MRI Body Protocols - ARA Diagnostic Imaging...Adrenals (Updated 2/27/17) For follow-up with prior...

Austin Radiological Association

MRI Body Protocols Adult 1.5T

Questions? Last Update: 4/13/2020 10:20 AM

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PROTOCOLS

General Guidelines for Body Imaging ..................................................................................................................................................................................................... 1

Chest………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………2

Abdomen: Routine .................................................................................................................................................................................................................................. 3

Abdomen: Adrenals ................................................................................................................................................................................................................................ 4

Abdomen: Kidneys .................................................................................................................................................................................................................................. 5

Abdomen: Pancreas ................................................................................................................................................................................................................................ 6

Abdomen: Wall Mass .............................................................................................................................................................................................................................. 7

Liver: Eovist ............................................................................................................................................................................................................................................. 8

Liver: Gaucher Disease / Lipidosis ........................................................................................................................................................................................................... 9

Liver: Routine ....................................................................................................................................................................................................................................... 10

Liver: Hemochromatosis *1.5T Only ..................................................................................................................................................................................................... 11

MRCP ..................................................................................................................................................................................................................................................... 12

MRCP Without Contrast ........................................................................................................................................................................................................................ 13

Appendicitis during Pregnancy ............................................................................................................................................................................................................. 14

Enterography *3T Preferred ................................................................................................................................................................................................................. 15

Urogram ................................................................................................................................................................................................................................................ 16

Bone Survey for Metastasis .................................................................................................................................................................................................................. 17

Pelvis: Anal Sphincter ............................................................................................................................................................................................................................ 18

Pelvis: Defecography ............................................................................................................................................................................................................................. 19

Pelvis: Rectal Cancer *3T Preferred ...................................................................................................................................................................................................... 20

Pelvis: Rectum for Pain / Abscess / Fistula *3T Preferred .................................................................................................................................................................... 21

Female Pelvis: Routine .......................................................................................................................................................................................................................... 22

Female Pelvis: Mullerian Duct .............................................................................................................................................................................................................. 23

Female Pelvis: Placenta Accreta / Increta / Precreta / Previa *1.5T Only ............................................................................................................................................ 24

Female Pelvis: Oncology *3T Preferred ................................................................................................................................................................................................ 25

Female Pelvis: RTP ................................................................................................................................................................................................................................ 26

Female Pelvis: Urethral Diverticulum ................................................................................................................................................................................................... 27

Male Pelvis: Routine ............................................................................................................................................................................................................................. 18

Male Pelvis: Penis .................................................................................................................................................................................................................................. 29

Male Pelvis: Testicles ............................................................................................................................................................................................................................ 30

Prostate: Diagnostic *3T Preferred ....................................................................................................................................................................................................... 31

Prostate: Post Prostatectomy *3T Preferred ........................................................................................................................................................................................ 32

Prostate: Non-contrast ......................................................................................................................................................................................................................... 33

Prostate: Austin Cancer Center (ACC) Therapy Planning ..................................................................................................................................................................... 34

Prostate: Cyberknife Therapy Planning ................................................................................................................................................................................................ 35

Prostate: SpaceOAR Therapy Planning ................................................................................................................................................................................................. 36

Prostate: Therapy Planning ................................................................................................................................................................................................................... 37

Elastography *ACB Only…..……………………………………………………………………………………………………………………………………………………………………………………………………………………….38

General Guidelines

NEVER hesitate to reach out to a radiologist for guidance!

Siemens / GE terminology, other abbreviations:

o HASTE / SSFSE

1.5T HASTE – ideal TR 1000, no less than 800

3T HASTE – ideal TR 1600, no less than 1200

o VIBE / LAVA

o TruFisp / Fiesta

o FLASH/SPGR/FL2D – An in-phase range TE should be used

o BH – Breath Hold

o FB – Free Breathing

Calculating pixel size: FOV/matrix x FOV/matrixACR: must include entire boney pelvis

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 prescribed in an axial plane and positioned just inferior to right side

diaphragm & the immediate post initiated when contrast is seen in descending aorta.

o Delayed post series to be performed 5 minutes post injection at minimum.

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 The FOV should include air on all sides.

o If using iPAT, must have at least two coil elements on in the phase direction.

Dixon – do not send non-fat sat series to PACS.

