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Imaging Recommendations

View or download our guide to procedures typically recommended for a variety of common conditions including Abdomen/Pelvis, Chest, Thyroid, Muskuloskeletal, Brain/Head, Eye/Ear/Nose/Throat, and Spine categories. Each category has a number of conditions listed by Clinical Signs/Conditions, Clinical Diagnosis and Imaging Modality.


NOTE: If pt has history of recent or active cancer, order exam with and without IV contrast.

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Body Imaging

Abdominal-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Abdominal Pain or Mass

Mass or Inflammation

CT

Acute Abdomen

Perforation, Free Air, Diverticulitis, Shortness of Breath, Ischemic Bowel, IBD, Omental Infarct

CT

Right Lower Quadrant Pain

Appendicitis

CT & Ultrasound

Weight Loss

Occult Primary Cancer

CT & MR

Adrenal-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Adrenal Mass

Cyst, Myelolipoma, Hemorrhage, Met, Lymphoma

CT & MR

Cushing’s or Conn’s Syndrome

Hyperplasia, Adenoma, Cancer

CT

Hypertension, Flushing, Rash

Pheochromocytoma

CT & MR

Non-Hyperfunctioning Adenoma

Met vs. Adenoma

MR & CT

Aorta-Specifica Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Pulsatile Abdominal Mass

Aortic Aneurysm: Screening or F/u, Rupture, Pre-Op Planning & Post-Op F/u

Ultrasound, CT, MRA or CTA and CTA

Biliary-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Abnormal Liver Function Test

Mass or Obstruction

Ultrasound, CT & MR Cholangiography/MR Liver

RUQ Pain

Acute Cholecystitis, Cholelithiasis, Biliary/Gallbladder Dysfunction

Ultrasound, CT, MRCP & HIDA (Nuc Med)

Gastroenterology-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Abdominal Pain

Known or Suspected Crohn’s Disease, or Other Inflammatory Bowel Disease

CT Enterography & MR Enterography
(younger pts or previous significant radiation exposure)

Chronic GI bleed

CT Enterography

Post-Prandial Pain/Nausea

Gastric Outlet Obstn/Gastroparesis

CT, Gastric Emptying (Nuc Med)

Rectal Cancer

Local Staging

MR

Rectal Pain & Fever

Perineal Abscess & Perianal Fistula

MR

Liver-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Abnormal Liver Function Test, Steatosis

Fatty Infiltration

MR

Hepatocellular Cancer/Mass

Cirrhosis & Hepatitis B

MR & CT

Hypervascular Liver Metastases

Renal, Carcinoid, GTD, Thyroid, Melanoma, Islet Cell Cancer Pancreas, Leiomyosarcoma, GI Tract

MR & CT

Mass < 2cm

Cyst vs. Met vs. Hemangioma

MR

Mass > 2cm

Hemangioma, Met, FNH, Adenoma

MR

Pancreas-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Elevated Amylase-Lipase

Acute Pancreatitis

CT

Endocrine Abnormality

Islet Cell Tumor Pancreas

CT & MR

Pain & Steatorrhea

Chronic Pancreatitis

CT & MRCP/MR

Recurrent Pancreatitis

Pancreas Divisum

MRCP

Weight Loss & Back Pain

Pancreatic Cancer

CT & MR/MRCP

Urologic-Specific Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Complex Cyst on Ultrasound / CT

Hemorrhagic Renal Cyst

MR

Hematuria

Rule-Out Renal Cancer, TCC, Bladder Cancer

CT Urogram & MR

Hypertension

Renal Artery Stenosis

MR Angiography & CT Angiography, If Stent

Increase in PSA, Abnormal Digital Exam

Prostate Cancer

Transrectal US Biopsy, Multiparametric 3T MR & CT

Pyuria, Fever, Flank Pain

Pyelonephritis/Hydronephrosis

US & CT Urogram

Renal Colic, Hematuria

Ureteral Stone

CT

Scrotal Mass/Pain

Testicular Cancer

US

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Abnl CXR-Hilar or Mediastinal Mass

