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.