INDEX. A Word From Our Radiologists. Locations. CPT Codes. MRI Anatomical Guide. CT Anatomical Guide. Ultrasound Anatomical Guide.

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1 INDEX A Word From Our Radiologists Locations CPT Codes MRI Anatomical Guide CT Anatomical Guide Ultrasound Anatomical Guide Exam Preps Insurance / Pre-Cert Scheduling FAQ Medical Records Radiologists

2 A word from our radiologists As healthcare costs have continued to rise over the years, insurance carriers have designated certain studies for preauthorization, particularly for high-end imaging procedures. The ever-increasing practice by insurance carriers of requiring preauthorizations for procedures such as MRI, CT and Ultrasound has changed the way medical decisions are made by referring physicians. This extra layer of work has been confusing and expensive to implement. When your patient has an insurance plan that does not require preauthorization or the patient is a self-pay patient, requesting a procedure is relatively simple and straightforward. Ordering MRI, CT or Ultrasound for this patient population can be written as simply as MRI brain, contrast as needed, or US pelvis with TVP, if necessary. Radiologists tailor the protocol for studies in this category based on patient history and symptoms. When the patient s insurance policy requires preauthorization, it is the responsibility of the referring physician to obtain this preauthorization. Raleigh Radiology cannot assume this responsibility. The preauthorization process is specific and rigid. When there is conflicting information on the written order and the insurance authorization, our insurance verification staff will contact you to obtain any additional information. In order for the imaging procedure to be covered by the authorization, Raleigh Radiology must follow the specific requirements outlined in the authorization form. Failure to follow the authorization results in non-payment for the services rendered. In order to help our referrers, Raleigh Radiology is committed to providing as much assistance as necessary to ensure accurate orders are in place. If you have any questions, please feel free to call any of our offices. We have also created this guide to help you determine the appropriate exam based on patient clinical indications. Although we cannot answer every scenario, this guide is intended to provide you with information that is concise and as complete as possible regarding preauthorization and contrast requirements. In these economical times, there is valuable information available to patients to assist them in making informed decisions about their healthcare choices. We encourage you and your patients to utilize the online cost estimator found on most insurance carriers websites. We hope that you will find these resources useful in determining the appropriate exam for your patients. We appreciate your support as we continue to serve the needs of your practice and patients. Sincerely, Raleigh Radiology Associates

3 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY BLuE RIDGE BBT Bank 3200 Blue Ridge Road, Suite 100, Raleigh, NC (Phone) (Fax) From Knightdale: Take 64 W/US-264 E-Raleigh. Take exit 419 for US-440 W toward US-1 Wake Forest. Merge onto 440 North. Take Exit 5 for Lake Boone Trail. Turn Right at Lake Boone Trail. Turn Right at Blue Ridge Road. At the second stop light turn Right (you will see a BB&T bank at this light) and stay on Blue Ridge Road Blue Ridge Road on the Right (Suite 100) - RexView Medical Plaza. From Garner/Clayton: Take US-70 W. Turn Left onto S. Saunders Street. Turn Left onto the US-64 W/Inner Beltline/1-40W Ramp to Cary/Durham. Merge onto I-40 W/I-440 W. Take Exit 293 B to merge onto I-440 N toward Raleigh. Take Exit 5 for Lake Boone Trail. Turn Right on Lake Boone Trail. Turn Right on Blue Ridge Road. At the second stop light turn Right (you will see a BB&T bank at this light) and stay on Blue Ridge Road Blue Ridge Road on the Right (Suite 100) - RexView Medical Plaza. From Interstate 540 East: Take Exit 4A Glenwood Avenue/US 70 E. Turn Right onto Duraleigh Road. Turn Left onto Blue Ridge Road Blue Ridge Road on the Right (Suite 100) - RexView Medical Plaza.. From Cary & Apex: Take US1 East to I- 440 north. Take Exit 5 Lake Boone Trail. At the ramp turn left on Lake Boone Trail. Travel approximately ¼ mile turn right on Blue Ridge Road. Continue 0.4 miles and turn right onto Blue Ridge Road (there is a BB & T Bank at this light). Travel 0.2 miles to 3200 Blue Ridge Road Suite 100 RexView Medical Plaza. From Wake Forest: Take Capital Blvd. / US-1 South. Merge onto I-440 west / US- 1 South toward Sanford. Take the Lake Boone Trail exit 5. Turn right onto Lake Boone Trail. Turn right onto Blue Ridge Road. Turn right to stay on Blue Ridge Road after you pass Rex Hospital (there is a BB & T Bank at this light). Travel 0.2 miles to 3200 Blue Ridge Road Suite 100 RexView Medical Plaza.

4 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY CEDARHuRST 1212 Cedarhurst Drive, Raleigh, NC (Phone) (Fax) From South & West Raleigh, Cary & Apex: Take the I-440 inner beltline towards North Raleigh. Take the Wake Forest Road exit, EXIT 10. Turn left to travel north on Wake Forest Road. Travel north. Watch that the road name will change to Falls of Neuse Road. Turn right at the stop light intersection of Millbrook Road. Take the first right onto Cedarhurst. Drive. We are the second building on the left. From Garner & Clayton: From 70, take I40 west to the outer I-440 beltline in Raleigh. Take the Wake Forest Road exit, EXIT 10, off of I-440 and turn right to travel North. Travel north. Watch that the road name will change to Falls of Neuse Road. Turn right at the stop light intersection of Millbrook Road. Take the first right onto Cedarhurst Drive. We are the second building on the left. From Wake Forest: Follow US 1/Capital Blvd. South into Raleigh, NC. Turn right at the stop light intersection of Millbrook Road. Travel approximately 1 mile to the stop light intersection of Falls of Neuse Road and turn left. Take the first left onto Cedarhurst Drive. We are the second building on the right. From Knightdale: Follow US 64 into Raleigh, NC. Turn right onto New Hope Road. Follow New Hope Road until you reach Capital Blvd. Go Straight at stop light to cross Capital onto Millbrook Road. Travel approximately 1 mile to the stop light intersection of Falls of Neuse Road and turn left. Take the first left onto Cedarhurst Drive. We are the second building on the right. From Durham & Chapel Hill: Take I-540 towards Raleigh. Exit South on Falls of Neuse Road and travel south to the stop light intersection of Millbrook Road. Turn left onto Millbrook and take the first right onto Cedarhurst Drive. We are the second building on the left.

