Protocol guide
139 acquisition protocols — what contrast goes in, at what dose, how long you wait, what you cover, and the technique errors that turn a reasonable request into a non-diagnostic study. Each phase is described once and shared, so portal venous means the same thing wherever you meet it.
Timings and volumes are typical values from published guidance, not local policy. Confirm against your department's protocol.
MRI59
Short-axis stack covering both ventricles from base to apex, plus two-, three- and four-chamber long-axis views.
Full short-axis and long-axis cine coverage, with mapping and late enhancement across the same slices.
Three short-axis slices at basal, mid and apical levels for perfusion, plus full cine and late enhancement coverage.
Hip joint, acetabular labrum, capsule and proximal femur, including radial reformats around the femoral neck axis.
Glenohumeral joint, labrum, capsule and rotator cuff, with the same oblique planes as the routine shoulder study plus any additional position.
Diaphragm to pubic symphysis, covering the whole small bowel, the colon and the perianal region where relevant.
Superior sagittal, transverse and sigmoid sinuses, straight sinus, deep venous system, and jugular bulbs, with whole-brain parenchymal sequences.
Aortic arch and origins of the great vessels to the skull base, usually with intracranial coverage on the same run or as a separate time-of-flight acquisition.
Distal vertebral and petrous/cavernous internal carotid arteries through the circle of Willis and proximal major branches.
Pancreatic duct along its whole length with the common bile duct, plus the duodenum for the fluid-filling response.
Intrahepatic and extrahepatic biliary tree, gallbladder, cystic duct, and the full length of the pancreatic duct to the ampulla.
Diaphragm to symphysis pubis
Both adrenal glands with the upper abdomen; thin sections through the lesion of interest.
Distal tibia and fibula through the talus, calcaneus and midfoot. Extend to the forefoot where diabetic foot infection is the question.
Whole brain including posterior fossa; intracranial arterial coverage from the vertebral and internal carotid arteries through the circle of Willis when angiography is included.
Whole brain including the full extent of the cerebellum, brainstem and upper cervical cord on the sagittal acquisitions.
Whole brain, with dedicated high-resolution coverage of both temporal lobes and hippocampi.
Vertex to foramen magnum, including the whole cerebellum and craniocervical junction.
Whole brain vertex to foramen magnum. Extend to the whole neuraxis where leptomeningeal spread is a concern.
As for the routine brain study, with the enhanced series matched in plane and thickness to the unenhanced T1.
Both breasts and axillae, prone.
Both breasts, axillae and anterior chest wall, prone in a dedicated breast coil.
Both breasts including the full anteroposterior extent of the implants and the axillary tail, prone in a breast coil.
Craniocervical junction to at least T2/T3, so that the cervicothoracic junction is included.
Fetal thorax, abdomen and pelvis in three planes relative to the fetus, plus the placenta, the uterine wall and the maternal bladder interface where abnormal placentation is the question.
Whole fetal brain in three orthogonal planes referenced to the fetal head, not to the mother; a survey of the maternal pelvis and the placenta is usually included.
For occult fracture and avascular necrosis, both hips and the whole pelvis including the sacrum and pubic rami in a large field of view. For a joint-specific question, add a small field-of-view series over the symptomatic hip.
Both internal auditory canals, cerebellopontine angles, membranous labyrinth and adjacent brainstem, with whole-brain sequences included to avoid missing an unrelated cause.
As for the unenhanced screen, with thin post-contrast T1 through both internal auditory canals and the labyrinth.
From above the suprapatellar pouch to below the tibial tuberosity, including the whole patella, both menisci and the proximal tibiofibular joint.
Whole liver for the quantitative maps; a single mid-hepatic slice is used for some R2* schemes but volumetric coverage is preferred so that regional variation is visible.
Whole liver on all phases; the hepatobiliary acquisition should also include the biliary tree where a leak or anatomical question is being asked.
Whole liver on every phase; the portal venous phase is usually extended to include the spleen, upper abdomen and any relevant nodal stations.
From at least the T12/L1 level, including the conus medullaris, to the S1/S2 level, with axial sections through the lower lumbar discs at minimum.
Conus medullaris to the sacrum. Where the history raises the possibility of a higher lesion, extend to whole-spine coverage rather than repeating later.
Primary subsite with high-resolution small field-of-view imaging, plus nodal levels I-V and the retropharyngeal nodes; extend to the skull base where perineural spread is possible.
Skull base to thoracic inlet for a general survey, or a targeted small field-of-view block over the named subsite with a wider survey for nodes.
Whole pancreas, peripancreatic vessels and the biliary tree; portal venous phase extended to include the liver for metastases.
Whole pelvis including the parametria, pelvic sidewalls and ureters, extended superiorly to the renal hila for para-aortic nodes and hydronephrosis.
Pelvis from above the uterine fundus to the perineum, with sequences extended to include both kidneys to detect ureteric obstruction.
