what to order when 2021 radnet-full color
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WhatTo OrderWhenA Guide To The Most Common Clinical Indications Related To Radiology
Version 03.16.21 | RadNetImaging.com
2021
WhatTo OrderWhen
The following are general guidelines to follow the most common clinical indications related to radiology. It is important to start with the least invasive study (e.g. pelvic ultrasound before ordering CT), and to protect thepatient from any unnecessary radiation and contrast exposure.
HEAD & NECKBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name CodeSPINE (in patient with history of cancer contrast may be indicated)
SINUSPolypsPost nasal dripSinusitisSurgical Planning
NO NO
NO
70486CT sinus completew/o contrast
CT maxillofacial softtissue w/contrast
TEMPORALBONES
Otitis MediaCholesteatomaConductive hearing lossMastoiditis
NO NO 70480CT temporal bones (includes mastoids)w/o contrast
FACE
CellulitisInfection/abscessSoft Tissue Mass
Injury/trauma,concern of fracture
YES 70487
NO CT maxillofacial bonesw/o contrastNO 70486
SOFTTISSUENECK
AdenopathyDysphagiaInfection/abscessMass/neoplasmVocal cord paralysis
Salivary gland calculi/adenitisParathyroid adenomaForeign body
YES NO CT neck soft tissuew/contrast
CT neck soft tissuew/wo contrast
70491
YES NO 70492
ORBITS MassProptosisInfectionSwellingVision changes
YES NO CT orbits w/wo contrast 70482
Injury/trauma,concern of fracture NO NO CT orbits w/o contrast 70480
CT
THORACICSPINE NO NO 72128CT spine, thoracic
w/o contrast
CERVICALSPINE
Evaluate hardware/fusion statusDegenerative changesR/O Fx
Evaluate hardware/fusion statusDegenerative changesR/O Fx
NO NO 72125CT spine, cervicalw/o contrast
LUMBARSPINE NO NO 72131CT spine, lumbar
w/o contrast
Evaluate hardware/fusion statusDegenerative changesR/O Fx
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1
CHESTBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
NO CT chest w/o contrast
CHEST
AsthmaAtelectasisBronchiectasisCOPDCoughInterstitial Lung DiseaseEmphysemaFollow up pulmonary noduleInjury/traumaPericardial effusionPleural effusionPneumothoraxPulmonary noduleRib Fracture
Abnormality involving hilumEmpyemaInfiltrateLung cancerMass/EmpyemaPneumoniaWork up of other cancer/malignancy
NO
NOYES
71250
CT chest w/contrast 71260
CT
LUNG NO NO G0297Low Dose Lung Cancer CTHistory of smoking
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2
ARTHROGRAMBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
UPPEREXTREMITIES Intra-articular NO
732007320173202
CT Upper Extremity w/o contrastCT Upper Extremity w/contrastCT Upper Extremity w/wo contrast
Shoulder, r/o internal derangement (rotator cuff, biceps/labrum)Elbow and Wrist(if patient cannot tolerateMRI; contraindicationsfrom implants, etc.)
LOWEREXTREMITIES Intra-articular NO
737007370173702
CT Lower Extremity w/o contrastCT Lower Extremity w/contrastCT Lower Extremity w/wo contrast
Knee (ligaments, meniscus) Hip and Ankle(if patient cannot tolerate MRI; contraindications from implants, etc.)