Sedation

o MRCP – can sedate, but do not give patient oral contrast agent with radiologist approval.

o Enterography – do not sedate

o Defecography – do not sedate

See next page

HCA Urologist (HCA DynaCAD) Images must be sent to HCA DynaCAD, not ARA DynaCAD. o Dr. Sandeep Mistry, PA’s Dustin Fontenot & Jason Ramsdell, Leonora Brown, RN o Dr. Chris Yang o Dr. Matthew Pearson, PA Diane Warmoth o Dr. Subir Chhikara, PA’s Ashley Dufour & Terry Farley o Dr. Kouskik Shaw, NPA Alecia Zuehlke o Dr. Michael Trotter o Dr. Samantha Thiry o Dr. Lawrence Tsai o Dr. Stacy Ong

Chest (Entire chest, not for a chest wall study)

Check with a Radiologist before performing an MR, may prefer CT

SEQUENCE FOV (mm) SLICE (mm) COMMENTS IMAGES

T1 FL2D Ax T2 HASTE FS Ax (HASTE IR if poor FS)

~360 7 x 2

T1 FL2D Cor T2 HASTE FS Cor (HASTE IR if poor FS)

~360 6 x 1

T1 FL2D Sag T2 HASTE FS Sag (HASTE IR if poor FS)

~360 7 x 2

Abdomen Routine (Updated )


T2 HASTE Cor BH ~360 8 x 2

T1 In/Out Ax BH T2 HASTE Ax BH T2 FS Ax BH

~360 7 x 2

To include from diaphragm through kidneys.

T1 VIBE FS Ax Pre BH ~360 3 – 4 - Slice thickness, as thin as possible within single breath

hold. - To include from diaphragm through kidneys.

Care Bolus Ax Begin immediate post when contrast is visualized in the

aorta, take into consideration timing of breath hold instructions.

T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax 2 min Post BH T1 VIBE FS Ax Delayed Post BH

~360 3 – 4 Delayed series must be at least 5 min post injection.

T1 VIBE FS Ax Pre must be performed on all abdomens without contrast Send care bolus and subtractions to PACS

Adrenals (Updated 2/27/17)

For follow-up with prior imaging of existing benign mass, IV contrast is not utilized


T2 FS Ax BH T2 HASTE Ax BH

~360 5 x 0 ~24 slices

T1 In/Out Ax BH

~360 2.5 x 0 ~44 slices

3 x 0 mm: Symphony SM, SW,

WMC, WLK

T1 In/Out Cor BH ~360 5 x 1

Cover diaphragm through bifurcation S-I

T1 VIBE FS Ax Pre BH Care Bolus Ax T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax Delayed Post BH

~360 ~3 x 0 Delayed series must be at least 5 min post injection.

T1 VIBE FS Ax Pre must be performed on all abdomens without contrast Send carebolus and subtractions to PACS

Kidneys (New finding and follow up renal lesion)

(Updated 7/11/17)

Perform routine abdomen protocol if exam is follow up post nephrectomy. This is to better visualize the renal bed and surrounding organs Abdomen for tuberous sclerosis is a renal study


T2 HASTE Cor BH ~360 4 x 0 ~30 slices

Include kidneys and mass

T1 In/Out Ax BH

~360 7 x 2 ~24 slices

Include entire liver and kidneys

T1 Ax BH T2 FS Ax BH T2 HASTE Ax BH

~360 4 X 0 ~36 slices

Include kidneys and mass

T1 VIBE FS Ax Pre BH Care Bolus Ax T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax Delayed Post BH

~360 3 x 0 Delayed series must be at least 5 min post injection.

T1 VIBE FS Cor post BH ~360 3 x 0 Scanned after immediate post

T1 VIBE FS Ax Pre must be performed on all abdomens without contrast Austin Kidney Associates: if requested for total kidney volume reserve exams for 3D lab to process Send care bolus and subtractions to PACS

Pancreas




~360 7 x 2 ~24 slices

T1 Ax BH

~360 5 x 1 Entire pancreas

T1 VIBE FS Ax Pre BH Care Bolus Ax T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax 2min Post BH T1 VIBE FS Ax Delayed Post BH


T1 FS VIBE Ax Pre must be performed on all abdomens without contrast Send care bolus and subtractions to PACS

Abdominal Wall Mass

For certain indications, this study does not require contrast Always use a skin marker Run phase direction to best minimize motion artifact Breath-held scans are used to avoid motion artifact Modify parameters depending on the size of the pathology


T1 FL2D Ax T2 FS Ax (HASTE IR if poor FS)

~320 5 x 1

T1 FL2D Cor T2 FS Cor (HASTE IR if poor FS)

~320 5 x 1

T1 FL2D Sag T2 FS Sag (HASTE IR if poor FS)

~320 5 x 1

T1 FL2D FS Ax Pre T1 FL2D FS Ax Post

~320 5 x 1 See above

T1 FL2D FS Cor or Sag Post (best plane)

~320 5 x 1 See above

Liver Eovist (Updated 12/13/19)

Eovist studies have to be approved by a specialty body radiologist if a previous ARA study does not recommend Eovist.

