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Advanced Medical Imaging Consultants, PC
MRI MSK Protocols
Updated April, 2020
1
MRI Protocols
Shoulder Protocols 3 Bony Pelvis Protocols 33
Shoulder Pictures 5 Bony Pelvis Pictures 37
Humerus Protocols 8 Hip Protocols 33
Elbow Protocols 9 Hip Pictures 42
Elbow Pictures 11 Femur Protocols 46
Forearm Protocols 14 Knee Protocols 48
Wrist Protocols 15 Knee Pictures 50
Wrist Pictures 17 Tibia/Fibula Protocols 53
Hand Protocols 22 Tibia/Fibula Pictures 54
Hand Pictures 23 Ankle/Hindfoot Protocols 56
Thumb/Finger Protocols 28 Ankle/Hindfoot Pictures 58
Thumb/Finger Pictures 30 Foot Protocols 63
Foot Pictures 65
Table of ContentsUpper Extremity Lower Extremity
General Notes on Musculoskeletal MRI Protocols
Throughout this book, CORONAL = LONG AXIS, AXIAL = SHORT AXIS
Whenever intravenous gadolinium is given, a pre-contrast fat suppressed T1-weighted sequence must be included. This sequence should have identical parameters to a post-contrast series in the same plane.
2
MRI Protocols
Upper Extremity
Sequence
ParametersSeries Description FOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-plane Locator R
or L ShiftSCOUT 25 8 15 5 1 256x128
Axial 3D GRE AX_3D_GRE 10-12 4/0.4
Axial PD FS AX_PD_FS 10-12 4/0.4 >2000 20-30 2 256x256
Coronal T2 FS COR_T2_FS 16-18 4/0.4 >3000 40-50 2 256x256
Coronal T1 COR_T1 16-18 4/0.4 400-800 Min 1 256x256
Sagittal T2 FS SAG_T2_FS 16-18 4/0.4 >3000 40-50 2 256x256
Sagittal T1 SAG_T1 16-18 4/0.4 400-800 Min 2 256x256
Sequence
ParametersSeries Description FOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Locator R
or L ShiftSCOUT 25 8 15 5 1 256x128
Axial T1 FS AX_T1_FS 10-12 4/0.4 400-800 Min 1 256x256
Axial 3D GRE AX_3D_GRE 10-12 4/0.4
Coronal T1 FS COR_T1_FS 16-18 4/0.5 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 16-18 4/0.5 >2000 70-80 2 256x256
Sagittal T1 SAG_T1 16-18 4/0.5 400-800 Min 1 256x256
Sagittal T2 FS SAG_T2_FS 16-18 4/0.5 >2000 70-80 2 256x256
Sequence Parameters
Arthrogram Labrum Pathology/Tear
Infection/Osteomyelitis/Mass
Routine
Arthrogram
Per Scanner
Per Scanner
Protocol Indications
Routine Shoulder Rotator Cuff Pathology/Evaluation
Shoulder
Overview
Photos - Shoulder AxialPhotos - Shoulder
Coronal ObliquePhotos - Shoulder Sagittal
3 7/2018
MRI Protocols
Upper Extremity
Sequence
ParametersSeries Description FOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout - R
of L ShiftSCOUT 25 8 15 5 1 256x192
Axial STIR AX_STIR 10-12 4/0.4 4000-6000 60-90 2-3 256x192
Axial T1 AX_T1 10-12 4/0.4 400-800 Min 1 256x256
Sagittal T1 SAG_T1 16-18 4/0.4 400-800 Min 2 256x256
Coronal T2 FS COR_T2_FS 16-18 4/0.4 >3000 70-80 2 256x256
Axial T1 FS Pre GD AX_T1_FS_PRE 10-12 4/0.4 400-800 Min 1 256x256
Axial T1 FS Post
GDAX_T1_FS_POST 10-12 4/0.5 400-800 Min 1 256x256
Coronal or
Sagittal T1 FS Post
GD
COR_T1_FS_POST or
SAG_T1_FS_POST16-18 4/0.5 400-800 Min 1 256x256
Comments: Choose Coronal or Sagittal T1 FS Post GD depending on location of mass.
Infection, Osteomyelitis, Mass,
4 7/2018
MRI Protocols
Upper Extremity
Shoulder - AxialFOV = 12-16 cm
Localizer: Coronal Oblique
Orient all imaging planes with respect to the glenoid articular surface. Scan superiorly through the AC joint and inferiorly to include a portion of
humeral diaphysis.
Figure 1. On the coronal localizer, the axial plane is perpendicular to the glenoid articular surface.
Figure 2. In this example, the patinet's shoulder is hunched. The axial plane must be angled to compensate for the glenoid position.
Shoulder - Axial, Final Image
5 7/2018
MRI Protocols
Upper Extremity
Shoulder - Coronal ObliqueFOV = 12-16 cm
Localizer: Axial
Orient all imaging planes with respect to the glenoid articular surface. Scan posteriorly to include all bones and anteriorly to include coracoid
process.
Figure 3. On the axial localizer, the coronaloblique plane is perpendicular to the glenoid.
Shoulder - Coronal Oblique, Final Image
6 7/2018
MRI Protocols
Upper Extremity
FOV = 12-16 cm
Axial and Coronal
Orient all imaging planes with respect to the glenoid articular surface. Scan laterally to include the bones. Scan medially to include 2-3 cm
medical to the glenoid articular surface.
Shoulder - Sagittal
Figure 4. On the coronal oblique localizer, the sagittal plane is parallel to the glenoid surface.
Figure 5. On the axial localizer, the sagittal plane is patallel to the glenoid surface.
Shoulder - Sagittal, Final Image
7 7/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
Axial T1 AX_T1 24 7 500 12 2 256X204
Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204
Coronal T1 COR_T1 32 5 500 12 1 256x192
Coronal STIR COR_STIR 32 5 5000 65 1 256x204
Sagittal T1 SAG_T1 32 5 500 12 1 256x192
Sagittal STIR SAG_STIR 32 5 5000 65 1 256x204
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
Axial T1 AX_T1 24 7 500 12 2 256X204
Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204
Coronal STIR COR_STIR 32 5 5000 65 1 256x204
Coronal T1 COR_T1 32 5 500 12 1 256x192
Sagittal STIR SAG_STIR 32 5 5000 65 1 256x204
Axial T1 FS Pre
GadAX_T1_FS_PRE 24 7 600 15 1 256x192
Axial T1 FS
Post GadAX_T1_FS_POST 24 7 600 15 1 256x192
Coronal or
Sagittal T1 FS
Post GD
COR_T1_FS_
POST or
SAG_T1_FS_
POST
32 7 600 15 1 256x192
Comments: Choose Coronal or Sagittal T1 FS Post GD depending on location of mass.
Humerus (Long Bone)Overview
If there is a specific mass or lump being evaluated, choose the Soft Tissue mass Protocol. The major difference is that this
protocol scans a larger area. This requires thicker slices and larger FOV, factors which may hinder soft tissue mass assessment.
In general, minimize the FOV on the axial images to improve resolution. Orient the scan planes with respect to the humerus. Axial
images should slice the humerus like a straight-cut loaf of bread.
If there is a specific region of interest or site of pain, bracket it with two vitamin capsules/markers. Do not press the markers into
the skin as this can distort MR signal.
For axial images, slice thickness/slice gap can be increased from 4mm/1mm up to 6mm/2mm to improve exam time.