HEAD Stenosis (MRA Preferred)Aneurysm
NECK YES NO 70498CT angio neckw/wo contrast
Carotid stenosis (pre-op eval),Dissection, Treated aneurysm
YES NO 70496CT angio brainw/wo contrast
CHEST YES NO
YES NO
YES NO
YES NO
72175CT spine, chestw/contrast
Suspected PE or evaluationof chronic PEThoracic aneurysm (ifascending, must havecardiac gating)
Abdominal aortic aneurysm
Intermittent claudicationLower extremity ischemiaPeripheral vascular disease
Mesenteric ischemiaPre op AAA surgeryPre or post-op evaluationPost stent grafting
ANGIOGRAPHY (CTA)Body Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
CT
ABDOMEN 74175CT angio abdomenw/wo contrast
CT angio abdomen/pelvis w/wo contrast
ABDOMEN& PELVIS 74174
ABDOMEN& PELVIS
W/ RUNOFF
75635
73706
CT angio abdominalaorta and bilateraliliofemoral with BLErunoff w/contrast
CT angio BLE’s to includebifurcation of aorta into illiac vessels w/contrast CT angio BLE’s w/contrast
EXTREMITIES YES NO
73206CT angio Upper Extremity w/contrast
AneurysmArterial occlusion/stenosisClaudicationCold footGangrenePainUlcerVenous occlusion/thrombosis (if patient cannot tolerate MRI; contraindications from implants, etc.)
73706CT angio Lower Extremity w/contrast
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3
EXTREMITIESBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
LOWEREXTREMITIES NO NO
737007370173702
CT Lower Extremity w/o contrastCT Lower Extremity w/contrastCT Lower Extremity w/wo contrast
UPPEREXTREMITIES
R/O ArthritisFracture(if patient cannot tolerate MRI; contraindications from implants, etc.)
R/O ArthritisFracture(if patient cannot tolerate MRI; contraindications from implants, etc.)
NO NO732007320173202
CT Upper Extremity w/o contrastCT Upper Extremity w/contrastCT Upper Extremity w/wo contrast
ABDOMEN & PELVISBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
WATERMultiphase CTabdomen/liverw/wo contrast
CT renals triple phasew/wo contrast- ABDOMEN
ABDOMEN
Renal mass
Abnormal liver enzymesJaundiceLiver mass
Abdominal painAbnormal labsAbscessAdenopathyAscitesInjury/traumaMetastasisPancreatitisPelvic painTumor/massUnexplained weight lossDiverticulosisDiverticulitisAppendicitisLymphomaHiatal Hernia
YES
WATERYES
YESYES
74170
74170
WATERMultiphase CTabdomen/liver w/wo contrast
PancreatitisJaundicePancreatic mass
YES 74170
CT abdomen/pelvisw/contrast and Oral Contrast
74177
CT
ABDOMEN& PELVIS
NO NO
NO NO
74176
74176
CT abdomen w/o contrast(with contrast if painful)
CT abdomen/pelvisw/o contrast
Ventral, umbilical hernia
SOFT TISSUEPELVIS
SOFT TISSUEPELVIS
YES YES
NO NO
NO NO
72193CT pelvis w/contrastAdenopathyMassPain
Inguinal Hernia
YES NO
Hydronephrosis (w/o flank pain)Flank painRenal StonesHematuria
Flank painRenal stones
Trauma, concern for fractureHip/SI joint w/ degenerativedisease
72192CT pelvis w/o contrast(w/contrast if painful)
UROGRAM 74178CT w/wo contrast(aka urogram)
STONEPROTOCOL
CT pelvis w/o contrastBONY PELVIS 72192
These recommendations are a general guideline and may not be applicable to everyone.
