaging such as below or may be done. 5. T2 thick slab (slice thickness between mm) SSFSE for patients with suspected choledocholithiasis or ureterolithiasis. This is optional. 6. Axial T2* = TR 30 msec, 45 degree flip, 3-skip-1, 256 x 128, 35 cm FOV. 7. DWI Coronal B-400 and B-800. Right-sided abdominal pain in pregnancy **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

9 Female Pelvis (King) Prep water and Glucagon (1 mg IM deltoid immediately before aquiring Locs - Must check with rad first, See contraindications) 20 ml ultrasound gel in a syringe with adapter, patient will administer to vagina 1. 3 Plane LOC 2. Coronal Haste - Sacrum through pelvic cavity. 3. T1 Axial - Aortic bifurcation through below vaginal canal; FOV, use smallest possible; phase encode right to left 4. Axial T2 - Same as Series Sagittal T2 - Include all of female anatomy, femoral head to femoral head; FOV, use smallest possible; phase encode superior to inferior 6. Coronal T2 - Sacrum through pelvic cavity 7. Axial STIR - Top of iliac crests through lesser trochanter; FOV to include bony pelvis, do not need to include all of the muscles or subcutaneous fat 8. Axial FLASH FS Pre - (BH) - Cover at least from the top of uterus through vaginal canal, possibly as high as aortic bifurcation; FOV, phase AP, adjust FOV so that 3/4 of FOV just covers skin to skin Post GAD - Inject and wait seconds, 3 ml/sec 9. Axial FLASH FS Post - (BH) - Same as Series Axial FLASH FS - At seconds 11. Sagittal FLASH FS Post - (BH) - Same as Series 5 Comments: 1. (BH) = Breath Hold 2. Call me for Urethral Diverticulum MRI 3. Run sequences along axis of uterus for endometrial masses and workup of infertility/mullerian duct anamoly With and Pelvic Pain, Mass seen on other imaging, Abnormal Bleeding, Amenorrhea, Fibroids **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

10 Female Pelvis (Nish) 3 Plane LOC - 45 x x Map - 50 x x Shim - 50 x x T2 Sagittal Sag 28 x x T2 FS Coronal Cor 38 x Strong 224 x Long Axis T2 FS Axial Ax 30 x Strong 224 x Short Axis T1 Axial Ax 30 x x Short Axis Sagittal Dynamic Sag 25 x nhance 192 x T1 FS Coronal Post Cor 38 x Strong 192 x Long Axis T1 FS Axial Post Ax 30 x Strong 192 x Short Axis With & Pelvic Pain, Mass seen on other imaging, Abnormal Bleeding, Amenorrhea, Fibroids Reviewed by Dr. King 4/2016

11 Perirectal Abscess Glucagon, Water, Center FOV at pubic symphysis 1. 3 Plane LOC 2. Coronal Haste - Sacrum through pelvic cavity. 3. Set up perpendicular to anal canal. Axial T1 - Iliac crest through rectum and subcutaneous fat. If an abnormality, may go inferiorly into upper thigh. Phase right to left. 4. Axial T2 - Same as Series Sagittal T2 FS - Femoral head to femoral head. Include all pathology if it extends farther down. Phase superior to inferior. 6. Set up along anal canal. Coronal T2 - All of sacrum to anterior part of pubic symphysis. 7. Coronal STIR - Same as Series Axial STIR - Same as Series Axial Flash FS Pre (BH) - Cover superiorly as much as a (BH) sequence will allow up to iliac crest FOV. Phase anterior to posterior. Post GAD, inject and wait sec, 3 ml/sec 10. and 11. Axial Flash FS Post (BH) - Same as Series Coronal Flash FS Post (BH) - Same as Series FOV. Use smallest FOV possible. Comments: (BH) = Breath Hold **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

