1. MSK CT PROTOCOLS May 2010 Revision
VCUHS Radiology
MSK CT PROTOCOLS
May 2010 Revision

2. MSK-01: MSK Chest Wall Protocols
MSK-01 Basic Protocol
1st
2nd
3rd
KVP/mAs (QRM)/Rotation time
120/350ma/1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
3X3
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra
Sternum
SC Joints
Clavicle
Axilla
Ribs
Chest Wall

3. MSK-01A: Sternum, SC Joints
Indications:
(-) trauma
(+) mass, infection
Use MSK-01 Basic protocol
FOV
Mark abnormality if present
Sag/Cor reformats (angle coronals to sternum)

4. MSK-01A: Sternum, SC Joints Planes for Reformatted Images

5. Example Images: Sternum, SC Joints
Sagittal Sternum
Coronal Manubrium and SC joints
Coronal Sternum

6. MSK-01B: Clavicle Indications: trauma Use MSK-01 Basic protocol FOV
Cor, sag reformats

7. MSK-01C: Axilla, Ribs, Chest Wall (-,+)
Indications:
Trauma
Mass, infection
Use MSK-01 Basic protocol
FOV (adjust as necessary)
Mark abnormality
Sag, Cor reformats
Angled axial (along axis of ribs) may be useful for a specific rib abnormality

8. MSK-02: Shoulder/Arm (at side)*
Shoulder/scapula
Shoulder arthro
Humerus
Elbow*
Forearm*
Wrist/hand*
MSK-02 Basic Protocol
KVP/Effective mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
3X3
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra
*For elbow and distally, only perform with arm at side if patient unable to place arm over head for more ideal scanning.

9. MSK-02A: Shoulder/Scapula (-,+)
Indications:
(-) trauma
(+) mass, infection
Use MSK-02 Basic protocol
FOV
Mark abnormality
Other arm above head
Fracture / bone lesion: Paracoronal, parasagittal reformats (see examples)
Soft Tissue lesion (mass, infection): perform straight coronals and sagittals
Hardware:
140 kvp / 400 ma / 1.0 sec
Collimation: 64 X 1.2 mm
3rd Recon: 1.2 mm X 0.6 mm

10. MSK-02A: Shoulder / Scapula Planes for (bone lesion) Reformatted Images
Ideally, planes should be specified in 3 planes, although (A) is most important for scapula and shoulder joint. (B) and (C) are important for proximal humerus fractures

11. MSK-02B: Shoulder Arthrogram
Shoulder Arthro Modified Protocol
KVP/Effective mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.5 mm
Image Order
Cr - Cau
FOV mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
2X2
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra
Indications: post arthrogram
FOV
Use Use MSK-02 Basic protocol with changes in red at right
Other arm above head
Paracor/parasag reformats

12. MSK-02B: Shoulder Arthrogram Planes for Reformatted Images
Ideally, parasagittal and paracoronal images should be prescribed in all 3 planes (axis of scapula and humerus)

13. Shoulder Arthrogram: Example Images

14. MSK-02C: Humerus (-,+) Indications: Use Basic MSK-02 protocol
(-) trauma
(+) mass, infection
Use Basic MSK-02 protocol
FOV (adjust as indicated)
Mark abnormality
Other arm above head
Cor/sag reformats (angle to bone)
Hardware:
140 kvp / 400 ma / 1.0 sec
Collimation: 64 X 1.2 mm
3rd Recon: 1.2 mm X 0.6 mm

15. MSK-02C: Hummers (at Side) Planes for Reformatted Images
For humerus, prescribe planes along long axis of humerus (A,B) and in plane of elbow joint (C) to give ideal coronal and sagittal view of humerus and upper arm

16. MSK-02D: Elbow (-,+) Indications: (-) trauma (+) mass, infection
Use Basic MSK-02 protocol
**Only perform with arm at side in patients unable to raise arm above head
FOV (adjust FOV as necessary to cover abnormality)
Other arm above head
Sag/cor reformats (angle to long axis of humerus)
For large Pt and/or arm across abdomen, may require max technique
Hardware:
140 kvp / 400 ma / 1.0 sec
Collimation: 64 X 1.2 mm
3rd Recon: 1.2 mm X 0.6 mm

