ct imaging of musculoskeletal system with protocol

1. MAAJID MOHI UD DIN MALIK
LECTURER COPMS,
ADESH UNIVERSITY, BATHINDA
PUNJAB

2.  The human musculoskeletal system (also
known as the locomotor system, and
previously the activity system) is an organ
system that gives humans the ability to move
using their muscular and skeletal systems. The
musculoskeletal system provides form,
support, stability, and movement to the body.

3.  It is made up of the bones of
the skeleton, muscles, cartilage, tendons, ligam
ents, joints, and other connective tissue that
supports and binds tissues and organs
together. The musculoskeletal system's
primary functions include supporting the
body, allowing motion, and protecting vital
organs. The skeletal portion of the system
serves as the main storage system
for calcium and phosphorus and contains
critical components of the hematopoietic
system.

4.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- Head first, spine with
ipsilaterial arm bedside the trunk and
contralateral shoulder slightly up.
 Topogram position/Landmark-
Anteroposterior;3cm superior to shoulder joint.
 Mode of scanning- Helical
 Scan orientation- Craniocaudal.

5.  Starting location- 1cm above the highest point
at the shoulder joint.
 End location- Neck of the Humerus.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the shoulder
joint including the acromioclavicular joint
including soft tissues.
 Contrast Administration- IV (optional-in case
of mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

6.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

10.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- spine with feet first,
 Topogram position/Landmark-
Anteroposterior;3cm level of the umbilicus.
 Mode of scanning- Helical
 Scan orientation- Craniocaudal.

11.  Starting location- 3cm above the acetabular
roof.
 End location- Up to the lesser Trochanter of the
femur.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the hip joint
including soft tissues.
 Contrast Administration- IV (optional-in case
of mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

12.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

15.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- prone with head first, with the
hand of interest elevated above the head lying in
pronated position. The other hand lies by the side
of the trunk.
 Topogram position/Landmark-
Anteroposterior;3cm superior distal limit of the
head.
 Mode of scanning- Helical
 Scan orientation- Distal to proximal.

16.  Starting location- Base of the Metacarpal.
 End location- Proximal limit of the distal Radio
ulnar joint.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the wrist joint
including soft tissues.
 Contrast Administration- IV (optional-in case
of mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

17.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

20.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- Spine with feet first, with
partial flexion at the knee joint.
 Topogram position/Landmark-
Anteroposterior;3cm superior to the shoulder
joint.
 Mode of scanning- Helical
 Scan orientation- Craniocaudal.

21.  Starting location- 1 cm above the superior limit of
the distal tibofibular joint,
 End location- 1cm distal to the calcaneocubiod
joint.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the ankle joint
including the distal tibofibular, calcaneocubiod
and talonavicular joint including he soft tissues.
 Contrast Administration- IV (optional-in case of
mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

22.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

25.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- Spine with feet first, in
extension.
 Topogram position/Landmark-
Anteroposterior;3cm superior to the knee joint.
 Mode of scanning- Helical
 Scan orientation- Craniocaudal.

26.  Starting location- The proximal limit of the
interocondylar line including proximal limit of the
Patella as well.
 End location- Distal limit of the proximal
tibofibular joint.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the knee joint
including the patellofemoral and the soft tissues.
 Contrast Administration- IV (optional-in case of
mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

27.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

31.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- Spine with head first with
the arms of interest elevated above the head
,the contralateral arm by the side of the chest.
 Topogram position/Landmark-
Anteroposterior; mid of the arm.
 Mode of scanning- Helical
 Scan orientation- Proximal to distal.

32.  Starting location- 2-3 cm above the superior
limit of the olecranon fossa.
 End location- Up to the radial head.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the elbow joint
including the soft tissues.
 Contrast Administration- IV (optional-in case
of mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

33.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

36.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- Spine with head or first
with the knees in extension.
 Topogram position/Landmark-
Anteroposterior; the level of umbilicus.
 Mode of scanning- Helical
 Scan orientation- craniocaudal.

37.  Starting location- The highest point on the iliac
crest.
 End location- Intertrochanteric region
bilaterally.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the pelvis
including the soft tissues.
 Contrast Administration- IV (optional-in case
of mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

38.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

42.  Indications- Suspected occult fracture, complex
fracture, preoperative baseline evaluation and
postsurgical /postarthroscope evaluation.
 Patient positioning- Head first or feet first,
supine or prone.
 Topogram position/Landmark-
Anteroposterior; landmark is decided by
radiologist or radiographer to include the
anatomic region of interest.
 Mode of scanning- Helical
 Scan orientation- Proximal to Distal.

43.  Starting location- 2-3cm above the superior
limit of region of interest.
 End location- 2-3cm above the superior limit of
region of interest.
 Gantry tilt- Nil.
 FOV- Just fitting the region of the interest
including the soft tissues.
 Contrast Administration- IV (optional-in case
of mass lesion)
 Volume of contrast- 60-80mL.
 Rate of Injection- 2-3mL/sec.
 Scan delay- 40-50 sec.

44.  Slice thickness in reconstruction-1-2.
 Slick interval- 0.5-1.0mm.
 3D reconstructions- MRP, thick and thin MIP.

49. Indications-
 Cartilaginous intra-articular bodies
 Cartilage defect
 Fracture fragments
 Synovial abnormalities
 Ligamentous disruption.
Injectate used
 Nonionic contrast, full strength 300mg/ml.
 Can also inject iodocaine or long acting
anesthetic for diagnostic exam.

50. Injection volumes
Upper Extremity
 Shoulder- 12-15cc
 Elbow- 7-10cc.
Wrist
 Radio carpal joint- 3-4cc.
 Midacarpal joint- 3-4cc.
 Distal Radial Ulnar joint- 1-2 cc.
Lower Extremity
 Hip– 10-12 cc.
 Knee- 20-30cc.
 Ankle- 7-12cc.

51. Ct Arthrogram - Wrist
Same positioning as regular wrist
 Patient prone.
 Arm overhead.
 Arm as straight as possible.
 Wrist centered in gantry.
 Scan as regular wrist with 0.5-0.6mm or
0.2mm axial, coronal and sagittal reformates.
 In addition, use the coronal images to obtain
reconstructed images.

52. Scanning plane
 For SL (scapholunate) ligament evaluation- Parallel to
the scapholunate articulation.
 For LT( lunatotriquetral) ligament evaluation-
perpendicular to lunatotriquetral articulations.
 May wish to obtain second scan in ulnar deviation to
evaluate SL ligament and radial deviation for LT
ligament.