Positioning
Protocol Indications
Routine
Mass/Infection/Abscess
Routine
Infection, Mass, Abscess
Sequence Parameters
8 07/2018
MRI Protocols
Upper Extremity
Sequence
ParametersSeries Description FOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout Small
FOVSCOUT_SM 20 8 15 5 1 256X128
Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256X256
Coronal T1 COR_T1 16 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 16 3/0.3 >3000 70-80 2 256x256
Coronal 3D GRE COR_3D_GRE 12 1.5 20 12 2 256x192
Sagittal Stir SAG_STIR 12 3/0.3 4500 65 1 256x204
Sequence
ParametersSeries Description FOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout Small
FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 10-121 3/0.3 >3000 70-80 2 256x256
Coronal T1 FS COR_T1_FS 16 3/0.3 400-800 Min 1 256x256
Sagittal T1 FS SAG_T1_FS 16 3/0.3 400-800 Min 1 256x256
Coronal PD FS COR_PD_FS 16 3/0.3 2000-2500 20-30 2 256x256
Elbow
Medial/Lateral Collateral Ligament Evaluation
Pre and Post Gadolinium Bicepts or Triceps Tear Infection, osteomyelitis, mass, bone lesion
Common Flexor/Common Extensor Tendon Pathology
Protocol Indications
Routine Elbow Medial/Lateral Collateral Ligament tears
Pictures of Elbow - Axial Pictures of Elbow - Coronal Pictures of Elbow - Sagittal
Arthrogram
Overview
Elbow anatomy is complex. A typical person has 15-20° of valgus angulation at the elbow. Therefore, the best imaging planes for the humerus
will not be the same best imaging planes for the proximal radius and ulna. The imaging strategy in this section is designed to optimize
visualization of critical structures nad should work well in most situations.
Patient Position #1 - "Superman": Provides the best signal because the elbow is closer to the isocenter of the magnet. Requires cooperative
patient without significant shoulder pain or injury. Patient is prone, arm above the head. The elbow is in full extension with the thumb up
(forearm supination). Neutral position/mild pronation (i.e. hand flat) is usually adequate, too. Pad the hand for comfort and to reduce motion. In
general, you should select the best available knee coil when scanning the elbow in the "superman" position.
Patient Position #2 - Supine: This positioning should be reserved for patients who cannot do the Superman position (e.g. shoulder pain or injury).
It has the disadvantages of reduced signal- to-noise and limited coil selection (further reducing signal-to-noise). Keep elbows as far from the edge
of the bore as possible. If the elbow is very close to the bore, fat saturation will not work. (You may need to substiture STIR for T2/PD fat sat).
Patient is supine, arm at the side. Eblow in full extension with the thumb up (forearm supination). Pad the hand for comfort and to reduce
motion. Larger coil devices such as an HR knee coil often won't fit next to the patient. Choose the best coil that will fit, often a flex coil.
Sequence ParametersRoutine Pain, Injury
Positioning
MR Elbow Arthrogram Intra-articular Body Evaluation
9 7/2018
MRI Protocols
Upper Extremity
Sequence
ParametersSeries Description FOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout Small
FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256 Zip 512
Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256X256
Cor STIR COR_STIR 16 3/0.3 4000-6000 60-90 2-3 256x192
Coronal T1 COR_T1 16 3/0.3 400-800 Min 1 256x256
Axial T1 FS Pre GD AX_T1_FS_PRE 10-12 3/0.3 400-800 Min 1 256x256
Axial T1 FS Post GD AX_T1_FS_POST 10-12 3/0.3 400-800 Min 1 256x256
Coronal or Sagittal
T1 FS Post GD
COR_T1_FS_POST or
SAG_T1_FS_POST16 3/0.3 400-800 Min 1 256x256
Comments: Choose Coronal or Sagittal T1 FS Post GD depending on location of mass.
Infection/Osteomyelitis/Mass
10 7/2018
MRI Protocols
Upper Extremity
Elbow - Axial FOV = 12 - 14 cm
Localizer: Axial and coronal
Figure 6. Include 6cm proximal to the joint line and all of the radial
Figure 7. On the sagittal localizer, the axial plan connects the center of the trochlea with the tip of
Figure 8. The axial plan bisects the epicondyles of the humerus.
Elbow - FinalImage.
11 7/2018
MRI Protocols
Upper Extremity
Elbow - CoronalFOV = 12 - 14 cm
Localizer: Axial and sagittal
Figure 9. On an axial localizer, the coronal plane bisects the epicondyles of the humerus.
Figure 10. On a sagittal localizer, the coronal plane is perpendicular to the line connecting the center of the trochlea and the tip of the olecranon (i.e., perpendicular to the axial plane).
Elbow - Final Image
12 7/2018
MRI Protocols
Upper Extremity
Elbow - SagittalFOV = 12 - 14 cm
Localizer: Axial and coronal
Figure 11. On the axial localizer, the sagittal plane is perpendicular to the coronal plane through
Figure 12. On the coronal localizer, the sagittal plane is perpendicular to the axial plane through the epicondyles of the humerus. Include all of the bones.
Elbow - Final Image.
13 7/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
Axial T1 AX_T1 24 7 500 12 2 256X204
Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204
Coronal T1 COR_T1 32 5 500 12 1 256x192
Coronal STIR COR_STIR 32 5 5000 65 1 256x204
Sagittal T1 SAG_T1 32 5 500 12 1 256x192
Sagittal STIR SAG_STIR 32 5 5000 65 1 256x204
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
Axial T1 AX_T1 24 7 500 12 2 256X204
Axial T2 FS AX_T2_FS 24 7 4020 65 2 256x204
Coronal STIR COR_STIR 32 5 5000 65 1 256x204
Coronal T1 COR_T1 32 5 500 12 1 256x192
Sagittal STIR SAG_STIR 32 5 5000 65 1 256x204
Axial T1 FS Pre
GadAX_T1_FS_PRE 24 7 600 15 1 256x192
Axial T1 FS
Post GadAX_T1_FS_POST 24 7 600 15 1 256x192
Coronal or
Sagittal T1 FS
Post GD
COR_T1_FS_
POST or
SAG_T1_FS_
POST
32 7 600 15 1 256x192
Comments: Choose Coronal or Sagittal T1 FS Post GD depending on location of mass.
Forearm (Long Bone)Overview
If there is a specific mass or lump being evaluated, choose the Soft Tissue mass Protocol. The major difference is that this
protocol scans a larger area. This requires thicker slices and larger FOV, factors which may hinder soft tissue mass assessment.
In general, minimize the FOV on the axial images to improve resolution. Orient the scan planes with respect to the radius. Axial
images should slice the forearm bones like a straight-cut loaf of bread.
If there is a specific region of interest or site of pain, bracket it with two vitamin capsules/markers. Do not press the markers into
the skin as this can distort MR signal.
For axial images, slice thickness/slice gap can be increased from 4mm/1mm up to 6mm/2mm to improve exam time.
Protocol Indications
Routine
Infection/Mass/Osteomyelitis/Abscess
Routine
Infection, Mass, Osteomyelitis, Abscess
Positioning
Sequence Parameters
14 07/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5ms 1 256x128
Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 8-10 3/0.5 >2000 70-80 2 256x256
Coronal T1 COR_T1 12-14 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 12-14 3/0.3 >3000 70-80 2 256x256
Coronal GRE 3D COR_3D_GRE 12-14
Sagittal STIR SAG_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 FS AX_T1_FS 8-10 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 8-10 3/0.3 >2000 70-80 2 256x256
Coronal T1 FS COR_T1_FS 12-14 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 12-14 3/0.3 >2000 70-80 2 256x256
Sagittal T1 SAG_T1 12-14 3/0.3 400-800 Min 1 256x256
Coronal 3D T1
FS-SPGR or
similar
COR_3D_T1_FS 12-14
Arthrogram
Routine, Pain, TFCC, Ligament
Per Scanner
Per Scanner
Protocol Indications
MR Wrist Arthrogram TFCC/LT/SL Ligament Tears
Infection/Mass/Osteomyelitis/Bone Lesion
Sequence Parameters
Routine Wrist TFCC, Lunotriquetral, Scapholunate Tear
Flexor Tendon/Carpal Tunnel/Extensor Tendon Pathology
Nonunion, AVN, Pseudoarthrosis
Wrist Overview
Tailor the FOV to the region of interest: wrist, metacarpal region (hand), or whole hand. Use a smaller FOV when targeting a specific
area of interest (e.g. soft tissue mass). Place the hand flat un the neurtal position, fingers and thumbs straight. Do not tuck the
thumb under unless required to do so when using a wrist coil. The imaging planes for HAND and WHOLE HAND (see overview page)
are both oriented to the metacarpals as described below. Choose the metacarpal closest to the site of pain or mass. If there is no
specific area, pick the 3rd metacarpal.