GFR testing is necessary if patient has kidney disease, diabetes, hypertension, multiple myeloma, solid organ transplant, severe hepatic disease, or ordered by an oncologist.


T1 In/Out Ax BH T2 HASTE Ax BH

~360 7 x 2

T1 VIBE FS Ax Pre BH ~360 3 – 4 Slice thickness, as thin as possible within single breath hold

T1 3D Ax FS Dynamic pre BH ~360 3 – 4 1 measurement 5-6 second scan

Care Bolus Ax BH Begin immediate post when contrast is visualized in the aorta

T1 3D Ax FS Dynamic post BH ~360 3 – 4 3 measurements in one breath-hold, 15-18 seconds

T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax 2 min Post BH T1 VIBE FS Ax 5 min Post BH T1 VIBE FS Ax 10 min Post BH T1 VIBE FS Ax 20 min Post BH

~360 3 – 4 Copy everything from pre.

T2 FS Ax BH ~360 7 x 2 Done between 5 & 10 min or 10 & 20 min post VIBE series

T1 VIBE FS Cor 20 min Post BH ~360 3 – 4

T2 HASTE FS Cor BH ~360 8 x 2 Done between 5 & 10 min or 10 & 20 min post VIBE series

Subtract the pre vibes and dynamic series from its respective post series, send the resulting 7 subtracted series to PACS

Send care bolus to PACS

Liver for Gaucher Disease / Lipidosis (Updated 8/6/15)

This study does not need contrast, if contrast is ordered, add pre/post dynamic sequences from routine liver protocol Include both liver and spleen


T2 HASTE Cor BH T1 Cor BH

~360 8 x 2 22 slices

T1 In/Out Ax BH T2 HASTE Ax BH T2 FS Ax BH T2 Heavy TE Ax BH (TE>200)

~360 7 x 2 ~24 slices

T2 HASTE FS Ax BH ~360 10 x 0

~24 slices This sequence is usually used for volume measurement

If contrast is given, use any VIBE series without motion artifact for measurement Volume measurement is performed by CT 3D Lab. Reserve study in pending 3D folder in PACS, e-mail *3DPostprocessing with details If 3D post processing is down, measurement is done using ROI tool in viewer of the MR console. Using ROI tool, trace around the liver on each image in

which the liver is seen. Save these images in a new series and send to PACS. Add the area (in square centimeters) of the ROI of each image together and enter this information into the notes in PACS

Repeat measurement process for Spleen

mailto:[email protected]

Liver Routine (hemangioma, lesion)

(Update )




~360 7 x 2 ~24 slices

T1 VIBE FS Ax Pre BH ~360 3 – 4 Slice thickness, as thin as possible within single breath

hold.

Care Bolus Ax Begin immediate post when contrast is visualized in

the aorta, take into consideration of breath hold instructions.

T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax 2 min Post BH T1 VIBE FS Ax Delayed Post BH


T1 VIBE FS Ax Pre must be performed on all abdomens without contrast Send care bolus and subtractions to PACS

Liver Hemochromatosis *1.5T Only (Iron overload)

Do not perform on GE, 3T or Symphony A40 (SM, SW MR1, WLK, WMC)

TR must remain consistent on T1 Axials with varying TEs, do not adjust parameters




~360 7 x 2 ~24 slices

T1 Ax Fl2D (TE 2.38) BH T1 Ax Fl2D (TE 4.76) BH T1 Ax Fl2D (TE 7.14) BH

~360 7 x 2 ~24 slices

T2* Multi Echo Gre BH

~360 3 slices Post Processing T2* Maps

T1 VIBE FS Ax Pre BH Care Bolus Ax T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax 2 min Post BH T1 VIBE FS Ax Delayed Post BH


Send care bolus and subtractions to PACS

Post Process the T2* Maps from the T2* Multi Echo GRE sequence and send to PACS

http://araportal/operations/Protocols/Magnetic%20Resonance%20Imaging/Informational%20Materials/How%20To%20Post%20Process%20T2%20Star%20Maps%20for%20Multi%20Echo%20Hemochromatosis.pdf

MRCP

(Updated 10/6/15)

Have the patient drink 12oz. of Pineapple or Blueberry (if diabetic) juice 10-15 minutes prior to scanning. Do not provide if sedating.

MRCP is usually ordered for the evaluation of the biliary system. However, the pancreatic duct should be included, especially if pancreatic cysts or duct is of interest.



T1 In/Out Ax BH T2 FS Ax BH T2 HASTE Ax BH

~360 7x 2 ~24 slices

Include-Liver, GB, pancreas, spleen, biliary system and duodenum

Radial thick slab MRCP BH ~250 40-80 thick

~6 slices Scan 1 image per location with the angles similar to what is pictured. Radial projection through biliary system.

