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ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule Out . . .” as the sole diagnosis/reason for exam. Likewise, a sole diagnosis/reason for exam such as “gallstones” cannot be accepted. A symptom that results in a suspicion of gallstones, e.g., “right upper quadrant pain after meals,” must be provided. If the patient does not speak English, you must notify Central Scheduling when you make the appointment that an interpreter will be needed. For additional information on ultrasound exams, and other radiology exams, please consult the American College of Radiology’s ACR Appropriateness Criteria® document found at www.acr.org. For ordering guidelines, please scroll to the appropriate page(s). For Breast Ultrasound, please see the section on Mammography and Breast Ultrasound. Abdominal Ultrasound Deep Vein Thrombosis Ultrasound Obstetrical Ultrasound Pelvic Ultrasound Scrotal Ultrasound Soft Tissue Ultrasound

ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

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Page 1: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

ORDERING GUIDELINES: ULTRASOUND

GENERAL INFORMATION

The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule Out . . .” as the sole diagnosis/reason

for exam. Likewise, a sole diagnosis/reason for exam such as “gallstones” cannot be accepted. A symptom that results in a suspicion of

gallstones, e.g., “right upper quadrant pain after meals,” must be provided.

If the patient does not speak English, you must notify Central Scheduling when you make the appointment that an interpreter will be

needed.

For additional information on ultrasound exams, and other radiology exams, please consult the American College of Radiology’s ACR

Appropriateness Criteria® document found at www.acr.org.

For ordering guidelines, please scroll to the appropriate page(s). For Breast Ultrasound, please see the section on Mammography and Breast

Ultrasound.

Abdominal Ultrasound

Deep Vein Thrombosis Ultrasound

Obstetrical Ultrasound

Pelvic Ultrasound

Scrotal Ultrasound

Soft Tissue Ultrasound

Page 2: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

ABDOMINAL ULTRASOUND EXAM INFORMATION

ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Abdominal

Limited RUQ

Includes: Pancreas

Liver Gallbladder

Bile Ducts Right Kidney

Right upper quadrant pain

Right flank pain

Epigastric pain

Jaundice

Abnormal liver function tests

Abnormality seen on another imaging study

Follow-up of known or suspected abnormality in the right upper quadrant

If the right upper quadrant area and both kidneys are desired, order US Abdominal Survey.

When the left upper quadrant only is the primary area of interest, order US Spleen.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

Patient may take medications with a small amount of water.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

US Spleen

Includes: Spleen

Left Kidney

Left upper quadrant pain

Left flank pain

Abnormality seen on another imaging study

Follow-up of known or suspected abnormality in the left upper quadrant

If the left upper quadrant area and both kidneys are desired, order US Abdominal Survey.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

Patient may take medications with a small amount of water.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

Page 3: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Abdominal

Survey

Includes: Pancreas

Liver Gallbladder

Bile Ducts Right and Left

Kidneys Spleen

Aorta (limited) IVC (limited)

Abdominal pain

Flank pain

Abnormal laboratory tests

Abnormality seen on another imaging study

Follow-up of known or suspected abnormality in the abdomen

AN ABDOMINAL SURVEY DOES NOT EXAMINE THE PELVIS OR BOWEL.

When the right upper quadrant only is the primary area of interest, order US Abd Limited RUQ.

When the left upper quadrant only is the primary area of interest, order US Spleen.

If an abdominal hernia is the area of interest, order US Abdominal Wall.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

Patient may take medications with a small amount of water.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

US Aorta

Includes: Aorta

Proximal Iliac Arteries

Palpable or pulsatile abdominal mass

Follow-up of a previously identified abdominal aortic aneurysm

Patient should have nothing to eat or drink for 6 hours prior to the exam.

Patient may take medications with a small amount of water.

Patient should have nothing to eat or drink for 6 hours prior to the exam.