Uterus and pelvis, extended superiorly to cover the para-aortic nodal station where nodal staging is required.
Pelvic brim to below the perineum, with the kidneys included where a congenital anomaly or ureteric obstruction is possible.
From above the levator plate to below the anal verge, including both ischioanal fossae, the supralevator space and the perineal skin.
Sella and parasellar region including both cavernous sinuses, the optic chiasm and the pituitary stalk. Whole-brain sequences are added only if a wider question is asked.
Whole prostate and seminal vesicles at high resolution.
Whole prostate and seminal vesicles at high resolution, with a large field-of-view sequence covering the pelvis to the aortic bifurcation for nodal and bone assessment when staging.
From at least the level of the sacral promontory (higher for a proximal tumour, to include the origin of the inferior mesenteric artery where nodal assessment demands it) to below the anal verge, including the whole mesorectum and both pelvic sidewalls.
Identical coverage and angulation to the primary staging study, planned from the pre-treatment images.
Both kidneys, the renal veins and the inferior vena cava; extended to the right atrium where tumour thrombus is suspected.
Acromioclavicular joint and acromion superiorly to below the glenoid inferiorly, including the whole rotator cuff, the glenoid labrum and the myotendinous junctions.
Centred on the skin marker over the palpable lesion, with the whole lesion, the entire involved compartment, the adjacent joint and the neurovascular bundle within the field of view; a large-field-of-view localiser through the whole limb segment is included so the lesion can be sited anatomically for the surgeon.
Whole cord from the craniocervical junction to the conus, with axial sections through every abnormal segment.
Whole-spine sagittal survey to detect non-contiguous involvement, then targeted sagittal and axial imaging of the affected segment including the paraspinal soft tissues and epidural space.
C7/T1 to L1/L2 inclusive, with axial sections through any abnormality.
Craniocervical junction to the sacrum and coccyx in continuous sagittal stations, with axial imaging through every significant abnormality.
Distal radioulnar joint through the carpus to the proximal metacarpals; extend distally where the question involves the digits.
Three overlapping stations from the infrarenal aorta to the pedal arch: abdomen and pelvis, thighs, and calves and feet, with a pre-contrast mask acquired at each station in the same geometry for subtraction.
Skull vertex to mid-thigh or to the feet, depending on the primary and the surveillance programme.
Skull vertex to at least the knees, and to the feet where symptoms or known disease require it, acquired as overlapping stations.
CT48
Diaphragm to the pubic symphysis (lesser trochanters where pelvic soft tissue matters).
Diaphragm to the pubic symphysis.
Diaphragm to the perineum, so that a low pelvic leak and any presacral collection are included.
Diaphragm to the lesser trochanters, including the whole bony pelvis.
Diaphragm to the pubic symphysis.
A limited block through the adrenal glands for all three acquisitions; the venous acquisition may be extended if there is a concurrent staging question.
Aortic arch to the vertex, including the great vessel origins, cervical carotid and vertebral arteries and the intracranial circulation.
Supracoeliac or infrarenal abdominal aorta through to the pedal arches.
Skull base (or arch, if the great vessels are also in question) to the vertex, covering the circle of Willis and its major branches.
Unenhanced series through the thoracic aorta, then an arterial acquisition from the thoracic inlet to the common femoral arteries so the full extent of any dissection and its branch involvement is defined.
Thoracic inlet or diaphragm (as clinically indicated) to the common femoral arteries.
Diaphragm to the common femoral arteries for all series; extended cranially for thoracic stent grafts.
The injected joint with a margin sufficient to include the capsule and any labral or ligamentous structure in question.
Skull base through the top of T1 at minimum; the cervicothoracic junction must be visualised or the study is incomplete.
Thoracic inlet to below the costophrenic angles as a minimum, extended to include the aortic arch and the upper abdomen so that the coeliac axis, the inferior phrenic arteries and the subclavian and internal mammary origins are covered — the non-bronchial systemic feeders live outside a standard chest field of view, and a study that omits them answers only half the question.
Lung apices to below the costophrenic angles, including the adrenal glands when staging.
Whole lung volumetric acquisition supine at full inspiration, with additional prone inspiratory and supine expiratory series.
Lung apices to the costophrenic angles, single inspiratory volumetric acquisition.
Lung apices to below the cardiac apex, ECG-synchronised.
Lung apices to below the costophrenic angles.
Diaphragm to below the pubic symphysis; the intravenous-enhanced acquisition covers the abdomen and pelvis for staging.
Diaphragm to below the pubic symphysis in each position, so that the whole colon and rectum is covered including a redundant sigmoid.
Carina to below the cardiac apex; extended cranially when arterial or venous grafts are in question.
Carina to below the cardiac apex.
Diaphragm to the pubic symphysis.
The soft-tissue compartment in question with generous margins, including the draining nodal basin where infection or tumour is suspected.
The joint or bony region in question with a margin above and below; the contralateral side is included only when a direct comparison is genuinely needed.