HASTE FS Cor hires BH ~360 3.5 x 0 Include pancreas and biliary system as shown in the image

HASTE FS Ax hires BH ~280 4 x 0 Include right and left main hepatic ducts through pancreatic head and

duodenum. Include the bottom of the kidneys to ensure coverage.

- continued on next page -

T2 3D Cor MRCP Trigger FB ~380 1.5 x 0 ~40 slices

- To include Gallbladder, biliary system and pancreas - Place trigger box on dome of the liver on a free breathing Cor scan/loc, center trigger box A-P using sag loc. Respiratory coaching might be necessary.

Trigger box location

T1 Ax BH (only if MRCP is for a pancreatic indication)


T1 VIBE FS Ax Pre BH Care Bolus Ax T1 VIBE FS Ax Immediate Post BH T1 VIBE FS Ax 2 min Post BH T1 VIBE FS Ax Delayed Post BH

~360 3 – 4 - Slice thickness, as thin as possible within single breath hold - Include liver, GB, pancreas, spleen, biliary system and duodenum - Delayed series must be at least 5 min post injection.

Create Lateral & Tumble cut MIPs off T2 3D Cor MRCP trigger Send care bolus and subtractions to PACS

MRCP Without Contrast (Updated 7/11/17)

Have the patient drink 12oz. of Pineapple or Blueberry (if diabetic) juice 10 - 15 minutes prior to scanning. Do not provide if sedating.

MRCP is usually ordered for the evaluation of the biliary system. However, the pancreatic duct should be included, especially if pancreatic cysts or duct is of interest.

SEQUENCE FOV (mm) SLICE (mm)

COMMENTS IMAGES


T1 In/Out Ax BH T2 FS Ax BH T2 HASTE Ax BH

~360 7 x 2 ~24 slices

Include-Liver, GB, pancreas, spleen, biliary system and duodenum

T1 VIBE FS Ax Pre BH ~360 3 – 4

Radial thick slab MRCP BH ~250 40 – 80 thick

~6 slices

Scan 1 image per location with the angles similar to what is pictured. Radial projection through biliary system.

HASTE FS Cor hires BH ~360 3.5 x 0 Include pancreas and biliary system as shown in the image

HASTE FS Ax hires BH ~280 4 x 0 Include right and left main hepatic ducts through pancreatic

head and duodenum. Include the bottom of the kidneys to ensure coverage.

- continued on next page -

T2 3D Cor MRCP Trigger FB ~380 1.5 x 0 ~40 slices

- To include Gallbladder, biliary system and pancreas - Place trigger box on dome of the liver on a free breathing Cor scan/loc, center trigger box A-P using sag loc. Respiratory coaching might be necessary. Trigger box location

T1 Ax BH (only if MRCP is for a pancreatic indication)


T1 VIBE FS Ax Pre must be performed on all abdomens without contrast Create Lateral & Tumble cut MIPs off T2 3D Cor MRCP trigger

Appendicitis during Pregnancy (Updated: 11/4/19)

Include from mid-upper abdomen through pubic symphysis on all scans


T2 HASTE Cor T2 HASTE FS Cor

~360 (adjust FOV as

needed)

4 x 1

T2 HASTE Ax T2 HASTE FS Ax T1 FL2D Ax

~360 4 x 1

T2 HASTE Sag ~360 4 x 1

Enterography

Do not sedate Do not scan on an Espree due to limited H – F FOV. Include mid liver to mid bladder Instruct patient to void prior to MR to avoid any disruptions during study Administer ½ of the Glucagon dose at the beginning of the exam and the other ½ prior to contrast injection Position patient in prone if possible The patient is required to drink 1 full bottle of Breeza 60, 40, & 20 minutes prior to the exam Arterial phase or No delay imaging is required


T2 HASTE Cor BH Trufi Cor BH

~380 6 x 0.6

T2 HASTE Ax BH T2 HASTE FS Ax BH PD/T2 Ax BH Trufi Ax BH

~360 5 x 1

T1 VIBE FS Cor Pre BH (administer gluc and gad) T1 VIBE FS Cor Immediate Post BH T1 VIBE FS Cor 90 second Post BH

~380 5 x 0

T1 Fl2D FS Cor Post BH ~380 6 x 0.6

T1 FL2D FS Ax Post BH ~360 5 x 1

Include T1 Vibe FS Cor on all Enterography studies without contrast

Send subtractions to PACS

Urogram

Do not scan on an Espree due to the limited H-F FOV Administer 20 mg of Lasix IV & 1mg Glucagon IV prior to scanning