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4
Silicone implant rupture
High risk for malignancyNewly diagnosed breast cancerProblem Solving-unresolveddiagnostic mammography
NOYESMRI breastw/wo contrast-malignancy study
MRI breastw/o contrast-implant rupture study
77049
BREAST
YES NO 71552MRI w/contrastand w/o IV contrastMediastinal Mass
CHEST
NO NO
NO NO
71550
77059
MRI MSK chestw/o contrast
Chest wall pain(CT exam is preferred)Rib pain(CT exam is preferred)Sternoclavicular joint/clavicle/scapula pain
BRAINBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
NO MRI brain and IAC’sw/wo contrast
MRI brain w/o contrast
BRAIN
CVA/TIADizzinessMemory lossTraumaTremors
IAC lesion/hearing loss/infection
DiplopiaHyperthyroidism (e.g. Graves disease)NystagmusStrabismusTumor/mass/metastasisUnexplained vision lossUnilateral vision defect
YES
NONO
NOYES
70551
MRI brain w/wo contrast
Chiari MalformationInfectionLesions (specify)Multiple sclerosisNeurofibromatosisSeizuresTumor/mass/metastasis
NOYES 70553
70553
NO MRI brain Trigeminal w/wo contrastTrigeminal neuralgia YES 70553
NO MRI brain Pituitaryw/wo contrastPituitary mass, elevated
prolactinYES 70553
MRI orbitsw/wo contrast 70543
MRI
ORBITS
NO NO 70540MRI facew/o contrastTrauma
YES NO 70543MRI facew/contrast
InfectionTumor/mass/metastasis
SOFTTISSUE
CHEST
FACE
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5
MRI
EXTREMITIESBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
MRI upper extremity,non-joint w/o contrast
MRI lower extremity,non-joint w/o contrast
NON-JOINTEXTREMITY:
HAND=FINGER,ARM, FOOT=TOE, LEG
Morton’s neuromaMuscle/tendon tearOsteomyelitisStress/fracture
ArthritisAVNJoint painLigament/tendonmuscle/cartilage/labraltear (initial study)Stress/fracture
AbscessCellulitisInflammatory arthritisSeptic arthritisSynovitisTumor/mass
NONO
73218
73718
MRI upper extremity,non-joint w/o contrast
MRI lower extremity,non-joint w/wo contrast
MRI upper extremity,joint w/o contrast
MRI lower extremity,joint w/o contrast
MRI upper extremity,joint w/wo contrast
MRI lower extremity,joint w/wo contrast
AbscessCellulitisFoot osteomyelitis indiabetic patientsOsteomyelitisTumor/mass/metastasis(soft tissue)
NOYES
73720
73220
JOINTEXTREMITY:SHOULDER,
ELBOW, WRISTHIP, KNEE,
ANKLE
NO NO
YES NO
73223
73723
73221
73721
6
ABDOMEN & PELVISBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
MRI abd/panc/biliarytree w/o contrast
ABDOMEN
MRCP (biliary/pancreaticducts, stones, jaundice NONO 74181
MRI abdomenw/wo contrast
Liver diseaseMass (adrenal, liver,pancreatic, renal
NOYES 74183
NO NO 72195MRI pelvisw/o contrast
MSK pain - SI joints,sacrum, coccyxMuscle tearOsteomyelitis
YES NO
YES NO
74183+
72197MR Enterography
Bowel obstructionsEvaluate small bowelCrohn’s diseaseUlcerative Colitis
AbscessAdenomyosisEndometrial abnormalitiesFibroidProstate cancerSeptic arthritisTumor/mass/metastasis
72197MRI pelvisw/wo contrast
MSK PELVIS
MR ENTERO-GRAPHY
SOFT TISSUEPELVIS
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MRI
NEUROGRAMBody Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
