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MSK CT Protocols

Table of Contents
  • General Principles
  • Upper Extremity
    • Shoulder
    • Elbow (cast)
    • Elbow (no cast)
    • Wrist
    • DRUJ Instability
Table of Contents • Lower Extremity • Pelvis/Sacrum • Hip • Hip – Anteversion • Knee • Ankle • Hindfoot/Midfoot • Midfoot/Forefoot
GENERAL PRINCIPLES
General Principles • Proper Patient Positioning
  • Patient comfort comes first, so may be difficult at times especially in cases of casting, fracture, or uncooperation
  • Allows for easier reformats
  • Reduces radiation dose to the patient • Reformats • Always include the entire field of view of the source images in the reformatted images • Soft tissue mass evaluation • Use palpable markers to bracket the area of palpable abnormality • Scan approximately 5 cm above and below the region of palpable abnormality • If study is ordered noncontrast, please check if patient can get intravenous contrast • Arthrograms • Dilute iodinated contrast with sterile saline or water in a 50/50 ratio
• Long Bone Protocol
General Principles
  • Includes humerus, forearm, femur, and lower leg/extremity
  • Cover entire long bone in the field of view and surrounding soft tissues to the skin surface
  • Axial reformats perpendicular to the long bone diaphysis
  • Sagittal and coronal reformats parallel to the long bone diaphysis
  • Be sure to include entire source field of view in the reformats
UPPER EXTREMITY
Shoulder
• Positioning
Shoulder
• Patient supine with palm up
  • Ideally, affected arm by side with contralateral arm raised above head
  • If contralateral arm can’t be raised, position shoulder being scanned higher than other shoulder
  • If not possible (i.e. acute trauma), do what you can to keep patient comfortable
Shoulder • Field of View
  • Above acromioclavicular (AC) joint to just below scapula
  • Medially to include scapula and laterally to skin surface
  • Do not need to include the whole clavicle
  • Include hardware if present • Scanning Parameters • 1.25 mm thick at 0.625 mm intervals
Shoulder • Sagittal and coronal reformats • 2 mm slice, 2 mm interval • Find axial image that shows glenohumeral joint (dashed line)
Shoulder
• Coronal reformats • 2 mm slice, 2 mm interval • Slices perpendicular to the glenohumeral joint line
• Sagittal reformats
• 2 mm slice, 2 mm interval
• Slices parallel to glenohumeral joint line
Shoulder
  • Axial oblique reformats
  • 2 mm slice, 2 mm interval
Shoulder
  • Find coronal reformat image showing the acromion (red arrow)
  • Orient slices perpendicular to the glenohumeral joint (dashed line)
Source axial
Reformat axial oblique*
Reformat coronal oblique*
Reformat sagittal oblique*
Shoulder CT Summary for fracture and bone lesion
PLANE
SECTION THICKNESS
1.25 mm
2 mm
2 mm
2 mm
INTERVAL
0.625 mm
2 mm
2 mm
2 mm
OVERLAP
50%
None
None
None
WINDOW
SOFT TISSUE
SOFT TISSUE BONE
BONE
BONE
*All reformats should include ENTIRE field of view of the source images
Shoulder CT Summary for CT Arthrogramⱡ or soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW
Source axial
1.25 mm
0.625 mm
50%
SOFT TISSUE
Reformat axial oblique*
2 mm
2 mm
None
SOFT TISSUE BONE
Reformat coronal oblique*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal oblique*
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images ⱡ Dilute iodinated contrast with sterile water or normal saline 50/50
Elbow (Cast)
• Most difficult to scan, particularly if in cast
  • Obviously can’t straighten elbow but must try to get arm above head
  • AVOID arm across chest • Causes beam hardening artifact, radiation to torso, and respiratory motion artifact
  • Scanning plane should be obliquely oriented towards the long axis of the radius and ulna (don’t scan parallel to radius and ulna)
Elbow (Cast)
• Positioning
Elbow (Cast)
• Field of View • Distal humerus to proximal forearm (distal to radial tuberosity) • Scanning Parameters • 0.6 mm thick at 0.3 mm intervals
Elbow (Cast)
• Field of View • Distal humerus to proximal forearm (past radial tuberosity) • Scanning Parameters • 0.6 mm thick at 0.3 mm intervals