T1 Ax T2 FS Ax

~340

8 x 0 ~42 slices

Scan from above kidneys through bladder

T2 HASTE Ax

~340 5 x 0 ~36 slices

Kidneys only

T2 HASTE FS Cor ~380 5 x 0 Kidneys, ureters, and bladder

T1 VIBE FS Ax Pre T1 VIBE FS Ax Post

~340 4 x 0 Kidneys only (Use care bolus to get good arterial phase imaging)

T1 VIBE FS Sag 5 minute ~380 4 x 0

~64 slices

T1 VIBE FS Cor 15 minute ~380

2.5 x 0

~64 slices

If you have any question whether enough contrast is seen in the Kidneys, Ureters, and Bladder, Check with a Radiologist prior to getting the patient off the

table.

Bone Survey for Metastasis

Only performed on Avanto (CIC, MID, QRY)


T1 Cor Upper IR Cor Upper

~480 (include orbits to

diaphragm)

8 x 0

T1 Sag Upper IR Sag Upper

~480 (spine only, include

orbits to diaphragm)

6 x 0

T1 Cor Lower IR Cor Lower

~480 (include diaphragm to

femoral heads)

8 x 0

T1 Sag Lower IR Sag Lower

~480 (spine only, include

diaphragm to femoral heads)

6 x 0

Anal Sphincter (Routine & Dr. Ernest Graves) (Updated: 11/4/19)


T1 Ax

~360 (include full pelvis)

6 x 1

T2 Ax

240 FOV 6 x 1

T2 Cor ~360 (include full pelvis)

5 x 1.5

T2 Ax Obl Hires 240

(include anal sphincter)

3 X 0

T2 Cor Obl Hires 240 mm (include anal

sphincter)

3 x 0 mm

Pelvis Defecography

Explain every step of the exam to the patient before beginning. Cooperation is a key factor for this exam Do not sedate-sedated patients might not be able to complete required functions of the procedure Position the patient with their knees bent as much as the space within the magnet bore allows All patients should have 240cc KY jelly in the rectum. Use a 60cc catheter tip syringe connected to 4-6” clear tube connected to enema tip to place KY jelly in

rectum


T2 FS Cor loc T2 FS Sag loc

280 6 x 0

T2 Ax

280

5 x 1

T2 Sag 240 5 x 1

T2 Trufi Sag Resting 220

10

1 slice at midline Tech to ensure good view of rectal canal before proceeding

T2 Trufi Sag Constrict (repeat 3 times)

220

10 1 slice at midline

Instruct patient to constrict their anal sphincter as much as possible. Resting between each run

T2 Trufi Sag Strain (repeat 3 times)

220

10 1 slice at midline

Instruct patient to strain but not enough to defecate KY Jelly. Again resting between each run

Instructions for the next sequence: Likely the patient will already have the urge to defecate due to the presence of the KY jelly in the rectum. Do not tell the patient to strain in order to defecate, just simply to defecate out the jelly. Confirm with patient if defecation occurred & if straining to defecate was done. In theory, a normal patient should not need to strain to defecate out the jelly, rather the patient should be able to just relax & defecate. Be sure to document in tech notes if the patient strained to defecate.

T2 Trufi Cine Sag (repeat 3-4 times)

220 10 1 slice at midline

25 measurements

Instruct patient to relax for the first 5 measurements, defecate over the next 15 measurements and relax for the remaining 5 measurements

T2 Trufi Cine Cor 240 10

1 slice at midline 25 measurements

Instruct patient to relax for the first 5 measurements, defecate over the next 15 measurements and relax for the remaining 5 measurements position the slice through the rectum and anus. Use sag cine to set up

Rectum Rectal Cancer *3T Preferred

Patient to follow LOSO PREP starting 24 hours prior to exam. We DO NOT prep patients with colostomies for this study Symptom of rectal bleeding will likely use this protocol, may need to verify diagnosis with referring or radiologist Scan straight, do not angle to anal canal Arterial phase or no delay post imaging is required


T1 Ax ~340 (min fov to

include entire bony pelvis)

6 x 1

T2 Cor

240

5 x 1.5 40 slices

T2 Sag 180 3 x 0

36 slices

T2 Ax T2 FS Ax

240

3 x 0 L5-ischium

T1 Dixon VIBE FS Ax Pre T1 Dixon VIBE FS Ax Post

240

3 72

slices/slab

Diffusion Ax (B0, 400, 800 with 1400 Calculated when possible)

240

3.6 x 0 46 slices


Rectum for Pain / Abscess / Fistula *3T Preferred

Patient to follow LOSO PREP starting 24 hours prior to exam. We DO NOT prep patients with colostomies for this study Be sure to completely scan through the patient’s pathology, extending the scan through the buttocks inferiorly is frequently needed


