D.17 2020 Rad Protocols.pdf

VA Medical Center Imaging Service, Radiology Salem, VA 24015 Policy # 16

August 29, 2018

STANDARD RADIOGRAPHIC, ULTRASOUND, DOPPLER, CT, AND MRI ROUTINES

1. PURPOSE: To provide guidance to the radiologic technologist on standard radiographic examination. To establish routines for sonograms, Doppler, and CT scanning, and MRI.

2. POLICY: Imaging Service staff will follow established standard radiographic, sonographic, Doppler, CT scanning, and MRI routines when studies are of a routine nature. More difficult studies may require correlation with the requesting physician or radiologist.

3. SCOPE: All radiologic technologists and sonographers.

4. RESPONSIBILITY: The Chief, Imaging Service is responsible for establishing standard routines for radiographic, sonographic, Doppler, and CT scanning, and MRI procedures. The radiologic technologist is responsible for following standard procedures and seeking the requesting physician’s or radiologist’s guidance when the examination becomes difficult or dangerous.

5. PROCEDURE:

a. STANDARD RADIOGRAPHIC ROUTINES:

• Finger PA Hand. Obl& Lat.of finger of interest Trauma PA hand, Lat.& obl.

• Thumb PA Hand AP& Lat. Trauma – PA hand, Lat. & AP thumb

• Hand PA, Obl. & Lat. Foreign body – PA & Lat.

• Bilateral Hand (rheumatology) Ball Catcher view Arthritis

• Wrist PA, Lat. & Obliques

• Wrist (ortho) PA, AP Clenched Fist Lat., Navicular View

• Forearm AP & Lat. Include both joints.

• Elbow AP, Lat & Obliques.

• Humerus AP & Lat. Trauma – AP & Transthoracic

• Shoulder (routine) AP Int. & Ext. & Axillary. Y view if unable to do Axillary.

Dislocation / FX – AP Transthoracic, & axillary.

If unable to do scapular Y view

• Shoulder (ortho) True AP, Do axillary only if requested Supraspinatus View, AP Internal & external

• Clavicle AP & Axial 15 degrees cephalic for axial

• Scapula AP & Lat.

D.17 2020 Rad Protocols 36C24621R0065

Salem, VA 24015 Policy # 16 August 29, 2018

• Toe DP Foot, Obl. Toe, & Lateral affected toe

• Foot DP, Medial Obl., Foreign body – DP & lat.

& Lat.

• Podiatry Foot Weight Bearing all 3 views. Will order non-weight bearing Oblique, & Lateromedial if required.

Lateral

• Ankle AP, Lat., & Obliques

• Podiatry Ankle Weight Bearing AP Mortise, medial oblique, & Lateral

• Os Calcis Lat. & Axial 35 degrees cephalic for axial

• Lower Leg/ Distal AP & Lat. include ankle Tibia/Fibula Proximal AP & Lat., include knee.

Include both joints.

• Knee AP & Lat. When requested: obls, tunnel, sunrise or standing.

• Knee (Trauma) AP/ Lat/Obliques Any history Standing

• Knee (Ortho) Weight Bearing AP bil. Sunrise or Tunnel only if requested.

Lateral of affected knee

• Radiopaque ruler

• Patella PA, Lat. & sunrise

• Femur AP & Lat. Include both joints

• Hip AP low pelvis & Frog Trauma – AP pelvis, OR lat.

• Post-op AP pelvis & OR lat. hip *Pay attention if Hip is ordered wait bearing by ortho: Standing pelvis & OR Lat if requested

• Pelvis AP include top of iliac crest

• Pelvis for hip AP include acetabulum

• prosthesis and entire shaft implant

• Extremities MRI Routine – Normal routine of the extremity ordered.

• Cervical Spine Lateral, Obliques, Trauma – Cross table lateral AP & Odontoid (show Dr. for clearance) Swimmers (if necessary) MRI Routine – AP & Lat.

• Thoracic Spine AP & Lat. MRI Routine – AP & Lat.

• Lumbar Spine AP, Lat. & L-5 MRI Routine – AP, Lat. & L-5 When requested Obliques.

• Sacrum AP & Lat. When requested: Ferguson view

• Coccyx AP & Lat

• Sacroiliac Joints AP, Obliques & Ferguson view

• Sternum RAO & Lat.

• Sterno-clavicular PA & Anterior obliques. Include joints.

• A.C. joints AP with & without weights

• Skull Towne (AP/30 degree Caudal, PA (15 degrees caudal)

& Lateral

• Facial Bones Waters, PA (30 degrees caudal), Lateral face, & Zygomatic Arches-if unable to obtain arches do Towne (30 degrees caudal)

• Optic Foramen Bilateral Rhese (rotate head 53 degree from ctr)

• Sella Turcica PA (10 degrees cephalic) & Lateral

• Mandible PA (20 degrees cephalic open & perpendicular closed mouth) & Lateral

• T.M.J. Bilateral laterals – open & closed mouth (25 degrees caudal)

• Orbital Rims Waters & bilateral Rhese & PA skull (30 degrees caudal)

• Orbits for MRI Waters only. If needed, and radiologist recommends, then waters up and down and lateral orbits.

• Sinuses Waters, SMV, Lat, Caldwell PA

• Mastoids Towne, PA, bilateral Laws & Stenvers

• Zygomatic Arches Waters, bilateral basal (tangential) & Lat.

• Nasal Bones Waters & Bilateral Lat. Nasal bone

• I.A.C. PA, Towne & bilateral Stenvers

• Barium Enema AP, AP sigmoid, both Obliques, Lat rectum & post evac (Single Contrast)

• Barium Enema AP, AP sigmoid, both decubs, Lat & cross-table prone

• (Double Contrast) lat. of rectum

• G.I. Series After films when requested

• Esophagram After films when requested

• Chest (lung biopsy) PA expiration only

• BONE LENGTH Long leg film for length discrepancy

• Bone Survey (metastatic) AP pelvis, AP bilat. femurs, AP bilat humerus AP & Lat.

thoracic, AP & Lat. lumbar, & Lat. skull & CXR PA

• Abdomen or KUB AP

• Chest or Abdomen AP – centered at xiphoid

• (Dobhoff)

• Abdomen for MRI- skin to skin

• Chest PA & Lat.

• Portable Chest AP erect, semi-erect, or supine

• Lordotic Chest AP

• Abdominal Series AP supine & erect abdomen & PA chest o (decub abdomen if pt unable to stand)