• Reformats
• 2 mm slice, 2 mm interval • Find sagittal image show elbow joint and olecranon (red arrow)
Elbow (Cast)
• Reformats
Elbow (Cast)
• 2 mm slice, 2 mm interval • Axial images perpendicular to long axis of humerus
• Reformats
Elbow (Cast)
• 2 mm slice, 2 mm interval • Axial images through long axis plane of forearm
Elbow (Cast) • Reformats • 2 mm slice, 2 mm interval • Long axis images to plane of the radius
Elbow (Cast) • Reformats • 2 mm slice, 2 mm interval • Coronal plane parallel to long axis of the ulna
Elbow (Cast)
  • From axial series through the humerus, find an image through the medial and lateral epicondyles
  • Note line parallel to the posterior border of the epicondyles
• Coronal reformats
• 2 mm slice, 2 mm interval • Coronal to humerus, parallel to inter-epicondyle line
Elbow (Cast)
• Sagittal Reformats
• 2 mm slice, 2 mm interval • Orient sagittal slices perpendicular to humerus and inter-epicondylar line
Elbow (Cast)
Cast Elbow CT Summary for fracture and bone lesion
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat axial to long axis of humerus*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat axial long axis plane of forearm*
2 mm
2 mm
None
BONE
Reformat long axis to plane of radius*
2 mm
2 mm
None
BONE
Reformat long axis to plane of ulna*
2 mm
2 mm
None
BONE
Reformat coronal to humerus, parallel to inter-epicondyle line
2 mm
2 mm
None
BONE
Reformat sagittal to humerus and inter- epicondylar line
2 mm
2 mm
None
BONE
*-All reformats should include ENTIRE field of view of the source images
Elbow (No Cast)
• Positioning • Most difficult to scan
Elbow (No Cast)
  • Arm MUST be raised above patient’s head
  • Should be as straight as possible with palm up
  • If patient CAN’T straighten elbow, use CAST protocol
  • AVOID arm across chest • Causes beam hardening artifact, radiation to torso, and respiratory motion artifact
  • Scanning plane should be perpendicular to the CT scanning plane • Allows easier reformatting
• Positioning • Most difficult to scan
Elbow (No Cast)
  • Arm MUST be raised above patient’s head
  • Should be as straight as possible with palm up
  • AVOID arm across chest • Causes beam hardening artifact, radiation to torso, and respiratory motion artifact
  • Scanning plane should be perpendicular to the CT scanning plane • Allows easier reformatting
Elbow (No Cast)
• Field of View
• Distal humerus to proximal forearm (distal to radial tuberosity) • Scanning Parameters • 0.6 mm thick at 0.3 mm intervals
• Field of View
• Distal humerus to proximal forearm (distal to radial tuberosity) • Scanning Parameters • 0.6 mm thick at 0.3 mm intervals
Elbow (No Cast)
Elbow (No Cast)
  • From axial series through the humerus, find an image through the medial and lateral epicondyles
  • Note line parallel to the posterior border of the epicondyles
• Coronal reformats
• 2 mm slice, 2 mm interval • Coronal to humerus, parallel to inter-epicondyle line (red lines)
Elbow (No Cast)
• Sagittal Reformats
Elbow (No Cast)
• 2 mm slice, 2 mm interval • Orient sagittal slices perpendicular to humerus and inter-epicondylar line (red lines)
Noncasted Elbow CT Summary for fracture and bone lesion
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Axial
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat coronal to humerus, parallel to inter-epicondyle line
2 mm
2 mm
None
BONE
Reformat sagittal to humerus and inter- epicondylar line
2 mm
2 mm
None
BONE
*-All reformats should include ENTIRE field of view of the source images
Noncasted Elbow CT Summary for CT arthrogramⱡ and soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Axial
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat coronal to humerus, parallel to inter-epicondyle line
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal to humerus and inter- epicondylar line
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images ⱡ Dilute iodinated contrast with sterile water or normal saline 50/50
Wrist
Wrist
• Positioning • Prone
  • Arm over head and straight as possible with palm down