T1 Ax ~340 (min FOV to

include entire bony

pelvis)

6 x 1

T2 FS Sag

180

3 x 0 36 slices

(SI jt-SI jt to cover rectum)

T2 Cor Obl 240 3 x 0 76 slices

Slices parallel to anal canal (blue line)

T2 Obl Ax T2 FS Obl Ax

240

3 x 0

Slices Perpendicular to anal canal

T1 Dixon VIBE FS Obl Ax Pre T1 Dixon VIBE FS Obl Ax Post

240 FOV

3 72 slices/slab


Female Pelvis (Updated 12/6/2019)

With empty bladder. If bladder is area of interest, then image with full bladder This protocol is done for routine, adenomyosis, endometriosis, adnexal mass, uterine fibroids, Pre/Post uterine fibroid embolization (UFE), etc. Increase FOV and/or slice coverage to include uterus with any fibroids in its entirety on both sagittal and coronal views, i.e., do not perform with cor upper

and cor lower. This is so that the rads can provide an accurate measurement of uterus and tumors.


T1 Ax

~360 Pixel Area ≤ 2.4 mm²

5 x 1 ACR: must include entire boney pelvis

T2 HASTE Ax T2 FS Ax


5 x 1 ACR: must include vaginal introitus through iliac crests &

pelvic sidewalls

T2 Cor ~240 mm (increase fov if need)

5 x 1

T2 Sag T2 HASTE Sag


(increase fov if needed)

5 x 1

(ex. of a giant uterine mass in single FOV)

T1 FS Ax Pre T1 FS Ax Post


5 x 1 ACR: must include entire boney pelvis

T1 Sag Post (if for fibroids or pre/post UFE)

~240 (increase fov if needed)

5 x 1


Sag post is only needed for fibroids and pre/post UFE studies * ACR Requirements – Do not adjust parameters.

Female Pelvis Mullerian Duct (Updated: 11/4/19)

Infertility, Unicornuate, Arcuate, Bicornuate, Septate, or Didelphic With empty bladder

SEQUENCE FOV(mm) SLICE (mm) COMMENTS IMAGES

T2 HASTE Cor - abdomen ~360 8 x 2 *renal agenesis is sometimes associated with mullerian duct anomalies

T1 Ax T2 HASTE Ax BH T2 FS Ax

~240

5 x 1

T2 Sag T2 HASTE Sag

~240 5 x 1

T2 FS Cor ~240 4 x 0

T2 HASTE Obl Ax loc (short axis) A haste *3-plane loc positioned parallel/perpendicular to uterus should be ran before this sequence for better planning of the Oblique scans.

~240 4 x 0

T2 Obl (long axis - parallel to long axis of uterus)

~200 4 X 0

Female Pelvis for Placenta Accreta / Increta / Precreta / Previa *1.5T Only (Updated: 11/4/19)

Encourage a full bladder to accurately assess for placenta percreta FOV and slices to cover entire uterus to below the bladder Need for IV contrast will be determined by the radiologist on a case by case basis Using a second coil (flex/torso) can help with signal Recumbent supine position is difficult for pregnant patients. Imaging fast and words of encouragement will help them complete the exam


T2 HASTE Ax T1 In/Out AX

~360 (adjust FOV as needed)

7 x 2

T2 HASTE Cor BH

~380 5 x 1

T2 HASTE Sag BH T2 HASTE FS Sag BH TrueFisp/Fiesta Sag BH

~380 5 x 1

Placenta Accreta – placenta grows too deeply into the uterine wall

Placenta Increta – attaches even deeper into the uterine wall and penetrate into the uterine muscle

Placenta Percreta – placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder

Placenta Previa – placenta covers the opening in the mother's cervix

Female Pelvis Oncology *3T Preferred (Uterine, Endometrial, Cervical, Vaginal Ca and Dr. Wu RTP) (Updated 12/6/19)

With empty bladder If ordering physician is Dr. Catherine Wu, have the patient apply 20 cc of KY jelly into the vagina


T1 Ax ~340 (include

entire bony pelvis)

5 x 1.5

T2 FS Ax Trigger 240 5 x 1.5

T2 Sag tse T2 Sag HASTE *for motion on T2 tse Sag

200 3.5 x 0.5

T2 Cor 240 4 x 1

T2 Obl Ax Hires *add for cervical CA

180 3 x 0 (True axials

through long axis of cervix)

Consult with body rad for positioning

Diffusion Ax (B0, B400, B800 Values)