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

Page 4: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Aorta

Screening

Includes: Aorta

Proximal Iliac Arteries

Screening evaluation for abdominal aortic aneurysm

Patient should have nothing to eat or drink for 6 hours prior to the exam.

Patient may take medications with a small amount of water.

This exam is only performed as an outpatient exam.

US Kidneys

Includes: Right and Left

Kidneys

Flank pain

Abnormal renal laboratory tests

Renal abnormality seen on another imaging study

Follow-up of known or suspected renal abnormality

Hematuria in a child

If both kidneys and the right upper quadrant area are desired, order US Abdominal Survey.

If both kidneys and the left upper quadrant area are desired, order US Abdominal Survey.

RENAL VASCULAR STUDIES ARE ORDERED THROUGH THE CARDIOVASCULAR DEPARTMENT

None None

Page 5: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Kidney & U

Bladder

Includes: Right and Left

Kidneys Urinary Bladder

Flank pain

Abnormal laboratory tests

Abnormality seen on another imaging study

Follow-up of known or suspected renal or urinary bladder abnormality

Hematuria in a child

If the bladder only is the area of interest, order US Bladder.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

If the patient has a Foley catheter, it should be clamped prior to the exam in so that the bladder is full at the time of the exam.

Page 6: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

ABDOMINAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Bladder

Includes:

Urinary Bladder

Urinary retention, frequency, or urgency

Palpable mass

Hematuria

If the kidneys are also of interest, order US Kidneys & U Bladder

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

If the patient has a Foley catheter, it should be clamped prior to the exam so that the bladder is full at the time of the exam.

US Ascites 4 Quad Measure

Includes: Abdomen

Peritoneal Cavity

Search for free or loculated peritoneal and/or retroperitoneal fluid

This exam looks for ascites only; it does not examine organs.

None None

Page 7: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION

IMPORTANT INFORMATION: All arterial studies of extremities are ordered through the cardiovascular department.

DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US DVT Left Leg

Includes:

Deep venous system of left leg from the groin to

the upper calf

Pain and swelling in left leg

Follow-up for patients with known DVT in left leg

This exam looks for deep vein thrombosis

If a palpable mass of the left leg is the area of interest, order US Soft Tissue Left Leg

If a Baker’s Cyst only is suspected, order US Soft Tissue Left Leg

None Patient should be transported on a stretcher or bed

Patient MUST have his/her pants/pajama bottoms removed before being transported. Underwear does not need to be removed.

US DVT Right Leg

Includes: Deep venous

system of right leg from the groin to

the upper calf

Pain and swelling in right leg

Follow-up for patients with known DVT in right leg

This exam looks for deep vein thrombosis

If a palpable mass of the right leg is the area of interest, order US Soft Tissue Right Leg

If a Baker’s Cyst only is suspected, US Soft Tissue Right Leg

None Patient should be transported on a stretcher or bed

Patient MUST have his/her pants/pajama bottoms removed before being transported. Underwear does not need to be removed.

Page 8: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US DVT Bilateral

Legs

Includes: Deep venous

system of both legs from the

groin to the upper calf

Pain and swelling in both legs

Follow-up for patients with known DVT in both legs

This exam looks for deep vein thrombosis

None Patient should be transported on a stretcher or bed

Patient MUST have his/her pants/pajama bottoms removed before being transported. Underwear does not need to be removed.

US DVT Left Arm

Includes: Deep venous

system of left arm from the neck to

the elbow

Pain and swelling in left arm

Follow-up for patients with known DVT in left arm

This exam looks for deep vein thrombosis

If a palpable mass of the left arm is the area of interest, order US Soft Tissue Left Arm

None Patient should be dressed in a gown with snaps at the shoulders

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

US DVT Right Arm

Includes: Deep venous

system of right arm from the neck

to the elbow

Pain and swelling in right arm

Follow-up for patients with known DVT in right arm

This exam looks for deep vein thrombosis

If a palpable mass of the right arm is the area of interest, order US Soft Tissue Right Arm

None Patient should be dressed in a gown with snaps at the shoulders

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

Page 9: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

DEEP VEIN THROMBOSIS ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US DVT Bilateral

Arms

Includes: Deep venous

system of both arms from the

neck to the elbows

Pain and swelling in both arms

Follow-up for patients with known DVT in both arms

This exam looks for deep vein thrombosis

None Patient should be dressed in a gown with snaps at the shoulders

All EKG leads and stickers located in the area of interest should be removed so that the sonographer can access the area to be scanned.

