Top 20 Radiology Requests: The Rationale Behind Ordering Tests

Top 20 Radiology Requests: The Rationale Behind Ordering Tests free pdf ebook was written by SSkootsky on June 08, 2006 consist of 4 page(s). The pdf file is provided by www.radnet.ucla.edu and available on pdfpedia since April 24, 2012.

ucla medical group practice guideline: ambulatory radiology table a: table b: table c: table..dissection and rupture, carotid stenosis and dissection, peripheral vascular disease); image guided..severe headache acute neurological deficit brain mri interstial lung disease, tumor perilesional staging. renal colic and hematuria. characterize size and...

x
send send what is readshare?


Thank you for helping us grow by simply clicking on facebook like and google +1 button below ^^

Top 20 Radiology Requests: The Rationale Behind Ordering Tests pdf




Read
: 346
Download
: 0
Uploaded
: April 24, 2012
Category
Author
: SSkootsky
Total Page(s)
: 4
Top 20 Radiology Requests: The Rationale Behind Ordering Tests - page 1
UCLA Medical Group Practice Guideline: Ambulatory Radiology Table A: Table B: Table C: Table D: General Overview of Imaging Modalities Common Cross-Sectional Studies that may be Performed Without Contrast Agents Common Cross-Sectional Studies Utilizing Ultrasound Appropriate Use of Contrast Agents for Common Studies Table A: General Overview of Imaging Modalities Modality Plain Film Radiography & Computed Radiography Fluoroscopy Common Clinical Usage Cancer screen, chest symptoms, weight loss; Severe Abdominal Pain (free air) & Obstruction, Calcifications; Trauma; Osteomyelitis; Arthritis; Joint Replacements Comment Gall stones and Renal Calculi better evaluated by U/S and CT respectively. Cost + Gastrointestinal studies (UGI/SBFT, BE, Enteroclysis); Arthrography; Interventional Radiology; Genitourinary exams (RUG, VCUG, Antegrade/retrograde Pyelography) Peripheral Vascular Disease; AV Shunt Management; Stage Aneurysms and other vascular malformation of CNS; Evaluation of Acute Cerebral Ischemia for Thrombolytic intervention Multidetector CT Angiography & MR Angiography has largely replaced conventional angiography for diagnostic examinations. First choice imaging of RUQ Pain and Female Pelvic Pain Preferred over MRI for Bone and Lung evaluation, e.g. eval following spinal surgery or HRCT lung Preferred over CT for soft tissue. e.g. for radiculopathy For symptomatic patients order a diagnostic study and specify complaint(s). ++ Angiography - Conventional +++ Ultrasound Computed Tomography Magnetic Resonance Imaging Abdominal Pain and Pelvic Pain; Visualization of GB stones; Hydronephrosis; Vascular Studies; Testicular Pain and Masses; Breast Imaging; Image guided biopsy. Oncologic staging and follow up for chest, abdomen and pelvis. Trauma; Stroke evaluation. Bone tumors; Spine evaluation; Pulmonary Artery CTA and other angiographic applications (aortic aneurysm, dissection and rupture, carotid stenosis and dissection, peripheral vascular disease); Image guided biopsy. Hyper-acute stroke evaluation (MRI diffusion weighted images); CNS tumors (1º and 2º); Spinal cord compression; Vascular Studies; Musculoskeletal tumors and infections; Hepatobiliary disease; Breast Disease. Screening examinations and Diagnostic Mammography. Comparison exams essential! ++ +++ ++++ Mammography + Additional Information: NIA Radiology Guidelines used for UCLA Medical Group UM determinations can be reviewed at http://mcoperations.mednet.ucla.edu (see section under Medical Management). Page 1 of 4 pages
You're reading the first 4 out of 4 pages of this docs, please download or login to readmore.
Top 20 Radiology Requests: The Rationale Behind Ordering Tests - page 2
Table B: Common Cross-Sectional Studies that may be Performed Without Contrast Agents Study Head CT Common Indications Trauma Imaging Goal Visualize edema, hemorrhage, herniation, and fractures. (N.B. i.v. Contrast can mimic subarachnoid hemorrhage. Noncontrast CT should always precede the administration of i.v. contrast). Visualize edema, hemorrhage, herniation, masses, hydrocephalus Identify Acute/Hyperacute CVA Visualize early and or small lesions (tumor, infection, demyelination) that may be occult at CT Define fractures that may be occult on plain films and or better visualized by CT. Excellent utility of multiplanar reformations with multidetector CT. Visualize edema and hemorrhage of the spinal cord. Visualize extrinsic cord compression Define bony impingement upon spinal canal and neural foramina. Excellent utility of multiplanar reformations with multidetector CT. Visualize disk abnormalities that are subtle or occult on CT. Identify cord lesions that would never be seen on CT: mass, edema, syrinx. Excellent view of marrow infiltrative processes. Define level of cord compression and causative lesion: metastatic bone lesions, epidural versus intra- axial versus intra-thecal extra-axial