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Ultrasound Ordering Guidelines

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Ultrasound Ordering Guidelines ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule Out . .” as the sole diagnosis/reason for exam. Likewise, a sole diagnosis/reason for exam such as “gallstones” cannot be accepted. A symptom that results in a suspicion of gallstones, e.g., “right upper quadrant pain after meals,” must be provided. If the patient does not speak English, you must notify Central Scheduling when you make the appointment that an interpreter will be needed. For additional information on ultrasound exams, and other radiology exams, please consult the American College of Radiology’s ACR Appropriateness Criteria® document found at www.acr.org. For ordering guidelines, please scroll to the appropriate page(s). For Breast Ultrasound, please see the section on Mammography and Breast Ultrasound. Abdominal Ultrasound Deep Vein Thrombosis Ultrasound Obstetrical Ultrasound Pelvic Ultrasound Scrotal Ultrasound Soft Tissue Ultrasound ABDOMINAL ULTRASOUND EXAM INFORMATION ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US Abdominal Right upper quadrant If the right upper Patient should have Patient should have nothing to Limited RUQ pain quadrant area and both nothing to eat or drink eat or drink for 6 hours prior to Right flank pain kidneys are desired, for 6 hours prior to the the exam. Epigastric pain order US Abdominal exam. All EKG leads and stickers located Includes: Jaundice Survey. Patient may take in the area of interest should be Pancreas Abnormal liver When the left upper medications with a small removed so that the sonographer Liver function tests quadrant only is the amount of water. can access the area to be Gallbladder Abnormality seen on primary area of scanned. Bile Ducts another imaging study interest, order US Right Kidney Follow-up of known or Spleen. suspected abnormality in the right upper quadrant US Spleen Left upper quadrant If the left upper Patient should have Patient should have nothing to pain quadrant area and both nothing to eat or drink eat or drink for 6 hours prior to Left flank pain kidneys are desired, for 6 hours prior to the the exam. Includes: Abnormality seen on order US Abdominal exam. All EKG leads and stickers located Spleen another imaging study Survey. Patient may take in the area of interest should be Left Kidney Follow-up of known or medications with a small removed so that the sonographer suspected abnormality amount of water. can access the area to be in the left upper scanned. quadrant ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US Abdominal Abdominal pain AN ABDOMINAL Patient should have Patient should have nothing to Survey Flank pain SURVEY DOES NOT nothing to eat or drink eat or drink for 6 hours prior to Abnormal laboratory EXAMINE THE PELVIS for 6 hours prior to the the exam. Includes: tests OR BOWEL. exam. All EKG leads and stickers located Pancreas Abnormality seen on When the right upper Patient may take in the area of interest should be Liver another imaging study quadrant only is the medications with a small removed so that the sonographer Gallbladder Follow-up of known or primary area of amount of water. can access the area to be Bile Ducts suspected abnormality interest, order US Abd scanned. Right and Left in the abdomen Limited RUQ. Kidneys When the left upper Spleen quadrant only is the Aorta (limited) primary area of IVC (limited) interest, order US Spleen. If an abdominal hernia is the area of interest, order US Abdominal Wall. US Aorta Palpable or pulsatile Patient should have Patient should have nothing to abdominal mass nothing to eat or drink eat or drink for 6 hours prior to Includes: Follow-up of a for 6 hours prior to the the exam. Aorta previously identified exam. All EKG leads and stickers located Proximal Iliac abdominal aortic Patient may take in the area of interest should be Arteries aneurysm medications with a small removed so that the sonographer amount of water. can access the area to be scanned. ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US Aorta Screening evaluation Patient should have This exam is only performed as Screening for abdominal aortic nothing to eat or drink an outpatient exam. aneurysm for 6 hours prior to the Includes: exam. Aorta Patient may take Proximal Iliac medications with a small Arteries amount of water. US Kidneys Flank pain If both kidneys and the None None Abnormal renal right upper quadrant Includes: laboratory tests area are desired, order Right and Left Renal abnormality US Abdominal Survey. Kidneys seen on another If both kidneys and the imaging study left upper quadrant Follow-up of known or area are desired, order suspected renal US Abdominal Survey. abnormality RENAL VASCULAR Hematuria in a child STUDIES ARE ORDERED THROUGH THE CARDIOVASCULAR DEPARTMENT ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US Kidney & U Flank pain If the bladder only is Patient must have a full Patient must have a full bladder. Bladder Abnormal laboratory the area of interest, bladder. Patient should drink four 8-ounce tests order US Bladder. Patient should drink four glasses of water prior to the Includes: Abnormality seen on 8-ounce glasses of water exam. Patient should be Right and Left another imaging study prior to the exam. FINISHED drinking the water at Kidneys Follow-up of known or Patient should be least one hour before the exam. Urinary Bladder suspected renal or FINISHED drinking the Patient should not void before urinary bladder water at least one hour the exam. abnormality before the exam. In lieu of drinking water, patient Hematuria in a child Patient should not void can have IV fluids. before the exam. A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder. If the patient has a Foley catheter, it should be clamped prior to the exam in so that the bladder is full at the time of the exam. ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US Bladder Urinary retention, If the kidneys are also Patient must have a full Patient must have a full bladder. frequency, or urgency of interest, order US bladder. Patient should drink four 8-ounce Includes: Palpable mass Kidneys & U Bladder Patient should drink four glasses of water prior to the Urinary Bladder Hematuria 8-ounce glasses of water exam. Patient should be prior to the exam. FINISHED drinking the water at Patient should be least one hour before the exam. FINISHED drinking the Patient should not void before water at least one hour the exam. before the exam. In lieu of drinking water, patient Patient should not void can have IV fluids. before the exam. A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder. If the patient has a Foley catheter, it should be clamped prior to the exam so that the bladder is full at the time of the exam. US Ascites 4 Search for free or This exam looks for None None Quad Measure loculated peritoneal ascites only; it does and/or retroperitoneal not examine organs. Includes: fluid Abdomen Peritoneal Cavity DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION IMPORTANT INFORMATION: All arterial studies of extremities are ordered through the cardiovascular department. DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US DVT Left Leg Pain and swelling in left This exam looks for deep None Patient should be transported on a leg vein thrombosis stretcher or bed Includes: Follow-up for patients If a palpable mass of the Patient MUST have his/her Deep venous with known DVT in left left leg is the area of pants/pajama bottoms removed system of left leg leg interest, order US Soft before being transported. from the groin to Tissue Left Leg Underwear does not need to be the upper calf If a Baker’s Cyst only is removed. suspected, order US Soft Tissue Left Leg US DVT Right Leg Pain and swelling in This exam looks for deep None Patient should be transported on a right leg vein thrombosis stretcher or bed Includes: Follow-up for patients If a palpable mass of the Patient MUST have his/her Deep venous with known DVT in right leg is the area of pants/pajama bottoms removed system of right leg right leg interest, order US Soft before being transported. from the groin to Tissue Right Leg Underwear does not need to be the upper calf If a Baker’s Cyst only is removed. suspected, US Soft Tissue Right Leg DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION EXAM COMMON ORDERING NOTES OUTPATIENT INPATIENT AND INDICATIONS PREP EMERGENCY DEPARTMENT PATIENT PREP US DVT Bilateral Pain and swelling in This exam looks for deep None Patient should be transported on a Legs both legs vein thrombosis stretcher or bed Follow-up for patients Patient MUST have his/her Includes: with known DVT in pants/pajama bottoms removed Deep venous both legs before being transported. system of both Underwear does not need to be legs from the removed. groin to the upper calf US DVT Left Arm Pain and swelling in left This exam looks for deep None Patient should be dressed in a arm vein thrombosis gown with snaps at the shoulders Includes: Follow-up for patients If a palpable mass of the All EKG leads and stickers located Deep venous with known DVT in left left arm is the area of in the area of interest should be system of left arm arm interest, order US Soft removed so that the sonographer from the neck to Tissue Left Arm can access the area to be scanned.
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