12 Prostate **Need to get surgical record or H&P - date of most recent biopy, lobe of prostate involved, Gleason Score.** Biopsy Proven Carcinoma: Glucagon per standing order 1. Sagittal localizer. Coverage is body coil, check ER coil placement. 2. Axial T1. Cover prostate. 3. Axial T2. Same coverage. 4. Sagittal T2. Cover prostate. 5. Oblique Coronal T2. Angle along prostate. 6. Remove coil. Then Wide FOV T1 Axial from L4-5 through bony pelvis. 7. ADC, DWI B1000 and B1500 Non-Biopsy Proven: Run steps 1-5 and 7 (from above), then: 8. T1 Axial FS, mimic step 2 coverage. 9. Inject GAD (Prohance or Magnevist). 10. T1 Axial FS at 30 seconds, 60 seconds, and 180 seconds. 11. Perform subtractions with series #10 minus #8. Comments: If have no ER coil, limit FOV to include posterior aspect of bladder, prostate, rectum in Series 1-5. With and Biopsy proven carcinoma Non-biopsy proven **Values will vary between machines. Use your own discretion when selecting values.** Reviewed by Dr. King 4/2016

13 Brain 3 Plane LOC - 33 x x DWI Ax 27 x x T1 Sagittal Sag 25 x x T2 Axial Ax 24 x x Flair Axial Ax 24 x x T1 Axial Ax 24 x x Only for exams with contrast T2 Coronal Cor 24 x x GRE Axial Ax 24 x x Optional Flair Sagittal Sag 230 x x Only for Dr. Janus' MS Brains Contrast T1 Axial Post Ax 24 x x T1 Coronal Post Cor 24 x x T1 Sagittal Post Sag 25 x x For 3T Scanners: 1. Include T1 Axial FSAT Pre Gad sequence, if contrast is used 2. All post scans are FSAT With & Headaches, TIA or Stroke Symptoms, Parkinson's, Tremors History of Cancer, Weakness, Loss of Sensations, Changes in Vision, MS Reviewed by Dr. Depena 6/2017

14 Brain / Posterior Fossa Cranial Nerve Evaluation 3 Plane LOC - 33 x x DWI Ax 27 x x T1 Sagittal Sag 25 x x T2 Axial Ax 24 x x Flair Axial Ax 24 x x T2 FASE Axial Thin Ax 19 x x T1 Axial Thin Ax 23 x x D Sequence GRE Axial Ax 24 x x Contrast T1 Axial Thin Post Ax 23 x x \ 3D Sequences; Scan limits depend on V1, V2, V3; Pons / T1 Coronal Thin Post Cor 23 x x thru maxillary sinuses T1 Axial Post Ax 24 x x Whole Brain For 3T Scanners: Include T1 Axial FSAT Pre Gad sequence, if contrast is used With & Facial Pain and/or Numbness, Cranial Nerve Palsey, Facial Paralysis, Bell's Palsy Reviewed by Dr. Depena 11/2016

15 Brain Seizures / Memory Loss 3 Plane LOC - 33 x x DWI Ax 27 x x T2 Axial Ax 24 x x Flair Axial Ax 24 x x GRE Axial Ax 24 x x T2 Coronal Thin Cor 20 x x Angle with Hippocampus T1 Axial Ax 24 x x Contrast T1 Axial Post Ax 24 x x T1 Coronal Post Cor 20 x x NeuroQuant Sag 25 x x If unavailable, see below For 3T Scanners: If NeuroQuant sequence is unavailable: 1. Include T1 Axial FSAT Pre Gad sequence, if contrast is used 2. All post scans are FSAT 1. Include T1 Sagittal Pre Gad sequence instead. 2. Include T1 Coronal IR Pre Gad sequence instead. With & Memory Loss, Organic Brain Syndrome, Seizures, Dementia Memory Loss, Organic Brain Syndrome, Seizures, Dementia **Perform the exam as ordered by the referring physician** Reviewed by Dr. Depena 6/2017

