Musculoskeletal CT Protocols

General Indications
• Detect—or rule out—spinal column damage in patients who
have been injured.
• Evaluate the spine before and after surgery.
• Detect various types of tumors in the vertebral column
• Help diagnose spinal pain
• Assess for congenital anomalies of the spine.
 Preparation

Patient preparation:
For routine test
 Explaining the procedure to the patient
 Removal any metallic object in the area of examination

Contrast:
– No contrast in routine examination
 Protocols
• Positioning:
– Supine feet first or head first
– Arms above the head
– The knees flexed 30º
 Protocols
• Parameters: Block scan
o Scout lateral
o Starting at Xyphoid process
o Ending at the level of hip joint
o Scan type (helical for routine
– axial for intervertebral disc)
o Respiration suspended in
expiration
o Gantry tilt: 0º (for helical
scan). OR parallel to the disc
space ( axial)
o Slice thickness:3mm

Scan through IVD spaces

Bone window Soft-tissue window
UPPER EXTREMITY
 SHOULDER
- Positioning
o Patient supine
o Affected arm by side of
body
o Contra-lateral arm raised
above head
- Indication
o Trauma
 SHOULDER
- Parameters:
• Scout: AP
• Scan type: helical
• Slice thick: 1.25 – 2 mm
• Cover from AC joint through proximal humeral diaphysis
• Bone and soft tissue window
 SHOULDER
Relevant Anatomy Scanning Plane (Axial)

AC joint
 ELBOW
- Positioning
• Patient supine
• Affected elbow is above
the head
• Unaffected arm by side
• Palm up
- Indication
•Trauma Elbow of concern is above the head
 ELBOW
Parameters:
• Scout: AP
• Scan type: helical Radial head Ulna

• Slice thick: 1.25 – 2 mm Radial tuberosity

• Coverage Scan from distal

humeral shaft to just past radial tuberosity.
• Bone and soft tissue window
 WRIST
- Positioning
•Patient prone
•Affected arm above head
•Arm as straight as possible
• Palm down
•Wrist centered in gantry
-Indications
• Trauma
 WRIST
Parameters:
• Scout: AP
• Scan type: helical
• Slice thick: 1.25 – 2 mm
•Bone and soft tissue
window
LOWER EXTREMITY
 HIP

- Positioning
•Patient Supine
•Legs flat on table
- Indications
•Trauma
 HIP
Parameters:
• Scout: AP
• Gantry tilt: 0⁰
• Scan type: helical
• Slice thick: 1.25 – 2 mm
• Bone and soft tissue
window
 KNEE
- Positioning:
• Patient supine with feet
first into scanner
• Keeps knees extended,
side-by-side
• Slide patient so that
knee being scanned is in
center of table
- Indications
• Trauma
 KNEE
Parameters:
• Scout: A.P Scanning Plane

• Gantry tilt: 0⁰
• Scan type: helical
• Slice thick: 1.25 – 2 mm
• Bone and soft tissue
window
 ANKLE
- Positioning:
• Patient supine
• Center in scanner foot of interest
• Use foot holder if available
• If imaging both feet, bring them
together
• Toes pointing straight up
• Foot inverted slightly
- Indications
• Trauma
 ANKLE
Parameters:
• Scout: lateral
• Scan type: helical
• Slice thick: 1.25 – 2 mm
• Bone and soft tisse
window
 FOOT

- Positioning
• Patient supine
• Center in scanner foot of
interest
• Use foot holder if
available
• If imaging both feet, bring
them together
• Toes pointing straight up
• Foot inverted slightly
 FOOT
Parameters:
• Scout: lateral
• Scan type: helical
• Slice thick: 1.25 – 2 mm
• Bone and soft tissue
window