Lung Cancer, Lymphoma, Sarcoid

CT

Abnl CXR-Interstitial Lung Disease

IPF, UIP, Sarcoid

CT w/ high resolution thin sections

Abnl CXR-Nodule

Lung Cancer, Metastasis, Granuloma

CT

Abnl CXR-Pleural Fluid and/or Mass

Empyema, Pleural Mass, Mesothelioma

CT

Abnl CXR-Posterior Mediastinal Mass

Neural Tumor

MR

Dysphagia

Rule-Out Esophageal Cancer

CT

Known Lung Nodule ≥ 10mm

Characterize, Rule-Out Malignancy

PET/CT

Lung Cancer (Known)

Staging

PET/CT

Non-Cardiac Chest Pain

Aortic Dissection

CT Angiogram

SOB, Dyspnea & Chest Pain

Pulmonary Embolus

CT Angiogram

General Indications

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Mass, Leg Swelling

Lymphadenopathy, Tumor

CT

Posterior Buttock/Leg pain

Lumbosacral Plexopathy

MR & CT

Gynecologic

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Cervical Cancer

Local Staging

MR & CT

Endometrial Cancer

Local Staging

Ultrasound, MR & CT

Elevated BETA HCG

Gestational Trophoblastic Disease

Ultrasound, MR & CT

Abdominopelvic Mass (Suspected), Ascites, Increase in CA 125 Antigen

Rule-Out Ovarian Neoplasm

CT & MR

Adnexal Mass (Known)

Characterize

Transvaginal Ultrasound & MR

Infertility

Congenital Anomaly

Ultrasound & MR

Infertility

Tubal Patency

HSG

Pelvic Pain, Anemia

Ectopic Pregnancy

Ultrasound

Pelvic Pain, Fever, Leucocytosis

Tubo-Ovarian Abscess

Ultrasound & CT

Pelvic Pain, Menorrhagia

Leiomyoma vs. Adenomyosis

MR

Post Menopausal Bleeding

Hyperplasia, Polyp, Cancer

US w/ Hysterosonography & MR

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Thyroid Nodule or Goiter

Rule-Out Thyroid Cancer

US, Possible Biopsy

Hyper/Hypothyroidism

Assess Thyroid Function

I-123 Thyroid Scan (Nuc Med)

Thyroid Cancer (Known)

Initial Staging

Ultrasound & CT

Thyroid Cancer (Known)

Restaging

PET/CT & CT

Musculoskeletal Imaging

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Ankle

Pain, Occult Fracture, Osteochondritis Dissecans, Achilles Tendon Tear, Tendon Tears, Tendonitis, Avascular Necrosis, Infection/Osteomyelitis, Tumor/Mass

MR

Ankle

Impingement

MR Arthrogram

Ankle

Complex Fracture

CT

Elbow

Pain, Occult Fracture, Distal Biceps Tendon Tear, Epicondylitis, Avascular Necrosis, Tumor/Mass, Infection/Osteomyelitis

MR

Elbow

Collateral Ligament Tear

MR

Elbow

Complex Fracture

CT

Foot

Pain, Occult Fracture, Infection/Osteomyelitis, Tumor/Mass, Plantar Fasciitis, Tarsal Coalition, Tendon Tears, Tendonitis, Avascular Necrosis

MR

Foot

Complex Fracture

CT

Hip

Pain, Occult Fracture, Avascular Necrosis, Infection/Osteomyelitis, Tumor/Mass, Bursitis, Myositis/Tendonitis

MR

Hip

Acetabular Labral Tear, Impingement

MR Arthrogram

Hip/Pelvis

Complex Fracture, Painful Arthroplasty

CT

Knee

Pain, Occult Fracture/Contusion, Avascular Necrosis, Meniscal Tear, Cruciate Ligament Tear, Collateral Ligament Tear, Osteochondritis Dissecans, Infection/Osteomyelitis, Tumor/Mass