17. MSK-02E: Forearm (-, +) Indications: Use Basic MSK-02 protocol
(-) trauma
(+) mass, infection
Use Basic MSK-02 protocol
**Only perform with arm at side in patients unable to raise arm above head
FOV (adjust FOV as necessary to cover abnormality)
Other arm above head
Sag/cor reformats (angle to long axis of ulna)
For large Pt and/or arm across abdomen, may require max technique
Hardware:
140 kvp / 400 ma / 1.0 sec
Collimation: 64 X 1.2 mm
3rd Recon: 1.2 mm X 0.6 mm

18. MSK-02F: Wrist/Hand (-,+)
Indications:
(-) trauma
(+) mass, infection
**Only perform with arm at side in patients unable to raise arm above head
Adjust MSK02 protocol with changes as noted in red
FOV (adjust FOV as necessary to cover abnormality)
Other arm above head
Sag/cor reformats
For large Pt and/or arm across abdomen, may require max technique
Hardware:
140 kvp / 400 ma / 1.0 sec
Collimation: 64 X 1.2 mm
3rd Recon: 1.2 mm X 0.6 mm
Wrist / Hand Modified Protocol
VP/Effective mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
2.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
2x2
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra

19. MSK-02G: Entire Arm (+) Indications: mass, infection
Use Basic MSK02 protocol
FOV (mark mass, adjust FOV as necessary to cover abnormality, elbow straight as possible)
Other arm above head
Slice thickness of 5mm x 5mm
Sag/cor reformats (angle to long axis of humerus)

20. MSK-03: Arm (Over Head) Elbow Forearm Wrist Hand DRUJ study
MSK-03 Basic Protocol
1st
2nd
3rd
KVP/mAs(QRM)
Rotation time
120/150ma/1.0 sec
Collimation
64 x 1.2 mm
Slice Width
3.0 mm (Elb/FA)
2.0 mm (Wrist/Hand)
1.2 mm
Pitch
0.75
Kernel
B30
B70
B30B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV mm
as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Sag, Cor 2x2 to PACS
Send both sets of
Thin axials to
PACS & Terra
Elbow
Forearm
Wrist
Hand
DRUJ study

21. MSK-03A: Elbow Indications: Use MSK-03 Basic Protocol
(-) trauma
(+) infection, mass
Use MSK-03 Basic Protocol
FOV (adjust FOV as necessary to cover abnormality, elbow straight as possible)
Mark abnormality if present
Sag/cor reformats (angle to long axis of humerus)
This protocol may be use for isolated humerus abnormality
Hardware: use 140 kV, 250 ma

22. MSK-03A: Elbow (Fx) Planes for Reformatted Images
Planes must be prescribed carefully and in 3 planes in order to achieve true axial (A), coronal (B), and sagittal (C) images.

23. MSK-03A: Example Images

24. MSK-03B: Forearm (-,+) Indications: Use MSK-03 Basic Protocol
(-) trauma
(+) mass, infection
Use MSK-03 Basic Protocol
FOV (adjust FOV as necessary to cover abnormality)
Mark abnormality, elbow straight as possible
Sag/cor reformats (angle to long axis of ulna)
Hardware: use 140 kV, 250 ma

25. MSK-03C: Wrist/Hand (-,+)
High Res Hand / Wrist Modified Protocol
Indications:
(-) trauma
(+) mass, infection
Use MSK-03 Basic Protocol
For High Res study, see modifications at right (must be isocenter)
FOV (adjust FOV as necessary to cover abnormality, wrist and fingers straight as possible)
Sag/cor reformats (angle to long axis of radius)
Hardware: use 140 kV, 250 ma
VP/Effective mAs/Rotation time
120/150 ma
1.0 sec
Collimation
12 x 0.6 mm
Slice Width
2.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
U70
B30/U70
Increments
0.5 mm
Image Order
Cr - Cau
FOV mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
2x2
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra

