CT — Gleznă MAVEN (MCB)

Updated 05/09/25 CT MAVEN Ankle Reviewed 05/15/25 Indications - pre surgical evaluation prior to ankle joint replacement. Bill under CT LE w/o Contrast charge. Do not include separate knee and ankle charges. GENERAL SCAN NOTES Remove any metal from the imaging field of view. Patient positioning (see images at bottom of page): Foot of interest must be dorsiflexed with foot perpendicular to tibia (90 degrees). A foot holder/brace is not required. Do not place a cushion/pillow under the leg of interest. The opposite leg can be flat next to the leg of interest, unless there is knee and/or ankle hardware in the opposite leg, then have the opposite leg bent at knee with ankle/foot out of way of ankle of interest. Topogram - from above knee through bottom of foot. Craniocaudal scan coverage (see images at bottom of page): 5 cm superior to knee continuously through bottom of foot (metatarsals must be imaged entirely). FOV: 25 cm (preferred) up to 40 cm acceptable. IV Contrast: not given for this protocol. For GE scanners, it is essential for the 1st recon thickness on the scanner to match the 1st recon thickness in this protocol book for the prescribed Noise Index to be valid. The 1st recon should generally be the thickest recon in the protocol. Prepare an uncompressed DICOM disc and upload to www.apexankle.com. Contact: Rick Agliata, [email protected], 904-562-9334. Ankle Positioning Craniocaudal Scan Coverage

CT MAVEN Ankle SIEMENS PARAMETERS & RECONS For Knee and Ankle scans: Scan
Care
mAs Care
Pitch Acq Coll Rot Mode kV Dose kV & Lvl Time Sensation 16 spiral 120 140 on NA 0.55 16 0.75 1.0 Go Up 32 spiral Sn 110 366 on on 75 0.40 32 0.7 1.0 Sensation 64 spiral 120 140 on NA 0.90 64 0.6 1.0 Definition 64 spiral 120 100 on off 0.80 64 0.6 1.0 Go Top 64 spiral Sn 110 898 on on 0.40 64 0.6 1.0 Drive 128 spiral 120 70 on off 0.80 128 0.6 1.0 Force 192 spiral 0.6 1.0 120 70 on off 0.80 192 Recon
Name of Series Thick Interval Kernel Window IR
Lvl Direction AX BONE 3.0 3.0 Br59 / B60 bone/osteo 3 head/feet MAVEN specific recon. AX THINS BONE 1.0 1.0 Br59 / B60 bone/osteo 3 head/feet COR BONE 3.0 3.0 Br59 / B60 bone/osteo 3 front/back SAG BONE 3.0 3.0 Br59 / B60 bone/osteo 3 left/right AX SOFT 3.0 3.0 Br59 / B60 abdomen 3 head/feet GE PARAMETERS & RECONS Scan
Smart
Beam
Dose
ASIR Slice
Type SFOV kV mA
Range Noise
Index mA Thick Coll Pitch Speed Rot
Time Red LS 16 helical large 120 100-440 12.50 on 2.5 10 0.938 9.37 0.5 NA NA Opt 540 helical large 120 100-440 0.5 NA NA 2.5 10 0.938 9.37 12.50 on 2.5 40 0.984 39.37 0.5 20 LS VCT 64 helical large body 120 100-450 16.00 on 20 Disc VCT 64 helical large body 120 100-450 16.00 on 2.5 40 0.984 39.37 0.5 20 20 KNEE RECONS Window
Recon Name of Series Thickness Interval Recon
Algorithm/Mode Width/Level Direction AX BONE 2.5 2.5 bone full 2500/480 head/feet Must be first recon. MAVEN specific recon. AX THINS 1.25 1.25 bone full 2500/480 head/feet COR BONE 2.5 2.5 bone full 2500/480 front/back SAG BONE 2.5 2.5 bone full 2500/480 left/right AX SOFT 2.5 2.5 bone full 400/40 head/feet

CT MAVEN Ankle PHILIPS PARAMETERS & RECONS Scan
Dose
3D
Colli Rot Mode kV Avg
mAs Index Dose Pitch Detect Time Incisive 128 helical 120 85 32 on 0.80 64 0.625 1.00 Name of Series Thick Interval Filter Window iDose Recon
Direction head/feet AX BONE 3.0 3.0 YC bone 3 AX THINS 1.0 1.0 YC bone 3 head/feet MAVEN specific recon. COR BONE 3.0 3.0 YC bone 3 front/back left/right SAG BONE 3.0 3.0 YC bone 3 AX SOFT 3.0 3.0 YC abdomen 3 head/feet

SIMULATED WEIGHT-BEARING
CT SCANNING PROTOCOL MAVEN™ PSI System – APEX 3D™ Total Ankle Replacement PURPOSE: Conduct simulated weight-bearing CT scan for MAVEN™ Patient-Specific Guide and Surgical Planning Case Report creation for the Paragon 28® APEX 3D™ Total Ankle Replacement System. Adhering to this CT scan protocol is critical. PATIENT POSITION ON CT TABLE: • Patient: Supine position - No cushions/wedges under legs or feet; may push metatarsal bases out of the field of view, causing scans to be rejected. • Affected leg: Foot in neutral flexion - Foot MUST be perpendicular to table with toes pointed up - Holder/brace use is REQUIRED to ensure foot alignment • Unaffected leg: Flat on table next to affected leg, UNLESS: - If there is a knee (TKR) or ankle (TAR) implant in the unaffected leg, flex leg to get implant out of plane from affected leg and FOV. Positioned in neutral/90°
to the leg. (Use of box or positioning box if necessary). • INSTRUCT: Patient CANNOT move during scan OR between scan(s). SCAN REQUIREMENTS: • Scout - Above knee contiguous – down through extents of foot. • Scan - Range: Include full knee to ankle. Ensure complete foot is in view (MUST include metatarsals without cut off; can cut off posterior heel and distal toes). See following page. - Scan mode: Helical - Gantry tilt: 0° - File format: Uncompressed DICOM - Pixel size: 0.8mm or smaller in axial view (25cm DFOV preferred, up to 40cm accepted) • Reformats: None • Burn: DICOM CD - Upload through website: www.apexankle.com - Mail: Attn: Paragon 28® MAVEN™ TAR PSI 5381 South Alkire Circle Littleton, CO 80127 1

SIMULATED WEIGHT-BEARING
CT SCANNING PROTOCOL MAVEN™ PSI System – APEX 3D™ Total Ankle Replacement CT SCAN PARAMETERS – PARAGON 28 MAVEN TAR PROTOCOL Exam Scan Mode Pitch Slice Thickness (mm) Slice Spacing (mm) kV mA/Auto mA Noise Index Dose Range DFOV (cm) Recon Type 25 preferred (Up to 40 Bone 2000/400 Lower Extremity Helical Up to 1 1.25 1.25 120 115 accepted) • Continuous Scan: - 5 cm proximal to knee joint through bottom of foot (MUST include metatarsals without cut off; can cut off posterior heel and distal toes; see gray shaded region in figure) 50 mm Distal Knee joint line DFOV 25cm preferred (up to 40cm accepted) 1.25 mm (maximum) slice spacing continuous through purple shaded region Continuous Scan Ankle joint line Scan past foot to capture entire region of interest Figure 1. Schematic of scan boundary and slice spacing for continuous knee and ankle scan 2