16 Brain IAC's 3 Plane LOC - 33 x x DWI Ax 27 x x T1 Sagittal Sag 25 x x T2 Axial Ax 24 x x Flair Axial Ax 24 x x D FASE Axial Ax 18 x x GRE Axial Ax 24 x x T1 Axial Thins Ax 160 x x Contrast T1 Axial Post Ax 24 x x T1 Coronal Thin Post Cor 18 x x T1 Axial Thin Post Ax 18 x x For 3T Scanners: 1. Include T1 Axial FSAT Pre Gad sequence, if contrast is used 2. Include T1 Axial FSAT Post Gad sequence, if contrast is used With & Acoustic Neuroma, Tinnitis, Hearing Loss, CPA Tumor, Dizziness, Vertigo Reviewed by Dr. Depena 11/2016

17 Pituitary 3 Plane LOC - 33 x x DWI Ax 27 x x T1 Sagittal Sag 25 x x T2 Axial Ax 24 x x Flair Axial Ax 24 x x GRE Axial Ax 24 x x T1 Sagittal Thin Sag 18 x x T2 FASE Coronal Thin Cor 18 x x T1 Coronal Thin Cor 18 x x Coronal Dynamic Cor 23 x x Run times T1 Sagittal Thin Post Sag 18 x x T1 Axial Post Ax 24 x x For 3T Scanners: 1. Include T1 Axial FSAT Pre Gad sequence also 2. T1 Axial Post Gad sequence is FSAT With & Tumor, Growth Hormone Defficiency, Short Stature, Precocious Puberty, Hyperprolactinemia, Craniopharyngioma, Increased Prolactin, Galactorrhea, Amenorrhea, Micro/Macro Adenoma, Diabetes Insipidus Reviewed by Dr. Depena 8/2016

18 Orbits 3 Plane LOC - 33 x x DWI Ax 27 x x T1 Sagittal Sag 25 x x T2 Axial Ax 24 x x Flair Axial Ax 24 x x GRE Axial Ax 24 x x T2 FS Coronal Thin Cor 18 x Strong 224 x T1 FS Axial Thin Ax 18 x Strong 224 x D FASE Axial Ax 18 x x Contrast T1 FS Axial Thin Post Ax 18 x Strong 192 x T1 FS Coronal Thin Post Cor 18 x Strong 192 x T1 Axial Post Ax 24 x x For 3T Scanners: 1. Include T1 Axial FSAT Pre Gad sequence also 2. T1 Axial Post Gad sequence is FSAT With and 6th Nerve Palsy, Mass, Diplopia, Optic Neuritis, Cellulitis, Abscess, Vision Changes Reviewed by Dr. Depena 8/2016

19 Mandible T1 Axial Ax 180 x x Cover mandible T2 FS Axial Ax 180 x Strong 212 x Cover mandible T1 Coronal Cor 180 x x Cover mandible T2 FS Coronal Cor 180 x Strong 240 x Cover mandible T1 Obl Sagittal Sag 170 x x Angle with affected mandible T2 FS Obl Sagittal Sag 170 x Strong 224 x Angle with affected mandible T1 FS Coronal Cor 180 x Strong 240 x Only for exams with contrast Contrast T1 FS Axial Post Ax 180 x Strong 212 x Cover mandible T1 FS Coronal Post Cor 180 x Strong 240 x Cover mandible T1 FS Obl Sagittal Post Sag 170 x Strong 224 x Angle with affected mandible With & Pain Soft Tissue Mass, Osteomyelitis Reviewed by Dr. Depena 6/2017

20 Soft Tissue Neck Sagittal LOC Sag 35 x x Coronal LOC Cor 30 x x T1 Axial Ax 26 x x T2 FS Axial Ax 26 x Strong 256 x T2 FS Coronal Cor 32 x Strong 256 x T1 Sagittal Sag 32 x T1 Coronal Cor 32 x x T1 FS Coronal Cor 32 x Strong 256 x For exams w/ contrast;see below Contrast T1 FS Axial Post Ax 26 x Strong 192 x T1 FS Coronal Post Cor 32 x Strong 192 x For exams with contrast: When post FSAT sequence being performed, please include a pre-contrast FSAT sequence in at least one plane. With & Abscess, Mass, Adenopathy, Cellulitis, Salivary Gland Abnormality Reviewed by Dr. Depena 6/2017

