Cardiac – Chest Protocol Form Inland Imaging REV. 10-2012

Name______DOB______

Date of Exam______Radiologist______

ROUTINE CARDIAC Monitored
Coil:
__ _ 8 channel cardiac
__ _ 4 channel cardiac – due to patient size (no MR Echo)
Contrast: Circle choice
Agent: MULTIHANCE GADAVIST OTHER______
Dosage: 0.1mmol/kg (1x dose) 0.15mmol/kg (1.5x dose) 0.2mmol/kg (2x dose)

Sequences: All scans done on expiration
A. 3pl ssfse
B. Gated SSFP FIESTA (pre contrast preferred)
1. Axial
__ _ 3 slices mid heart
__ _ Whole heart
2. Sagittal oblique (Approximate 2 chamber) GRx on Axial
3. Axial oblique (Approximate 4 chamber) GRx on approx 2ch
4. Short axis whole heart (base to apex of left ventricle) GRx on 4ch
5. Long axis
2 chamber
3 chamber
4 chamber
__ _ Additional SSFP FIESTA, (i.e. RV long axis, RVOT, LVOT, etc.)
3
NOTES: __ _
___ Myocardial tagging (pre contrast)
___ Black blood (pre contrast preferred)
□ Double Inversion Recovery
Orientation: _ __
□ T2 with fat saturation
Orientation: _ __
□ IDEAL
Orientation: _ __
_ __ PERFUSION - MR echo Fgre Asset (Time Course)
Orientation: _ __
MRA - MRV
__ _ Pulmonary artery (3D Cor ceMRA)
Pre, During, Post IV contrast
__ _ Aorta (3D Cor ceMRA)
Pre, During, Post IV contrast
__ _ TRICKs
Orientation: _ __
_ __ Delayed myocardial enhancement (Viability – IR SPGR)
Orientation: _ __
___ Other sequences (i.e. research sequences)
NOTES: __ _
___ STRESS PERFUSION
All scans done on expiration
1. 3pl ssfse
2. Ax gated FIESTA 3 slices mid ventricle
3. Approximate 2 chamber gated FIESTA GRx on axial
4. Approximate 4 chamber gated FIESTA GRx on approx 2ch
5. Short Axis gated FIESTA
6. Long Axis gated FIESTA Left 2 ch, 3 ch LVOT, 4 ch
Nurse will administer stressor medication
7. STRESS PERFUSION Contrast: ¾ dose @ 4 mL/sec
Nurse will administer reverse stressor medication
8. REST PERFUSION Contrast: ¾ dose @ 4 mL/sec
Wait 10 minutes after second dose of contrast
9. Long Axis delayed myocardial enhancement - VIABILITY
10. Short Axis delayed myocardial enhancement - VIABILITY / BASIC CARDIAC:
Approx 2ch GRx on axial: @ level of mitral valve; thru LV; parallel to septum
Approx 4ch GRx on approx 2ch: parallel along mid LA – Mitral Valve – LV axis
SA – Short Axis
GRx on 4ch: perpendicular to LV/RV from base (mitral valve) through apex
LA – Long Axis
Lt 2ch GRx on SA: Bisecting LV: Parallel to septum
4 Ch GRx on SA: A line from highest curvature of RV bisecting thru LV
LVOT GRx on SA @ base: bisecting parallel thru LV & aortic outflow tract;
perpendicular to the aortic valve Flow analysis VENC 250
Rt 2ch GRx on 4ch: parallel thru long axis of RV
RVOT GRx on SA @ base: perpendicular to pulmonary valve
Flow analysis VENC 180
VALVES:
Aortic Valve
GRx on LVOT: parallel thru aortic valve Flow analysis VENC 200
Mitral Valve
GRx on 4ch: perpendicular to mitral valve Flow analysis VENC 80
Triscupid Valve
GRx on 4ch: perpendicular to triscupid valve Flow analysis VENC 80
Pulmonary Valve
GRx on RVOT or SA @base transverse to pulm valve Flow analysis VENC 180
*NOTES: PERFUSION / VIABILITY-Delayed Enhancement
CONTRAST:
Perfusion only: Contrast @ 4 mls/sec
Viability only: Contrast @ 2 mls/sec (may hand inject)
Perfusion & Viability:
Perfusion: Inject and record injection time
Wait 10 minutes before beginning DE viability scans
PERFUSION
Routine PERFUSION - MR echo Fgre Asset or MR Echo
Timing: Start scan. Inject and breath hold when images appear
DE - VIABILITY - Delayed enhancement
Wait 10 minutes after injection of contrast before DE
Optimize TI:
Myocardium = dark Blood pool = grey Infarction = Bright
Overall too dark = Ti is too low
Overall too bright = Ti is too high
Viability Scans copy Rx of pre contrast gated FIESTAS
1. LA 2 ch gated FIESTA Parallel to septum @ mid LV
2. LA 3 ch LVOT gated FIESTA Rx on SA base image through
the left ventricle and aortic outflow tract, and
perpendicular to the aortic valve
3. LA 4 ch gated FIESTA Perpendicular to septum @ mid LV
4. Copy Rx of SA gated FIESTAs
Optimizing TI for viability scan
Copy and paste series, changing TI time
Or
Modify TI without prescribing a new series
- Research operations: Modify CV > Type in: opti
- Enter new value (for TI 220 type in 220000) be sure to “enter”
___ CHEST MEDIASTINAL MASS
Monitored
___ CHEST WALL
Monitored
___ With contrast ___ Without contrast
Radiologist MUST individually tailor exam to the patient
NOTES: