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    Clinical Indications for corresponding imaging modality

Clinical problemFirst imaging choiceSecond imaging choiceComments
HEAD, NECK AND SPINE
Cauda Equina SyndromeMRI spine without contrastCT spine without contrastCT only if MRI is contraindicated and has low yield
Cerebral aneurysmMRA head without contrastCTA head without/with contrastFor patients with suspected or family history of aneurysm or follow up to prior known diagnosis
Cerebrovascular accidentCT head without contrastMRI head without contrastCT is needed first to exclude intracerebral hemorrhage
Dementia-Movement DisorderCT head without contrastMRI head without contrast 
DysphagiaBarium SwallowModified barium swallow (with speech therapist) if aspiration suspectedCT neck with contrast if neck mass suspected
Head traumaCT head without contrastMRI head without contrastMRI is indicated only if CT findings requires further imaging. Routine x-ray series (skull, sinuses, facial bones, etc.) has very low sensitivity for significant injury
Headache- intracranial infection/inflammationMRI head without/with contrastCT head without/with contrast 
Headache-chronicCT head without contrastMRI head without contrast 
Headache-worst headache, sudden onsetCT head without contrastCTA head without/with contrast, MRA head without contrastIf subarachnoid hemorrhage is suspected, CSF sampling may be needed since head CT can occasionally be false negative
Hearing loss - temporal bone traumaCT temporal bone without contrast  
Hearing loss - sensorineuralMRI IAC without/with contrastCT temporal bone without contrastCT temporal bone 1st choice if hearing loss is not sensorineural type
Intracranial bleedCT head without contrastMRI head without contrastMRI is indicated only if CT findings requires further imaging
Myelopathy- spinal infection or metastaticMRI spine without/with contrastCT spine with contrastCT only if MRI is contraindicated
Myelopathy-traumaticCT spine without contrastMRI spine without contrast MRI if CT is inconclusive or further imaging desired
Neck vascular injury CTA neck without/with contrast Conventional angiography may be needed for vascular injury
Pituitary lesion or neoplasmMRI sella without/with contrastCT sella without/with contrastCT only if MRI is contraindicated and has low yield
Proptosis, ophtalmoplegiaMRI orbit without/with contrastCT orbit/head with contrastCT is first choice if trauma is present
Seizures-EpilepsyCT head without contrastMRI head without/with contrastBaseline CT is to exclude urgent findings like bleed. MRI is needed to search for seizure cause
Sinusitis- acute or chronicCT sinus without contrastX-ray sinus seriesLimited sinus CT only uses few skipped coronal images; CT sinus with contrast or MRI sinus without/with contrast if further imaging is needed
Spine-Cervical stenosis or spondylosisMRI spine without contrastCT spine without contrast or spine x-rays 
Spine-Lumbar stenosis or spondylosis or sciaticaMRI spine without contrastCT spine without contrast or spine x-raysMRI with contrast if prior back surgery is performed
Spine injury- mild, no neurologic symptomsX-ray SpineCT Spine without contrast 
Spine injury- moderate/severe or neurologic symptomsCT spine without contrastMRI spine without contrastMRI if spinal ligamentous injury is suspected or CT is not helpful
Vertigo-Ataxia, no traumaMRI head without contrastCT head without contrastMRI spine without contrast if spinal origin of ataxia is suspected
Vision loss- sudden or transientMRA head/neck without/with contrastCTA head/neck without/with contrast 
 
Clinical problemFirst imaging choiceSecond imaging choiceComments
CHEST
Acute respiratory IllnessX-ray chestCT chest with contrastCT is reserved for complicated or unresolved cases, such as unresolved pneumonia or other lung disease
Breast massDiagnostic mammogram+US breast, if age over 30US breast, if age below 30 
Chest pain- aortic dissection or injuryCTA chest+abdomen without/with contrastMRA chest/abdomen without/with contrastBaseline chest x-ray is needed. Trans-esophageal echo if imaging findings are inconclusive
Chest pain - pulmonary embolismCTA chest without/with contrastV/Q scanBaseline chest x-ray is needed
Dyspnea or hemoptysisX-ray chestCT chest with contrast 
Lung massCT chest with contrastFDG PETXray chest is 3rd alternative and can be used as initial test but it is not very sensitive for small or subtle lesions
Metastasis screeningCT chest with contrastFDG PETStart with baseline chest x-ray
Rib injury/fractureX-ray chest+Rib seriesCT chest without contrastCT chest with contrast for complicated cases
Solitary pulmonary noduleCT chest without contrastFDG PETIV contrast is often needed for CT to evaluate mediastinum
 