  • Wrist centered in gantry • Scanning Parameters
• 0.625 mm thick at 0.3 mm intervals • Field of view • Proximal-Radius/Ulnametaphysis • Can scan more proximally to include extent of fracture • Distal – Past metacarpal bases
• Positioning • Prone
Wrist
  • Arm over head and straight as possible with palm down
  • Wrist centered in gantry • Scanning Parameters
• 0.625 mm thick at 0.3 mm intervals • Field of view • Proximal-Radius/Ulnametaphysis • Can scan more proximally to include extent of fracture • Distal – Past metacarpal bases
• Axial reformats
Wrist
• 1.5 mm thickness, 1.5 mm interval • Axial images through the radioulnar joint (red arrow)
• Sagittal reformats
Wrist
  • 2 mm thickness, 2 mm interval
  • Sagittal images through long axis of the wrist (perpendicular to axial reformats or along the long axis of the radius)
• Coronal reformats
Wrist
  • 2 mm thickness, 2 mm interval
  • Coronal images through long axis of the wrist (perpendicular to sagittal reformats)
Scaphoid Reformat • ADD if clinical history includes scaphoid pathology • oblique sagittal along long axis of scaphoid • 1 mm slice thickness, 1 mm interval
Wrist CT Summary for fracture and bone lesion
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat axial*
1.5 mm
1.5 mm
None
BONE SOFT TISSUE
Reformat coronal*
2 mm
2 mm
None
BONE
Reformat sagittal*
2 mm
2 mm
None
BONE
Reformat scaphoid oblique sagittal1
1 mm
1 mm
None
BONE
*-All reformats should include ENTIRE field of view of the source images 1-Perform if clinical history of scaphoid fracture
Wrist CT Summary for CT Arthrogramⱡ or soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat axial*
1.5 mm
1.5 mm
None
SOFT TISSUE BONE
Reformat coronal*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal*
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images ⱡ Dilute iodinated contrast with sterile water or normal saline 50/50
DRUJ INSTABILITY
DRUJ Instability • DRUJ = distal radioulnar joint • Positioning
  • Prone with BOTH arms as straight as possible above head
  • 3 separate images obtained of BOTH wrists in neutral, supine, and prone
  • Keep both arms aligned with each other • Scanning Parameters
  • Same field of view as routine wrist
  • Only need axial images (but must be true axials as with routine wrist)
3 Separate Source axials (neutral/prone/supine)
Reformat axial NEUTRAL*
Reformat axial PRONE*
Reformat axial SUPINE*
Reformat bilateral coronal oblique
DRUJ Instability Summary
PLANE
SECTION THICKNESS
0.625 mm
2 mm
2 mm
2 mm
1 mm
INTERVAL
0.3 mm
2 mm
2 mm
2 mm
1 mm
OVERLAP
50%
None
None
None
None
WINDOW WIDTH/LEVEL
SOFT TISSUE
BONE
BONE
BONE
BONE
*-All reformats should include ENTIRE field of view of the source images
LOWER EXTREMITY
Pelvis/Sacrum
• Positioning • Patient supine
Pelvis
• Legs flat on table, avoid cushions under legs or feet • Field of View must include
  • Above iliac crests (white line)
  • Below lesser trochanter and ischial tuberosity (red line)
  • Skin to Skin • Scanning Parameters
• 1.25 mm thick at 0.625 mm intervals
• Axial reformats
• 2 mm slice, 2 mm interval
Pelvis
  • Coronal image that shows both femoral heads
  • Angle such that slice cuts evenly through both femoral heads (dotted line)
  • Coverage from iliac crests to below lesser trochanters ( solid lines)
  • FAI (FEMORAL-ACETABULAR IMPINGEMENT): Include angled oblique axials through femoral necks (three solid lines)
• Coronal reformats
  • 2 mm slice, 2 mm interval
  • Axial image that shows pubic symphysis (red arrow)
  • Angle evenly through ischial tuberosities (dotted line)
Pelvis
• Coverage from anterior aspect of the pubic symphysis to posterior to the musculature(solid lines)
• Sagittal reformats
  • 2 mm slice, 2 mm interval
  • Axial image that shows pubic symphysis (red arrow)
Pelvis
• Cover from hip to hip (solid lines)
Sacroiliac Joints
• Reformats
• 2 mm slice, 2 mm interval • Oblique Coronal • Mid-line Sagittal image through sacrum • Angle slices parallel to the long axis of sacrum (top image) • Cover sacrum in entirety, including entire sacroiliac joints • Oblique Axial
  • Same mid-line Sagittal image through sacrum