Wrist/Hand Overview Wrist - Axial (Short Axis) Wrist - Coronal (Long Axis) Wrist - Sagittal
Wrist: 3 cm proximal to the radiocarpal joint line and 5-7 cm distal. FOV (all planes) = 8-10 cm
Hand: Radiocarpal joint proximal and MCP joints distal. FOV (all planes) = 8-10 cm
Whole Hand: CMC joints proximal to the tips of the fingers dital. FOC (long axis) = 14-18 cm. FOV (short axis) = 8-12 cm
15 07/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256
Coronal T1 COR_T1 12-14 3/0.3 400-800 Min 2 256x256
Coronal T2 FS COR_T2_FS 12-14 3/0.3 >3000 70-80 2 256x256
Sagittal STIR SAG_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192
Coronal T1 FS
Pre GdCOR_T1_FS_PRE 12-14 3/0.3 400-800 Min 1 256x256
Coronal T1 FS
Post GdCOR_T1_FS_POST 12-14 3/0.3 400-800 Min 1 256x256
Axial T1 FS
Post GdAX_T1_FS_POST 8-10 3/0.3 400-800 Min 1 256x256
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 8-10 3/0.3 >2000 70-80 2 256x256
Coronal T1 COR_T1 12-14 3/0.3 400-800 Min 1 256x256
Coronal STIR COR_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192
Sagittal T1 SAG_T1 12-14 3/0.3 400-800 Min 1 256x256
Coronal T1 FS
Pre GdCOR_T1_FS_PRE 12-14 3/0.3 400-800 Min 1 256x256
Coronal T1 FS
Post GdCOR_T1_FS_POST 12-14 3/0.3 400-800 Min 1 256x256
Nonunion, Pseudoarthrosis, AVN
Infection, Osteomyelitis, Bone Lesion, Mass
16 07/2018
MRI Protocols
Upper Extremity
Wrist and Hand - Overview
Figure 13. Tailor the FOV appropriately.
17 07/2018
MRI Protocols
Upper Extremity
INCORRECT
Wrist and Hand - OverviewCORRECT
Figure 14. CORRECT - The hand and wrist should be laid flat in the neutral position (no ulnar deviation). This hand and wrist are properly positioned. The second digit and radius line up.
Figure 15. INCORRECT -This hand and wrist are not properly positioned. There is ulnar deviation. Notice how the second digit and radius do not line up.
18 07/2018
MRI Protocols
Upper Extremity
FOV = 8-10 cm
Localizer: Coronal and Sagittal
Wrist - Axial (Short Axis)
Figure 16. On a coronal localizer, azial images slice the distal radiusperpendicular to the cortex like a straight-cut loaf of bread (not a sloped-cut loaf of bread).
Figure 17. Axial images slice the distal radius perpendicular to the cortexlike a straight-cut load of bread (not a sloped-cut loaf of bread).
Wrist - axial. Final image.
19 07/2018
MRI Protocols
Upper Extremity
FOV = 8-10 cm
Localizer: Axial and Sagittal
First Choice: FOV = 8 cm (3 cm proximal to radiocarpal joine line and 5 cm distal)
Second Choice: FOV = 10 cm (4 cm proximal to radiocarpal joint line and 6 cm distal)
Wrist - Coronal (Long Axis)
Figure 18. On the axial localizer, the coronal plane bisects the distal radius and the ulna.
Figure 19. On a sagittal localizer, the coronal plane is parallel to the distal radius and capitate (or the 2nd metacarpal) if the wrist is in the proper neutral position.
Wrist - Coronal (Long axis). Final Image.
20 07/2018
MRI Protocols
Upper Extremity
FOV = 8-10 cm
Localizer: Coronal and Axial
Wrist - Sagittal
Figure 21. On a coronal locator, the sagittal plane should be exactly perpendicular to the axial (short axis) plane ("reference line"). Notice how the sagittal plane traverses teh 2nd metacarpal ANC is perpendicular to the axial plane reference line. This is possible only when the wrist is properly positions (i.e., in the neutral position).
Figure 20. On anaxial localizer, the sagittal plane should be exactly perpendicular to the coronal (long axis) plane ("reference line").
Wrist - Sagittal. Final Image.
21 07/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256x256
Coronal T1 COR_T1 16 3/0.3 400-800 Min 1 256x256
Coronal STIR COR_STIR 16 3/0.3 4000-6000 60-90 2-3 256x192
Sagittal T1 SAG_T1 12-16 3/0.3 400-800 Min 2 256x256
Sagittal PD FS SAG_PD_FS 12-16 3/0.3 2000-2500 20-30 2 256x256
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 10-12 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 10-12 3/0.3 >3000 70-80 2 256x256
Sagittal STIR SAG_STIR 10 3/0.3 4500 65 2 256x192
Coronal T1 COR_T1 16 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 12-16 3/0.3 >3000 70-80 2 256x256
Axial T1 FS Pre
GdAX_T1_FS_PRE 10-12 3/0.3 400-800 Min 1 256x256
Axial T1 FS
Post GdAX_T1_FS_POST 10-12 3/0.3 400-800 Min 1 256x256
Coronal or
Sagittal T1 FS
Post Gd
COR_T1_FS_
POST or
SAG_T1_FS_
POST
16 3/0.5 400-800 Min 1 256x256
HandOverview
FOV = See Wrist and Hand Overview page
Hand - Axial Hand - Coronal Hand - Sagittal
Protocol Indications
Routine/Pain/Injury
Infection/Sepsis/Osteomyelitis/Mass
Infection, Sepsis, Osteomyelitis, Mass
Note: Choose coronal or sagittal post pontrast based on which will better depict the mass.
Sequence ParametersRoutine, Pain, Injury
22 07/2018
MRI Protocols
Upper Extremity
Hand - Axial (short axis)
FOV = See Wrist and Hand Overview PageLocalizer: Sagittal and Coronal
Figure 22. On a sagittal localizer, azial images slice the metacarpals perpendicularto the cortex like a straight-cut loaf of bread (not a sloped-cut loaf of bread).
Figure 23. This is incorrect because the metacarpals are sliced as a sloped-cut loaf of bread.
Figure 24. On a coronal (long axis) localizer, the axial plane is perpendicular to a line drawn through the 3rd metacarpal.
Hand - Axial (Short Axis) Final Image.
23 07/2018
MRI Protocols
Upper Extremity
Localizer: Axial and Sagittal
Hand - Coronal (Long Axis)
FOV = See Wrist and Hand Overview Page
Figure 25. On the axial (short axis)localizer, draw a "best fit" line through the 2nd through 5th metacarpals.
Figure 26. In this example, the coronal plane is incorrectly set as parallel to the table.
