CT Ordering Guide for Referring Physicians

 

BODY IMAGING

 

LUNGS

 

CT with contrast for initial screening of lung disease, generalized chest pain or other lung pathology.

CT with contrast when for lung mass.

CT without contrast for follow up of pulmonary nodules.

CTA Chest with contrast for pulmonary embolism.

CTA with intravenous contrast for evaluation of the coronary arteries. (Cardiac CTA)

 

 

ABDOMEN AND PELVIS

 

For screening of abdominal pain, order a CT Abdomen and Pelvis with iv and oral contrast.

For more specific concerns, see individual organs below.

Liver/

Liver:  If suspect liver lesion or for liver mass/hepatitis screening, order a CT Abdomen with contrast, Liver protocol (triphasic protocol.)

 

Pancreas: CT Abdomen with contrast, Pancreatic protocol or initial workup of the pancreas or for pancreatic masses.

 

Spleen: If there is no known abnormality but there is a concern and a general screening is needed, order a CT Abdomen with contrast.

Spl

Kidneys:

CT without contrast if there is flank pain, or renal stone.

CT without and with contrast (Hematuria/ IVP protocol) for evaluation of the renal collecting system.

CT without and with contrast (Renal mass protocol) if real mass is suspected.

 

Adrenal Glands:  CT with and without contrast, Adrenal protocol for initial evaluation and for adrenal mass.

 

Bowel:

CT of the abdomen and pelvis without contrast for evaluation of appendicitis.

CT of the abdomen and pelvis with iv and oral contrast. for all other concerns related to the bowel.

If iv contrast cannot be given due to renal insufficiency, CT with oral contrast will be sufficient.

Uterus/

Bladder:

For evaluation of bladder pathology order a CT Pelvis with and without contrast.

Aorta/

Aorta or Vascular:

CTA with contrast of the chest, abdomen, pelvis or any combination for aortic aneurysm, dissection or follow-up of aortic endograft placement.

CTA lower extremities for upper and lower extremity vascular imaging.

CTA Abdomen  for evaluation of the mesenteric or renal arteries.

 

MUSCULOSKELETAL IMAGING

 

CT: CT is generally utilized in evaluation of the bony structures and is usually requested  specifically by the orthopedic surgeon. For most musculoskeletal issues, MRI is the imaging procedure of choice.

 

MRI:  MRI is the optimal examination available for joints and the surrounding tendons, ligaments, and cartilage.  MRI is also helpful for persistent for unexplained joint pain in the elderly as it very sensitive in the detection of occult fracture in patients with osteopenia or osteoporosis.

 

NEUROLOGIC IMAGING

 

Soft Tissue Neck:  CT with contrast for evaluation all neck pathology

except for parotid, tongue and nasopharyngeal masses.

Paranasal

Paranasal sinuses: CT without contrast for initial sinus evaluation. 

 

Brain: 

CT without contrast for initial evaluation for trauma/hemorrhage.

CT without and with contrast for evaluation of infection, inflammation and neoplasm. 

 

Face: CT without contrast for initial evaluation all pathologies including trauma.

 

Orbits: 

CT without contrast for trauma.

CT without and with contrast for orbital mass.

 

Temporal Bones:  CT without contrast for evaluation ossicles and other bony structures. Initial evaluation for all congenital, infectious, inflammatory and neoplastic processes.

Neck Vessels,

Neck, Vessels, Circle of Willis: CTA with and without contrast for circle of Willis and with contrast and for neck vessels.

 

Temporal Mandibular Joints: CT without contrast.

 

Spine:

CT without contrast for trauma. 

CT without and with contrast evaluation infection, inflammation, neoplasm.

MRI with and without contrast for myelopathy, spinal cord compression, post operative spine, known malignancy and suspected infectious or inflammatory process.

Questions?   A radiologist will be happy to help at:

Chinese Hospital:   (415) 677-2320

San Joaquin General Hospital:  (209) 468-6224