CT Ordering Guide

CT SCAN PROCEDURE GUIDELINES

Prior to ordering CT with contrast:

For all CT studies with IV contrast

 

1. Bun/Creatinine/GRR blood work guidelines-  For all CT scans with IV contrast,  a bun/creatinine and GFR level needs to be drawn within 6 weeks of the procedure., if the patient has ANY of these risk factors:

A. Is over the age of 60.
B. History of “kidney disease” as an adult including tumor or transplant
C. Is a Diabetic being treated with insulin or oral agents.
D. Paraproteinemia (e.g. myeloma).
E. Collagen vascular disease (e.g. SLE, scleroderma, rheumatoid arthritis)
F. Myasthenia Gravis
G. Pheochromocytoma
H. Sickle Cell Anemia

2. Diabetic Patients- Patients who are diabetic and on Glucophage, Glucovance, Riomet, Actoplus MET, Avandamet, Metformin or Metaglip need to stop medication 48 hours after the exam and also need a Bun, Creatinine and GFR performed 48 hours after the CT Scan. The patient will need to have a normal serum creatinine before resuming medications.

3. Contrast Allergy:
Patients with known contrast allergy need to be scheduled at the Hospital. The referring physician should consult with the radiologist to discuss a premedication protocol.

4. Patient Prep:

CT Scan with IV contrast and/or PO Contrast:

*Preferred NPO 2 hours prior to test

*CT scanning of the abdomen should be done prior to barium studies whenever possible, as the barium causes severe artifacts.

*If indicated, PO contrast will be given to the patient prior to the exam. The patient will be instructed to drink all of the PO contrast as quickly as tolerated.

CT scan without IV contrast: No prep needed

Prior to ordering CT exams:
*All  patients 15 years and younger can have their CT exams scheduled at the following facilities: Middlesex Hospital Campus, Marlborough Medical Center, Shoreline Medical Center in Essex.

* Women of childbearing age (age 11-59). The first 10 days after the onset of the menstrual cycle is generally considered safe for radiologic and nuclear medicine testing. For procedures that require direct radiation to the abdominal or pelvic area, past ten days after the start of the menstrual cycle may require either rescheduling of the procedure to a later date or a
urine test for pregnancy.

Middlesex Hospital CT procedure guidelines:

The following CT protocols are Middlesex Hospital specific. Indications for CT are included, but are not limited to those mentioned. For further protocol recommendation or radiology testing recommendations please contact Middlesex Radiology and/or refer to:
http://www.acr.org/Quality-Safety/Appropriateness-Criteria/Diagnostic

  • CT Scan Head:

a.)   Without contrast - Headaches, migraine, trauma

b.)   With IV contrast and without contrast - Tumor or stroke pathway

  • CTA Head (COW):

     a.) With and Without IV contrast- aneurysm, stenosis

  • CT Scan Orbits and Sinuses:

a.)   Without IV contrast - Trauma, sinusitis, facial pain

b.)   With contrast - Tumor of eye, abscess, ascites.

  • CTA Neck: (includes Neck and COW)

     a.) With IV contrast- Stenosis, dissection,

  • CTA Head and Neck: (includes Neck and entire head)

    a.) With and Without IV contrast- aneurysm, stenosis, dissection.

  • CT Neck:

     a.) With IV contrast- mass, ascites, swelling, abscess, difficulty swallowing, Soft tissue trauma, Vocal cord paralysis,
     b.) Without IV contrast- salivary gland stone, foreign body.

  • CT Chest:

a.)   Without IV contrast - Known pneumonia or pneumothorax.

b.)   With IV contrast - Pulmonary embolism, METs, tumor, abnormal chest X-ray.

  • CTA Chest

      a.) With IV contrast only- SOB, Chest pain, Hypoxemia, increased  

D-Dimer,  question pulmonary embolus, Aneurysm

  • CTA Chest/Abdomen

       a.) With IV contrast only- dissection, Aneurysm,
      CT Chest Low dose- Follow up of known lung nodule.
A.) CT Chest Without IV contrast.

  • CTLNGSCRN- Low Dose CT for lung cancer screening without contrast. (self-pay exam)

A.) CT Chest w/o contrast

  • CTA Coronary :

a.) CTA Coronary with contrast- is performed for the morphologic evaluation of the cardiac chambers, valves, ventricular myocardium, coronary arteries and veins, aortic root, central pulmonary arteries and veins, and pericardium. (Practice guidelines ACR pg2 resolution 38) and patency of coronary artery bypass grafts.

**please call MH CT @ 860-358-6861 to discuss eligible patients and exclusions before scheduling patient.

  • CT calcium scoring-

a.) CT Calcium scoring w/o contrast-  is performed primarily for detecting and evaluating cardiac calcification, i.e, of the coronary arteries (calcium scoring) (ACR guidelines ACT pg 2/cardiac CT)

  • CT Scan ABD / Pelvis:.

         a.) With IV and with PO contrast- Acute (Non Localized) Abdominal Pain and Fever or Suspected Abdominal Abscess, Diverticulitis, Appendicitis, Bowel Perforation , METS, colitis

b.)   Without IV and  PO contrast - Renal or Ureteral Stone, Hematuria with pain, high creatinine.

c.)   With IV contrast only- Trauma, METs, Renal Mass or Lesion, or Urinary tract obstruction, Renal Cell carcinoma follow up.

d.)   With and Without IV Contrast - Painless Hematuria,  Cancer, Mets, Renal cell Carcinoma staging, invasive bladder cancer, Renal mass. Adrenal mass

  • CTA Abdomen

      a.) With IV Contrast only- ischemic bowel, AAA, Dissection
      b.) With and Without IV contrast  GI bleed

  • CT Pelvis:

a.) With IV contrast-  Trauma, abscess, Mass or lesion or Bladder pathology

b.) Without IV contrast- R/O FX, history of trauma, radiculopathy

  • CT Liver:

a.)   With IV contrast - METs, painful jaundice, trauma       

b.)   With and without IV contrast - Painless jaundice

  • CT  Pancreas:

a.) With PO and IV contrast only-  Tumor, mass, Mets, known pancreatitis.

  • CT Hematuria: (CT urography)

a.) With and Without IV contrast (includes excretory phase).-  painless hematuria

  • CT Spine: (C-Spine, D-Spine, L/S Spine)

     a.) Without IV contrast- trauma, fracture, radiculopathy
   b.) With IV contrast- cellulitis, swelling.

  • CT Extremities and Spine:

a.)   Without IV contrast - For legs, arms, C-spine, T-spine, and L-spine to R/O FX, history of trauma, radiculopathy

b.)   With IV contrast-For cellulitis, swelling



updated 1/7/12 bh

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