MR

Knee

Internal Derangement–MR Contraindicated

CT Arthrogram

Knee

Complex Fracture, Painful Arthroplasty

CT

Shoulder

Rotator Cuff Tear, Occult Fracture, Pain, Tendonitis, Bursitis, Impingement Syndrome, Proximal Biceps Tendon Tear, Avascular Necrosis, Tumor/Mass, Infection/Osteomyelitis

MR

Shoulder

Glenoid Labrum Tear

MR Arthrogram

Shoulder

Internal Derangement–MR Contraindicated

CT Arthrogram

Shoulder

Complex Fracture, Painful Arthroplasty

CT

Wrist

Pain, Occult Fracture, Avascular Necrosis, Carpal Tunnel Syndrome, Tumor/Mass, Infection/Osteomyelitis

MR

Wrist

TFCC/Interosseous Ligament Tear

MR Arthrogram

Wrist

Complex Fracture

CT

Known Myeloma

PET/CT

Suspected Skeletal Metastasis

Bone Pain

Bone Scan (Nuc Med) & F18 PET

Suspected Soft Tissue Mass or Abscess

MR (if MR contraindicated, CT

Ulcer/Infection

Rule-Out Osteomyelitis

MR (if MR contraindicated or hardware present), CT, Bone Scan (Nuc Med)

Neuroradiology

Any brain/head order with a diagnosis of aneurysm or family history of aneurysm will have an MRA of the Circle of Willis (COW) in addition to the routine brain scan.

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Acute Headache

Subarachnoid Hemorrhage

CT

Cranial Nerve Dysfunction

Neuritis, Tumor

MR

Fever and Headache

Brain Abscess, Encephalitis

MR

Fluctuating Neurologic Symptoms

Multiple Sclerosis, Lyme Disease

MR

Galactorrhea, Elevated Prolactin

Pituitary Adenoma

MR Pituitary

Head, Neck, Vascular Work-Up

TIA, Stroke

MRA Carotid and Circle of Willis (COW) CTA if MRA Contraindicated

Head Trauma

Subdural Hematoma, Parenchymal Hemorrhage

CT

Headache With Neurologic Deficit

Tumor

MR

Headache Without Neurologic Deficit

Tension Headaches

CT

Known Malignancy With Neurologic Deficit

Metastasis, Carcinomatosis

MR

Progressive Neurologic Symptoms

Tumor

MR

Seizures

Congenital Anomaly, Tumor

MR

Temporal Visual Field Cut

Pituitary Adenoma

MR Pituitary

Transient Ischemic Attack/Stroke (Symptoms less than 6 hours)

Bleed/Infarct

CT & MR

Transient Ischemic Attack/Stroke (Symptoms greater than 6 hours)

Bleed/Infarct

MR

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Double Vision, Diplopia

Neuritis, Tumor

Brain and Orbit MR

Facial Pain, Draining Nose

Sinusitis

Coronal CT

Infection, Draining Ear

Cholesteatoma

Temporal Bone CT

Proptosis

Orbital Mass

CT Orbit and Pituitary Region

Tinnitus, Sensorineural Hearing Loss

Acoustic Neuroma

MR

Lymphadenopathy/Mass

CT & MR

Head & Neck Cancer (Known)

Staging/Restaging

PET/CT

Clinical Signs & Symptoms

Clinical Diagnosis

Imaging Modality

Myelopathy

Spinal Stenosis

MR

Progressive Spinal Cord Symptoms

Transverse Myelitis, Cord tumor

MR

Radiculopathy

Osteophyte, Disc Protrusion

MR

Spine Pain With Known Malignancy

Metastasis

MR

Trauma

Fracture

CT

Contrast Guidelines

Exam

Clinical Diagnosis

Contrast Usage

CT Abdomen/Pelvis

Eval Abdominal Organs, Abdomen Pain, Eval or F/u Cancer, Eval Hernia, Post-Trauma for Injury to Organs

With IV and Oral Contrast

CT Abdomen/Pelvis

Kidney Stones, Contraindication to IV Iodine (Allergy, Poor Kidney Function)