  • Angle slices perpendicular to the oblique coronals (bottom image)
  • Cover sacrum in entirety, including sacroiliac joints
Source axial
Reformat axial*
Reformat coronal*
Reformat sagittal*
Reformat axial oblique femoral neck1
Reformat oblique coronal sacroiliac joints2
Reformat oblique axial sacroiliac joints2
Pelvis CT Summary for fracture or bone lesion
PLANE
SECTION THICKNESS
1.25 mm
2 mm
2 mm
2 mm
2 mm
2 mm
2 mm
INTERVAL
0.625 mm
2 mm
2 mm
2 mm
2 mm
2 mm
2 mm
OVERLAP
50%
None
None
None
None
None
None
WINDOW WIDTH/LEVEL
SOFT TISSUE
BONE SOFT TISSUE
BONE
BONE
BONE
BONE
BONE
*-Should include ENTIRE field of view of the source images 1-Perform if clinical history of FAI or femoroacetabular impingement 2-Perform if clinical history of sacroiliac/sacral pathology
Pelvis CT Summary for soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
1.25 mm
0.625 mm
50%
SOFT TISSUE
Reformat axial*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat coronal*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal*
2 mm
2 mm
None
SOFT TISSUE
*-Should include ENTIRE field of view of the source images
Hip
Hip
• Positioning • Patient supine
• Legs flat on table, avoid cushions under legs or feet • Field of View must include
  • Superiorly above iliac crest (white line)
  • Inferiorly below lesser trochanter and ischial tuberosity (red line)
  • Laterally to the skin surface (green line)
  • Medially through the symphysis pubis (yellow line) • Scanning Parameters
• 1.25 mm thick at 0.625 mm intervals
PROSTHESIS: Hip
• Positioning • Patient supine
• Legs flat on table, avoid cushions under legs or feet • Field of View must include
  • Superiorly above iliac crest (white line)
  • Laterally to the skin surface (green line)
  • Medially through the symphysis pubis (yellow line)
  • Scan below hardware (red line) • Scanning Parameters • 1.25 mm thick at 0.625 mm intervals
  • Axial and axial oblique reformats
  • 2 mm slice, 2 mm interval
  • Coronal image that shows femoral head
  • Straight Axial: • Angle such that slice cuts evenly through the superior femoral head (dotted line) • Coverage from above iliac crest to below lesser trochanters (red lines)
  • FAI (FEMORAL-ACETABULAR IMPINGEMENT): Include angled oblique axials through femoral necks (solid yellow lines)
Hip
  • 2 mm slice, 2 mm interval
  • Axial image that shows anterior acetabulum (red arrow)
  • Angle evenly through anterior acetabulum (dotted line)
Hip
• Coronal reformats
• Cover from skin to skin (red lines)
• Sagittal reformats
Hip
• 2 mm slice, 2 mm interval
  • Same axial image as the coronal reformats
  • Angle perpendicular to coronal plane (dotted yellow line)
  • Cover entire field of view (red lines)
Hip CT Summary for fracture or bone lesion
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
1.25 mm
0.625 mm
50%
SOFT TISSUE
Reformat axial*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat coronal*
2 mm
2 mm
None
BONE
Reformat sagittal*
2 mm
2 mm
None
BONE
Reformat axial oblique femoral neck1
2 mm
2 mm
None
BONE
*-Should include ENTIRE field of view of the source images 1-Perform if clinical history of FAI or femoroacetabular impingement
Hip CT Summary for CT arthrogramⱡ or soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
1.25 mm
0.625 mm
50%
SOFT TISSUE
Reformat axial*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat coronal*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal*
2 mm
2 mm
None
SOFT TISSUE
Reformat axial oblique femoral neck1
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images ⱡ Dilute iodinated contrast with sterile water or normal saline 50/50 1-Perform if clinical history of FAI or femoroacetabular impingement
Hip - Anteversion
Hip - Anteversion
• Positioning • Patient supine
  • Legs flat on table and as close together as possible
  • tape feet together with toes pointed straight up
  • avoid cushions under legs or feet • Scout • AP plane • Hips and Knees • Scanning Parameters
  • 5.00mmthickat5.00mmintervals
  • Hips – just above femoral heads and to just below lesser trochanters
  • Knees – just above femoral physis and thru tibial plateau
