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Radiology Ordering Guide

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Radiology Ordering Guide Radiology Ordering Guide Prepared By Diplomate of the American Board of Radiology Diplomate of the American Board of Nuclear Medicine Certification Board of Nuclear Cardiology Certification Board of Cardiovascular CT Certificate of Added Qualification: Vascular & Interventional Radiology, Neuroradiology & Pediatric Radiology Copyright 2013 Version 3 TABLE OF CONTENTS HEAD ................................................................................................................................. 1 ORBITS ............................................................................................................................. 3 TEMPORAL BONES ....................................................................................................... 3 FACIAL ............................................................................................................................. 4 NECK ................................................................................................................................. 4 CHEST ............................................................................................................................... 4 CARDIAC .......................................................................................................................... 7 ABDOMEN / PELVIS ...................................................................................................... 9 NUCLEAR MEDICINE ................................................................................................. 11 MUSCULOSKELETAL ................................................................................................ 13 PEDIATRIC .................................................................................................................... 15 INTERVENTIONAL SERVICES ................................................................................. 16 BREAST IMAGING ....................................................................................................... 17 MISCELLANEOUS ....................................................................................................... 18 MRI Contraindications for Scanning............................................................................ 19 Exam & Procedure Preparation by Modality .............................................................. 20 MRI CONTRAST GUIDE ............................................................................................. 22 CT CONTRAST GUIDE ................................................................................................ 23 Iodinated Contrast Precautions (IVP, Enhanced CT) ............................................. 24 GENERAL DESCRIPTION OF TERMS .................................................................... 25 WHAT ARE BI-RADS®? ........................................................................................................ 25 WHAT IS BREAST IMAGING? ............................................................................................. 25 WHAT IS CARDIOVASCULAR RADIOLOGY? .................................................................. 25 WHAT IS CT? .......................................................................................................................... 25 WHAT IS INTERVENTIONAL RADIOLOGY? .................................................................... 26 WHAT IS MAMMOGRAPHY?............................................................................................... 26 WHAT IS MRI? ........................................................................................................................ 26 WHAT IS MUSCULOSKELETAL RADIOLOGY? ............................................................... 26 WHAT IS NEURORADIOLOGY? .......................................................................................... 26 WHAT IS NUCLEAR MEDICINE? ........................................................................................ 27 WHAT IS POSITRON EMISSION TOMOGRAPHY? ........................................................... 27 WHAT IS PEDIATRIC RADIOLOGY? .................................................................................. 27 WHAT IS RADIOGRAPHY? .................................................................................................. 27 WHAT IS ULTRASOUND? .................................................................................................... 