TABLE 34-1 SCREENING AND/OR CONFIRMATORY RADIOLOGIC TESTS FOR DIFFERENT DISEASES
Radiology
1 Cover the right-hand columns and specify what imaging study you should order for the following conditions
CONDITION
SCREENING (OR ONLY) TEST TO ORDER
CONFIRMATORY TEST
COMMENTS
Cardiovascular
Aortic aneurysm
Abdominal US
CT with contrast
Screening US recommended for male smokers aged 65-75 years
Aortic dissection
CT with contrast
MRA or TEE
Aortic trauma (tear)
CT with contrast
MRA or TEE
Carotid stenosis
Duplex US
MRA
Gastrointestinal
Abdominal abscess
CT scan with contrast
Abdominal trauma
FAST scan (Focused assessment with Sonography for Trauma) to assess for hemoperitoneum
CT with contrast
Laparotomy is the gold standard
Appendicitis
US (particularly in pregnant patients and children)
CT with contrast
Never truly confirmed until surgery
Bowel obstruction
Abdominal x-ray
CT with contrast
Bowel perforation
Upright abdominal film/chest x-ray
CT with contrast
Cholecystitis
US
Nuclear hepatobiliary study (HIDA scan)
Look for gallbladder wall thickening and pericholecystic fluid on US
Choledocholithiasis
US
ERCP or MRCP
Cholelithiasis
US
Diverticulitis
CT with contrast
No endoscopy acutely as there is a risk of perforation
Esophageal disease
Gastrografin or barium x-ray
CT with contrast (for rupture)
Endoscopy usually necessary as a follow-up study
GI bleeding
Endoscopy
Tagged red cell scan if unable to visualize on endoscopy
Hematemesis
Endoscopy
Meckel diverticulum
Meckel scan (nuclear medicine)
Peptic ulcer disease
Endoscopy
Pyloric stenosis
US
Barium x-ray
Gynecologic
Fibroids
US
MRI
Ovarian disease
US
MRI
Laparoscopy may be needed
Pelvic mass (female)
US
MRI or CT with contrast or laparoscopy
Pregnancy evaluation
US
Transvaginal US for early pregnancy; transabdominal for the remainder
Neurologic
Acute stroke
Noncontrast CT
MRI
Brain tumor
CT with contrast
MRI with contrast
Head trauma
Noncontrast CT
Intracranial hemorrhage
Noncontrast CT
Multiple sclerosis
MRI
Skull fracture
Noncontrast CT
Orthopedic
Arthritis
X-ray
MRI if more detailed evaluation is needed
Bone metastases
Bone scan
PET scan
Plain x-rays for multiple myeloma
Fracture
X-ray
Noncontrast CT
CT can pick up many fractures not seen on x-ray
Osteomyelitis
X-ray
Bone scan or tagged white blood cell nuclear scan
MRI without contrast can be helpful
Pelvic trauma
X-ray
Noncontrast CT
Scaphoid fracture
X-ray
MRI
Respiratory
Chest mass
Chest x-ray
CT with contrast
Chest trauma
Chest x-ray
CT with contrast
Hemoptysis
Chest x-ray
Bronchoscopy or CT with contrast
Pneumonia
Chest x-ray
CT with contrast
Pulmonary embolism
CT with contrast
Pulmonary angiogram
Ventilation/perfusion nuclear scan if unable to tolerate radiation (pregnancy) or contrast
Pulmonary nodule
Chest x-ray
CT with contrast
May need PET scan to assess for malignancy
Urologic
Hematuria (persistent)
CT scan with contrast (without contrast if painful hematuria)
Cystoscopy
Hydronephrosis
US
CT with contrast
Nephrolithiasis
Noncontrast CT
Intravenous pyelography rarely indicated or used
Ureteral reflux
Voiding cystourethrogram (VCUG)
Suspected urethral trauma
Retrograde urethrogram
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Radiology