Foramen magnum to vertex, including the skull base and calvarium.
Foramen magnum to vertex for both series.
Upper poles of the kidneys to below the pubic symphysis, so the vesicoureteric junctions and the whole bladder are included.
Liver only for the unenhanced and arterial acquisitions where dose matters; the portal venous acquisition usually extends through the abdomen and pelvis when staging.
Liver for the unenhanced and arterial acquisitions; abdomen and pelvis for the portal venous acquisition when staging.
T12 through the sacrum and sacroiliac joints, extended when a specific level or hardware is in question.
Diaphragm through the pelvis for the venous acquisition; the arterial acquisition covers the coeliac axis, superior and inferior mesenteric arteries and their branches.
Skull base to the thoracic inlet, extended into the upper mediastinum when the question is nodal or when a retropharyngeal collection may track inferiorly.
Skull base to thoracic inlet.
Pancreas and upper abdomen for the pancreatic phase; whole abdomen and pelvis for the portal venous phase when staging.
Frontal sinuses to the hard palate, including the ostiomeatal complexes and anterior skull base.
A fixed slab through the brain, whose z-axis extent depends on detector width; wide-detector scanners cover most of the supratentorial brain, older scanners a limited slab that must be positioned deliberately.
Extended above the standard sinus block to include the orbits and the frontal lobes, so intracranial and intraorbital complications are within the field.
From the arcuate eminence above to below the mastoid tip, covering both temporal bones for comparison.
C7-T1 through L1-L2, with the vertebral level unambiguously countable from a fixed landmark.
Upper poles of the kidneys to the pubic symphysis.
Upper poles of the kidneys to the pubic symphysis, including the whole bladder.
Foramen magnum to vertex, covering the superior sagittal, transverse, sigmoid and straight sinuses and the internal jugular veins to the skull base.
Unenhanced head and cervical spine, then a contrast-enhanced acquisition from the thoracic inlet to the lesser trochanters. Thoracolumbar spine and pelvic reformats are generated from the torso dataset.
Restricted to the pulmonary arterial tree — lung apices to the costophrenic angles — with no incidental extension into the abdomen.
Lung apices to below the costophrenic angles, covering the whole pulmonary arterial tree to segmental and subsegmental level.
Ultrasound18
Common, internal and external carotid arteries bilaterally; vertebral flow direction
The target lesion held in a single acoustic window, imaged continuously through arterial, portal venous and late phases, followed by a survey of the remaining liver.
The anal canal from the puborectalis sling to the subcutaneous external sphincter in three levels — upper, mid and lower canal — with the internal and external sphincters assessed circumferentially and any track followed to its internal opening.
Right iliac fossa; pelvis and both renal tracts as indicated
Distal aorta and common, internal and external iliac arteries where insonation allows, then common femoral, profunda, superficial femoral, popliteal, and the anterior tibial, posterior tibial and peroneal arteries to the ankle; grafts and stents along their whole length where present.
Fetal biometry, liquor volume, presentation, placental site, umbilical artery Doppler
Tailored to the clinical question — pylorus, bowel, appendix, renal tract
Uterus, endometrium, both ovaries, adnexa, pouch of Douglas
Aorta at the level of the renal arteries, both main renal arteries from origin to hilum where insonation allows, and intrarenal segmental and interlobar arteries in upper, mid and lower poles of both kidneys. Renal length and cortical thickness are part of the study, not an extra.
Both testes and epididymes with side-to-side comparison, and spermatic cords
Area of clinical concern, with axilla where malignancy is suspected
Both hemithoraces where the question is bilateral, otherwise the symptomatic side: costophrenic recess, the full craniocaudal extent of any collection, the diaphragm and the underlying lung and, where a drain is planned, the intended intercostal space with the patient in the position they will occupy for the procedure.
Parasternal long and short axis, apical four-, five-, two- and three-chamber, subcostal and suprasternal windows, with two-dimensional, M-mode, colour, spectral and tissue Doppler.
Liver, gallbladder, biliary tree, pancreas, spleen, kidneys, aorta, bladder
Region of clinical concern, with dynamic assessment and contralateral comparison
Thyroid, cervical nodal levels, salivary glands as indicated
Both kidneys, ureters where visible, bladder pre- and post-void
Common femoral to popliteal veins; extended to calf veins per local protocol
Radiography5
Diaphragms to inferior pubic rami
Both lungs, mediastinum, diaphragm, bony thorax
Region of interest including the joint above and below where relevant
Whole skeleton to a prescribed series; follow-up films at around 11-14 days in suspected physical abuse
Region of interest with adequate visualisation of the cervicothoracic junction where relevant
Fluoroscopy3
Nuclear medicine3
Whole skeleton; three-phase acquisition where infection is the question
Anterior abdomen and pelvis in a single field of view, acquired dynamically for at least 60-90 minutes, with delayed images at intervals up to 24 hours where bleeding recurs.
Both lungs, multiple projections or SPECT per local protocol