Clinical problemFirst imaging choiceSecond imaging choiceComments
BONE
Bone tumorX-rayMRI without/with contrastCT if MRI is inconclusive
Extremity (hip, knee, wrist, etc.) pain or injuryX-rayMRI without contrastCT if MRI is not feasible or inconclusive
Infection/OsteomyelitisX-rayMRI without/with contrastCT with contrast and 3-phase bone scan are third alternatives
Metastatic bone diseaseWhole body bone scanSkeletal surveySkeletal survey only for Myeloma
Soft tissue massMRI without/with contrastCT without/with contrastStart with x-rays. If chest or abdominal wall mass, CT is first choice
Stress/insufficiency fractureX-rayMRI without contrastCT is third alternative if MRI is inconclusive
Clinical problemFirst imaging choiceSecond imaging choiceComments
 
Clinical problemFirst imaging choiceSecond imaging choiceComments
ABDOMEN
Abdominal traumaCT abdomen/pelvis with PO+IV contrastCT abdomen/pelvis with IV contrast onlyOther tests (US, MRI, KUB, barium studies, etc.) depend on CT findings
Acute abdominal painCT abdomen/pelvis with PO+IV contrast Other tests (US, MRI, KUB, barium studies, etc.) depend on CT findings
Adnexal massUS pelvis TA+TVMRI Pelvis without/with contrastStart with bHCG test when needed. CT abdomen with PO+IV contrast if PID is suspected
Adrenal nodule-indeterminateCT abdomen without/with IV contrastMRI abdomen without contrastMRI first choice in younger patients given high CT radiation dose
Flank pain/ renal stone protocolCT abdomen/pelvis without PO or IV contrastKUBKUB or US renal is preferred for uncomplicated subsequent symptoms given high CT radiation dose
HematuriaCT urogram without/with IV contrastUS renalNo PO contrast used for CT. KUB is third alternative
JaundiceUS Abdomen CT abdomen with PO+IV contrastMRI Abdomen without contrast ( MRCP) is third alternative
Liver mass MRI Abdomen without/with contrastCT abdomen without / with PO+IV contrastFDG PET and US Abdomen are third alternatives
Postmenopausal vaginal bleedUS pelvis TA+TVMRI pelvis without/with contrastTransvaginal (TV) US has higher yield and should be included in all cases unless contraindicated
Pulsatile abdominal massCTA Abdomen without/with contrastUS aortaUS has limited coverage and sensitivity. MRA abdomen without/with contrast is third alternative
Renal failureUS renalMRA kidneys without/with IV contrastMAG3 nuclear medicine renal scan is third alternative
Renal mass-indeterminateCT abdomen without/with IV contrast + PO ContrastMRI kidney without/with IV contrastUS renal is third alternative. MRI first choice in younger patients given high CT radiation dose
Scrotal painUS scrotum Other imaging tests depend on ultrasound findings
Urinary traumaCT abdomen/pelvis with IV contrastUS renalNo PO contrast. Request delayed scan to check for urinary extravasation
UTI/pyelonephritisCT abdomen/pelvis with PO+IV contrastUS renalCorrelation with urinalysis is needed since imaging may be negative in infection
 
Clinical problemFirst imaging choiceSecond imaging choiceComments
PEDIATRIC
Fever without sourceX-ray chest Other tests (whole body bone scan, CT abdomen/pelvis with PO+IV contrast, etc.) depend on clinical findings
Head TraumaCT head without contrastMRI head without contrastMRI is indicated only if CT findings requires further imaging. Routine x-ray series (skull, sinuses, facial bones, etc.) has very low sensitivity for significant injury
HematuriaUS RenalKUBCT abdomen/pelvis without IV or PO contrast (stone protocol) is third alternative
Hip dysplasia-6 months or olderX-ray hipsUS HipUS can be attempted between 6-12 months but has low sensitivity at this period
Hip dysplasia-newbornUS hipX-ray hipsIf positive clinical finding is present, wait 2 wks, if screening for dysplasia due to risk factors with normal exam, wait 4-6 wks after birth
Kidney-abdomen traumaCT abdomen/pelvis with IV contrastKUB 
LimpingX-ray hips/lower extremity Bone scan or MRI, if x-rays are not helpful
Nonaccidental traumaSkeletal surveyCT head without contrast or organ of interest (with IV contrast if chest/abdomen/pelvis)Bone scan is third alternative. MRI head without contrast if CT head is abnormal
Pyloric stenosisUS Abdomen UGI barium studyKUB is needed as baseline and to check for gastric distention
Seizures-EpilepsyCT head without contrastMRI head without/with contrastBaseline CT is to exclude urgent findings like bleed. MRI is needed to search for seizure cause
UTIVCUG+ US renalCT abdomen/pelvis with PO+IV contrastCT for complicated cases
VomitingX-ray abdomenUGI barium studySmall bowel series are not very helpful in childhood

 

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Indications
Updated 3/29/2016
Indications
Anticoagulation
Updated 4/25/2013
Anticoagulation

 

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