Head
Neck
Spine
Cardiovascular
Pulmonary
Gastrointestinal
Renal
Genitourinary
Musculoskeletal

Specific information regarding appropriateness criteria for imaging can be viewed at the ACR website, ACR Appropriateness Criteria.

For any questions regarding ordering of imaging studies, please contact us.

• All traumas = head CT without contrast
• Head CT without contrast is the initial imaging of choice for any brain lesion such as stroke, bleed, or tumor
• Tumors and cerebral aneurysms may need further evaluation with a contrast enhanced head CT.
• Early stroke may not be detected by CT. If there is continued clinical concern for acute ischemia, obtain an MRI brain without contrast
• Brain tumors, multiple sclerosis, and meningitis/encephalitis require an MRI brain with and without contrast
• Lesions of the pituitary, optic nerves, or acoustic nerve require an MRI brain with and without contrast and thin slices through the region of interest

• All traumas = neck CT without contrast
• Concern for cervical vascular injury, obtain a CTA neck (CT Angiogram with contrast).
• Suspected cord injury requires an MRI of the C spine without contrast.
• For retropharyngeal abscess, peritonsillar abscess, or lymphadenopathy, obtain a soft tissue neck with contrast.
• Thyroid disease = thyroid ultrasound
• For suspected brachial plexus injury, obtain an MRI brachial plexus with contrast

• Suspected cord injury requires an MRI of the spine (C, T, or L) without contrast.
• For epidural abscess/hematoma or spinal tumor, obtain an MRI of the spine with and without contrast.
• Fractures are best seen with CT without contrast. If CT is equivocal, obtain an MRI of the spine without contrast

• Start with a chest x-ray (PA and lateral is prefered).
• Suspected aortic dissection or aneurysm will need a CTA chest with cardiac gating.
• Coronary artery disease can be assessed with Cardiac CT. Please call x4755 for scheduling.
• Post-traumatic vascular injury and peripheral vascular disease requires a CTA of the extremity.
• For abdominal aortic aneurysms, obtain a CTA abdomen and pelvis with and without contrast.
• Portal vein thrombosis and portal hypertension are assessed with a limited abdominal ultrasound.

• Start with a chest x-ray (PA and lateral is prefered).
• For suspected pulmonary embolism, obtain a CT chest with contrast for PE. If the patient cannot obtain this study (contrast allergy, renal failure, or over the weight limit), obtain a nuclear medicine VQ study.
• Further assessment of pulmonary nodules, pneumothorax, pleural effusion, or penumonia can be made with a CT chest without contrast
• For lung mass, obtain a CT chest with contrast
• Interstitial lung disease requires a high resolution CT of the chest

• Initial imaging of the abdomen may include a KUB x-ray.
• Suspected small bowel obstruction = CT abdomen and pelvis with IV and oral contrast
• Suspected Cholecystitis = RUQ ultrasound
• Suspected Appendicitis = CT abdomen and pelvis with IV and oral contrast. Rectal contrast can be administered as an alternative to oral contrast.
• Suspected Appendicitis in children or pregnant patients = Limited RLQ ultrasound
• Pancreatitis = CT abdomen pancreas protocol
• Liver pathology can be assessed by CT abdomen liver protocol, but may require further evaluation with MRI abdomen or a limited liver ultrasound
• The esophagus is best evaluated by fluoroscopic esophagram
• Initial imaging for stomach ulcers or mass can be made with fluoroscopic upper GI series
• Inflammatory bowel disease can be assessed by a fluoroscopic small bowel series
• Suspected colitis or diverticulitis = CT abdomen and pelvis with IV or oral contrast
• Colorectal tumor = CT colonography. Please call x4755 for scheduling and preparation instructions.

• The kidneys are best assessed with renal ultrasound (ie. renal cysts, renal insifficiency, pyelonephritis, hydrocephalus, renal mass)
• A CT abdomen renal protocol may be necessary for further evaluation (renal cyst or renal mass).
• For suspected kidney stone = CT abdomen without contrast
• Uretheral injuries are assessed with a fluoroscopic retrograde cystourethrogram
• Ureteral reflux or ureteroceles are evaluated by fluoroscopic cystogram

• The uterus and adnexa are best evaluated initially by pelvic ultrasound
• Ovarian torsion, TOA, dermoid, ovarian cysts = pelvic ultrasound
• Ectopic pregnancy + Beta HCG > 1500 = OB ultrasound (Ectopic pregnancy cannot be ruled out for B-HCG < 1500)
• Endometriosis can be evaluated with MRI of the pelvis with and without contrast during the menstrual phase
• Further evaluation with CT abdomen and pelvis with IV and oral contrast may be required for equivocal TOA or ovarian dermoid
• Testicular torsion, hydrocele, epididimytis, or mass = scrotal ultrasound

• All bony pathology should initially be assessed by x-ray (ie. fractures, tumors, osteomyelitis, arthritis, etc).
• Fractures are assessed by x-ray. Equivocal findings may require a limited CT without contrast or MRI without contrast.
• Bone tumors may require further evaluation with MRI with and without contrast
• Osteomyelitis should be assessed with MRI with and without contrast. If MRI is contraindicated, obtain a nuclear medicine 3 phase bone scan.