5 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY CARY 150 Parkway Office Court, Cary, NC (Phone) (Fax) From Kildaire Farm Road: Travel toward WakeMed Cary. Make left onto Tryon Road. At 2nd traffic light, make a left onto Cary Parkway. At 1st entrance; make a left into parking lot. Our Building is directly in front. From Crossroads area of Cary on Tryon Road: Turn left onto Tryon Road. At 2nd traffic light make a left onto Cary Parkway. At 2nd entrance make a left onto Parkway Office Court. Our Building is to directly in front. From Preston, Carpenter & Green Hope area of Cary: Take SW Cary Parkway to Parkway Office Court (cross over 64/1). Turn Right onto Parkway Office Court. Our Building is to directly in front. From Apex or Sanford: Take US 1 North. Get off on Cary Parkway Exit 99. At traffic light, make a right onto Cary Parkway. Make right onto Parkway Office Court. Our Building is to directly in front. From Walnut Street (near Cary Towne Center): Go Northwest on Walnut Street toward SE Maynard Road. Go 1.2 miles. Take a sharp Left at SE Maynard Road. Make left onto Cary Parkway. Cross over US1/64. Make right onto Parkway Office Court. Our Building is to directly in front. From Holly Springs: Take Holly Springs Road to Kildaire Farm Road. Make a right onto Tryon Road. At 2nd traffic light, make a left onto Cary Parkway. At 2nd entrance; make a left onto Parkway Office Court. Our Building is to directly in front. From Raleigh: Take I-440 (Outer Beltline)/ US 1 South towards Sanford. Continue to follow US 1 South. Take Exit 99 for Cary Parkway. At the traffic light, turn Left onto SE Cary Parkway. Make right onto Parkway Office Court. Our Building is to directly in front.

6 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY WAkE FOREST 839 Durham Hwy Unit A, Wake Forest, NC (Phone) (Fax) From Capital Blvd North: Take the exit for Hwy 98 W (Durham Hwy). Turn Right at the bottom of the exit. Take an immediate right into the Wake Forest Business Park just past McDonald s. (Raleigh Radiology Wake Forest is located in the back left of the business park in Unit A.) From US-401 S/S Bickett Blvd: Turn right onto Hwy 56 West. Take Capital Blvd/US 1 South to NC 98 W (Durham Hwy). Turn left at the bottom of the exit. Turn right into the Wake Forest Business Park just past McDonald s. (Raleigh Radiology Wake Forest is located in the back left of the business park in Unit A.) From Main Street: Head towards Jewitt Avenue. Turn right onto NC 98 West and keep right after Lowes. Exit right on Capitol Blvd. north towards 98 West/Durham/Henderson. Pass NC 98 East. Exit right on NC 98 West/Wake Forest Downtown/Durham. Keep right on exit ramp. Take right onto old 98 at stop sign. Take an immediate right into the Wake Forest Business Park just past McDonald s. (Raleigh Radiology Wake Forest is located in the back left of the business park in Unit A.) From Henderson: US 1 South 26.8 miles. NC 98 BR Exit 125 toward Wake Forest Downtown. Turn left onto Durham Road/NC 98 BR (business). Take an immediate right into the Wake Forest Business Park just past McDonald s. (Raleigh Radiology Wake Forest is located in the back left of the business park in Unit A.) From Louisburg: From N. Main St. Left onto NC-56. 1st right onto 401 S. Slight right onto NC 98 W. Merge onto Capitol Blvd./NC 98 W/US 1 N. NC 98 BR (business) exit 125 toward Wake Forest. Take an immediate right into the Wake Forest Business Park just past McDonald s. (Raleigh Radiology Wake Forest is located in the back left of the business park in Unit A.)

7 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY BREAST CENTER 3900 Barrett Drive Suite 100, Raleigh, NC (Phone) (Fax) From I-440 & North Hills Area: Take Six Forks Road south traveling inside the Beltline. Turn Left at the 1st stop light onto Barrett Drive. Our office is the 4th building on the Right. SIX FORKS DR. COMPUTER DR. 440 From Wake Forest Road: Take Six Forks Road north towards I-440/North Hills Area. Turn Right at the 3rd stop light onto Barrett Drive. Our office is the 4th building on the Right. HAWORTH DR. N BARRETT DR. SIX FORKS DR. Raleigh Radiology Breast Center 3900 Barrett Dr., Suite 100

8 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY CLAYTON Currently Located at 300 Guy Road, Suite 102, Clayton, NC October 2012 relocating to Spring Branch Medical Pavilion 166 Springbrook Avenue, Suite 103, Clayton, NC (Phone) (Fax) To Garner To Benson Cornwallis Road Johnston Medical Center-Clayton Guy Road Raleigh Radiology Clayton 166 Springbrook Avenue, Suite 103 Clayton, NC Business Clayton Bypass Clayton From Garner: Head south on Benson Road toward W Main St. Turn left to merge onto US-70 E. Merge onto I-40 E via the ramp to Benson. Take exit 309 to merge onto US-70 E toward Smithfield/Goldsboro. Take exit 320 for N Carolina 42 toward Clayton. Turn left onto N Carolina 42 E. Destination will be on the left. From Smithfield: Head northwest on E Market St toward N Brightleaf Blvd. Take the 1st right onto N Brightleaf Blvd. Continue onto S Pollock St. Turn left onto US-70 W. Take the ramp onto US-70 W. Take the exit toward N Carolina 42 E. Turn right onto N Carolina 42 E. Destination will be on the left. From Benson: Head southeast on W Main Street. Turn left onto the I-95 S ramp to I-40. Merge onto I-95 N. Take exit 81 to merge onto I-40 W toward Raleigh. Take exit 312 for N Carolina 42 toward Clayton/Fuquay Varina. Turn right onto N Carolina 42 E. Destination will be on the left. From Raleigh: Head northeast on Hammond Road. Merge onto I-40 E/US-64 E via the ramp to I-440. Slight right onto I-40 E (signs for Benson/Wilmington). Take exit 309 to merge onto US-70 E toward Smithfield/Goldsboro. Take exit 320 for N Carolina 42 toward Clayton. Turn left onto N Carolina 42 E. Destination will be on the left.

