CT

CT Chest
If no contraindications to IV contrast exists, all CT chest examinations should be ordered with IV contrast with the exception of high-resolution chest CT.

CT Abdomen
A number of protocols are available. If no contraindication to IV contrast exists, IV contrast is preferable except for certain indications. Oral contrast will be administered to all patients having a CT scan of the Abdomen unless specified below. If a patient for any reason should not be given oral contrast, please include in ordering comments.

• Without IV contrast

1. CT Stone protocol-no oral or IV contrast. Includes CT Abdomen and CT Pelvis. To look for urinary stones

2. Non-contrast CT Abdomen or Abdomen and Pelvis-use only if IV contrast is contraindicated

• With IV contrast

1. CT Abdomen or Abdomen and Pelvis with IV contrast-for all indications other than those listed below

2. CT 3-Phase liver/pancreas protocol-includes pre-contrast arterial and portal venous phases. Does not include CT Pelvis; order separately if required. Suitable for patients with:

-elevated liver function tests
-hepatitis
-cirrhosis
-suspected liver mass
-suspected pancreatic tumor or biliary obstruction on prior imaging examination

3. CT Hematuria protocol-includes pre- and post-IV contrast CT. Includes CT abdomen and CT Pelvis. Looks for stones and tumor.

4. CT Adrenal protocol-includes pre- and post-IV contrast CT. Does not include CT Pelvis; order separately if required.

-use only to evaluate adrenal mass seen by another imaging examination
-suspected primary hypercortisolism or Cushing’s

5. CTA-includes CT Abdomen and CT Pelvis

-abdominal aortic aneurysm
-suspected renal artery stenosis
-chronic mesenteric ischemia (acute mesenteric ischemia may need conventional angiography)

CT Pelvis
• Almost always performed with IV and oral contrast. If a patient should not receive oral
  contrast, please specify in ordering comments.
• For GYN problems, MR is preferable; consult Radiologist for individual cases.

NOTE ABOUT IV CONTRAST: Contraindications to IV contrast with CT examinations:
• If a patient has a previous history of mild allergic reaction, use a steroid prep.
• If a patient has a previous history of severe allergic reaction, then a non-contrast CT or a
  contrast enhanced MR should be substituted. Consult Radiologist for individual cases.

MRI

MR Chest
Currently there is no role for MR in general chest cases. Sometimes it may be suitable for mediastinal abnormalities; consult Radiologist in individual cases.

MR Abdomen
Currently abdominal MR is performed for specific abdominal organs, as the protocols are organ specific. All abdominal MRs should be ordered without and with IV contrast. The following protocols are available:

1. Liver (with or without MRCP)
2. Kidneys
3. Adrenals
4. Pancreas
5. MRCP-order as Liver wo/w contrast WITH MRCP
6. MRA-protocols currently in development