Clinician’s Guide to Ordering CT Imaging Studies

HOW and WHEN DO I ORDER CONTRAST?

  • Almost always, CTs should be ordered “with” OR “without’ only – NOT BOTH.
  • A ‘with and without’ protocol is generally needed only for exams to assess hematuria, or known masses of the liver, kidneys, and pancreas.
  • CT of the abdomen and pelvis (with the exception of a CT stone study and CT angiography) should receive an oral contrast prep.
  • General survey exams for pain or other non-specific symptoms can be performed either “with IV contrast only” or “without IV contrast only” but should not be “with and without” as such a scan increases patient radiation dose and generally does not add diagnostic value.
  • Common indications that do not require the use of IV contrast: diverticulitis, hernia.
  • Appendicitis is best assessed with IV contrast but can be done without if necessary.
  • CT Chest for possible or follow up nodules should be ordered WITHOUT contrast.
  • Any CT for evaluation of vascular pathology, abscess, or neoplasm (known or suspected) should be performed with IV contrast if possible.
  • Orthopedic and musculoskeletal CT is performed WITHOUT contrast unless looking for an abscess.

* IF YOU HAVE ANY QUESTIONS ON A PARTICULAR CASE SCENARIO, PLEASE DO NOT HESITATE TO CALL YOUR LOCAL McLAREN RADIOLOGY DEPARTMENT

*Please note that these are general guidelines only, and may not definitively apply to all scenarios*

Clinician’s Guide to Ordering MRI Imaging Studies

DO I NEED TO ORDER CONTRAST?

  • General principle – All MRIs ordered with contrast should be ordered “without and with”
  • General principle – If the patient’s GFR is below 30, contrast should not be given

Exam you would like to order

Contrast?

Abdominal MRI

Without and With

Pelvic MRI (non boney/soft tissue)

Without and With

Thoracic/Brachial Plexus

Without and With

ANY Orthopedic/Musculoskeletal Exam in the absence of a known or palpable mass.

Without

 

ANY Orthopedic/Musculoskeletal examination to assess a known or palpable mass or infection.

Without and With

MRA Neck

Always without and with

MRI Neck

Always without and with

MRI Brachial Plexus

Always without and with

MRI Orbits

Always without and with

MRV Brain

Always without and with

Exams with caveats

 

MRI Brain

Order “without and with” if the

following apply

Otherwise, order “without only”

 
  • Known hx of cancer, metastatic disease
  • Known hx of any brain mass
  • Vertigo/tinnitus (MRI IACs)
  • Known Multiple Sclerosis
  • Specific cranial neuropathy
  • Pituitary or hormonal imbalance (MRI Pit)

MRA Brain

Order “without and with” if the

following apply

Otherwise, order “without only”
  • Known hx of aneurysm clipping/coiling
  • Known AVM

MRI Cervical Spine

Order “without and with” if the

following apply

Otherwise, order “without only”

 
  • Known hx of cancer, metastatic disease
  • Known hx of any spinal cord mass
  • Known multiple sclerosis
  • High suspicion for epidural abscess or discitis/osteomyelitis

MRI Thoracic/Lumbar Spine

Order “without and with” if the

following apply

Otherwise, order “without only”
  • Known hx of cancer, mestastatic disease
  • Known hxof any spinal cord mass
  • Known multiple sclerosis (MRI TSpine only)
  • Previous spinal surgery
  • High suspicion for epidural abscess or discitis/osteomyelitis