9 RALEIGH RADIOLOGY LOCATIONS DIRECTIONS TO RALEIGH RADIOLOGY BRIER CREEk 8851 Ellstree Lane, Suite 100, Raleigh, NC (Phone) (Fax) From Raleigh -Interstate 540 West Take Exit 3- Lumley Road. Turn Left onto Lumley Road. Take first Left onto Ellstree Lane Ellstree Lane is the 2 story medical office building behind the Bank. Raleigh Radiology is in Suite 100. LUMLEY RD BRIER CREEK PKWY CHICK- FIL-A RINK RD Raleigh Radiology Brier Creek LUMLEY RD 8851 ELLSTREE LANE, SUITE 100 RALEIGH, NC BJ S TARGET 540 From Durham Take I-40 East Take I-540 East- Exit 283 toward US 70. Take Exit 3- Lumley Road. Turn Left onto Lumley Road. Travel 0.3 miles and take a Left onto Ellstree Lane Ellstree Lane is the 2 story medical office building behind the Bank. Raleigh Radiology is in Suite 100. From Chapel Hill Take NC- 54 East. Merge onto I-40 East toward Raleigh. Take I-540 East- Exit 283 toward US 70. Take Exit 3- Lumley Road. Turn Left onto Lumley Road. Travel 0.3 miles and take a Left onto Ellstree Lane Ellstree Lane is the 2 story medical office building behind the Bank. Raleigh Radiology is in Suite 100. From Cary- Interstate 40 West Merge onto I-540 East. (Exit 283B toward US-70) Take Exit 3- Lumley Road. Turn Left onto Lumley Road. Travel 0.3 miles and take a Left onto Ellstree Lane Ellstree Lane is the 2 story medical office building behind the Bank. Raleigh Radiology is in Suite 100.

10 RALEIGH RADIOLOGY MRI CPT CODES

11 RALEIGH RADIOLOGY CT CPT CODES

12 RALEIGH RADIOLOGY U LTRASOUn D CPT CODES Ultrasound Head/Neck/Chest Ultrasound Neck Tissues Ultrasound Thyroid Ultrasound Duplex Scan, Carotid Ultrasound Chest Ultrasound Guidance Thyroid FNA Breast Ultrasound Breast (unilateral or bilateral) Ultrasound Axilla Abdomen Ultrasound Abdomen, Complete Ultrasound Abdomen Ltd,(single organ-appendix) Ultrasound Abdomen, Ltd (Liver/RUQ) Ultrasound Renal (includes aorta + IVC) Ultrasound Aorta Ultrasound Soft Tissue Torso Area OB Ultrasound Pregnant < 14 wks FI Ultrasound Pregnant each additional gestation Ultrasound OB, Complete 14 wks A Ultrasound OB, Multiple Ultrasound OB, Limited Limited Limited, Fetal Size, follow-up Ultrasound Pregnant, Transvaginal Pelvic Ultrasound, Transvaginal Ultrasound, Pelvic Ultrasound, Pelvic ltd, followup Pelvic COMBO Ultrasound Pelvic + Transvaginal Testicular Ultrasound, Scrotal Extremity (non vascular) (complete) (limited) Shoulder Neonatal Neonatal Hips Neonatal Spine Pyloric Stenosis Other Ultrasound Aspiration/Injection Ultrasound Vascular ABI Duplex / Doppler Lower Extremity Arterial Bilateral Duplex / Doppler Lower Extremity Arterial Unilateral (Ltd) Duplex / Doppler Upper Extremity Arterial Bilateral Duplex / Doppler Upper Extremity Arterial Unilateral (Ltd) Duplex / Doppler Lower Extremity Venous Bilateral (DVT) Duplex / Doppler Lower Extremity Venous Unilateral (DVT) Duplex / Doppler Upper extremity venous bilateral (venous mapping) Duplex / Doppler Upper extremity venous unilateral (venous mapping) Duplex / doppler abd / pelvic / scrotal / retroperitoneal / Renal Artery Duplex / doppler aorta / ivc / iliac or Bypass complete Duplex / doppler aorta / ivc / iliac or Bypass ltd unilateral Duplex / doppler carotid HSG Hysterosalpingogram Combo (HSG)

13 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Anatomical Guide We require Creatinine levels if contrast is needed for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all MRI locations. Area of Concern Body Part Reason for Exam IV w/contrast Head Brain Alzheimer s Mental Status Change Confusion Dementia Memory Loss Suspected MS Stroke /CVA TIA Trauma Dizziness / Vertigo (CVA) Headaches Procedure to Pre-Cert Codes No MRI Brain w/o Contrast Tumor / Mass / Cancer Cranial Nerve Lesions HIV Infection Multiple Sclerosis Neurofibromatosis Hearing Loss, IAC Mass Pituitary Lesion Acoustic Neuroma Syrinx Visual Change Vascular Lesions (AVM) Elevated Prolactin Vertigo / Dizziness (IAC) Bell s palsy Yes MRI Brain w/ & w/o Contrast MRV Brain Venous Thrombosis No MRV w/o Contrast Orbits (includes whole brain - Trauma No MRI Orbits/ Face/ Neck w/o Contrast plus thin cuts thru the orbits) Graves Disease Exopthalmos / Proptosis Vascular Lesions (Hemangioma) Tumor / Mass / Cancer / Mets Pseudotumor Yes MRI Orbits/ Face/ Neck w/ & w/o Contrast Neck Infection Pain Tumor / Mass / Cancer / Mets Vocal Cord Paralysis Yes MRI Orbits/ Face/ Neck w/ & w/o Contrast Chest Mediastinum Tumor / Mass / Cancer / Mets Yes MRI Chest / Mediastinum w/ & w/o Contrast Brachial Plexus Brachial Plexus Injury Nerve Avulsion Yes MRI Chest / Mediastinum w/ & w/o Contrast Breast Breast Newly diagnosed cancer Personal History of BC BRCA 1 or 2 Gene High risk screening Implant Integrity/Rupture Evaluate response to chemo Dense breasts Palpable lump w/abnormal US or mammographic findings Yes MRI Breast Bilateral w/wo contrast This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

