Imaging Recommendations
A Guide to Recommended Imaging Procedures
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.
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 |
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.