260 FOV 3.6 X 0 ~46 slices

Cover area of interest, consult with rad if needed


~340

5 x 1.5

T1 FS Sag Post 200 3.5 x 0.5


Female Pelvis RTP

With empty bladder, unless specified otherwise by oncologist Include entire anatomy in the FOV, skin to skin RTP for Dr. Wu is 3T oncology pelvis


T2 3D Ax T2 FS Ax T1 Ax T1 FS Ax

Include entire soft tissue pelvis, skin to skin from side to side and front to back

3 x 0 Acquire enough slices to cover abnormality fully

Female Pelvis Urethral Diverticulum (Updated 12/2/19)

Patient should be told to hold still and relax the pelvic muscles during imaging Phase oversampling will need to be increased on larger patients to avoid/reduce wrap around artifact Empty bladder


T1 Ax ~340 (minimum FOV

to include entire bony

pelvis)

5 x 1.5

T2 Sag Hires

180 3 X 0 24 slices

T2 FS Ax Hires T2 Ax Hires

180 3 X 0 24 slices

T2 Cor Hires 180 3 X 0

24 slices

T1 FS Ax Hires Pre T1 FS Ax Hires Post

180 3 X 0


Male Pelvis (Updated 12/6/19)

With full bladder, if area of interest


T1 Ax

~360 (minimum FOV to include

entire boney pelvis)

8 x 2


~240

8 x 2

T2 Cor 240 7 x 1

T2 Sag ~240 5 x 1

T1 FS Ax pre T1 FS Ax Post (2 minute delay)

~360 (minimum FOV to include

entire boney pelvis)

8 x 2

Male Pelvis for Penis (Updated 11/4/19)

With empty bladder Allow anatomy to remain in natural position.


T1 Ax

~340 (minimum FOV to

include entire pelvis, penis and

testes)

7 x 1

T2 Sag hires ~200 3 x 0.5

T2 Ax hires ~200 3 x 0.5

T2 Cor hires

~200 3 x 0.5

T1 DIXON VIBE FS Obl Ax Pre T1 DIXON VIBE FS Obl Ax Post

~200 3 x 0

OR

Male Pelvis for Testicles (Updated 12/6/19)

With empty bladder/ /Build up testes using a folded towel. Tape penis to pelvis


T1 Ax

~360 (minimum FOV to include entire pelvis and testes)

8 x 2


~240 (include pelvis and testes)

8 x 2

T2 HASTE Cor 280 mm 4 x 1

T2 HASTE Sag ~280 4 x 1

T2 FS Ax Hires T2 HASTE Ax Hires

~200 3 x 1


~360 (minimum FOV to include entire pelvis and testes)

8 x 2

T1 FS Ax Hires Post ~200 3 x 1

Prostate Diagnostic *3T Preferred

If 3T is contraindicated, MRI may be performed on 1.5T at MID, QRY, VIL, CP, GTN, or RCP Patients with recent positive prostate biopsy can have their MRI immediately and don’t have to wait 4-6 weeks for the inflammation to do down Empty bowels and bladder before beginning exam. T2 Axial-best image quality required. Repeat for motion


T2 Sag

200 3 x 0

Diffusion Ax (B 0, 400, 800 Value)

200

3.6 x 0 (~33 slices)

include from top of seminal vesicles through urogenital diaphragm

Split and save B-Values into its own series

T2 Ax 180 3 x 1 include from top of seminal vesicles through urogenital diaphragm

T1 Ax ~360 5 x 1.5 Cover entire bony pelvis(L5-lesser trochanter)

T2 Cor

180 3 x 1 Include seminal vesicles

T1 VIBE Ax Dynamic Perfusion Pre/Post

200 3.6 x 0


Scan time is approximately six minutes

60 total measurements

Begin contrast injection after the second measurement is completed

Inject at 3ml/sec

HCA Urology studies will go to HCA CAD, See referral request instructions for techs in MI for HCA CAD instructions

Send to PACS-T2 Sag, T2 Ax, T1 Ax full pelvis, T2 Cor, Diff ADC map, T1 Vibe Axials, renamed B0 Value, B400 Value, B800 Value, any repeats

Send to HCA or ARA CAD- T2 Sag, T2 Ax, T1 Ax full pelvis, T2 Cor, Diff ADC map, T1 Vibe Axials

Prostate Post Prostatectomy *3T Preferred

If 3T is contraindicated, MRI may be performed on 1.5T at MID, QRY, VIL, CP, GTN, or RCP Empty bowels and bladder before beginning exam. T2 Axial-best image quality required. Repeat for motion


T2 Sag

200 3 x 0

Diffusion Ax (B 0, 400, 800 Value)

200

3.6 x 0 (~33 slices)



T2 Ax T2 Ax FS T1 Ax

200 3 x 1 include from top of seminal vesicles through urogenital diaphragm

T1 Ax ~360 5 x 1.5 Cover entire bony pelvis(L5-lesser trochanter)