14 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Anatomical Guide Area of Concern Body Part Reason for Exam IV w/contrast Abdomen and Pelvis Abdomen: General Tumor / Mass / Cancer / Mets Hematuria Abdominal Pain Abdomen: Liver We require Creatinine levels if contrast is needed for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all MRI locations. Post embolization Hemangioma Hepatoma Hepatitis Cirrhosis Increased LFTs Procedure to Pre-Cert Codes Yes MRI Abdomen w/ & w/o Contrast MRCP: Biliary Biliary Obstruction Stones Jaundice Abdnormal enzymes No MRI Abdomen w/o Contrast (MRCP) MRCP: Renal Renal Mass (cyst or solid) Hematuria Transitional cell carcinoma of kidney Abnormal finding Yes MRI Abdomen w/ & w/o Contrast MRCP: Adrenal Adrenal Mass or Lesion Pheochromocytoma Hypertension No MRI Abdomen w/o Contrast Pancreas Pancreatitis Pancreas Mass Cholangiocarcinoma PSC (primary sclerosing cholangitis) Increased LFT s Painless jaundice Ampulla evaluation Yes MRI Abdomen w/ & w/o Contrast Pelvis Soft Tissue: General Tumor / Mass / Cancer / Mets Pain Abscess Decubitus Ulcer Yes MRI Pelvis w/ & w/o Contrast Pelvis Soft Tissue: Uterus Pelvis Soft Tissue: Ovaries Fibroid Adenomyosis Ovarian Mass Pre/Post Fibroid Embolization Infertility Endometrioma Pelvis Soft Tissue: Bicornuate Uterus Septate Uterus No MRI Pelvis w/o Contrast Prostate Cancer Staging Treatment Planning No MRI Pelvis w/o Contrast MRI Abd / Pelvis Enterography Diagnosis and follow up of Crohn s disease Low- grade small bowel obstruction Small bowel tumors Yes (Glucagon is also administered to relax bowel motion) MRI abdomen w/ &w/o MRI pelvis w/ & w/o This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

15 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Anatomical Guide We require Creatinine levels if contrast is needed for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all MRI locations. Area of Concern Body Part Reason for Exam IV w/contrast Musculoskeletal Extremity: Non Joint Upper Forearm Humerus Hand/finger/thumb Lower Lower Leg/Calf Femur/Thigh/hamstring Foot (midfoot, forefoot) Toes Extremity: Joint Upper Wrist Elbow Shoulder Lower Ankle/hind foot (Includes distal, tibia & fibula thru base of metatarsals) Knee Hip - will include whole pelvis Fracture Stress Fracture Abscess Ulcer Tumor / Mass /Mets Cellulitis Fasciitis Arthritis Avascular Necrosis (AVN) Stress Fracture Internal Derangement Pain Labral Tear Abscess Ulcer Cellulitis Fasciitis Myositis Muscle / Tendon Tear Myositis Morton s Neuroma Osteomyelitis (contrast as needed) Soft tissue Tumor/ Mass/ Mets Meninscal Tear Muscle Tear Ligament Tear Cartilage Tear Ostochondritis Dissecans (OCD) Bony Cyst Inflammatory Arthritis Osteomyelitis (contrast as needed) Septic Arthritis Tumor/ Mass/ Mets No Yes No Yes Procedure to Pre-Cert MRI Non Joint Without Contrast Upper Extremity Lower Extremity MRI Non Joint w/ & w/o Contrast Upper Extremity Lower Extremity MRI Joint Without Contrast Upper Extremity Lower Extremity MRI Joint w/ & w/o Contrast Upper Extremity Lower Extremity Codes Bony Pelvis/Pelvis/Hip Fracture Pain Trauma Muscle/ Tendon Tear No MRI Pelvis w/o Contrast Tumor/ Mass/ Cancer/ Mets Osteomyelitis Septic Arthritis Yes MRI Pelvis w/ & w/o Contrast Spine: Cervical Arm/ Shoulder Pain Numbness Neck Pain Disc Herniation Radiculopathy Degenerative Disease No MRI Cervical Spine w/o Contrast Syrinx Discitis Osteomyelitis Myelopathy Multiple Sclerosis Tumor/ Mass/ Cancer/ Mets Yes MRI Cervical Spine w/ & w/o Contrast This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

16 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Anatomical Guide Area of Concern Body Part Reason for Exam IV w/contrast Musculoskeletal continued Spine: Thoracic We require Creatinine levels if contrast is needed for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all MRI locations. Back pain Degenerative disc disease Disc Herniation Radiculopathy Trauma Compression Fracture (no hx of malignancy) Procedure to Pre-Cert Codes No MRI Thoracic Spine w/o Contrast Discitis Post-op Fusion Syrinx Osteomyelitis Multiple Sclerosis Myelopathy Tumor/ Mass/ Cancer/ Mets Compression Fracture (w/ hx of malignancy) Yes MRI Thoracic Spine w/ & w/o Contrast Spine: Lumbar Back, Leg pain Degenerative Disease Disc Herniation Radiculopathy Trauma Sciatica Spondylolisthesis Spinal Stenosis Compression Fracture (no hx of malignancy) No MRI Lumbar Spine w/o Contrast Discitis Osteomyelitis Post-Op-Hx of Back Surgery Tumor/ Mass/ Cancer / Mets Yes MRI Lumbar Spine w/ & w/o Contrast Musculoskeletal MR Arthrography Wrist Arthrogram TFCC tear Intercarpal Ligaments Soft tissue ganglia *Gad is injected into the joint space by a MSK radiologist. *Labs not required MR Upper Ext Joint w/ Contrast Injection - Wrist Rad exam - wrist Elbow Arthrogram Loose body Internal derangement Collateral Ligament tear *Gad is injected into the joint space by a MSK radiologist. *Labs not required MR Upper Ext Joint w/ Contrast Injection - Elbow Rad exam - elbow Shoulder Arthrogram Labral tear Synovitis RCT Adhesive capsulitis *Gad is injected into the joint space by a MSK radiologist. *Labs not required MR Upper Ext Joint w/ Contrast Injection - Shoulder Rad exam - shoulder Hip Arthrogram Labral tear *Gad is injected into the joint space by a MSK radiologist. *Labs not required MR Lower Ext Joint w/ Contrast Injection - Hip Rad exam - hip Knee Arthrogram Recurrent meniscal tear post op Loose bodies Chondromalacia *Gad is injected into the joint space by a MSK radiologist. *Labs not required MR Lower Ext Joint w/ Contrast Injection - Knee Rad exam - knee Ankle Arthrogram Loose body OCD *Gad is injected into the joint space by a MSK radiologist. *Labs not required MR Lower Ext Joint w/ Contrast Injection - Ankle Rad exam - ankle This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