Page 10: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION

Obstetrical Ultrasound exams are divided below into three categories:

Less Than 14 Weeks Exams

Greater Than 14 Weeks Exams

Multiple Gestations Exams.

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP

LESS THAN 14 WEEKS EXAMS

US Preg Less Than 14 Weeks

Size and dates

Vaginal bleeding in early pregnancy

Patient should have a positive pregnancy test before ultrasound is ordered.

This exam includes evaluation of the maternal uterus and adnexae.

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have the results of βHcG test before ultrasound is ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

Page 11: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US

Limited/Viability/Ectopic

Determine viability/fetal heart beat

Suspected ectopic pregnancy

This exam does not routinely examine the maternal uterus and adnexae.

Patient should have a positive pregnancy test before ultrasound is ordered.

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have the results of βHcG test before ultrasound is ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

Page 12: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Follow Up Less

14 Weeks

Re-examination of an abnormality seen on a previous ultrasound

Vaginal bleeding in early pregnancy when an initial ultrasound exam has already been performed

A transvaginal exam may also be per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

US Preg 1st Tri Screening

Nuchal Lucency First Trimester Screening Test

Lab order must also be placed

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

This exam is only performed as an outpatient exam.

Page 13: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP

GREATER THAN 14 WEEKS EXAMS

US Preg Greater Than 14 Weeks

Fetal Survey

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

This exam is only performed as an outpatient exam.

US Follow Up Greater 14 Weeks

Re-evaluation of an abnormality seen on a previous ultrasound

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Please call the Ultrasound Department (ext. 4448) for information about the patient prep for this exam.

Page 14: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Biophysical

Profile

Evaluate fetal well-being

Does not include estimated fetal weight unless specifically requested.

None None

MULTIPLE GESTATION EXAMS:

US Preg Less Than 14 Wks Mult

Size and dates

Vaginal bleeding in early pregnancy

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

Page 15: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Follow Up Less

14 Wks Mult Re-examination of an

abnormality seen on a previous ultrasound

Vaginal bleeding in early pregnancy when an initial ultrasound exam has already been performed

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

US Preg Greater 14 Weeks Mult

Fetal Survey

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

This exam is only performed as an outpatient exam.

Page 16: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

OBSTETRICAL ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Follow Up

Greater 14 Mult Re-evaluation of an

abnormality seen on a previous ultrasound

A transvaginal exam may also be performed per department protocol or if specifically requested by the provider. A separate exam does not need to be ordered.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Please call the Ultrasound Department (ext. 4448) for information on the prep for this exam.

US Biophysical Profile Mult

Evaluate fetal well-being

Does not include estimated fetal weight unless specifically requested.

None None

Page 17: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

PELVIC ULTRASOUND EXAM INFORMATION

PELVIC ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Pelvic Non OB

Includes:

Uterus Endometrium

Adnexae Ovaries

Pelvic pain

Amenorrhea

Menorrhagia

Metrorrhagia

Menometrorrhagia

Post-menopausal bleeding

This exam normally includes both a transabdominal exam and a transvaginal exam for patients age 18 or over. A separate transvaginal exam does not need to be ordered

Patient may choose not to do the transvaginal exam

Provider should provide any special instructions (such as “no transvaginal” or “transvaginal only.”)