24 07/2018
MRI Protocols
Upper Extremity
Hand - Coronal (Long Axis)
FOV = See Wrist and Hand Overview PageLocalizer: Axial and Sagittal
Figure 27. On a sagittal localizer, draw a line along the 3rd metacarpal shaft (or the metacarpal closest to the region of interest). The example on the right is incorrect because the plane is parallel to the table, not the metacarpal.
Hand - Coronal (Long Axis) Final Image.
25 07/2018
MRI Protocols
Upper Extremity
Hand - Sagittal
FOV = See Wrist and Hand Overview Page
Scan to include at least one metacarpal on either side of the region of interest. If there is no specific area, scan to include
all bones.
Localizer: Axial and Coronal
Figure 28. On a coronal (long axis) localizer, the sagittal plane is along the 3rd metacarpal (or the metacarpalclosest to the region of interest).
Figure 29. On the axial localizer, draw a line perpendicular to the "best fit" line through the 2nd - 5th metacarpals (permendicular to
26 07/2018
MRI Protocols
Upper Extremity
Hand - Sagittal
FOV = See Wrist and Hand Overview PageLocalizer: Axial and Coronal
Scan to include at least one metacarpal on either side of the region of interest. If there is no specific area, scan to include
all bones.
Figure 30. In this example, the scan plane is incorrctly set with respect to the table.
Hand - SagittalFinal Image
27 07/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 8-10 3/0.3 >3000 70-80 2 256x256
Coronal T1 COR_T1 8 3/0.3 400-800 Min 1 256x256
Coronal PD FS COR_PD_FS 8-10 3/0.3 2000-2500 20-30 2 256x256
Sagittal STIR SAG_STIR 8-10 3/0.3 4000-6000 60-90 2-3 256x192
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 8-10 3/0.3 >3000 70-80 2 256x256
Coronal T1 COR_T1 8 3/0.3 400-800 Min 1 256x256
Coronal STIR COR_STIR 8-10 3/0.3 4000-6000 60-90 2-3 256x192
Sagittal T1 SAG_T1
Sagittal PD FS SAG_PD_FS 8-10 3/0.3 2000-2500 20-30 2 256x256
Thumb and FingerOverview
Thumb and Finger Axial Thumb and Finger Coronal Thumb and Finger Sagittal
Mass/Infection/osteomyelitis/Arthritis
Protocol Indications
Routine Thumb Ulnar collateral ligament injury/stenor lesion/sprain/fracture/pain
Routine Finger Injury/Tendon Injury
PositioningPlace the hand flat, fingers and thumb straight. Do not tuck the thumb under. Thumb: include the tip of the thumb distally and the
base of the first metacarpal proximally. Finger: Center on the region of interest with FOV as small as possible. Scan from the fingertip
through the MCP joint.
Sequence Parameters
Routine Finger
Routine Thumb
28 07/2018
MRI Protocols
Upper Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Small FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 8 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 8-10 3/0.3 .3000 70-80 2 256x256
Sagittal STIR SAG_STIR 8-10 3/0.3 4000-6000 60-90 2-3 256x192
Coronal T1 COR_T1 8 3/0.3 400-800 Min 1 256x256
Axial T1 FS Pre
GdAX_T1_FS_PRE 8 3/0.3 400-800 Min 1 256x256
Axial T1 FS
Post GdAX_T1_FS_POST 8 3/0.3 400-800 Min 1 256x256
Coronal or
Sagittal T1 FS
Post Gd
COR_T1_FS_
POST or
SAG_T1_FS_
POST
8 3/0.3 400-800 Min 1 256x256
Comments: Choose Coronal or Sagittal T1 FS Post GD depending on location of mass.
Infection, Mass, Osteonyelitis
29 07/2018
MRI Protocols
Upper Extremity
Thumb/Finger - Axial (Short Axis)FOV = 8-10 cm
See Thumb and Finger Positioning
Localizer: Coronal and Sagittal
Figure 31. On a sagittal localizer, draw a reference line through the MCP joint. The axial (short axis) plane is perpendicular to this reference
Figure 32. On a coronal (long axis) localizer, draw a refernce line through the MCP joint. The axial (short axis) plane is perpenducilar to this reference
Thumb/Finger - Axial (Short Axis) Final Image
30 07/2018
MRI Protocols
Upper Extremity
Thumb/Finger - Coronal (Long Axis)FOV = 8-10 cm
Localizer: Axial and Sagittal
See Thumb and Finger Positioning
Figure 33. On an axial localizer, the coronal (long axis) plane is parallel to the dorsal cortex of the finger or of the thumb at the level of the sesamoids. For the thumb, this line is usually parallel to a line connecting the thumb sesamoids.
Figure 34. This patient has "hitchhiker" thumb where the distal phalanx hyperextends. By default, the coronal plane is straight through the MCP joint since it is usually of greater interest. Therefore, the IP joint will not always be in plane.
Thumb/Finger -Coronal (Long Axis) Final Image.
31 07/2018
MRI Protocols
Upper Extremity
FOV = 8-10 cm
Localizer: Coronal and axial
See Thumb and Finger Positioning
Thumb/Finger - Sagittal
Figure 35. On an axial (short axis) localizer, the sagittal plane is perpendicular to the coronal (long axis) plane as described above.
Figure 36. On a coronal (long axis)localizer, the sagittal plane is straight through the MCP joint. The sagittal plane is perpendicular to the axial (short axis) plane ("Reference Line").
Thumb/Finger - Sagittal Final Image
32 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T1 Whole
PelvisAX_T1 36-40 5/1 400-800 Min 1 256x256
Coronal T2 FS
PelvisCOR_T2_FS 36-40 5/1 >3000 70-90 2 256x256
Sagittal T1 FS
OBL Affected
Hip
SAG_T1_FS_
OBL14-16 4/0.4 400-800 Min 1 256x256
Coronal T1 FS
OBL Affected
Hip
COR_T1_FS_
OBL14-16 4/1.4 400-800 Min 1 256x256
Axial OBL T1 FS
Affected HipAX_OBL_T1_FS 14-16 4/0.4 400-800 Min 1 256x256
Sagittal PD FS
Affected HipSAG_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256
COR PD FS
Affected HipCOR_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T1 Whole
PelvisAX_T1 36-40 5/1 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 36-40 5/1 >2000 70-80 2 256x256
Coronal T1
Whole PelvisCOR_T1 36-40 5/1 400-800 Min 1 256x256
Coronal STIR COR_STIR 33-40 5/1 4000-6000 60-90 2-3 256x192
Sagittal T2 FS SAG_T2_FS 30-40 5/1 >2000 70-80 2 256x256
MARS
SI Joints
TJUH Athletic PubalgiaAthletic Pubalgia, sports hernia, sportsman's hernia, adductor
tear/strain, rectus abdominus injury
Metal Artifact Reduction Sequence) DePuy Recelled Hip
Bony Pelvis (Pain/Trauma/Fracture/AVN)
Hip Arthrogram
Sequence Parameters
Non-Contrast HipPain, labral tear, FAI or dysplasis when direct MR arthrography not
possible
Post Gadolinium Hip Infection, mass, osteomyelitis
Post Gadolinium Pelvis Infection, mass, osteomyelitis
Protocol Indications
Bony Pelvis Pain, Fracture, AVN