21 Brachial Plexus Cor LOC Cor 50 x x Plane LOC - 45 x x Map - 45 x x T1 Coronal Cor 46 x x Bilat T2 Coronal Cor 46 x x Bilat T1 Axial Ax 46 x x Bilat T2 Axial Ax 46 x x Bilat T1 Sagittal Sag 27 x x T2 Sagittal Sag 27 x x Shim - 42 x x /9 T1 FS Coronal Cor 46 x Light 192 x For exams w/ contrast;see below Contrast T1 FS Coronal Post Cor 46 x Light 192 x Bilat T1 FS Axial Post Ax 46 x Light 192 x Bilat T1 FS Sagittal Post Sag 27 x Light 192 x For exams with contrast: When post FSAT sequence being performed, please include a pre-contrast FSAT sequence in at least one plane. With & Brachial Plexopathy, Mass Check with radiologist to determine if contrast is needed. Reviewed by Dr. Depena 6/2017

22 C-Spine Sagittal LOC Sag 35 x x Coronal LOC Cor 30 x x T2 Sagittal Sag 24 x x T1 Sagittal Sag 24 x x D FE Axial Ax 19 x x T2*Dual Axial Ax 20 x x /18 STIR Sagittal Sag 24 x x T1 Axial Ax 20 x x D Sequence Optional T1 FS Sagittal Post Sag 24 x Strong 224 x T1 Axial Post Ax 20 x x D Sequence With & WithoutContrast: Neck Pain, Numbness or Tingling of the Arms or Fingers, Pain in the Upper or Lower Extremities History of Multiple Sclerosis (MS), Transverse Myelities, Tumors, Cancer ** A history of cervical or thoracic spine surgery DO NOT require contrast** Reviewed by Dr. Depena 8/2016

23 T-Spine Sagittal Count Sag 35 x x Coronal LOC Cor 35 x x Sagittal LOC Sag 35 x x Change Coils T2 Sagittal Sag 34 x x T1 Sagittal Sag 34 x x T2 Axial Ax 24 x x T1 Axial Ax 24 x x STIR Sagittal Sag 34 x x Optional T1 FS Sagittal Post Sag 34 x Strong 256 x T1 Axial Post Ax 24 x x D FE Axial Ax 24 x x With & Mid-Back Pain, Numbess or Tingling of the Arms or Fingers, Pain in the Upper or Lower Extremities History of Multiple Sclerosis (MS), Transverse Myelitis, Tumors, Cancer **A history of cervical or thoracic spine surgery DO NOT require contrast** Reviewed by Dr. Depena 8/2016

24 L-Spine Sagittal LOC Sag 50 x x Coronal LOC Cor 45 x x T2 Sagittal Sag 27 x x T1 Sagittal Sag 27 x x T2 Axial Ax 20 x x T1 Axial Ax 20 x x STIR Sagittal Sag 27 x x Optional T1 FS Sagittal Post Sag 27 x Strong 224 x No FS if metal T1 Axial Post Ax 20 x x T1 Coronal Cor 30 x x For Scoliosis With and Low Back Pain, Pain Radiating to the Hips or Down the Legs, Numbess in the Legs History of Lumbar Surgery, Transverse Myelitis, Multiple Sclerosis (MS), Tumor, Cancer Reviewed by Dr. Depena 8/2016

25 Sacrum /SI Joints Sagittal LOC Sag 50 x x Coronal LOC Cor 45 x x Map - 40 x x T1 Coronal Cor 28 x x STIR Coronal Cor 28 x x T1 Axial Ax 30 x x T2 FS Axial Ax 30 x Light 256 x T2 FS Sagittal Sag 26 x Light 192 x Pain, Injury Reviewed by Dr. Choi 4/2016