If an inguinal hernia is suspected, order US Pelvic Wall.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

Page 18: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

PELVIC ULTRASOUND EXAM INFORMATION EXAM COMMON

INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Pelvic Follow

Up Non OB

Includes: Uterus

Endometrium Adnexae

Ovaries

Follow-up of previously detected abnormality

Further evaluation of pelvic abnormality detected on another imaging study

This exam normally includes both a transabdominal exam and a transvaginal exam for patients age 18 or over. A separate transvaginal exam does not need to be ordered

Patient may choose not to do the transvaginal exam

Provider should provide any special instructions (such as “no transvaginal” or “transvaginal only.”)

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

Patient must have a full bladder.

Patient should drink four 8-ounce glasses of water prior to the exam. Patient should be FINISHED drinking the water at least one hour before the exam.

Patient should not void before the exam.

In lieu of drinking water, patient can have IV fluids.

A bladder scan should be performed before the patient is sent to the ultrasound department to verify that the patient has at least 250 ml of fluid in the bladder.

Page 19: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

SCROTAL ULTRASOUND EXAM INFORMATION

SCROTAL ULTRASOUND EXAM INFORMATION EXAM COMMON INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP Scrotum

Testes

Scrotal Sac Epididymides

Scrotal pain Testicular trauma Palpable scrotal mass Scrotal asymmetry,

enlargement, or swelling Suspected scrotal hernia Undescended testicle(s) Follow-up of prior

abnormality Follow-up of

abnormality found on another imaging study

None None

Page 20: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

SOFT TISSUE ULTRASOUND EXAM INFORMATION

SOFT TISSUE ULTRASOUND EXAM INFORMATION EXAM COMMON INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Soft Tissue

Head/Neck Soft tissue mass on head

or neck – not thyroid-related

Order must identify location

None None

US Chest Wall Soft tissue mass on chest (excluding breast) or upper back

Pleural effusion

Order must identify location of mass

None None

US Abdominal Wall Soft tissue mass on front

or back of abdomen

Suspected hernia

Order must identify location

None None

US Pelvic Wall Soft tissue mass in pelvic wall, buttocks, perineum or penis

Suspected hernia

Order must identify location

None None

Page 21: ORDERING GUIDELINES: ULTRASOUND · ORDERING GUIDELINES: ULTRASOUND GENERAL INFORMATION The patient’s history/diagnosis/reason for exam MUST include a symptom. We cannot accept “Rule

SOFT TISSUE ULTRASOUND EXAM INFORMATION EXAM COMMON INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Soft Tissue Left

Leg

Evaluation of soft tissue masses, swelling, or fluid collection in left leg

Detection of foreign bodies in superficial soft tissues of left leg

Soft tissue mass on left buttock

Soft tissue mass on perineum

Order must identify location

None Patient MUST have his/her pants/pajama bottoms removed before being transported. Underwear does not need to be removed.

US Soft Tissue Right Leg

Evaluation of soft tissue masses, swelling, or fluid collection in right leg

Detection of foreign bodies in superficial soft tissues of right leg

Soft tissue mass on right buttock

Soft tissue mass on perineum

Order must identify location

None Patient MUST have his/her pants/pajama bottoms removed before being transported. Underwear does not need to be removed.

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SOFT TISSUE ULTRASOUND EXAM INFORMATION EXAM COMMON INDICATIONS ORDERING NOTES OUTPATIENT

PREP

INPATIENT AND EMERGENCY

DEPARTMENT PATIENT

PREP US Soft Tissue Left

Arm

Evaluation of soft tissue masses, swelling, or fluid collection in left arm

Detection of foreign bodies in superficial soft tissues in left arm

Order must identify location

None None

US Soft Tissue Right Arm

Evaluation of soft tissue masses, swelling, or fluid collection in right arm

Detection of foreign bodies in superficial soft tissues in right arm

Order must identify location

None None

US Foot Plantar Faciitis

Suspected plantar fasciitis in one or both feet

Order must identify location

None None

US Foot Mortons Neuroma

Suspected Morton’s neuroma in either foot

Order must identify location

None None