Hip - Anteversion • Find slice that best reveals alignment of femoral neck • Measure the neck – horizontal angle (NH) • Find the slice that best reveals alignment of femoral condyles • Measure the condyle – horizontal angle (CH) • Calculate angle of neck relative to condyle (NC = NH – CH)
Hip - Anteversion • Find slice that best reveals alignment of femoral neck • Measure the neck – horizontal angle (NH)
Hip - Anteversion • Find the slice that best reveals alignment of femoral condyles • Measure the condyle – horizontal angle (CH)
Hip - Anteversion • Calculate angle of neck relative to condyle (NC = NH – CH)
Knee
Knee
• Positioning • Patient supine
  • Slide patient so that knee being imaged is centered in the scanner
  • Tapping toes together may help positioning
  • Can scan both legs together, but if other leg has metal MUST bend so it is not in the scanning plane
• Field of View must include
  • Entire patella
  • Both femoral condyles
  • Proximal tibia to just past the fibular head
  • METAL PROSTHESIS: Must scan entire length of the femoral and tibial components • Scanning Parameters • 0.625 mm thick at 0.3 mm intervals
Knee
• Axial reformats
• 2 mm slice, 2 mm interval
  • Coronal image that shows tibial plateaus (solid line)
  • Angle such that slice cuts evenly through tibial plateaus (dotted lines)
  • Coverage from femoral metaphysis to below fibular head
Knee
Knee • Coronal • 2 mm slice, 2 mm interval • Axial image that shows distal patella • Angle such that slice are parallel to a line connecting the posterior aspect of the femoral condyles (dotted line)
• Sagittal
• 2 mm slice, 2 mm interval
Knee
  • Axial image that shows distal patella (same image as for coronal reformats)
  • Angle such that slice are parallel to the coronal reformats
Knee CT Summary for fracture or bone lesion
PLANE
SECTION THICKNESS
INTERV AL
OVERLA P
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat axial*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat coronal*
2 mm
2 mm
None
BONE
Reformat sagittal*
2 mm
2 mm
None
BONE
*All reformats should include ENTIRE field of view of the source images
Knee CT Summary for CT arthrogramⱡ or soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERV AL
OVERLA P
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat axial*
2 mm
2 mm
None
SOFT TISSUE
Reformat coronal*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal*
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images ⱡ Dilute iodinated contrast with sterile water or normal saline 50/50
Ankle
• Positioning • Patient supine
Ankle
  • Use foot holder
  • Feet together, centered in scanner
  • Toes pointing straight up
  • Typically scan both feet together (if can’t bring feet together, ensure imaged foot is centered in gantry) • Scanning Parameters • 0.625 mm thick at 0.3 mm intervals
Ankle
• Field of View must include • Start above ankle joint just above tibial metaphysis • Include calcaneus and metatarsal bases
• Axial reformats
• 2 mm slice, 2 mm interval
  • Find sagittal image of tibiotalar joint (dotted yellow line)
  • Orient slices parallel to the tibiotalar joint (solid yellow lines)
Ankle
• Coronal reformats
• 2 mm slice, 2 mm interval
  • Find tibiotalar joint on axial image (same level as sagittal reference image)
  • Orient slices parallel to the joint
Ankle
• Sagittal reformats
• 2 mm slice, 2 mm interval
  • Find tibiotalar joint on axial image (same level as sagittal reference image)
  • Orient slices perpendicular to the joint
Ankle
Ankle CT Summary for fracture or bone lesion
Source axial
Reformat axial*
Reformat coronal*
Reformat sagittal*
PLANE
SECTION THICKNESS
0.625 mm
2 mm
2 mm
2 mm
INTERV AL
0.3 mm
2 mm
2 mm
2 mm
OVERLA P
50%
None
None
None
WINDOW WIDTH/LEVEL
SOFT TISSUE
BONE SOFT TISSUE
BONE
BONE
*All reformats should include ENTIRE field of view of the source images
Ankle CT Summary for CT arthrogramⱡ or soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERV AL
OVERLA P
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat axial*
2 mm
2 mm
None
SOFT TISSUE BONE