17 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Anatomical Guide We require Creatinine levels if contrast is needed for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all MRI locations. Area of Concern Body Part Reason for Exam IV w/contrast MRA MRA Brain (COW) Aneurysm, family hx Anuerysm TIA Stroke / CVA Procedure to Pre-Cert Codes No MRA Brain w/o Contrast MRA Neck Bruit Stroke/ CVA TIA Abnormal doppler or dizziness Yes MRA Neck w/ & w/o Contrast MRA Arch and Great Vessels Stroke / CVA Bruit TIA Yes MRA Neck w/ & w/o Contrast MRA Abdominal Aorta Abdominal Aortic Dissection Aneurysm Yes MRA Aorta w/ & w/o contrast MRA Chest Aneurysm Thoracic Aortic Dissection Excluding cardiac myocardium Yes MRA Chest w/ & w/o contrast MRA Abdomen Renal artery stenosis Hypertension Mesenteric Arterial Ischemia Yes MRA Abdomen w/ & w/o contrast MRA Pelvis Femoral Arteries Yes MRA Pelvis w/ & w/o contrast MRA Upper Extremity Subclavian Tenderness Yes MRA Upper Extremity w/ & w/o Redness, swelling MRA Lower Extremity (run off) Peripheral vascular disease Yes MRA Lower Extremity w/ & w/o This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

18 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Safety Magnetic Resonance Imaging (MRI) is a way of obtaining very detailed images of organs and tissues throughout the body without utilizing radiation. Instead, MRI utilizes a powerful magnetic field, radio waves, a rapidly changing magnetic field, and a computer to demonstrate whether or not there is an injury or some disease process present. An MRI exam causes no pain, and the magnetic fields produce no known tissue damage or side effects. However, the powerful magnetic field of the MR system will attract iron-containing (ferromagnetic) objects or cause them to move suddenly and with great force. This includes items in the body (aneurysm clips ) or external objects. Other metallic implants or objects may distort the MRI images. For this reason, great care is taken to ensure the safety of our patients. Some MRI exams may require the injection of a contrast material called gadolinium into a vein to help interpret the exam. Although gadolinium does not contain iodine, recent findings have shown the gadoliniumbased contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in certain patients. Therefore, we have adjusted our screening guidelines to ensure the highest safety standards for patients. Weight Limits & Claustrophobia Open bore MRI 550 lbs or less Most claustrophobic patients have successful MRI exams. Some patients may require a mild oral sedative prescribed by their doctor. Open Bore MRI may be an option for claustrophobic or larger patients. New 1.5T High-field Open Bore MRI technology (vs. traditional low field open mri) provides the same strength and quality of conventional MRI scanners, while also providing patients with a wider and shorter opening with a design similar to that of a CT scanner. Open Bore MRI is available at all MRI locations. IV valium sedation is offered for severely claustrophobic patients ages 18 and older at our Blue Ridge, Cary and Cedarhurst locations. Gadolinium-based contrast agents and NSF: As your partner in healthcare, we would like to keep you up to date on aspects related to Radiology. Since June 2006, the FDA has issued two Public Health Advisories concerning gadolinium-based contrast agents (GBCA s) and a disease known as Nephrogenic Systemic Fibrosis (NSF), formerly known as Nephrogenic Fibrosing Dermopathy (NFD). Depending on a patients individual history and symptoms, injection of MRI contrast may enhance the images and give the radiologists better differenciation and clarity for parts of the body. To ensure the highest safety standards for your patients, the following factors are used to help screen patients for renal disease. 1. History of renal failure or dialysis* 2. Age If over the age of 60, a current creatinine level is needed.* 3. Sex 4. Race * Age and history of renal faliure are screening questions at the point of MRI scheduling. Using the creatinine value, age, sex and race, a scientific score commonly referred to as GFR is calculated and reviewed by a radiologist. This score assists the radiologists and referring physicians in make a determination to: 1. Inject MRI contrast at a normal rate 2. Reduce the amount of contrast used 3. Perform MRI without contrast Contraindications: Cardiac Pacemakers, Defibrillators, Cochlear Implants, Cerebral Aneurysm Clips, Metal in the eye, clips placed by colonoscopy. To ensure the highest standard of safety, we would like to review any metallic objects in the body or topical treatments (such as wound treatments) prior to your MRI exam. Typically dental work does not affect an MRI, but the technologist may have you remove partials or dentures discretely prior to the exam for head or neck imaging. What type of patient may need an Open Bore MRI? Severely claustrophobic Athletes with broad shoulders (up to 28 diameter) Larger patients up to 550 lbs Children Patients who have had unsuccessful conventional MRI experiences Anyone who simply wants more space

19 RALEIGH RADIOLOGY MRI ANATOMICAL GUIDE MRI Screening Questions Yes No q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q Is this your first MRI? If no, where was the previous MRI performed? Was the previous MRI for the same problem? Are you claustrophobic? If you and your physician determine that a sedative (such as Valium) is needed for this procedure, you must arrive one hour early and complete all paper work before taking medications and you MUST bring a driver. What is your weight? Have you ever sought medical treatment for getting metal fragments in your eyes or had significant exposure to welding, grinding or soldering due to your profession or hobby? If yes, an orbit x-ray will be done free of charge prior to your scan. These x-rays are done on a walk in basis at participating facilities. Is there any chance you could be pregnant? Do you have any implanted devices such as Aneurysm clips, insulin pumps, TENS unit, epidural drug delivery, artificial heart valve, defibrillator or a Pacemaker? (If yes, you probably cannot have an MRI or your physician must provide us documentation with make and model of implanted devices) Do you have breast tissue expanders? (if yes, then we will be unable to do an MRI) Have you had surgery in the last 6 weeks? If yes, what kind? (We suggest you schedule 6 weeks after your surgery) Have you ever had any surgery on the area being scanned? If yes, when? Have you ever had any type of cancer? If yes, what type and when were you diagnosed? Do you have renal failure? AAre you over 60 yrs old? Are you diabetic? Do you have high blood pressure? If so, we must have labs with a Creatinine to determine GFR. (Labs are considered current within 90 days) Does this exam require pre-authorization from your insurance? Please bring a list of all medications you are currently taking. Have you had a colonoscopy? If yes, were clips placed? Are you in a wheelchair? Breast MRI Screening Questions Yes No q q q q q q q q q q Reason for Exam q Screening due to high risk (Must have a mammogram within 12 months) q Implant Integrity / Rupture (Must have a mammogram within 6 months; Silicone implants only) q Newly diagnosed Breast Cancer (Must have a mammogram within 6 months) Do you have breast implants? Silicone, Saline or Both What year did you get them? What is the address and phone number where you had your last mammogram? Have you had a Breast MRI before? If so, when and where? Are you a high risk patient? Have you tested positive for the BRCA gene? Last Menstrual Period Date. If you have tested positive for the BRCA gene, it is best to schedule the MRI between the 5th and 11th day of the cycle. Have you had a previous breast biopsy or breast surgery? When and which breast? Please have the results faxed to our office. Have you ever had chemotherapy or radiation treatment? Are you currently on hemodialysis?

20 RALEIGH RADIOLOGY CT ANATOMICAL GUIDE CT Anatomical Guide We require Creatinine levels for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all CT locations. Area of Concern Body Part Reason for Exam Oral Prep Test Head Brain Trauma Headaches CVA Stroke/ Bleed Alzheimer s Memory Loss, Confusion Facial Droop Hydrocephalus TIA Change in mental status Dizziness, Vertigo Loss of Balance Syncope Tinnitus IV w/contrast Procedure to Pre-Cert Codes No No CT Head w/o Mass/ Tumor Infection/Abcess Meningioma Metastatic Staging HIV No Yes CT Head w/ & w/o (* MR Brain may be preferred if patient is able) Orbits Trauma Fracture Foreign Body Bony Abnormalities No No CT Orbits w/o Graves Disease Mass, swelling Pain Abscess Cellullitis No Yes CT Orbits w/ Sinus Sinusitis Mass Pain Foreign body Congestion Nasal polyps Deviated septum Sinus headache No No CT Sinus w/o Face (From orbits to mandible) Trauma Pain Fracture Bony abnormalities No No CT maxillofacial w/o Tumor Swelling, Mass in face Infection Abscess No Yes CT maxillofacial w/ Temporal Bones/Mastoids Congenital hearing loss Tinnitus Trauma Cholesteatoma Mass in ear No No CT temporal bones w/o This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

21 RALEIGH RADIOLOGY CT ANATOMICAL GUIDE CT ANATOMICAL GUIDE We require Creatinine levels for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all CT locations. Area of Concern Body Part Reason for Exam Oral Prep Test Neck Neck Focal mass Lymphadenopathy Lymphoma Dysphagia Goiter Esophageal cancer IV w/contrast Procedure to Pre-Cert Codes No Yes CT soft tissue neck w/ Abdomen and Pelvis from Lung Bases Abdomen: General (From the Lung Bases to the Iliac Crest) (Pancreas) Salivary gland stone No No CT soft tissue neck w/o Abdominal pain Abnormal US Neoplasm/Mass Weight Loss Hernia Trauma Pancreatic Lesion Elevated LFT Pancreatitis Yes Yes CT abdomen w/ CT Abdomen CT Abdomen and Pelvis to Iliac Crest from Lung Bases to Pubis Abdomen & Pelvis: General (From the Lung Bases to Pubis) Pelvis: General (From Iliac Crest to Pubis) Mass Abdominal pain Pelvic pain Appendicitis Lymphoma Nausea / Vomiting / Diarrhea Bloody stools Diverticulitis Diverticulosis Abnormal US Cancer staging for melanoma Pelvic pain Groin pain Abnormal pelvic US Pelvic mass Neoplasm Fever, Elevated WBC Weight loss Hernia Trauma Constipation, obstruction IBD Metastasis All Cancer Staging, except melanoma or carcinoid carcinoid Hernia Trauma Adnexal mass Yes Yes CT abdomen w/ CT pelvis w/ Yes Yes CT abdomen w/ & w/o CT pelvis w/ Yes Yes CT pelvis w/ from Iliac Crest CT Pelvis CT Abd / Pelvis Enterography Crohn s disease or Suspected Crohn s disease Small bowel tumors GI bleeding (chronic) Yes (*Volumen) Yes CT abdomen w/ CT pelvis w/ This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

22 RALEIGH RADIOLOGY CT ANATOMICAL GUIDE Ct Anatomical Guide We require Creatinine levels for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all CT locations. Area of Concern Body Part Reason for Exam Oral Prep Test Adrenal / Renal Liver Liver Cancer Cirrhosis Hepatitis Hemachromatosis Hepatoma Jaundice IV w/contrast Procedure to Pre-Cert Codes Yes Yes CT Abdomen w/ contrast Renal Stone Hematuria Flank pain Urinary frequency Renal Stone Dysuria Retroperitoneal Bleed No No CT abdomen w/o & CT pelvis w/o Renal Renal Mass work-up Complex Renal Cyst Abnormal US Hematuria Yes Yes CT abdomen w/ & w/o CT Urogram (Urinary System) (Kidneys to Bladder) Hematuria Abnormal cystogram Bladder mass No (Unless specifically indicated by referrer) Yes CT abdomen w/ & w/o CT pelvis w/ & w/o Adrenal Adrenal mass No No** CT abdomen w/o *A CT abdomen w/ may be added at the radiologists discretion in cases where mass measurement results from the w/o scan are abnormal CT Angiography CTA Head Aneurysm AV Malformation Stenosis Occlusion Thrombosis Dissection Congenital abnormalities Vascular injury Pre Op Evaluation for tumor blood supply No Yes CTA Head w/ & w/o CTA Neck Aneurysm AV Malformation Stenosis Occlusion Thrombosis Dissection Congenital abnormalities Vascular injury Pre Op Evaluation for tumor blood supply Post Op Carotid endarterectomy / Post carotid stenting No Yes CTA Neck w/ contrast CTA Chest Pulmonary Embolism Chest Pain Shortness of Breath No Yes CTA Chest w/ CTA Chest Aortic Dissection Aneurysm No Yes CTA Chest w/ & w/o This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