masses. Gadolinium can assist identification of small leptomeningeal tumors that seed over the cord and cauda equina, eg. Breast CA Limited sampling of lung tissue used to characterize lung interstitium and identify patients with signs of active alveolitis. Characterize size and location of urinary calculi, assess hydronephrosis, hydroureter; Define fractures, Characterize bone lesions: location, aggressiveness, biopsy and treatment planning Stage parametrial lesions, assess uterine lesions: adenomyomatosis vs. fibroids, dynamic stress studies for cystoceole Head CT Brain MRI Acute Neurological Deficit and AMS, Severe Headache Acute Neurological Deficit Trauma Spine CT Spine MRI Spine CT Trauma Radiculopathy, Back Pain Radiculopathy, Back Pain Spine MRI Spine MRI Cord compression Thorax HRCT Interstial lung disease, tumor perilesional staging. Renal colic and hematuria. Trauma, Infection and Tumors. Joints. Lesions of the female pelvis CT KUB Musculoskeletal CT Pelvic MRI Additional Information: NIA Radiology Guidelines used for UCLA Medical Group UM determinations can be reviewed at http://mcoperations.mednet.ucla.edu (see section under Medical Management). Page 2 of 4 pages
Top 20 Radiology Requests: The Rationale Behind Ordering Tests - page 3
Table C: Common Cross-Sectional Studies Utilizing Ultrasound Study Ultrasound Neonatal cranial and spine Ultrasound Vascular studies Common Indications Depressed infant, A & B’s, sacral dimple/hairy nevus Extremity swelling, pain, claudication, cold/blue extremity UTI, palpable mass Imaging Goal IVH, hydrocephalus, spinal dysraphism. Ultrasound Pediatric body imaging Ultrasound Pediatric hips Ultrasound Adult Abdomen Ultrasound Female Pelvis Ultrasound Scrotum Hip clicks and clunks, breech, family hx. RUQ Pain, RLQ Pain, Epigastic Pain, Renal Colic, Distention/Ascites, tumor screening OB Complications, Ectopic pregnancy, vaginal bleeding, pelvic pain Pain, Mass, Infertility DVT, Arterial Stenosis, Aneurysms and Pseudoaneurysms. AV fistula, AV malformations Screening for hydronephrosis, masses. Recommend MRI for paraneoplastic syndromes Screening for hip dysplasia, effusion Excellent visualization of Renal and GB stones. Biliary dilatation, cholecystitis, pancreatitis, hydronephrosis, organomegaly Fetal viability, identification of IUP/Ectopic, free pelvic fluid, masses and cysts, hydrosalpinx, torsion Orchitis, torsion, hemorrhage and or masses, hydrocele, varicocele Additional Information: NIA Radiology Guidelines used for UCLA Medical Group UM determinations can be reviewed at http://mcoperations.mednet.ucla.edu (see section under Medical Management). Page 3 of 4 pages
Top 20 Radiology Requests: The Rationale Behind Ordering Tests - page 4
Table D: Appropriate Use of Contrast Agents for Common Studies Contrast Agent Intravenous Iodine Pre-procedure creatinine is desirable for diabetics and hypertensives and other vasculopaths. NPO 2-4 hours (aspiration rare). In Neuro Imaging CT: Screening for masses and infection. (Lesion enhancement is contingent on breakdown of the blood brain barrier. Higher- grade masses enhance more than lower grade lesions). CTA: for carotid/vertebral and circle of Willis. In Chest Imaging CTA and Aortography: Contrast is mandatory for all vascular studies. Contrast assists in the identification of lymph nodes. Identify lung and pleural enhancement related to metastases and infection. In Abd/Pelvis Imaging CT: Usually desirable. Pre/post contrast studies for liver mets and evaluation on unexplained weight loss Contrast timing is critical in certain instances. Pancreas and liver are optimally studied with a three-phase protocol: noncontrast, pancreatic/arterial phase, portal venous phase. In Musculoskeletal Imaging CT: Can help for soft tissue masses to evaluate vessel patency and relationship to major vessels (surgical roadmap), and to provide lesion enhancement, define extent of the lesion. Intravenous Gadolinium MRI: 1º 2º Tumor; Infection MRA: Aorta and Pulmonary Arteries Intra-articular contrast NA NA MRI: Not usually indicated (but is visible when concentrated in urine). Use for iodine contrast allergy. NA MRI: Tumors. Viability of tissue in diabetic feet/PVD Iodine conventional arthrography, hip, shoulder and wrist. Gad for hip & shoulder. Characterize derangement of articular cartilage injuries of the joint capsule and ligaments, labral injuries. To speak with Dr. Jonathan Goldin, Chief of Radiology at Santa Monica Hospital 310-319-1259 To speak with Dr. Ed Zaragoza, Clinical Director 310-319-4320 Revised & Approved by UCLAMG May 2006 Additional Information: NIA Radiology Guidelines used for UCLA Medical Group UM determinations can be reviewed at http://mcoperations.mednet.ucla.edu (see section under Medical Management). Page 4 of 4 pages
You're reading the first 4 out of 4 pages of this docs, please download or login to readmore.

People are reading about...