26 Bony Pelvis / Hip (Over 65 y/o) 3 Plane LOC - 45 x x Map - 50 x x STIR Coronal (Bilat) Cor 37 x x Entire Pelvis T1 Coronal (Bilat) Cor 37 x x Entire Pelvis Shim - 28 x x T2 FS Axial Ax 35 x Light 192 x Entire Pelvis T1 Axial Ax 35 x x Entire Pelvis PD FS Sagittal Sag 20 x Light 224 x Cover Joint Optional T1 Sagittal Sag 20 x x Cover Joint T1 Axial Ax 24 x x Cover Joint T1 Coronal Cor 20 x x Cover Joint Optional Contrast T1 FS Coronal Post Cor 35 x Light 192 x Entire Pelvis T1 FS Axial Post Ax 35 x Light 192 x Entire Pelvis T1 FS Sagittal Post Sag 35 x Light 192 x Entire Pelvis With & Evaluate for Fracture, Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2017

27 Bony Pelvis / Hip (65 y/o & Younger) 3 Plane LOC - 45 x x Map - 50 x x STIR Coronal (Bilat) Cor 37 x x Entire Pelvis T1 Coronal (Bilat) Cor 37 x x Entire Pelvis Shim - 28 x x T2 FS Axial Ax 24 x Light 192 x ASIS thru Symphysis T2 FS Coronal Cor 20 x Light 224 x PD FS Sagittal Sag 20 x Light 224 x \ Include T1 Sagittal Sag 20 x x / Symphysis T1 Axial Ax 24 x x ASIS thru Symphysis T1 Coronal Cor 20 x x Optional Contrast T1 FS Coronal Post Cor 20 x Light 192 x T1 FS Axial Post Ax 24 x Light 192 x ASIS thru Symphysis With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2017

28 Hip Arthrogram 3 Plane LOC - 45 x x Map - 50 x x T1 Axial Ax 20 x x Shim - 22 x x T1 FS Coronal Cor 20 x Light 192 x T2 FS Coronal Cor 20 x Light 192 x T1 FS Sagittal Sag 20 x Light 192 x T1 FS Parallel Obl 20 x Light 224 x Parallel to Neck T1 FS Perpendicular Obl 20 x Light 192 x Perpendicular To Neck With Contrast: Pain, Decreased Range of Motion, Tears, Groin Pain, Catching, Evaluate for labral tear Reviewed by Dr. Choi 11/2016

29 Femur Coronal LOC Cor 28 x x Plane LOC - 28 x x Map - 50 x x T1 Sagittal Sag 17 x x Shim - 21 x x STIR Coronal Cor 47 x x T2 FS Sagittal Sag 17 x Light 192 x T2 FS Axial Ax 16 x Light 224 x T1 Axial Ax 16 x x T1 Coronal Cor 47 x x Optional STIR Sagittal Sag 17 x x Optional Contrast T1 FS Coronal Post Cor 47 x Light 192 x T1 FS Sagittal Post Sag 17 x Light 192 x T1 FS Axial Post Ax 16 x Light 192 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

30 Knee Coronal LOC Cor 50 x x Plane LOC - 50 x x Shim - 20 x x PD FS Axial Ax 15 x Light 224 x PD Sagittal Sag 15 x x T2 FS Sagittal Sag 15 x Light 256 x PD FS Coronal Cor 15 x Light 224 x T1 Coronal Cor 15 x x Sagittal Oblique ACL Obl 16 x Light 224 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 4/2016

31 Knee Arthrogram LOCS T2 FS Axial Ax 17 x x PD Sagittal Sag 16 x x T1 FS Coronal Cor 16 x x T2 FS Sagittal Sag 16 x x T1 FS Sagittal Sag 16 x x With Contrast: Ligament Tears Reviewed by Dr. Choi 11/2016