YES NO 72197MRI lumbosacral plexusw/wo contrast
Lumbosacral plexus injuryNerve avulsionTumor/mass/metastasis
YES NO 73220-22MRI brachial plexusw/wo contrast-brachial plexus protocol
Brachial plexus injuryNerve avulsionTumor/mass/metastasis
LUMBOSACRALPLEXUS
BRACHIALPLEXUS
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name CodeHEAD & NECK
YES NO 72156MRI soft tissue neckw/wo contrast
DysphagiaInfectionPersistent hoarsenessTumor/mass/metastasisVocal cord paralysis
NECKSOFT TISSUE
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7
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
YES NO
74185+72198+73725
-50
MRA abd aorta, bilateraliliofemoral w/runoffw/wo contrast
73725-50
MRA bilateral lowerextremitiesw/wo contrast
AneurysmArterial occlusion/stenosisClaudicationCold footGangrenePainUlcerVenous occlusion/thrombosis
ANGIOGRAPHY (MRA)
YES NO 74185MRA abdomenw/wo contrast
Abdominal aortic aneurysmDissectionMesenteric ischemiaRenal artery stenosis/aneurysmVasculitis
MRAEXTREMITIES
MRAABDOMEN
MRI angio headw/o contrast
MRA HEAD
HeadachesStenosisAVM (MRI brain w/wo contrast)CVA/TIAAneurysmStrong family history ofcerebral aneurysms
NONO 70544
MRI angio headw/wo contrast
Dissection (CTA preferred),History of treated aneurysm NOYES 70546
YES NO 70546MRI venogram headw/wo contrastVenous thrombosis
YES NO 70549MRI angio neckw/wo contrast
StenosisAneurysmAVMCVA/TIADissection/vessel injury(CTA preferred)Subclavian steal
MRV HEAD
MRA NECK
MRI
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8
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
Intra-articular NO73222+24220+77002
MRI arthrogram elbowLigament tearLoose bodies(pre and post-op)
ARTHROGRAMS
Intra-articular NO
Intra-articular NO
73222+25246+77002
MRI arthrogram wristLigament tear(pre and post-op)
Labral tearRotator cuff (post-op)
73222+23350+77002
MRI arthrogramshoulder
Intra-articular NO73222+27093+77002
MRI arthrogram hipLabral/Ligament tear(pre and post-op)
Intra-articular NO73222+27648+77002
MRI arthrogram ankleOsteochondral lesion(post-op)
Intra-articular NOMeniscus (post-op)73722+27370+77002
MRI arthrogram knee
ELBOW
WRIST
SHOULDER
HIP
ANKLE
KNEE
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name Code
NO NO 72141MRI spine cervical w/o contrast
Neck PainRadiculopathyDegenerative discdisease/herniationCanal StenosisCompression fracture
SPINE
YES NO 72149MRI spine, lumbarw/wo contrast
MSDiscitis/osteomyelitisPost-op painTumor/mass/metastasis
YES NO 72156MRI spine, cervicalw/wo contrast
MSDiscitis/osteomyelitisPost-op painTumor/mass/metastasis
NO NO 72148MRI spine, lumbarw/o contrast
RadiculopathyDegenerative discdisease/herniationCanal StenosisCompression fracture
YES NO 72147MRI spine, thoracicw/wo contrast
MSDiscitis/osteomyelitisPost-op painTumor/mass/metastasis
NO NO 72146MRI spine, thoracicw/o contrast
RadiculopathyDegenerative discdisease/herniationCanal StenosisCompression fracture
CERVICAL
LUMBAR
THORACIC
MRI
These recommendations are a general guideline and may not be applicable to everyone.