T1 VIBE Ax Dynamic Perfusion Pre/Post

200 3.6 x 0


Scan time is approximately six minutes

60 total measurements

Begin contrast injection after the second measurement is completed

Inject at 3ml/sec

Send to PACS-T2 Sag, T2 Ax, T2 Ax FS, T1 Ax, T1 Ax full pelvis, T2 Cor, Diff ADC map, T1 TWIST Axials, renamed B0 Value, B400 Value, B800 Value, any repeats

To CAD-No image is sent to CAD

Prostate Without Contrast (Dr. Hsu)

If 3T is contraindicated, MRI may be performed on 1.5T at MID, QRY, VIL, CP, GTN, or RCP Patients with recent positive prostate biopsy can have their MRI immediately and don’t have to wait 4-6 weeks for the inflammation to do down

Empty bowels and bladder before beginning exam. T2 Axial-best image quality required. Repeat for motion


T2 Sag

200 3 X 1 ~30 slices

Diffusion Ax (B 0, 400, 800 Value) 1400 calculated

~200 3.6 X 0 (~33 slices)



T2 Ax ~150 3 X 1 ~30 slices


T2 Ax ~400 100 PFOV

3 X 0 ~38 slices

Skin to skin, no angles

T1 Ax ~340

(minimum FOV to include entire bony

pelvis)

5 X 1.5 ~40 slices

Prostate Austin Cancer Center (ACC) Therapy Staging

Include patient’s entire anatomy in the FOV, skin to skin.


T1 Ax T1 FS Ax T2 FS Ax T2 3D Ax

~400-500 3 x 0

Prostate Cyberknife Therapy Planning (Dr. Ghafoori)

Feet first supine, tape feet together. Include entire anatomy, 100% FOV, skin to skin, no angles, No contrast


T1 FS Ax T2 FS Ax

~400-500 2 x 0 ~54 slices

Prostate RTP - SpaceOAR Planning (Dr. Garza)

Head first supine, tape feet together, keep hands on chest to a void wrap in pelvic area

Include entire anatomy, 100% FOV, skin to skin, no angles

Cover from top of seminal vesicles through urogenital diaphragm

No contrast


T1 FS Ax T2 FS Ax

~400-500 2 x 0 ~54 slices

Prostate Therapy Planning (Dr. Rufus Mark)

Feet first supine, tape feet together

Include entire anatomy, 100% FOV, skin to skin, no angles

No contrast


T1 Ax T1 FS Ax T2 FS Ax T2 3D Ax

~400-500 3 x 0 ~54 slices

10 cm above prostate to 6 cm below prostate

T2 Ax ~140 3 x 0 Scan from top of seminal vesicles through

urogenital diaphragm

T2 FS Ax (if post prostatectomy)

Elastography on GE

Preparation

Consent form must be signed. NPO for six hours, water ok up to two hours prior to exam

Always do a routine liver study after the Elastography

Set posterior torso coil on the table like a routine abdomen and place neoprene strap on the table in the area of liver. The passive driver (paddle) is going to be placed on the right side of the abdomen at the level of the xiphoid process. Secure the passive driver tight with the neoprene strap.

For female patients ask them to lift breast tissue if the tissue is in the way of paddle placement. For skinny patient the passive driver can be placed partially on the side of the patient

Attach the plastic tubing to the passive driver and place anterior torso coil on the top of the abdomen

Scanning

Register the Elastography protocol

Before scan, the scanner must be placed in research mode(under scan mode) and in clinical mode when done


Gre Ax BH Ex ~360 10 Center the slices on the meat of the liver. Try to avoid heart and gallbladder Scan loc and Elastography sequences on exhalation (14 sec scan)

Post Processing

For each of the four slices in the elastography sequence, you will need to plot 3 ROI’s

Load the Elastography sequence, series 300 labeled PROC (this one is used for ROI’s) and series 303(grid) into the Mini-viewer

Try to place ROI’s in blue area of the liver that are not covered by the grid. If the patient does not have many blue areas or any at all, that is ok

SCRNSAVE the PROC image with the 3 ROI’s

Page down 1 slice on each of the mini viewers so that all they all have the same slice

Repeat for all 4 slices. Send everything to ARA PACS

Send everything except SCNSAVE #99 to ACBCC

Place scanner back in clinical mode and proceed with routine liver

MRI Body Protocols - ARA Diagnostic Imaging...Adrenals (Updated 2/27/17) For follow-up with prior...

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Transcript of MRI Body Protocols - ARA Diagnostic Imaging...Adrenals (Updated 2/27/17) For follow-up with prior...