<p> CT GUIDED JOINT INJECTION PROCEDURES PROCEDURE: Joint steroid and arthrogram injection procedures performed by the Radiologist using CT guidance. Shoulder, Hip, Knee, Elbow CT and MRI Arthrograms And/Or Steroid injections. Sacroiliac joint steroid injections. INDICATIONS: Pain, rotator cuff tear, labral tear, meniscus tear PATIENT PREP: None IV CONTRAST: None ORAL CONTRAST: None POSITIONING: Shoulder/Hip/Knee: Feet First Supine. Elbow: Head First Prone, Elbow Flexed. Adjust to region of interest. Sacroiliac: Feet First Prone. TOPOGRAMS: Shoulder/Hip - AP. Range: Through the region of interest according to performing Radiologist guidance. 35 mA, 120 kV. Elbow – Lateral. Range: Through the region of interest according to performing Radiologist guidance. 35 mA, 120 kV. Knee – AP and Lateral. Range: Through the region of interest according to performing Radiologist guidance. 35 mA, 120 kV. Sacroiliac - PA. Range: Through the region of interest according to performing Radiologist guidance. 35 mA, 120 kV. SCAN TYPE: Spiral/Helical NOTES: Shoulder/Hip/Elbow/Sacroiliac: Under Radiologist guidance perform a Control Scan at the level of interest. For Knee perform a Lateral Topogram instead. If necessary perform a short scan range with just a few slices above and below the level of interest. Using sterile technique assist the Radiologist with equipment and patient preparation. Once the procedure has begun, under guidance from the Radiologist perform short scan ranges through the region to check needle placement. ALARA – Keep radiation dose As Low As Reasonably Achievable. SHOULDER INJECTION PROCEDURES CONTROL SCAN Scan Scan Direction Respiration Scan CARE Effective CARE kV Detector Configuration Table Cycle Scan SFOV Range Delay DOSE mAs kV Feed Time Time (cm) Scan Type (Seconds) 4D Slices Per Tube Rotation (Seconds) (Seconds) Single slice at Craniocaudal Quiet 2 OFF 40 OFF 120 Detectors: 1 x 5.0 mm 0.0 mm 1.5 Full 50 Level of Interest Sequential Respiration Seconds Slices Per Tube Rotation: 1 Seconds 1.0 Sec cm Plane Slice Interval/ Kernal Window DFOV Thickness Table Feed Width/Level (cm) RECON – AXIAL BONE Axial 5.0 mm 0.0 mm B40s Osteo FOV to include shoulder joint LEFT/RIGHT MIRRORING ON Medium 1500/450 And skin surface</p><p>SHOULDER INJECTION PROCEDURES Scan Scan Direction Respiration Scan CARE Effective CARE kV Detector Configuration Pitch Rotation SFOV Range Delay DOSE mAs kV Table Increment/Speed: Time (cm) Scan Type (Seconds) 4D Slices Per Tube Rotation (mm/rotation) (Seconds) Short Scan Range Craniocaudal Quiet 2 OFF 40 OFF 120 Detectors: 64 x 0.6 mm Pitch: 0.8 0.5 50 Few Slices Respiration Seconds Seconds cm Above And Below Spiral/Helical Slices Per Tube Rotation: 32 Table Increment/Speed: Level of Interest 15.36 mm/rotation Plane SAFIRE Slice Interval Kernal Window DFOV Strength Thickness Width/Level (cm) RECON – AXIAL BONE Axial OFF 3.0 mm 3.0 mm B30f Osteo FOV to include shoulder joint LEFT/RIGHT MIRRORING ON Medium Smooth 1500/450 And skin surface</p><p>NETWORK: Exam to PACS</p><p>Page 1 of 4 HIP INJECTION PROCEDURES CONTROL SCAN Scan Scan Direction Respiration Scan CARE Quality CARE kV Detector Configuration Table Cycle Scan SFOV Range Delay DOSE Reference kV Feed Time Time (cm) Scan Type (Seconds) 4D mAs Slices Per Tube Rotation (Seconds) (Seconds) Single slice at Craniocaudal Quiet 2 ON 40 OFF 120 Detectors: 1 x 5.0 mm 0.0 mm 0.75 Full 50 Level of Interest Sequential Respiration Seconds Slices Per Tube Rotation: 1 Seconds 0.5 Sec cm Plane Slice Interval/ Kernal Window DFOV Thickness Table Feed Width/Level (cm) RECON – AXIAL BONE Axial 5.0 mm 0.0 mm B40s Osteo FOV to include hip joint LEFT/RIGHT MIRRORING ON Medium 1500/450 And skin surface</p><p>HIP INJECTION PROCEDURES Scan Scan Direction Respiration Scan CARE Quality CARE Quality Detector Configuration Pitch Rotation SFOV Range Delay DOSE Reference kV Reference Table Increment/Speed: Time (cm) Scan Type (Seconds) 4D mAs kV Slices Per Tube Rotation (mm/rotation) (Seconds) Short Scan Range Craniocaudal Quiet 2 ON 40 ON 120 Detectors: 64 x 0.6 mm Pitch: 0.8 0.5 50 Few Slices Respiration Seconds Seconds cm Above And Below Spiral/Helical Slices Per Tube Rotation: 32 Table Increment/Speed: Level of Interest 15.36 mm/rotation Plane SAFIRE Slice Interval Kernal Window DFOV Strength Thickness Width/Level (cm) RECON – AXIAL BONE