23 CT Anatomical Guide RALEIGH RADIOLOGY CT ANATOMICAL GUIDE We require Creatinine levels for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within months. We require Creatinine levels for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As convenience, Raleigh Radiology can draw Creatinine labs at all CT locations. As a convenience, Raleigh Radiology can draw Creatinine labs at all CT locations. Area of Concern Body Part Reason for Exam Oral Prep Test CT Angiography continued CTA Abdomen Abdominal Aortic Aneurysm Renal artery stenosis Trauma Abnormal US Post stent grafting Mesenteric ischemia IV w/contrast Procedure to Pre-Cert No Yes CTA Abdomen w & w/o contrast Codes CTA Abdomen & Pelvis Abdominal Aortic Aneurysm Renal Artery Stenosis Dissection Trauma Abnormal US Post stent grafting Mesenteric ischemia No Yes CTA Abdomen w & w/o CTA Pelvis w & w/o General Chest General Chest Abnormal CXR Pneumonia Cough Hemoptysis Sarcoidosis Hilar abnormality Hx cancer, tumor, mets Chest Pain Neoplasm / Mass Abscess Enlarge aortic arch Lymphadenopathy Aswbestos exposure Shortness of breath Trauma Asbestos No Yes CT Chest w/ contrast Lung nodule follow up Bony abnormality Rib fractures, trauma Chronic cough H/O chronic smoking No No CT Chest w/o contrast Hi Resolution Chest Interstitial disease Fibrosis Bronchiectasis COPD /emphysema Asbestos exposure No No CT Chest w/o contrast Lung Screening 50 years old or older with pack/year smoking history Asbestos exposure or obstructive airway disease Patients w/ smoking history and additional risk factors such as radon exposure, certain occupational exposure, COPD, and pulmonary fibrosis No No At this time, this exam is not covered by insurance. Our cost is $ This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

24 RALEIGH RADIOLOGY CT ANATOMICAL GUIDE CT Anatomical Guide We require Creatinine levels for all patients 60 and older, diabetic, or with H/O renal failure. Labwork is current within 3 months. As a convenience, Raleigh Radiology can draw Creatinine labs at all CT locations. Area of Concern Body Part Reason for Exam Oral Prep Test Musculoskeletal Extremities Upper Hand, wrist, elbow, radius/ ulna, humerus, shoulder Lower Foot, ankle, knee, hip, tibia/fibula, femur Spine Pain Arthritis Fracture Infection Tumor/ mass/ cancer/ mets Pain, trauma, fracture, fusion Pre or post surgery Infection Tumor, mass, cancer, mets Fusion Malunion (MRI more sensitive) (MRI more sensitive) Disc Degeneration IV w/contrast Procedure to Pre-Cert No No CT w/o contrast Upper extremity Lower extremity No Yes CT w/ contrast Upper extremity Lower extremity No No CT w/o contrast Cervical Thoracic Lumbar No Yes CT w/ contrast Cervical Thoracic Lumbar Codes Pelvis/ Hips Acetabulum Pain Fracture Mets, Cancer Arthritis Bone Lesions No No CT pelvis w/o contrast Soft tissue mass Tumor/ mets Abscess Infection Cellulitis Yes Yes CT pelvis w/ contrast This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

25 RALEIGH RADIOLOGY CT ANATOMICAL GUIDE Diagnostic Imaging: Radiation Dose and PATIENTs Concerns Exposure to ionizing radiation during diagnostic radiologic procedures carries small but real risks. Ionizing radiation can damage living cells by causing undesired chemical reactions that alter the structure of macromolecules within the cell. Children, young adults, and pregnant women are especially vulnerable. On the other hand, the images produced can contain critical diagnostic information that may greatly benefit the patient. Therefore, the risks and benefits must be considered before proceeding with any diagnostic test involving ionizing radiation. Exposure to ionizing radiation should be kept as low as reasonably achievable, while still answering the clinical question at hand. Quantifying the Radiation Dose Everyone is constantly exposed to naturally occurring ionizing radiation, commonly called background radiation. Some comes from radioactive elements present in the earth since its formation, such as uranium and the natural products of its decay, radium and the gas radon. Other background radiation is in the form of cosmic rays, highenergy particles that constantly bombard the atmosphere and create radioisotopes of carbon and nitrogen. The average annual effective dose from background radiation is estimated at 3.6 millisieverts (msv). Some diagnostic procedures involve an effective dose of radiation that is a tiny fraction of that from background radiation, whereas many impart several times that amount (Table 1). Radiation Risks of Imaging A widely accepted estimate of the risk of radiation-induced carcinogenesis in diagnostic imaging comes from the National Research Council Committee on the Biological Effects of Ionizing Radiation (BEIR VII). The BEIR VII states that an effective dose of 10 msv to a working-age adult results in a 1 in 1,000 lifetime risk of developing radiation-induced cancer. Or, if 10,000 adults receive this dose, around 10 of them will develop radiation induced cancer during their lifetime. The relative risk is small, however, since 4,200 people out of 10,000 are expected to develop cancer for other reasons. Ionizing radiation can be both carcinogenic and teratogenic to the fetus. The National Council on Radiation Protection and the American College of Obstetricians and Gynecologists maintain that a cumulative effective dose to the fetus of less than 50 msv is not associated with any increased risks and none of the studies listed in Table 1 exceeds this. Nevertheless, the use of diagnostic imaging in pregnant patients requires careful consideration. The fetus is most sensitive to the teratogenic effects of ionizing radiation from the second to the eighth week of development. But exposure at even up to 20 weeks of development increases the risk of microcephaly, mental retardation, and growth retardation, and radiation exposure at all gestational ages increases the risk of childhood leukemia. Ways to Minimize Patient Exposure Use CT with discretion. CT accounts for two thirds of the cumulative patient dose from diagnostic radiologic procedures. The cumulative dose from CT is rising as technological advances increase the number of indications for and the capabilities of CT. Minimize imaging of the young. Risks from radiation exposure are higher in children and young adults, as these patients are likely to survive the latent period of cancer development. Avoid studies that do not influence patient care, such as plain radiography for suspected rib and coccyx fractures, and lumbar spine radiography in a patient without radiculopathy, which uses an exceptionally high effective dose for a plain radiographic study (Table 1). Consider alternatives to ionizing radiation. Ultrasonography and MRI as yet have no practically demonstrated adverse effects. Consider whether follow-up diagnostic radiologic studies are truly necessary and what the appropriate follow-up interval should be. Doubling the follow-up interval for regular examinations halves the cumulative effective dose. Table 1: Estimated effective radiation dose of common diagnostic imaging tests Study Effective Dose in Millisieverts (msv) Chest radiography, posteroanterior and lateral 0.06 Screening mammography 0.6 Kidney-ureter-bladder radiography (KUB) 1.7 CT of the head 1.8 Lumbar spine radiography 2.1 Background radiation, annual dose 3.6 CT of the pelvis 7.1 CT of the abdomen 7.6 CT of the chest 7.8 Barium enema 8.7 Intravenous pyelography