32 Tib/Fib Coronal LOC Cor 28 x x Plane LOC - 28 x x Map - 50 x x T1 Sagittal Sag 14 x x T2 FS Sagittal Sag 14 x Light 192 x Shim - 21 x x T1 Coronal Cor 40 x x STIR Coronal Cor 40 x x T2 FS Axial Ax 15 x Light 224 x T1 Axial Ax 15 x x Optional Contrast T1 FS Coronal Post Cor 40 x Light 192 x T1 FS Sagittal Post Sag 14 x Light 192 x T1 FS Axial Post Ax 15 x Light 192 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis, Evaluate for Stress Fracture, Running Injury Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

33 Ankle/Hindfoot Coronal LOC Cor 28 x x Plane LOC - 25 x x Shim - 28 x x T2 FS Axial Ax 14 x Light 224 x Long Axis T1 Axial Ax 14 x x Long Axis T1 Sagittal Sag 14 x x STIR Sagittal Sag 14 x x T1 Coronal Cor 14 x x Short Axis T2 FS Coronal Cor 14 x Light 192 x Short Axis PD Coronal Tendon Obl 14 x x Peroneal Tendon Optional Contrast T1 FS Axial Post Ax 14 x Light 256 x T1 FS Coronal Post Cor 14 x Light 256 x T1 FS Sagittal Post Sag 14 x Light 192 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

34 Ankle Arthrogram LOCS T1 FS Axial Ax 14 x x T1 FS Sagittal Sag 14 x x STIR Sagittal Sag 14 x x T1 FS Coronal Cor 14 x x PD FS Coronal Cor 14 x x D FE Coronal Cor 14 x x With Contrast: Ligament Tears Reviewed by Dr. Choi 11/2016

35 Lisfranc Coronal LOC Cor 28 x x Plane LOC - 25 x x Shim - 28 x x PD FS Axial Ax 14 x Light 224 x Short Axis: 1st TMT T1 Axial Ax 14 x x Short Axis: 1st TMT T1 Sagittal Sag 14 x x STIR Sagittal Sag 14 x x T1 Coronal Cor 14 x x Long Axis: 1st TMT PD FS Coronal Cor 14 x Light 224 x Long Axis: 1st TMT With & Pain midfoot, Evaluate for lisfanc ligament injury Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

36 Mid/Forefoot Coronal LOC Cor 28 x x Plane LOC - 25 x x Shim - 28 x x T2 FS Axial Ax 14 x Light 224 x Short Axis T1 Axial Ax 14 x x Short Axis T1 Sagittal Sag 14 x x STIR Sagittal Sag 14 x x T1 Coronal Cor 14 x x Long Axis T2 FS Coronal Cor 14 x Light 224 x Long Axis Optional Contrast T1 FS Axial Post Ax 14 x Light 192 x T1 FS Sagittal Post Sag 14 x Light 192 x T1 FS Coronal Post Cor 14 x Light 192 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

37 Midfoot Stress Fracture Coronal LOC Cor 28 x x Plane LOC - 25 x x Shim - 28 x x T2 FS Axial Ax 14 x Light 224 x Short Axis to Metatarsal T1 Axial Ax 14 x x Short Axis to Metatarsal T1 Sagittal Sag 14 x x Sagittal to Metatarsal STIR Sagittal Sag 14 x x Sagittal to Metatarsal T1 Coronal Cor 14 x x Long Axis to Metatarsal T2 FS Coronal Cor 14 x Light 224 x Long Axis to Metatarsal Optional Contrast T1 FS Axial Post Ax 14 x Light 192 x T1 FS Sagittal Post Sag 14 x Light 192 x T1 FS Coronal Post Cor 14 x Light 192 x With & Midfoot stress fracture, Running injury, Runner Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

