What to Order When 2021 RadNet-Full Color

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


NO NO 72125CT spine, cervicalw/o contrast

LUMBARSPINE NO NO 72131CT spine, lumbar

w/o contrast


1

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

2

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

3

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.

4

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

5

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

6

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

7

7


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

8

8


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


MRI arthrogram hipLabral/Ligament tear(pre and post-op)


MRI arthrogram ankleOsteochondral lesion(post-op)

Intra-articular NOMeniscus (post-op)73722+27370+77002

MRI arthrogram knee

ELBOW

WRIST

SHOULDER

HIP

ANKLE

KNEE


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


NO NO 72148MRI spine, lumbarw/o contrast

RadiculopathyDegenerative discdisease/herniationCanal StenosisCompression fracture

YES NO 72147MRI spine, thoracicw/wo contrast


NO NO 72146MRI spine, thoracicw/o contrast

RadiculopathyDegenerative discdisease/herniationCanal StenosisCompression fracture

CERVICAL

LUMBAR

THORACIC

MRI


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)


11

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


Bonnie Freitas, MD Neuroradiology ImagingMedical Director

Beverly Radiology Medical Group


Robert Lee, MD MSK Imaging MedicalDirector



RobertPrincenthal, MD

[email protected] (818) 292-5000Prostate Imaging MedicalDirector

Beverly RadiologyMedical Group

Jason McKellop, MD Breast Imaging MedicalDirector



Judith Rose, MD PET/CT & Nuclear MedicineImaging Medical Director



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