26 R A L E I G H R A D I O L O G Y U L T R A S O U N D A N A T O M I C A L G U I D E ULTRASOUND ANATOMICAL GUIDE Area of Concern Body Part Reason for Exam Ultrasound Prep Codes Abdomen Abdomen Aorta/IVC/Pancreas/Liver Abdominal Pain Hepato/Splenomegaly NPO 8 hours GB/CBD/Kidneys/Spleen Elevated Liver Function Tests Cirrhosis Nausea/Vomiting/Fever Weight Loss Epigastric Pain Jaundice Bloating Palpable Mass RUQ /Liver Pancreas/Liver/GB/CBD RUQ pain Chest Pain NPO 8 hours Right Kidney Elevated Liver Function Tests Epigastric Pain Nausea/Vomiting Abdomen Limited Single Organ Abdomen Splenic Trauma LUQ pain NPO 6-8 hrs preferred but not required Splenomegaly Hernia Renal Kidneys/Bladder/Aorta/IVC Proteinuria Urinary Frequency Drink 24oz of water 1 hour prior Elevated Creatinine UTI to exam and hold it Flank Pain, HTN Hematuria, Dysuria Renal Artery Duplex Kidneys/Bladder/Aorta/IVC Uncontrolled Hypertension NPO 8 hours except for water. Drink VASCULAR DUPLEX Doppler Renal/Arcuate Arteries 24oz of water 1 hour prior to exam and hold it. Schedule in am to limit bowel gas. Duplex Abdomen Aorta/IVC/Pancreas/Liver Portal Hypertension NPO 8 hours Duplex Hepatic/Portal GB/CBD/Kidneys/Spleen Hepato/Splenomegaly VASCULAR DUPLEX Doppler, Hepatic Artery Cirrhosis Portal/Hepatic/Splenic Veins Duplex SMA/Celiac Aorta/IVC/Pancreas/Liver Post prandial pain NPO 8 hours. Patient will drink fatty meal VASCULAR DUPLEX GB/CBD/Kidneys/Spleen exocrine pancreatic insufficiency (ensure) when they arrive. Images taken Doppler, SMA/Celiac Axis at minute timed intervals Duplex TIPS Aorta/IVC/Pancreas/Liver Portal Hypertension NPO 8 hours VASCULAR DUPLEX GB/CBD/Kidneys/Spleen Cirrhosis Doppler Portal/Hepatic/Splenic Veins Hepatic Artery/TIPS Shunt Aorta IVC/Aorta/Kidneys Family History of AAA Back Pain/Smoker NPO 8 hours VASCULAR DUPLEX HTN/Elevated Cholesterol Paracentesis Abdomen Acites Abdominal distention None Abdominal swelling This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.

27 R A L E I G H R A D I O L O G Y U L T R A S O U N D A N A T O M I C A L G U I D E ULTRASOUND ANATOMICAL GUIDE Area of Concern Body Part Reason for Exam Ultrasound Prep Codes Pelvis Appendix Appendix RLQ pain no prep Bladder Bladder Urinary Frequency Cystitis Drink 24oz of water 1 hour prior Hematuria UTI to exam and hold it Dysuria Pelvic/TV Uterus/Ovaries/Bladder/Adnexa Pelvic Pain Amenorrhea Drink 32oz of water 1 hour prior BOTH EXAMS PERFORMED TOGETHER Endometriosis/cyst/torsion RLQ/LLQ Pain to exam and hold it AND PROVIDES BEST VISUALIZATION Menorrhagia Post Menopausal Bleeding OF STRUCTURES IN THE PELVIS Menometrorrhagia Dysmenorrhea Abnormal Uterine Bleeding Fibroids TV Uterus/Ovaries/Adnexa Pelvic Pain Amenorrhea no prep Endometriosis/cyst/torsion RLQ/LLQ Pain Menorrhagia Post Menopausal Bleeding Menometrorrhagia Dysmenorrhea Abnormal Uterine Bleeding Fibroids Pelvic Uterus/Ovaries/Bladder/Adnexa Pelvic Pain Amenorrhea Drink 32oz of water 1 hour prior Endometriosis/cyst/torsion RLQ/LLQ Pain to exam and hold it Menorrhagia Post Menopausal Bleeding Menometrorrhagia Dysmenorrhea Abnormal Uterine Bleeding Fibroids HSS Uterus/Ovaries/Adnexa/ Post Menopausal Bleeding Menorrhagia Schedule day 7-10 of LMP (Hysterosonogram) Endometrial Cavity Bleeding between menses Post Coidal Bleeding (Sonohysterogram) Breast/Axilla Breast Breast/Axilla Nipple discharge Focal Pain No prep. Performed in leiu of Palp Lump 6 month f/u ultrasound Mammography only in pts under age 30 Axilla Axilla Palp Lump Focal Pain no prep Small Parts Thyroid Thyroid Palp Lump, Elevated TSH Swollen neck, Goiter no prep Thyroidmegaly(enlarged thyroid) Scrotum Testicles/Inguinal Canal Infection/epididymitis/orchitis Enlarged scrotum no prep Epididymis/Scrotum Pain, Swelling, Trauma Palp Lump Doppler Testicles/Epididymis Head or Neck/ Soft tissue Head or Neck Soft tissue Palp Lump Lymphadenopathy no prep Chest Chest/Superficially Palp lump no prep Scrotum with Doppler Testicles/Inguinal Canal Pain- R/O Torsion no prep VASCULAR DUPLEX Epididymis/Scrotum AND Doppler Testicles/Epididymis This is for reference only. These are the protocol standards for Raleigh Radiology facilities. Information subject to change.