Direct or Indirect Arthrogram Hip Hip labrum tear, FAI or dysplasia
Bony Pelvis
Hip Sagittal
Bony Pelvis Sagittal Hip Axial Hip Axial Oblique Hip Coronal
Bony Pelvis Axial Bony Pelvis Axial Oblique Bony Pelvis Coronal Bony Pelvis Coronal Oblique
33 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Coronal T1
Whole PelvisCOR_T1 36-40 5/1 400-800 Min 1 256x256
Coronal STIR
Whole PelvisCOR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192
Axial T2 FS
Whole PelvisAX_T2_FS 36-40 5/1 >2000 70-80 2 256x256
Axial T1 Whole
PelvisAX_T1 36-40 6/1 400-800 Min 1 256x256
Axial T1 FS
PreGd Whole
Pelvis
AX_T1_FS_PRE 36-40 4/0.4 400-800 Min 1 256x256
Axial T1 FS
PostGd Whole
Pelvis
AX_T1_FS_POST 36-40 4/0.4 400-800 Min 1 256x256
Coronal T1 FS
PostGd Whole
Pelvis
COR_T1_FS_
POST36-40 4/0.4 400-500 Min 1 256x256
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T2 FS
Whole PelvisAX_T2_FS 36-40 5/1 >2000 70-80 2 256x256
Coronal T1
Whole PelvisCOR_T1 36-40 5/1 400-800 Min 1 256x256
Coronal STIR
Whole PelvisCOR_STIR 33-40 5/1 4000-6000 60-90 2-3 256x192
Sagittal PD FS
Affected HipSAG_PD_FS 16-20 4/0.4 2000-2500 20-30 2 256x256
Coronal
Oblique PD FS
Affected Hip
COR_OBL_PD_
FS16-20 4/0.4 2000-2500 20-30 2 256x256
Axial Oblique
PD FSAX_OBL_PD_FS 20 4/0.4 2000-2500 20-30 2 256x256
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T1 Whole
PelvisAX_T1 40 6 500 15 1 512x256
Coronal T1
Whole PelvisCOR_T1 40 6 500 15 1 512x256
Coronal STIR
Whole PelvisCOR_STIR 40 6 5000 70 2 256x192
Coronal T2
Affected HipCOR_T2 24 3 4500 75 2 256x256
Sagittal T2
Affected HipSAG_T2 24 3 4500 75 2 256x256
Hip
Pelvis: Bone Lesion, Soft Tissue mass, Infection, Osteomyelitis
Optional: * If history includes labral tear, evaluate for labral tear or prior labral surgery, add an Axial Oblique PD FS
MARS
34 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
COR T1 - Angle
to SI jointsCOR_T1 24 4/1 400-800 Min 1 256x256
COR STIR -
Angle to SI
joints
COR_STIR 24 4/1 4000-6000 60-90 2-3 256x192
AX T1 - Angle
to SI jointsAX_T1 24 4/1 400-800 Min 1 256x256
AX T2 FS -
Angle to SI
Joints
AX_T2_FS 24 4/1 >2000 70-80 2 256x256
SAG T2 (no FS) -
Angle to SI
joint
SAT_T2 24 4/1 >3000 70-80 2 256x256
Ax T1 FS PreAX_T1_FS_
PRE24 4/1 400-800 Min 1 256x256
Ax T1 FS PostAX_T1_FS_
POST24 4/1 400-800 Min 1 256x256
Cor T1 FS PostCOR_T1_FS_
POST24 4/1 400-800 Min 1 256x256
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane
LocatorSCOUT 50 8 15 5 1 256x128
Coronal STIR
Large FOVCOR_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192
Coronal T1
Large FOVCOR_T1 36-40 4/1 400-800 Min 1 256x256
Axial T2 FS
Large FOVAX_T2_FS 36-40 4/1 >2000 70-80 2 256x256
Sagittal T2 FS SAG_T2_FS 36-40 4/1 >2000 70-80 2 256x256
Axial Oblique
PDAX_OBL_PD 20 4/1 >2000 30-40 2 256x256
Axial Oblique
T2 FS
AX_OBL_T2_
FS20 4/1 >2000 70-80 2 256x256
SI Joints
Sports HerniaComments:
Center on symphysis pubis and have patient empty bladder prior to scanning.
Axial: Scan from superior acetabulum thru symphysis pubis.
Coronal: Use an angle parallel with symphysis pubis and scan from back of ischial tuberosities thru pubis.
Sagittal: Angle perpendicular to coronal plane and scan from left thru right ischial tuberosities.
Axial Obl: Angle parallel to anterior ilio-pubic cortex and scan from back of acetabulum thru soft tissue anteriorly.
Optional: * if ordered with gad
35 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm)
Slice
ThicknessTR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial STIR
Whole PelvisCoronal T1
Whole PelvisCOR_T1 36-40 5/1 400-800 Min 1 256x256
Axial T1 AX_T1 36-40 6/1 400-800 Min 1 256x256
Sagittal T2 FS SAG_T2_FS 36-40 4/1 >2000 70-80 2 256-256
Axial T1 FS
PreGd
AX_T1_FS_
PRE36-40 4/0.4 400-800 Min 1 256x256
Axial T1 FSAX_T1_FS_
POST36-40 4/0.4 400-800 Min 1 256x256
Coronal T1 FS
PostGd
COR_T1_FS_
POST36-40 4/0.4 400-500 Min 1 256x256
Comments:
Ok to expand FOV as necessary to include entire pelvis if needed
HIP: Bone Lesion, Soft Tissue mass, Infection, Osteomyelitis
36 07/2018
MRI Protocols
Lower Extremity
Bony Pelvis - AxialFOV = 30-40 cm
Localizer: Coronal
Figure 37. The scan plane is parallel to a line along the top of the femoral heads. Scan from the iliac crests through the ischial tuberosities.
Bony Pelvis - Axial. Final Image.
37 07/2018
MRI Protocols
Lower Extremity
Bony Pelvis - CoronalFOV = 30-40 cm
Localizer: Axial
Figure 38. The scan plane is parallel to a line connecting the femoral heads. Scan to include all bones.
Bony Pelvis -Coronal. Final Image.
38 07/2018
MRI Protocols
Lower Extremity
Bony Pelvis - SagittalFOV = 20-26 cm
Localizer: Coronal
Figure 39. The scan plane is perpendicular to a line along the top of the femoral heads. Scan from the iliac crests through the ischial tuberosities.
Bony Pelvis -Sagittal. Final Image.
39 07/2018
MRI Protocols
Lower Extremity
Localizer: Sagittal
Bony Pelvis - Athletic Pubalgia/"Sports Hernia" - Axial ObliqueFOV = 20 cm
Figure 40. The scan plane is along the anterior iliac crest near the lateral margin of the femoral head.
Athletic Pubalggia/"Sports Hernia" -Axial Oblique. Final Image.
Figure 41.
40 07/2018
MRI Protocols
Lower Extremity
Sacrum or Sacroilian Joints - Coronal ObliqueFOV = 18-24 cm
Figure 42.
Figure 43.
Sacrum/Sacroilian Joints -Coronal Oblique. Final Image.
41 07/2018
MRI Protocols
Lower Extremity
Hip - AxialLarge FOV = 34-40 cm (include both hips and pelvis)
Normal FOV for one side = 14-18 cm
Localizer: Coronal
Draw a line actoss tops of both femoral heads or estimate this line if localizer only of one hip. Scan superiorly to include
acetabulum and inferiorly to include all of the lesser trochanger. Scan medially to include pubic symphysis and laterally
to include all bones, muscles and any fluid collection. Lateral subcutaneous fat may be excluded. If the pubic symphysis
is not included on the acials, it should definitely be included on the coronals.
Figure 44. The scan plane is parallel to a line along the top of the femoral heads.
Hip - Axial. Final Image.
42 07/2018
MRI Protocols
Lower Extremity
Hip - CoronalLarge FOV = 34-40 cm (include both hips and pelvis)
Normal FOV for one side = 14-18 cm
Localizer: Axial
The medial margin of the scan is the first part of the opposite pubic bone (i.e., just barely include both sides of the
pubic symphysis).