9
9
YES NO7219776377
MRI Prostatew/wo contrast with3D-Rendering
Positive biopsy forpretreatment evaluationActive surveillance withrising PSAPost HIFU with rising PSAPost biopsyPSA relapse from eitherRP or RT
PROSTATE(STAGING &
RECURRANCE)
Body Part Reason for exam IV Contrast Oral Contrast Procedure Name CodePROSTATE
YES NO 7214872146
MRI Prostatew/wo contrast
PSA relapsePost treatmentInitial staging high riskpatient
PROSTATE(BONES &NODES)
YES NO 5570077021
MRI Prostatew/wo contrast
It requires one ofthe above protocolsto be done prior tobiopsy
PROSTATE(MRI TARGETED
BIOPSY)
NO NO MRI Prostatewo contrast
Limited to high qualityaxial, sagital T2,axial gradient echoto evaluate for fiducialseed placementNo need for diffusion,or contrast exam,or large field viewof pelvis
PROSTATE(RADIATIONTREATMENTPLANNING/HYDROGEL
SPACERCONFIRMATION- LIMITED EXAM)
72195
YES NO7219776377
MRI Prostatew/wo contrast with3D-Rendering
Elevated PSARising PSA followingtreatment for malignantneoplasm of ProstatePalpable nodulePre-biospy evaluationPrior negative biopsyStable active surveilanceand stable post HIFU
PROSTATE(DETECTION)
Body Part Reason for exam Code
THYROID
Elevated calcium/abnormal thyroid blood workEnlarged thyroid glandHistory of thyroid cancerHyper/hypothyroidismMassMultinodular goiterParathyroid adenomas
Lymph nodeParotidSub mandibular mass
76536
76536
Amaurosis FugaxAphasiaAtaxiaBruitHemiplegiaSyncopeTransient vision lossVertigo/dizziness
93880
76604
ULTRASOUND
CAROTIDS
Abnormal mammographic findingsPalpable massTargeted area of pain 76642 x2BREAST
SOFT TISSUENECK
Pleural effusionPalpable/Superficial Mass
76775Abdominal aortic aneurysm screening of follow-upBruitPulsatile aorta
76770
Abnormal LFT’S/fatty liverCirrhosis of hepatic diseaseGallstonesHepatomegalyJaundicePainSplenomegaly
Tras Vaginalonly - 76830
TransAbdominal
only - 76856TV and TA -
76856 & 76830
Adnexal abnormalitiesDysfunctional uterine bleedingEnlarged uterus or ovaryExcessive bleeding/pain after surgeryFibroid uterusLocalization of intrauterine contraceptive device+X-Ray Pelvis/csdom Pelvis/Abdomen DX X-RayMenstrual cycle irregularitiesOvarian cystOvarian torsionPainPCOSPrecocious pubertyPost menopausal bleeding
CHEST
ABDOMINALAORTA
ABDOMEN
PELVIS-FEMALE
10
10
Body Part Reason for exam Code
PELVIS-MALEBladder OnlyGeneral PainUrinary Frequency
EpididymitisHydrocele (swelling)MassPainTraumaTorsionUndescended testesVaricocele
76856
76870
Bladder diverticulaHematuriaHydronephrosisNeurogenic bladderRenal failure/diseaseRenal stoneTraumaUTI/cystitis/pyelonephritisUrinary retention
Renal andBladder76770
Renal Only76775
Bladder Only76857
ULTRASOUND
KIDNEY &BLADDER
SCROTUM
93970
Calf painDVT follow-upEdema/swellingPositive Homan sign
76882Fluid collectionPalpable Mass
93923
ClaudicationPADPVDDiabetesWeak Pedal PulsesRest Pain
UPPER OR LOWER EXTREMITY(VENOUSDOPPLER)
UPPER OR LOWER EXTREMITY
(NON VASCULAR)
(SOFT TISSUE)
ARTERIAL BRACHIAL
INDEX (ABI)
These recommendations are a general guideline and may not be applicable to everyone.
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11
12
MEDICAL DIRECTORS
12
Physician Title Group Email Phone
Jason Sinner, MD Practice Medical Director Beverly Radiology Medical Group
[email protected] (818) 441-6809
Patrick Alore, MD Body Imaging MedicalDirector
Beverly RadiologyMedical Group
[email protected] (310) 445-2800
Bonnie Freitas, MD Neuroradiology ImagingMedical Director
Beverly Radiology Medical Group
[email protected] (818) 933-2020
Robert Lee, MD MSK Imaging MedicalDirector
Beverly Radiology Medical Group
[email protected] (818) 933-2020
RobertPrincenthal, MD
[email protected] (818) 292-5000Prostate Imaging MedicalDirector
Beverly RadiologyMedical Group
Jason McKellop, MD Breast Imaging MedicalDirector
Beverly Radiology Medical Group
[email protected] (818) 784-8799
Judith Rose, MD PET/CT & Nuclear MedicineImaging Medical Director
Beverly Radiology Medical Group
[email protected] (310) 445-2800