Axial ON 3.0 mm 3.0 mm I31f Osteo FOV to include hip joint LEFT/RIGHT MIRRORING ON 3 Medium Smooth 1500/450 And skin surface</p><p>NETWORK: Exam to PACS</p><p>KNEE INJECTION PROCEDURES KNEE INJECTION PROCEDURES Scan Scan Direction Respiration Scan CARE Effective CARE kV Detector Configuration Pitch Rotation SFOV Range Delay DOSE mAs kV Table Increment/Speed: Time (cm) Scan Type (Seconds) 4D Slices Per Tube Rotation (mm/rotation) (Seconds) Short Scan Range Craniocaudal Quiet 2 OFF 30 OFF 120 Detectors: 64 x 0.6 mm Pitch: 0.8 0.5 50 Few Slices Respiration Seconds Seconds cm Above And Below Spiral/Helical Slices Per Tube Rotation: 32 Table Increment/Speed: Level of Interest 15.36 mm/rotation Plane SAFIRE Slice Interval Kernal Window DFOV Strength Thickness Width/Level (cm) RECON – AXIAL BONE Axial OFF 3.0 mm 3.0 mm B30f Osteo FOV to include knee joint Medium Smooth 1500/450 And skin surface</p><p>NETWORK: Exam to PACS</p><p>Page 2 of 4 ELBOW INJECTION PROCEDURES CONTROL SCAN Scan Scan Direction Respiration Scan CARE Effective CARE kV Detector Configuration Table Cycle Scan SFOV Range Delay DOSE mAs kV Feed Time Time (cm) Scan Type (Seconds) 4D Slices Per Tube Rotation (Seconds) (Seconds) Single slice at Craniocaudal Quiet 2 OFF 40 OFF 120 Detectors: 1 x 5.0 mm 0.0 mm 0.75 Full 50 Level of Interest Sequential Respiration Seconds Slices Per Tube Rotation: 1 Seconds 0.5 Sec cm Plane Slice Interval/ Kernal Window DFOV Thickness Table Feed Width/Level (cm) RECON – AXIAL BONE Axial 5.0 mm 0.0 mm B40s Osteo FOV to include elbow joint Medium 1500/450 And skin surface</p><p>ELBOW INJECTION PROCEDURES Scan Scan Direction Respiration Scan CARE Effective CARE kV Detector Configuration Pitch Rotation SFOV Range Delay DOSE mAs kV Table Increment/Speed: Time (cm) Scan Type (Seconds) 4D Slices Per Tube Rotation (mm/rotation) (Seconds) Short Scan Range Craniocaudal Quiet 2 OFF 40 OFF 120 Detectors: 64 x 0.6 mm Pitch: 0.8 0.5 50 Few Slices Respiration Seconds Seconds cm Above And Below Spiral/Helical Slices Per Tube Rotation: 32 Table Increment/Speed: Level of Interest 15.36 mm/rotation Plane SAFIRE Slice Interval Kernal Window DFOV Strength Thickness Width/Level (cm) RECON – AXIAL BONE Axial OFF 3.0 mm 3.0 mm B30f Osteo FOV to include elbow joint Medium Smooth 1500/450 And skin surface</p><p>NETWORK: Exam to PACS</p><p>Page 3 of 4</p><p>SACROILIAC JOINT INJECTION PROCEDURES CONTROL SCAN Scan Scan Direction Respiration Scan CARE Quality CARE kV Detector Configuration Table Cycle Scan SFOV Range Delay DOSE Reference kV Feed Time Time (cm) Scan Type (Seconds) 4D mAs Slices Per Tube Rotation (Seconds) (Seconds) Single slice at Craniocaudal Suspended 5 ON 50 OFF 120 Detectors: 1 x 5.0 mm 0.0 mm 1.5 Full 50 Level of Interest Sequential Inspiration Seconds Slices Per Tube Rotation: 1 Seconds 1.0 Sec cm Plane Slice Interval/ Kernal Window DFOV Thickness Table Feed Width/Level (cm) RECON – AXIAL BONE Axial 5.0 mm 0.0 mm B40s Osteo FOV include vertebral bodies, discs LEFT/RIGHT MIRRORING ON Medium 1500/450 And skin surface</p><p>SACROILIAC JOINT INJECTION PROCEDURES Scan Scan Direction Respiration Scan CARE Quality CARE Quality Detector Configuration Pitch Rotation SFOV Range Delay DOSE Reference kV Reference Table Increment/Speed: Time (cm) Scan Type (Seconds) 4D mAs kV Slices Per Tube Rotation (mm/rotation) (Seconds) Short Scan Range Craniocaudal Suspended 5 ON 50 ON 120 Detectors: 64 x 0.6 mm Pitch: 0.8 1.0 50 Few Slices Inspiration Seconds Seconds cm Above And Below Spiral/Helical Slices Per Tube Rotation: 32 Table Increment/Speed: Level of Interest 15.36 mm/rotation Plane SAFIRE Slice Interval Kernal Window DFOV Strength Thickness Width/Level (cm) RECON – AXIAL BONE Axial ON 3.0 mm 3.0 mm I40s Osteo FOV include vertebral bodies, discs LEFT/RIGHT MIRRORING ON 2 Medium 1500/450 And skin surface</p><p>NETWORK: Exam to PACS</p><p>*The operator must check the CTDIvol before and after the scan to ensure it is within the allowed dose range. Scans performed outside of the allowed range must be documented and reviewed by the designated radiologist and/or physicist. Shoulder, Hip and Sacroiliac: Allowed CTDIvol Dose Ranges: 0.5 mGy – 50 mGy XR29 Dose Notification Value (CTDIvol): 50 mGy Knee and Elbow: Allowed CTDIvol Dose Ranges: 0.5 mGy – 20 mGy XR29 Dose Notification Value (CTDIvol): 20 mGy</p><p>12/2017 Page 4 of 4</p>