The lateral margin of the scan is just lateral to the greater trochanter, to include all of the gluteal tendons and any
trochangeric fluid collection.
Anteriorly, scan to includ the pubic symphysis.
Posteriorly, scan to include the ischial tuberosities.
Hip - Coronal.Final Image.
Figure 45.
43 07/2018
MRI Protocols
Lower Extremity
Large FOV = 34-40 cm (include both hips and pelvis)
Normal FOV for one side = 14-18 cm
Localizer: Coronal
Draw a line across tops of both femoral heads or estimate this line if localizer only of one hip.
Scan medially to include whole hip joint.
Scan laterally just past greater trochanter. It is not necessary to go all the way to skin unless there is a mass, abscess,
fluid collection, etc.
Hip - Sagittal
Figure 46. The scan plane is perpendicular to a line along the top of the femoral heads. Scan from the iliac crests through the ischial tuberosities.
Hip - Sagittal. Final Image.
44 07/2018
MRI Protocols
Lower Extremity
Hip - Axial Oblique(Femoroacetabular impingement [FAI] and labrum sequence)
Figure 48. This sequence can be a challenge to master. Notice how the lines do not go quite "down the barrel" of the femoral neck.
Hip -Axial Oblique Final Image.
Figure 47.
45 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256
Coronal T1 COR_T1 36-40 4/1 400-800 Min 1 256x256
Coronal STIR (include both legs)
COR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192
Sagittal STIR SAG_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane
LocatorSCOUT 45 10 15 5 1 256x128
Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256
Coronal T1 COR_T1 36-40 4/1 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192
Axial T1 FS Pre
GdAX_T1_FS_PRE 14-20 5/1 400-800 Min 1 256x256
Axial T1 FS
Post GdAX_T1_FS_POST 14-20 5/1 400-800 Min 1 256x256
Sag or Cor T1
FS Post Gd
SAG or
COR_T1_FS_
POST
36-40 4/1 400-800 Min 1 256x256
FemurOverview
Bracket region of interest with vitamin marker(s). Do not press markers into the skin as this can distort anatomy and local blood
flow.
Axial images should slice the long bones like a straight-cut loaf of bread.
AXIAL - Slice thickness/Gap:
6mm/2mm for diffuse pain or no specific lesion.
(less than or equal to) 4mm/(less than or equal to) 1 mm for mass/lump/lesion. (include lesion and at least 3 slices about and 3
slices below.
Protocol Indications
Choose coronal OR sagittal post gad to show mass. If mass is dorsal/ventral choose sagittal. If mass is medial/lateral choose
coronal.
Routine Femur/Thigh
Soft Tissue Mass or Bone Lesion, Infection
Routine Femur/Thigh Pain/Injury/Muscle Strain/Stress Fracture
Positioning
Soft Tissue Mass or Bone Lesion, Infection
Hamstring/Quads/Tear/Thigh
Sequence Parameters
FEMUR - Use the KNEE scan planes.
46 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256
Coronal T1 COR_T1 36-40 4/1 400-800 Min 1 256x256
Coronal STIR (include both legs)
COR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192
Sagittal STIR SAG_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192
Hamstring/Quads/Tear/Thigh
47 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or L ShiftSCOUT 28 8 15 5ms 1 256x128
Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
Sagittal PD FS SAG_PD_FS 14-16 3/0.3 2000-2500 20-30 2 256x256
Sagittal T1 SAG_T1 14-16 3/0.3 400-800 Min 1 256x256
Sagittal 3D GRE SAG_GRE 14-16 3/0.3
Coronal PD FS COR_PD_FS 14-16 3/0.3 2000-2500 20-30 2 256x256
Sagittal
Oblique ACLSAG_OBL_ACL 14 3 2500 70 1 256x256
Sagittal STIR SAG_STIR 14 4 6000 90 2 256x192
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scour
R or L ShiftSCOUT 28 8 15 5 1 256x128
Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
Sagittal PD FS SAG_PD_FS 14-16 3/0.3 2000-2500 20-30 2 256x256
Sagittal T1 FS SAG_T1_FS 14-16 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 16-18 3/0.3 >3000 70-80 2 256x256
Coronal T1 FS COR_T1_FS 16-18 3/0.3 400-800 Min 1 256x256
Sagittal T1 SAG_T1 14-16 3/0.3 400-800 Min 1 256x256
KneeOverview
Axial and Sagittal FOV = 14-16 cm
Coronal FOV = 16-18 cm
Knee Axial Knee Coronal Knee Sagittal
Protocol Indications
Routine Knee Meniscal Tear/Medial or Lateral Ligament Tear/ACL/PCL
Arthrogram Meinscal Re-Tear; Intra-articular Body
Sequence Parameters
Pre and Post Gadolinioum Knee Mass, infection, osteomyelitis
Popliteal Artery Entrapment
Pain, Routine
Arthrogram
Per Scanner
Optional: * If reported history includes: acute inury, OCD, loose body, torn cartilage add Sagittal Stir
48 04/2020
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or L ShiftSCOUT 28 8 15 5 1 256x128
Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
Sagittal STIR SAG_STIR 14-16 3/0.3 4000-6000 60-90 2-3 256x192
Sagittal T1 SAG_T1 14-16 3/0.3 400-800 Min 1 256x256
Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256
Axial T1 FS Pre-
GdAX_T1_FS_ PRE 14-16 3/0.3 400-800 Min 1 256x256
Axial T1 FS
Post-GdAX_T1_FS_ POST 14-16 3/0.3 400-800 Min 1 256x256
Coronal T1 FS
Post-Gd
COR_T1_FS_
POST14-16 3/0.3 400-800 Min 1 256x256
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or L ShiftSCOUT 28 8 15 5 1 256x128
Axial T1
NeutralAX_T1_NEUTRAL 36 6 470 2.3
Axial T2 FS
Neutral
AX_T2_FS_
NEUTRAL6 3000 60 1
Axial T2 FS
Toes Down
AX_T2_FS_
STRESSED36 6 3000 60 1
Twist Post
Neutral
TW_POST_
NEUTRAL40 2 12-15 phases
Axial T1 FS
Post Neutral
AX_T1_FS_POST_
NEUTRAL36 6 470 2.3 1
Twist Post
Stressed
TW_POST_
STRESSED40 2 12-15 phases
Axial T1 FS
Post Stressed
AX_T1_FS_POST_
STRESSED36 6 470 2.3 1
Popliteal Artery Entrapment
Infection, Osteomyelitis, Mass, Bone Lesion
49 04/2020
MRI Protocols
Lower Extremity
Knee - CoronalLocalizer - Axial
Figure 51. Draw a line parallel to the posterior margin of femoral condyles. Include patella anteriorly through popliteal vessels posteriouly.
Figure 52. In this example, the plane section is incorrectly set as parallel to the table, not to the posterior margin of the femoral condyles.
Knee - Coronal. Final Image.
50 07/2018
MRI Protocols
Lower Extremity
Knee - SagittalLocalizer - Axial
Figure 53. The scan plane is perpendicular to the coronal plane along the posterior margin of the femoral condyles. Include all bones.
Figure 54. In this example, the plane of secion is incorrectly set relative to the table instead of to the
Knee - Sagittal. Final Image.
51 07/2018
MRI Protocols
Lower Extremity
Localizer: Coronal and Sagittal
Knee - Axial
Figure 55. Scan parallel to the femoralcondyles. Cover 2 cm superior to the patella through the attachment of the patellar tendon on the tibia.
Figure 56. Scan parallel to the femoral condyles.
Knee - Axial. Final Image.