26. MSK-03C: Hand / Wrist Planes for Reformatted Images

27. MSK-03A: Wrist- DRUJ Study
Indications:
Distal Radio-ular joint (DRUJ) abnormality
Use MSK-03 Basic Protocol (high res may be necessary for one of the three scans)
FOV
Scan BOTH wrists separately in the arm overhead position
Scan in 3 positions:
Neutral
Full pronation
Full supination
Be sure to label R/L and which position for each series
Use High-Res technique with Sag/Cor recons for neutral position only

28. MSK-04 Basic Bony Pelvis Protocol
MSK-04: Pelvis/Hips
Pelvis (bone)
Hips (bilateral)
Hip (unilateral)
Acetabular dysplasia study
MSK-04 Basic Bony Pelvis Protocol
KVP/Effective mAs/Rotation time
120/300 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B60
B30/B60
Increments
0.6 mm
Image Order
Cr - Cau
FOV
380 mm
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
3X3
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra

29. MSK-04A: Pelvis (bone) (-,+)
Indications:
(-) trauma
(+) mass, infection
Use MSK-04 Basic Protocol
FOV (legs straight as possible)
Sag/cor reformats
Hardware: use 140 kV, 400 ma

30. MSK-04B: Hips (-) Indications: trauma Use MSK-04 Basic Protocol
FOV (legs straight as possible)
Use MSK-04 Basic Protocol
Sag/cor reformats
Hardware: use 140 kV, 400 ma

31. MSK-04C: Acetabular Dysplasia Study (-)
Indications:
suspected acetabular dysplasia
Use MSK-04 Basic Protocol
FOV (legs straight and symmetric as possible, toes straight up and together)
Sag/Cor and 3-D reformats

32. MSK-04D: Hip (unilateral)
Indications:
post arthrogram
Bony tumor
FOV (legs straight as possible)
Sag/cor reformats
Use MSK-04 Basic Protocol

33. MSK-04D: Hip Planes for Reformatted ImagesC B
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Additional angling in the long axis of the femur (off the sagittal) yields nice images of femur (C)

34. MSK-05 Basic Lower Ext Protocol
MSK-05: Lower Extremity
MSK-05 Basic Lower Ext Protocol
KVP/Effective mAs/Rotation time
120/250 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
1.2 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV
300 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
3X3
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra
Femurs (unilateral, bilateral)
Knee
Tib/fib (unilateral, bilateral)
Ankle/Hindfoot/Calcaneus
Foot
Entire leg
Miscellaneous
“Version” study
Patellar tracking study

35. MSK-05A: Femurs (bilateral)
Indications:
mass, infection
Use MSK-05 Basic Protocol
FOV (legs straight as possible)
Sag/cor reformats
Hardware: use 140 kV, 400 ma

36. MSK-05B: Femur (unilateral) (+,-)
Indications:
(-) trauma
(+) mass, infection
Use MSK-05 Basic Protocol
FOV (legs straight as possible)
Sag/cor reformats, angle along long axis of femur
Hardware: use 140 kV, 350 ma

37. MSK-05C: Entire Leg (unilateral) (+)
Entire Leg Modified Protocol
Indications:
Mass, infection
Use modified protocol at right
FOV (legs straight as possible)
Sag/cor reformats (angle along long axis of femur
Hardware: use 140 kV, 300 ma
KVP/Effective mAs/Rotation time
120/250 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
5.0 mm
2.0 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
1.0 mm
Image Order
Cr - Cau
FOV
300 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
5x5
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra

38. MSK-05D: Knee (unilateral)
Indications:
trauma (-)
mass, infection (+)
Use MSK-05 Basic Protocol
FOV (knee straight as possible)
Mark mass if present
Sag/Cor reformats (angle to posterior femoral condyles if possible)
Hardware: use 140 kV, 300 ma