Without IV Contrast, No Oral Contrast

CTA Abdomen/Pelvis

Known AAA, AAA Endograft for Leak, Eval for Abdominal Aortic Dissection

With IV Contrast, No Oral Contrast

CT Chest (High-Res)

Eval Interstitial Lung Disease (ILD)

Without IV Contrast, No Oral Contrast

CT Chest (Routine)

Eval Lung Mass/Abnormalities on X-ray, Susp. Primary Lung Cancer, Susp. Mediastinal Mass, Susp. Lung Abscess/Empyema, Initial Assessment of Pulmonary Nodules

With IV Contrast, No Oral Contrast

CT Chest (PE)

Pulmonary Embolism

With IV Contrast, No Oral Contrast

CT Chest

Surveillance of Known Lung Nodules

Without IV Contrast, No Oral Contrast

CTA Chest

Acute Aortic Syndromes, Including Aortic Dissection, Intramural Hematoma Penetrating Atherosclerotic Ulcer, Aortic Aneurysm

With IV Contrast, No Oral Contrast

CT Enterography

Crohn’s Disease, Eval Small Bowel Polyps

With IV and Special Oral Contrast

CT Facial Bones

Trauma, Post-Op or Pre-Surgery Planning, Eval Hardware

Without IV Contrast, No Oral Contrast

CT Facial Bones/Neck

Eval Facial Swelling/Redness, Rule-Out Abscess/Mass, Lymphadeonopathy

With IV Contrast, No Oral Contrast

CT Head

Headaches, Post-Trauma for Injury/Bleeds, Post-Op Eval, Shunt or Other Placements

Without IV Contrast, No Oral Contrast

CT Head (If MRI Contraindicated)

Eval Tumor(s)

With IV Contrast, No Oral Contrast

CTA Head or Neck

Eval Arteries in Brain for Poss. Aneurysms and/or Blockage, Eval for Stroke

With IV Contrast, No Oral Contrast

CT Liver w/ Pelvis

Eval Liver Masses, HCC, Elevated LFTs, Liver Failure

With IV and Oral Contrast

CT Orthopedic/MSK

Without IV Contrast, No Oral Contrast

CT Pancreas w/ Pelvis

Eval Pancreatic Masses

With IV and Oral Contrast

CT Urogram

Renal Mass/Hematuria/UTIs, Rule-Out Urinary Tract Cancer

With & W/o IV Contrast, No Oral Contrast

CT Sinus

Acute/Chronic Sinusitis

Without IV Contrast, No Oral Contrast

CT Soft Tissue Neck

Neck Mass, Soft Tissue Pathology, Neck/Facial Swelling/Redness

With IV Contrast, No Oral Contrast

CT Spine (If MRI Contraindicated)

Trauma, Post-Op Eval, DDD/Narrowing

Without IV Contrast, No Oral Contrast

CT Temporal Bones

Hearing Loss, Ear Pain, Trauma

Without IV Contrast, No Oral Contrast

Exam

Clinical Diagnosis

Contrast Usage

MRA/MRI Abdomen/Pelvis

With and Without IV Contrast No contrast if pt on dialysis or GFR <30

MRCPSuspected CBD stone

Without IV Contrast

MRI Brain

Suspected Tumor or Infection

Without IV Contrast

MRI Brain

Tumor, Infection

With and Without IV Contrast

MR Enterography

Abdominal Pain, Crohn’s Disease

With IV and Special Oral Contrast

MRI/MRA Neck

With and Without IV Contrast

MRI Orthopedic/MSK

Without IV Contrast

MRI Orthopedic/MSK

Suspected Tumor or Infection

With and Without IV Contrast

MRI Spine

HNP, Pain, Extremity Weakness, Tenderness, Cauda Equina

Without IV Contrast

MRI Spine

Suspected Abscess, Tumor, Recent Spine Surgery

With and Without IV Contrast

NOTE: If pt has history of recent or active cancer, order exam with and without IV contrast.

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