52 07/2018
MRI Protocols
Lower Extremity
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout SCOUT 45 10 15 5 1 256x128
Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256
Coronal T1 COR_T1 36-40 4/1 400-800 Min 1 256x256
Coronal STIR (include both legs)
COR_STIR 36-40 5/1 4000-6000 60-90 2-3 256x192
Sagittal STIR SAG_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane
LocatorSCOUT 45 10 15 5 1 256x128
Axial T1 AX_T1 14-20 5/1 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 14-20 5/1 >3000 70-80 2 256x256
Coronal T1 COR_T1 36-40 4/1 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 36-40 4/1 4000-6000 60-90 2-3 256x192
Axial T1 FS Pre
GdAX_T1_FS_PRE 14-20 5/1 400-800 Min 1 256x256
Axial T1 FS
Post Gd
AX_T1_FS_
POST14-20 5/1 400-800 Min 1 256x256
Sag or Cor T1
FS Post Gd
SAG or
COR_T1_FS_
POST
36-40 4/1 400-800 Min 1 256x256
Tibia/FibulaOverview
Bracket region of interest with vitamin marker(s). Do not press markers into the skin as this can distort anatomy and local blood
flow.
Axial images should slice the long bones like a straight-cut loaf of bread.
AXIAL - Slice thickness/Gap:
6mm/2mm for diffuse pain or no specific lesion.
(less than or equal to) 4mm/(less than or equal to) 1 mm for mass/lump/lesion. (include lesion and at least 3 slices about and 3
slices below.
Tibia/Fibula Axial Tibia/Fibula Coronal Tibia/Fibula Sagittal
Protocol Indications
Soft Tissue Mass or Bone Lesion, Infection
Soft Tissue Mass or Bone Lesion, InfectionChoose coronal OR sagittal post gad to show mass. If mass is dorsal/ventral choose sagittal. If mass is medial/lateral choose
coronal.
Routine Tibia/Fibular
Sequence Parameters
Routine Tibia/Fibular Pain/Injury/Muscle Strain/Stress Fracture
PositioningTIBIA/FIBULA - For distal pain, use ANKLE/HINDFOOT scan planes (see sample images). For proximal pain, use KNEE scan
planes.
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Tibia/Fibula - Axial
Tibia/Fibula - Coronal
Figure 48.
Figure 49.
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Tibia/Fibula - Sagittal
Figure 50.
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Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8 15ms Min 1 256x128
Sagittal T1 SAG_T1 16 4/0.4 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 16 4/0.4 4000-6000 60-90 2-3 256x256
Coronal PD FS COR_PD_FS 14 4/0.4 2000-2500 20-30 2 256x256
Coronal T1 COR_T1 14-16 4/0.4 400-800 Min 1
Axial T2 FS AX_T2_FS 14-16 4/0.4 >3000 70-80 2 256x256
Axial Oblique
PD FSAX_OBL_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256
Sagittal 3D T2
GRESAG_3D_ GRE 16-18 1
Coronal 3D T2
GRECOR_3D_ GRE 14-16 1
Coronal T2 FS COR_T2_FS 14 4/0.4 >3000 70-80 2 256x256
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8 15 5 1 256x128
Sagittal T1 SAG_T1 18 4/0.4 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 18 4/0.4 4000-6000 60-90 2-3 256x192
Coronal PD FS COR_PD_FS 18 4/0.4 2000-2500 20-30 2 256x256
Axial T2 FS AX_T2_FS 14-16 4/0.4 >3000 70-80 2 256x256
Axial T1 AX_T1 14-16 4/0.4 400-800 Min 1 256x256
Axial Oblique
PD FSAX_OBL_PD_FS 14-16 4/0.4 2000-2500 20-30 2 256x256
Per Scanner
Per Scanner
Optional: *If OCD/AVN/TALAR DOME, add Coronal T2 FS
2. SAGITTAL Sequences: Perpendicular to Axial sequences. Superior SatBand for STIR and T1. Use Axial LOC and find the distal-most
tendon and angle perpendicular to long axis of tendon. Center in the mid-Achilles tendon and use the slices given.
3. CORONAL Sequences: Perpendicular to sagittal sequences.
Routine Ankle
Supine with foot relaxed (approximately 90 degrees) and toes pointing up. Center coil at the malleoli.
Have foot relaxed and use sponges to reduce motion artifact.
Coverage includes proximal tendons.
For Achilles Tendon:
Larger coverage of lower calf. Supine with plantar flexion. Lift the other leg out of the way to prevent wrap.
Sequence Parameters
Optional: *If says coalition, add Coronal 3D GRE and Sagittal 3D GRE
Achilles Tendon1. AXIAL Seuqences: Use sagittal LOC and angle perpendicular to the Achilles tendon. Cover entire calcaneous up as proximal as the slices
go. Parallel Sat Bands for T2 and Superior Sat band for STIR.
Achilles Tendon
Positioning
Protocol IndicationsRoutine Ankle Pain/Sprain/Plantar fasciitis/tendon injury except for Achilles
Coalition
OCD/AVN/Talar Dome
Arthrogram
Pre and Post Gadolinium Osteomyelitis/mass/infection
Ankle/HindfootOverview
Coronal FOV = 10-14 cm, Axial and Sagittal FOV = 12-16 cm
Ankle/Hindfoot: Axial refers to the short axis of the tibia and fibula. Coronal refers to the long axis of the tibia and fibula.
If the Achilles tendon is torn, exten the scan superiorly to include the whole tear on Axial and Sagittal sequences.
Ankle/Hindfoot Axial Ankle/Hindfoot Axial Oblique Ankle/Hindfoot Coronal Ankle/Hindfoot Sagittal
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Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
Sm. FOVSCOUT_SM 20 8 15 5 1 256x128
Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256
Coronal T1 FS COR_T1_FS 14 3/0.3 400-800 Min 1 256x256
Sagittal T1 FS SAG_T1_FS 16 3/0.3 400-800 Min 1 256x256
Sagittal PD FS SAG_PD_FS 16 3/0.3 2000-2500 20-30 2 256x256
Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
If clinical concern is a toe ulcer, center on forefoot and include midfoot. If clinical concern is a heel ulcer, perform a hindfoot
****DO IN THIS ORDER IF POSSIBLE. IF LOTS OF MOTION, THIS ORDER WILL MAXIMIZE OUR ABILITY TO ANSWER CLINICAL QUESTIONS****
WITH AND
WITHOUT
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8mm 15 5 1 256x128
Sagittal T1 SAG_T1 16-18 3/0.3 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 16-18 3/0.3 4000-6000 60-90 2-3 256x192
Cor T1 COR_T1 14-16 3/0.3 400-800 Min 1 256x256
Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
Axial T1 FS
PreGdAX_T1_FS_ PRE 14-16 3/0.3 400-800 Min 1 256x256
Axial T1 FS
PostGd
AX_T1_FS_
POST14-16 3/0.3 400-800 Min 1 256x256
Cor or Sag T1
FS Post Gd
COR or
SAG_T1_FS_
POST
14 3/0.3 400-800 Min 1 256x256
WITHOUT
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8mm 15 5 1 256x128
Sagittal T1 SAG_T1 16-18 3/0.3 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 16-18 3/0.3 4000-6000 60-90 2-3 256x192
Cor T1 COR_T1 14-16 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
Axial T2 FS AX_T2_FS 14-16 3/0.3 >3000 70-80 2 256x256
Axial T1 AX_T1 14-16 3/0.3 400-800 Min 1 256x256
Soft Tissue Mass, Infection, OsteomyelitisComments:
Ankle Arthrogram
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Ankle/Hindfoot - AxialLocalizer - Satittal
Figure 57. Scan parallel to the long axis of the calcaneus. This is often the same plane as the
Figure 58. This graphic shows the ankle in varying degrees of flexion. If the ankle cannot be placed in the neutral position, adjust the scan plane along the long axias of the calcaneus as shown.