39. MSK-05D: Knee: Planes for Reformatted ImagesC B
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Use posterior femoral condyles to prescribe coronal and sagittal reformats (A, thick red line)

40. MSK-05E: Tib/Fib (unilateral) (-,+)
Indications:
(-) trauma
(+) mass, infection
Use MSK-05 Basic Protocol
FOV (knee straight as possible)
Mark abnormality if present
Sag/Cor reformats (angle to long axis of tibia)
Hardware: use 140 kV, 300 ma

41. MSK-05E: Tib/Fib Planes for Reformatted ImagesC
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Use posterior femoral condyles or midline of proximal tibia (A, thick red line) to prescribe coronal and sagittal reformats

42. MSK-05F: Ankle/Hindfoot
Indications:
(-) trauma
(+) mass, infection
Use modified MSK-05 Basic Protocol on right
FOV (foot at 90 degrees if possible)
Sag/Cor reformats (angle to approx axis of foot)
Hardware: use 140 kV, 300 ma
Ankle/Hindfoot Modified Protocol
KVP/Effective mAs/Rotation time
120/200 ma
1.0 sec
Collimation
64 x 0.6mm
Slice Width
2.0 mm
0.75 mm
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.5 mm
Image Order
Cr - Cau
FOV
150 mm
Or as indicated
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Soft tissue lesion:
SAG, COR recons
2x2
send to PACS
Bone lesion:
Send both sets of
Thin axials to
PACS & Terra

43. MSK-05F: Ankle/Hindfoot/Calcaneus Planes for Reformatted ImagesB C
Prescribe in sagittal (B) and coronal (C) planes off the axial (A). Use approximate long axis of calcaneus (A, thick red line) to prescribe coronal and sagittal reformats

44. MSK-05G: Foot (-,+) Indications: (-) trauma (+) mass, infection
Use Modified MSK-05 Protocol (same as Ankle/Hindfoot
FOV (foot at 90 degrees if possible)
Sag/Cor reformats (angle to long and short axes of metatarsals – see red lines at left)
Hardware: use 140 kV, 300 ma

45. MSK-05G: Foot Planes for Reformatted ImagesC B A
Prescribe in sagittal (B) and coronal (C) planes off the short axis plane (A). For midfoot, use axis of 2nd-5th MT’s (A, thick red line) to prescribe coronal and sagittal reformats. Depending upon positioning of patient in scanner, short axis plane (A) may need to be derived from original images as well.

46. MSK-05H: Patellar Tracking Study
Modified MSK-05: Patellar Tracking Protocol
Indications:
Patellar tracking abnormalities
FOV (legs symmetric as possible)
Scan in four positions: 0, 15, 30, 45 degrees of flexion
Use Modified MSK-05 Basic Protocol (Rt)
Archive thin sections from 1st position only
KVP/Effective mAs/Rotation time
120/150 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
1.2 mm*
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV
Both Knees
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
*Soft tissue lesion:
SAG, COR recons
3X3
send to PACS
*Bone lesion:
*Send both sets of
Thin axials to
PACS & Terra
*Send thin images and recons for 1st (extended) position

47. MSK-05I: Femoral Anteversion Study
Indications:
lower extremity alignment abnormalities
Use Modified MSK-05 Basic Protocol (Rt)
Keep FOV the same for all 3 scans
Legs straight as possible
Must not move between scans
AP scout from top of femur to ankle joint (need to be able to measure limb lengths)
Axials only
Modified MSK-05: Anteversion Study
KVP/Effective mAs/Rotation time
120/200 ma
1.0 sec
Collimation
64 x 1.2mm
Slice Width
3.0 mm
1.2 mm*
Pitch
0.75
Kernel
B30
B70
B30/B70
Increments
0.6 mm
Image Order
Cr - Cau
FOV
Both legs
Injection Rate
Scan Delay
Care Dose4D
Yes
PACS
Notes:
Send axials
To PACS

48. MSK-06. Ortho Spine
C-spine (-,+)
T-spine (-,+)
L-spine (-,+)
Post-Discogram (C, T, or L)