38 Plantar Plate/Turf Toe Coronal LOC Cor 28 x x Plane LOC - 25 x x Shim - 28 x x PD FS Axial Ax 14 x Light 224 x Short Axis: 1st MTP T1 Axial Ax 14 x x Short Axis: 1st MTP T1 Sagittal Sag 14 x x Sagittal: 1st MTP PD FS Sagittal Sag 14 x Light 192 x Sagittal: 1st MTP T1 Coronal Cor 14 x x Long Axis: 1st MTP PD FS Coronal Cor 14 x Light 224 x Long Axis: 1st MTP With & 1st MTP Pain, Evaluate plantar plate Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

39 Shoulder Axial LOC Ax 50 x X Plane LOC - 25 x x Shim - 18 x x PD FS Axial Ax 15 x Light 224 x No Speeder Coil TS FS Coronal Cor 14 x Light 224 x No Speeder Coil T1 Sagittal Sag 15 x x Speeder 1.3 T2 FS Sagittal Sag 15 x Light 192 x Speeder 1.3 T2 FS Oblique/Sagittal Obl 15 x Light 224 x Speeder 1.3 With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 4/2016

40 Shoulder Arthrogram 3 Plane LOC - 45 x x Large FOV 3 Plane LOC - 25 x x Shim - 18 x x T1 FS Axial Ax 15 x Light 224 x Speeder 1.5 T2 FS Coronal Cor 15 x Light 224 x No Speeder Coil T1 FS Coronal Cor 15 x Light 224 x Speeder 1.5 T1 FS Sagittal Sag 15 x Light 224 x Speeder 1.3 Optional (Ask Rad) Full-thickness Cuff Tear T2 Sagittal Sag 15 x x Speeder Plane LOC - 32 x x Large FOV Aber LOC Obl 25 x x Shim - 18 x x T1 FS Aber Obl 18 x Light 192 x No Speeder Coil Optional Sagittal T2 Sag 15 x x For RTC Surgery Axial T1 Ax 15 x x For Labral Surgery With Contrast: Shoulder Pain, Labral Tear, Popping, Clicking, Decreased Range of Motion, Pain Reviewed by Dr. Choi 11/2016

41 Humerus 3 Axis Lg LOC - 42 x x Plane LOC - 19 x x Map - 23 x x T1 Axial Ax 16 x x T2 FS Axial Ax 16 x Light 192 x Shim - 17 x x /9 T2 FS Coronal Cor 26 x Light 192 x T1 Coronal Cor 26 x x PD FS Sagittal Sag 14 x Light 192 x May need to be T2 FS Cor T1 Sagittal Sag 14 x x Optional STIR Coronal Cor 26 x x With Contrast: Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 4/2016

42 Elbow Axial LOC Ax 50 x x Plane LOC - 18 x x Map - 23 x x T1 Axial Ax 14 x x Shim - 12 x x T2 FS Axial Ax 14 x Light 192 x T1 Coronal Cor 14 x x T2 FS Coronal Cor 14 x Light 224 x PD FS Sagittal Sag 14 x Light 192 x T1 Sagittal Sag 14 x x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 4/2016

43 Elbow Arthrogram Axial LOC Ax 50 x x Plane LOC - 18 x x Map - 14 x x Shim - 14 x x T1 FS Axial Ax 14 x Light 224 x T1 FS Coronal Cor 14 x Light 224 x T1 FS Sagittal Sag 14 x Light 224 x T2 FS Axial Ax 14 x Light 192 x PD FS Coronal Cor 14 x Light 192 x Optional T1 Sagittal Sag 14 x x T1 Coronal Cor 14 x x With Contrast: Ligament Tears Reviewed by Dr. Choi 11/2016

44 Wrist Axial LOC Ax 50 x x Plane LOC - 18 x x Map - 13 x x Shim - 28 x x PD FS Axial Ax 11 x Light 224 x T1 Axial Ax 11 x x PD FS Coronal Cor 11 x Light 224 x T1 Coronal Cor 11 x x T2 FS Sagittal Sag 11 x Light 224 x T1 Sagittal Sag 11 x x D FE Coronal Cor 12 x x Cartilage Series Optional T1 FS Axial Post Ax 12 x Light 192 x T1 FS Coronal Post Cor 12 x Light 192 x T1 FS Sagittal Post Sag 12 x Light 192 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tisse Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 11/2016

