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3-PLANE LOCALIZER | Calibration Scan BH | AXL T1 BILAT | AXL IR BILAT HIPS | COR IR BILAT HIPS | COR T1 BILAT | SAG PD HIP (affected) |
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IMAGING PARAMETERS
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Plane
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3-PLANE | AXIAL | AXIAL | AXIAL | CORONAL | CORONAL | SAGITTAL |
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Mode
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2D | 2D | 2D | 2D | 2D | 2D | 2D |
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Pulse Seq
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Fiesta | Gradient Echo | FSE-XL | IR | IR | FSE-XL | FSE-XL |
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PSD Name
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-- | -- | -- | -- | -- | -- | -- |
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Imaging Options
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Seq Fast | Fast Calib | FC NPW TRF Fast ZIP512 | FC NPW Seq TRF Fast | NPW Seq TRF Fast | FC NPW TRF Fast ZIP512 |
NPW TRF Fast ZIP512 |
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SCAN TIMING
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# of Echoes
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1 | 1 | 1 | 1 | 1 | 1 | 1 |
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TE
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Minimum |
-- | Min Full | 130.0 | 130.0 | Min Full | 17.0 |
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TR
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-- |
-- | 650.0 | 3000.0 | 6000.0 | 650.0 | 2000.0 |
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Flip Angle
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45 | -- | -- | -- | -- | -- | -- |
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Bandwidth
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125.00 |
-- | 20.83 | 31.25 | 31.25 | 20.83 | 25.00 |
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ADDITIONAL PARAMETERS (see attached instructions)
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SAT
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ACQUISITION TIMING
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Freq
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256 |
-- | 256 | 256 | 256 | 256 | 256 |
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Phase
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128 | -- |
192 | 192 | 192 | 192 | 192 |
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NEX
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1.00 |
-- | 2.00 | 3.00 | 3.00 | 2.00 | 2.00 |
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Phase FOV
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1.00 | -- | -- | -- | -- | -- | -- |
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Locs Before Pause
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0 | -- | 0 | 0 | -- | 0 | -- |
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Freq Dir
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Unswap | A/P | A/P | A/P | R/L | S/I | A/P |
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Auto Center Freq
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Auto Shim
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Auto | Auto | Auto | Auto | Auto | Auto | Auto |
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Contrast
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No | No | No | No | No | No | No |
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SCANNING RANGE
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FOV
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48.0 | 48.0 | 40.0 | 30.0 | 30.0 | 40.0 | 20.0 |
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Slice Thickness
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5.0 | 8.0 | 6.0 | 6.0 | 6.0 | 6.0 | 4.0 |
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Spacing
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5.0 |
0.0 | 1.0 | Intleave | 0.0 | 0.0 | 1.0 |
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Start - End
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# of Slices
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-- | 45 | 20 | 20 | 14 | 20 | -- |
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Scan Time
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or MRI pelvis with Gd 60 minutes
1) Is there a mass or
tumor?______ When did you first discover the mass?_______________________
2) Does the problem relate to a recent injuring? YES
NO DATE_____________________
3) Where does the hip hurt (
FRONT - BACK
- INSIDE -
OUTSIDE )?
4) Have you had surgery on your hip or pelvis? YES
NO
DATE__________________________
5) Have you had an x-ray?
Patient
Preparation:
Coil: Torso array
Patient Positioning: Supine, feet first,
Landmark: Pubic symphysis
Series 1: Locator
This high quality locator is
designed to screen the pelvis for masses that may cause symptoms referrable to
the hip. It
is performed as an interleaved
acquisition so that half of the images will be available half-way through the
scan to use
for proscribing the next series.
By landmarking on the pubic symphysis it will automatically cover nearly all
the way to
the top of the iliac crests.
However in large patients it may be useful to increase the slice thickness. Try
to stick to 20
images total so that they will all fit on a 20-on-1 sheet of film
Series
2: Coronal T1
Coronal T1 helps to define the anatomy. It should be
prescribed in a similar distribution as Series 2. The combinationof
this with series 1 and 2 helps to define the percentage of
the femoral head involved with osteonecrosis. Less than 25%
and it is left alone to heal but with greater than 50%
involvement femoral head collapse is common espcially if weight
bearing cannot be avoided.
Series
3: Coronal T2 Fat Sat/STIR
This sequence is prescribed to include sacro-iliac joints
posteriorly to the anterior acetabulum. An alternative sequence
with similar contrast is FSE T2 with fat saturation. T2 may
have slightly higher spatial resolution but may be degraded
in the setting of magnet field inhomogeneity which can interfere with fat saturation.
Series
4: 3D Cartilage (optional)
Examinination of the cartilage with this sequence is
important in the event that osteoarthritis or other arthropies are
expected. The volume of coverage should include from above the acetabulum to belowe the greater trocantor.
Filming
Instructions:
series 1: 20-on-one
series 2: 15 on one
series 3: 15 on one
series 4: 12-on-one of selected reformations in axial, coronal and sagittal planes
Billing
Instructions:
ICD9
Codes:
osteonecrosis
hip pain
osteomyelitis
fracture
stress fracture
tumor
effusion
developmental dysplasia
osteoarthritis
Sample
Normal Dictation:
Technique: Axial T1, Coronal STIR, Coronal T1 and 3D SPGR
fat sat for cartilage.
Findings: The left hip is normal with normal allignment and
no evidence of osteonecrosis, osteoarthritis, occult fracture,
tumor or other osseous abnormality. This is no significant
hip joint effusion.
The right hip joint has a moderate effusion. On T1 there is
a serpigenous low signal rim surrounding a T1 bright center
involving approximately 25% of the femoral head. It involves
primarily the (medial, central or lateral) aspect of the
femoral head where is (is not) significant weight bearing.
On STIR there is a bright peripheral rim with central T2
darkness and a double line sign which is also characteristic
of AVN in the acute phase. The femoral contour remains
rounded with no evidence of flattening or collapse at this
point. The AVN is categorized as (A,B,C or D) based on the
central signal and stage (0,I,II,III,IV,V).
Categorization: A = acute [center is same as fat: T1 bright
and STIR/T2 dark]
B = subacute [center contains blood: T1 bright and T2
bright]
C = subacute [center conains fluid: T1 dark and STIR/T2
bright]
D = chronic [center is fibrotic/sclerotic: T1 dark STIR/T2
dark]
Staging:
0 clinically asymptomatic: MRI may show focal marrow edema
(T1 dark, STIR/T2 bright)
I symptomatic:
II symptomatic with large MRI abnormality: T1 decreased but
heterogeneous, T2 heterogeneous
III cresent sign on X-ray: MRI show heterogenous signal on
T1 and T2
IV flatening of femoral head
V osteoarthritis
The sacro-iliac joints are normal (abnormal).
No pelvic masses are identified.
Impression:
No AVN of left hip