27 The enclosed information is only to be used as a guide Patient clinical history or contraindications may change orders Copyright Version 3 HEAD PATIENT SYMPTOMS DIAGNOSTIC EXAM Headache Low clinical suspicion, no CT without contrast focal signs High clinical suspicion, MRI without contrast focal neuro signs Concern for aneurysm MRA of Brain Trauma Acute CT without contrast Subacute or chronic MRI without contrast Stroke / Ischemia Acute MRI with diffusion images Chronic MRI without contrast Versus neoplasm MRI with & without contrast Venous sinus thrombosis MRV and MRI Multiple Sclerosis MRI with & without contrast (include sagital flair) Dementia MRI without contrast Carotid Disease Doppler Ultrasound Hydrocephalus MRI without contrast Hemorrhage Including subarachnoid, CT without contrast subdural, and parenchymal Seizures MRI with & without contrast Neoplasm MRI with & without contrast Metastasis MRI with & without contrast Acoustic neuroma/hearing loss MRI with & without contrast (Brain & IACs protocol) Cranial nerve deficit MRI with & without contrast The enclosed information is only to be used as a guide 1 Patient clinical history or contraindications may change orders Copyright 2013 Version 3 (HEAD CONTINUED) PATIENT SYMPTOMS DIAGNOSTIC EXAM Bone lesions including tumors CT skull without contrast & other defects Congenital craniofacial 3D-CT without contrast malformation including craniosynostosis AIDS MRI with & without contrast; PET/CT Encephalitis MRI with & without contrast Pituitary gland imaging MRI with & without contrast (pituitary protocol) The enclosed information is only to be used as a guide 2 Patient clinical history or contraindications may change orders Copyright 2013 Version 3 ORBITS PATIENT SYMPTOMS DIAGNOSTIC EXAM Proptosis, Optic neuritis, MRI Orbits & MRI Brain, with & without Tumor, Pseudotumor, contrast Inflammation Foreign body, Trauma, Bony CT without contrast Anomaly TEMPORAL BONES PATIENT SYMPTOMS DIAGNOSTIC EXAM Acoustic neuroma MRI with & without contrast (IAC protocol) Otosclerosis, Congenital CT Temporal bones without contrast malformations Chronic infection or hearing loss CT Temporal bones without contrast Mastoiditis CT Temporal bones without contrast The enclosed information is only to be used as a guide 3 Patient clinical history or contraindications may change orders Copyright 2013 Version 3 FACIAL PATIENT SYMPTOMS DIAGNOSTIC EXAM Sinuses CT without contrast TMJ Trauma CT without contrast Meniscal derangement MRI without contrast (TMJ protocol) Non-traumatic TMJ pain MRI without contrast (TMJ protocol) NECK PATIENT SYMPTOMS DIAGNOSTIC EXAM Mass (non-thyroid) CT with contrast Lymphadenopathy CT with contrast Cancer staging & restaging PET / CT Carotid blood vessels Doppler ultrasound Thyroid Nodule Ultrasound CHEST INDICATION / SYMPTOMS DIAGNOSTIC EXAM Lung Mass CT with contrast Cancer Restaging CT with contrast Lymphoma (Thoracic) CT with contrast Adenopathy CT with contrast Infection / Pneumonia CT with contrast Pulmonary Obstructive Disease CT with contrast The enclosed information is only to be used as a guide 4 Patient clinical history or contraindications may change orders Copyright 2013 Version 3 (CHEST Continued) INDICATION / SYMPTOMS DIAGNOSTIC EXAM Abnormal Chest X-ray CT with contrast Lymphadenopathy CT with contrast Lump in Chest CT with contrast Chest Pain (Non-Cardiac) CT with contrast Hemoptysis CT with contrast Initial Pulmonary Nodule / Mass CT with contrast Evaluation Pulmonary Nodule Follow Up Low Dose Unenhanced CT Chest ONLY. No history or suspicion for malignancy and NO other clinical concerns (chest pain, cough etc...) Interstitial Lung Disease CT without contrast Assess Air Trapping CT without contrast Small Airways Disease CT without contrast Bronchiectasis CT without contrast Pre and Post Lung Transplant CT without contrast Assessment of Acute or Chronic CT Pulmonary Embolism PE Assessment for Pulmonary AVM CT Pulmonary Embolism Takayasu’s, Behcet’s,Pulmonary CT Pulmonary Angiogram Artery Sarcoma, etc. The enclosed information is only to be used as a guide 5 Patient clinical history or contraindications may change orders Copyright 2013 Version 3 (CHEST Continued) INDICATION / SYMPTOMS DIAGNOSTIC EXAM Specific Request for SuperDimension Bronchoscopy SuperDimension TM Bronchoscopy Protocol for a thoracic surgeon or interventional pulmonologist prior to performance of image guided bronchoscopy. Lung Cancer Screening Low Dose Unenhanced CT Chest The enclosed information is only to be used as a guide 6 Patient clinical history or contraindications may change orders Copyright 2013 Version 3 CARDIAC DIAGNOSIS DIAGNOSTIC EXAM Amyloidosis - Cardiac Cardiac MRI with & without contrast Aortic Aneurysm - Abdominal CTA abdomen pelvis with contrast Aortic Aneurysm - Thoracic CTA chest with contrast Aortic Coarctation CTA aorta with contrast OR MRA aorta with contrast Aortic Dissection CTA aorta with contrast – dissection protocol Aortic Valve – stenosis or Cardiac MRI without contrast regurgitation Arrhythmogenic Right Cardiac MRI with & without contrast Ventricular Dysplasia (ARVD) Atrial Fibrillation
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