Reformat coronal*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal*
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images ⱡ Dilute iodinated contrast with sterile water or normal saline 50/50
Hindfoot/Midfoot
Hindfoot/Midfoot • Appropriate for Hindfoot fractures (calcaneus, talus), subtalar joint evaluation, tarsal coalition • Positioning
  • Patient supine
  • Use foot holder
  • Feet together, centered in scanner
  • Toes pointing straight up
  • Typically scan both feet together (if can’t bring feet together, ensure imaged foot is centered in gantry) • Scanning Parameters • 0.625 mm thick at 0.3 mm intervals
Hindfoot/Midfoot • Field of View must include • Start above ankle joint just above tibial metaphysis • Include calcaneus and metatarsal bases
• Axial reformats
  • 2 mm slice, 2 mm interval
  • Find sagittal image of tibiotalar joint (dotted yellow line)
  • Orient slices parallel to the tibiotalar joint (solid yellow lines)
Hindfoot/Midfoot
Hindfoot/Midfoot • Axial oblique reformats
  • 2 mm slice, 2 mm interval
  • Find sagittal image of posterior facet subtalar joint (dotted yellow line)
  • Orient slices parallel to the posterior facet subtalar joint (solid yellow lines)
Hindfoot/Midfoot • Coronal oblique reformats • 2 mm slice, 2 mm interval • Orient slices perpendicular to axial oblique reformats
Hindfoot/Midfoot • Straight sagittal reformats • 2 mm slice, 2 mm interval • Orient parallel to axial reformats
Hindfoot/midfoot CT Summary for fracture or bone lesion
Source axial
Reformat axial*
Reformat axial oblique*
Reformat coronal oblique*
Reformat sagittal*
PLANE
SECTION THICKNESS
0.625 mm
2 mm
2 mm
2 mm
2 mm
INTERV AL
0.3 mm
2 mm
2 mm
2 mm
2 mm
OVERLA P
50%
None
None
None
None
WINDOW WIDTH/LEVEL
SOFT TISSUE
BONE SOFT TISSUE
BONE
BONE
BONE
*All reformats should include ENTIRE field of view of the source images
Hindfoot/midfoot CT Summary for soft tissue mass/infection
Source axial
Reformat axial*
Reformat axial oblique*
Reformat coronal oblique*
Reformat sagittal*
PLANE
SECTION THICKNESS
0.625 mm
2 mm
2 mm
2 mm
2 mm
INTERV AL
0.3 mm
2 mm
2 mm
2 mm
2 mm
OVERLA P
50%
None
None
None
None
WINDOW WIDTH/LEVEL
SOFT TISSUE
BONE SOFT TISSUE
SOFT TISSUE
SOFT TISSUE
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images
Midfoot/Forefoot
Midfoot/Forefoot • Appropriate for Lisfranc fracture/dislocation, metatarsal fractures • Positioning
  • Patient supine
  • Use foot holder
  • Feet together, centered in scanner
  • Toes pointing straight up
  • Typically scan both feet together (if can’t bring feet together, ensure imaged foot is centered in gantry) • Scanning Parameters • 0.625 mm thick at 0.3 mm intervals
Midfoot/Forefoot • Field of View must include • Start from distal talonavicular joint to beyond the toes
Midfoot/Forefoot • Reformats (2 mm slice, 2 mm interval) • Relative to 2nd Metatarsal • LONG AXIS OBLIQUE
Midfoot/Forefoot • Reformats (2 mm slice, 2 mm interval) • Relative to 2nd Metatarsal • SHORT AXIS OBLIQUE
Midfoot/Forefoot • Reformats (2 mm slice, 2 mm interval) • Relative to 2nd Metatarsal • SAGITTAL
Midfoot/forefoot CT Summary for fracture or bone lesion
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat long axis oblique*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat short axis oblique*
2 mm
2 mm
None
BONE
Reformat sagittal*
2 mm
2 mm
None
BONE
*All reformats should include ENTIRE field of view of the source images
Midfoot/forefoot CT Summary for soft tissue mass/infection
PLANE
SECTION THICKNESS
INTERVAL
OVERLAP
WINDOW WIDTH/LEVEL
Source axial
0.625 mm
0.3 mm
50%
SOFT TISSUE
Reformat long axis oblique*
2 mm
2 mm
None
BONE SOFT TISSUE
Reformat short axis oblique*
2 mm
2 mm
None
SOFT TISSUE
Reformat sagittal*
2 mm
2 mm
None
SOFT TISSUE
*All reformats should include ENTIRE field of view of the source images
References • University of Wisconsin CT protocols https://www.radiology.wisc.edu/sections/msk/protocols.php • Thomas Jefferson University http://www.bone.tju.edu/protocols.htm

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Uterine Fibroid Embolization

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