45 Wrist Arthrogram Axial LOC Ax 50 x x Plane LOC - 18 x x Map - 13 x x Shim - 11 x x T2 FS Axial Ax 12 x Light 192 x T1 FS Axial Ax 12 x Light 192 x T1 FS Coronal Cor 12 x Light 192 x PD FS Coronal Cor 12 x Light 192 x T1 FS Sagittal Sag 12 x Light 192 x D FE Coronal Cor 12 x x Cartilage Series With Contrast: TFCC Tear, Ligament Tears Reviewed by Dr. Choi 11/2016

46 Hand Axial LOC Ax 50 x x Plane LOC - 24 x x Map - 18 x x Shim - 14 x x T2 FS Axial Ax 12 x Light 192 x T1 Axial Ax 12 x x T1 Coronal Cor 14 x x STIR Coronal Cor 14 x x T2 FS Sagittal Sag 13 x Light 192 x T1 Sagittal Sag 13 x x Optional 3D FE Coronal Cor 14 x x Cartilage Series PD FS Sagittal Sag 13 x Light 192 x With & Pain, Injury, Instability and Limited Range of Motion, Arthritis Bone and Soft Tissue Masses, Infection of the Bone and Soft Tissue Reviewed by Dr. Choi 4/2016

47 Breast Sequence Plane FOV Thickness Gap NSA TI PE x RO Matrix FA TR TE Comments Coronal LOC FE_SLT Cor 45 x x Ax/Sag LOC FE_SLT Sag 45 x x MAP/Ref FE_MAP Ax 65 x x Ax T2 FSE Ax 32 x recon x Ax T1 3D FFE Ax 32 x recon x Shimming FE_AAS Ax 37 x x / Ax F/S Dynamic FFE 3D Ax 36 x recon x Use lowest TR possible STIR Cor (Chest Wall) Cor 36 x x HR T2 Sag Rt Sag 35 x recon x Use lowest TR possible HR T2 Sag Lt Sag 35 x recon x Use lowest TR possible Comments: **Ax Dynamic: Run Pre, Inject 2 ml per second, wait 50 seconds and run 4 additional passes (1.26 per pass) **HR T2: Run affected breast first in protocol **Resolution must stay below 1.0 per ACR **If any questions, please call Clive MRI ( ). Reviewed by Dr. Westercamp 4/2016

48 MRA COW 3 Plane LOC - 33 x x Map - 30 x x Shim - 28 x x D TOF Ax 20 x x Identify Disease and Evaluate Aneurysms, Dizziness, Stroke, Stenosis, Bruits Reviewed by Dr. Depena 8/2016

49 MRA Carotids Sagittal LOC Sag 35 x x Coronal LOC Cor 30 x x Map - 40 x x Shim - 28 x x SSFP LOC Sag 27 x x T1 FS Axial Ax 26 x Strong 192 x D TOF Ax 20 x x CE MRA Cor 31 x x Set up fluoro Optional 3D TOF Metal Ax 20 x x T-Slip Cor 35 x Standar 192 x ECG Gated With and without contrast: Neck Pain, Identify Disease and Evaluate Aneurysms, Dizziness, Stroke, Stenosis, Bruits Reviewed by Dr. Depena 11/2016

50 MRV Head 3 Plane LOC - 33 x x D MRV Sag 22 x x Run thru Sagittal Sinus 3D MRV Ax 22 x x Run thru Transverse Sinus 2D TOF Coronal Cor 20 x x Evaluate Dural Venous Sinuses; Evaluate Idiopathic Intracranial Hypertension Reviewed by Dr. Depena 11/2016