ROUTINE HEART (rev. 7/1/2013)
1. 3 plane localizer
Heart at isocenter2. Axial Bright Blood FISP
Usually 25-30 slices, cover from aortic arch through bottom of heart
Straight axial
Prescribe off localizer
Do not clip the bottom of heart
Set to multiple breath holds (3) - tailor to patient's ability
Prospectively gated (Physio - capture cycle)
Can be OVERLAPPED for better images - set distance factor to -50%3. Axial Dark Blood HASTE
Usually ~20 slices (thicker than FISP)
Straight axial
Same coverage as FISP
Free breathing
Prospectively gated (Physio - capture cycle)4. CINE 2 Chamber
1 slice CINE, retrospectively gated (no need to capture cycle)
Breath hold
Prescribe off localizer or bright blood FISP
Center of plane in center of mitral valve
Rotate so it passes through apex of LV
Make perpendicular (Protocol - click "Perpendicular")
*make sure the plane you want to be perpendicular to is "highlighted" in planning window
5. CINE FAKE SHORT AXIS
1 slice CINE, retrospectively gated (no need to capture cycle)
For planning purposes
Breath hold
Prescribe off CINE 2 Chamber - single short axis slice through mid LV
Make perpendicular (Protocol - click "Perpendicular")
6. CINE 4 CHAMBER
1 slice CINE, retrospectively gated (no need to capture cycle)
Breath hold
Prescribe off BOTH CINE 2 Chamber and FAKE SHORT AXIS
- FAKE SHORT AXIS - plane through most angled portion of RV and mid LV papillary muscle
- 2 CHAMBER - plane through apex and mid mitral valve
7. T2 DARK BLOOD
For edema imaging if applicable - acute MI and infiltrative disease
Breath hold each slice
Prospectively gated (Physio - capture cycle)
Short axis stack - 4 or 5 slices through LV spaced accordingly. Prescribe off CINE 4 CHAMBER and CINE 2 CHAMBER
4 chamber - single slice, copy slice position from CINE 4 CHAMBER
2 chamber - single slice, copy slice position from CINE 2 CHAMBER8. FIRST PASS PERFUSION
3 short axis slices through LV spaced accordingly (one base, one mid LV, one apical) - prescribe off CINE 4 CHAMBER and CINE 2 CHAMBER
1 long axis slice through LV - plan as a 4 chamber view using FAKE SHORT AXIS and 2 CHAMBER
Inject 1/4 of double dose contrast
Start scan and inject contrast simultaneously (click both buttons at same time)
When contrast reaches RV, ask patient to hold their breath
They can slowly let air out when they can no long hold it
Make sure images are good with contrast and no wrap. If bad, adjust and repeat with another 1/4 dose of contrast.
If good, inject remainder of contrast dose.
*Note TIME of injection - do TI scout 10 minutes post injection9. CINE SHORT AXIS STACK
Most important sequence for quantification - cannot have motion!
Stack of CINE images through LV - breath hold, retrospectively gated (no need to capture cycle)
Prescribe off CINE 4 CHAMBER and CINE 2 CHAMBER - perpendicular cross sectional slices on both views
Cover from mitral valve through apex - can add or remove slices to ensure adequate coverage
**Check plane on axial and sagittal scouts to ensure no wrap
10. CINE 3 CHAMBER
3 chambers = LV, LA, AORTA
1 slice CINE, retrospectively gated (no need to capture cycle)
Breath hold
Prescribe off "snowman view" - one of the basal most CINE SHORT AXIS STACK slices - bisect the snowman - through LV and AORTA
Make perpendicular (Protocol - click "Perpendicular")
* Check position on 4 CHAMBER CINE - Through LV apex and LA
11. TI SCOUT
1 short axis slice through LV - COPY slice position from CINE FAKE SHORT AXIS
Prospectively gated (Physio - capture cycle)
Free breathing
~10 minutes post contrast injection (does not have to be exact!)12. MDE SINGLE SHOT
Copy slice positions from appropriate CINE sequences
Prospectively gated (Physio - capture cycle)
Find inversion time where myocardium is BLACK and blood is BRIGHT
* this should look like a delayed enhancement image
* tram tracking is TOO EARLY
Enter this inversion time + 20-30 msec (Contrast - TI)
Breath hold better, but free breathing okay
Short axis stack same number of slices as CINE
2, 3, 4 chamber - 5 slices each13. MDE SEGMENTED
Copy slice positions from appropriate CINE sequences
Prospectively gated (Physio - capture cycle)
Enter inversion time from scout + 20-30 msec (Contrast - TI)
*rule of thumb is to increase the TI ~30 msec for every ~5 mins of scanning post TI scout
Breath hold always - important to give good instructions as very motion sensitive
Short axis stack same number of slices as CINE
2, 3, 4 chamber only one slice14. AORTA PHASE CONTRAST
Use AXIAL BRIGHT BLOOD FISP, find the slice with the right main pulmonary artery, right click and then click "COPY IMAGE POSITION"
Breath hold
Ensure no aliasing, otherwise increase VENC and repeat