Ankle/Hindfoot - Axial.
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Ankle/Hindfoot - CoronalLocalizer - Axial
Figure 59. Use an image with both medial and lateral malleoli visible. The scan plane should split each of the three bones approximately in half. Cover the base of the metatarsals to the posterior
Figure 60.
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Ankle/Hindfoot - CoronalLocalizer - Axial
Figure 61. In this example, the plane of section is incorrectly set as parallel to the table, not with respect
to the axis of the talus.
Ankle/Hindfoot -Coronal. Final Image.
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Ankle/Hindfoot - SagittalLocalizer - Axial
Figure 62. The scan plane is perpendicular to the coronals. Scan medial to lateral to include all bones.
Figure 63. In this example, the plane section is incorrectly set as perpendicular to the table, not to the axis of the talus.
Ankle/Hindfoot - Sagittal. Final Image.
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Ankle/Hindfoot - Axial Oblique (Tendon Sequence)Localizer - Sagittal
Figire 64. Ankle/Hindfoot - Axial Oblique (Tendon Sequence)
Figure 65. In this example, the plane of sectionis incorrectly set at the wrong 45 degree angle to axial plane.
Ankle/Hindfoot - Axial Oblique (Tendon Sequence) Final Image.
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Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8 mm 15 5 1 256x128
Axial T1 AX_T1 12-14 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 12-14 3/0.3 >3000 70-80 2 256x256
Coronal T1 COR_T1 12 3/0.3 400-800 Min 1 256x256
Coronal PD FS COR_PD_FS 12 3/0.3 2000-2500 20-30 2 256x256
Sagittal STIR SAG_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8mm 15 5 1 256x128
Axial T1 AX_T1 12-14 3/0.3 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 12-14 3/0.3 >3000 70-80 2 256x256
Coronal T1 COR_T1 12 3/0.3 400-800 Min 1 256x256
Coronal PD FS COR_PD_FS 12 3/0.3 2000-2500 20-30 2 256x256
Sagittal STIR SAG_STIR 12-14 3/0.3 4000-6000 60-90 2-3 256x192
Axial T1 FS
PreGdAX_T1_FS_PRE 12 3/0.3 400-800 Min 1 256x256
Axial T1 FS
Post Gd
AX_T1_FS_
POST12 3/0.3 400-800 Min 1 256x256
Osteomyelitis/Infection/Mass
FootOverview
Midfoot/Forefoot Axial is through the short axis of the metatarsals (i.e., slicing metatarsals like a loaf of bread). Coronal is
through the long axis of the metatarsals (i.e., a cut of the entire metatarsal shaft is visible on one image).
Foot - Axial Short Axis Foot - Coronal Long Axis Foot - Sagittal
Protocol IndicationsRoutine Foot Pain/Stress Fracture/Fracture/Lisfranc Injury
Pre and Post Gadolinium Foot Morton's Neuroma
Plantar Plate
Positioning
Hindfoot - Use the ankle protocol and positioning for the hindfoot. Sample indications: plantar fasciitis, calcaneus fracture,
tarsal coalition, peroneal tendon evaluation.
Midfoot - Cover from the MTP joints through the Chopart joint (talonavicular and calcaneocuboid joints). Sample indication:
metatarsal stress fracture.
Forefoot - Cover tips of the toes through the metatarsals. Sample indications: Morton's Neuroma, Toe Ulcer, Plantar Plate
Injury.
Sequence ParametersRoutine Foot
Morton's NeuromaComments: Always centered on the forefoot
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WITHOUT AND
WITH
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8mm 15 5 1 256x128
Axial T1 AX_T1 12-14 3/0.5 400-800 Min 1 256x256
Axial T1 FS
PreGdAX_T1_FS_PRE 12-14 3/0.5 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 12-14 3/0.5 >2000 70-80 2 256x256
Sagittal T1 SAG_T1 12-14 3/0.5 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 12-14 3/0.5 4000-6000 60-90 2-3 256x192
Coronal T1 COR_T1 12 3/0.3 400-800 Min 1 256x256
Axial T1 FS
PostGd
AX_T1_FS_
POST12-14 3/0.5 400-800 Min 1 256x256
Cor or Sag T1
FS Post Gd
COR or
SAG_T1_FS_
POST
10 3/0.5 400-800 Min 1 256x256
WITHOUT
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8mm 15 5 1 256x128
Axial T1 AX_T1 12-14 3/0.5 400-800 Min 1 256x256
Axial T2 FS AX_T2_FS 12-14 3/0.5 >2000 70-80 2 256x256
Sagittal T1 SAG_T1 12-14 3/0.5 400-800 Min 1 256x256
Sagittal STIR SAG_STIR 12-14 3/0.5 4000-6000 60-90 2-3 256x192
Coronal T1 COT_T1 12 3/0.3 400-800 Min 1 256x256
Coronal T2 FS COR_T2_FS 12 3/0.5 >2000 70-80 2 256x256
Comments:
Sequence
Parameters
Series
DescriptionFOV (cm) Slice Thickness TR (ms) TE (ms) Avgs Resolution
3-Plane Scout
R or LSCOUT 26 8mm 15 5 1 256x128
Axial T1 AX_T1 8-10 3/0.3 400-800 Min 1 256x256
Axial PD FS AX_PD_FS 8-10 3/0.3 2000-2500 20-30 2 256x256
Sagittal PD SAG_PD 8-10 3/0.3 2000-2500 20-30 1 256x256
Sagittal STIR SAG_STIR 8-10 3/0.3 4000-6000 60-90 2-3 256x192
Coronal T1 COR_T1 10 3/0.3 2000-2500 20-30 1 256x256
Coronal PD FS COR_PD_FS 10 3/0.3 2000-2500 20-30 2 256x256
Plantar Plate
Most exams will be centered at the 1st MTP joint. If other toe indicated center on the appropriate MTP joint. All imaging planes
angled to MTP joint. Sagittal images to cover the affected MTP joint.
Soft Tissue Mass, Infection, Osteomyelitis
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Foot - Axial (Short Axis)Localizer - Sagittal and Coronal
Figure 66. Short axis axial images are perpendicular to the metatarsal shaft. The plane slices the metatarsals like a straight-cut loaf of bread, not like a sloped-cut loaf of bread.
Figure 68.
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Foot - Axial (Short Axis)Localizer - Sagittal and Coronal
Figure 69. In this example, the plane of section is incorrectly set relative to the table and not to the axis of the metatarsals. The "slices of bread" are sloped.
Foot - Axial (Short Axis). Final Image.
Figure 70.
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Foot - Coronal (Long Axis)Localizers - Axial and Sagittal
Figure 71. Choose an axial localizer image at the midpoint of the metatarsal shafts. Draw a line that roughly connects the 2nd through 5th
Figure 72. In this example, the plane of section is incorrectly set as parallel to the table, not with respect to the axis of the metatarsals.
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Foot - Coronal (Long Axis)Localizers - Axial and Sagittal
Foot - Coronal (long axis) Final image.
Figure 73.
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Foot - SagittalLocalizers - Axial and Sagittal
Figure 74. Choose an axial localizer image at the midpoint of the metatarsal shafts. Draw a line that roughly connects the 2nd through 5th metatarsals. The scan plane is perpendicular to this line.
Figure 75. In this example, the plane of section is incorrectly set as perpendicular to the table, not with respect to the metatarsals.
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Localizers - Axial and Sagittal
Foot - Sagittal
Foot - Sagittal. Final Image.
Figure 76.
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