::   How do I order exams?

MOST IMPORTANTLY, to optimize the imaging study, to minimize patient risk, and to aid image interpretation, please provide relevant medical history with the order. SECONDLY, please provide a doctor's phone number (i.e. not patient line) so that important/unexpected results may be efficiently relayed to the ordering physician.

A request must be faxed to 723-6036. For special scheduling issues, call 723-6855.

Cross-sectional, fluoroscopic, and nuclear studies should be discussed with the resident on the respective service. Services include body MRI, body CT, cardiovascular, chest, GI fluoroscopy, musculoskeletal, nuclear medicine, neuroradiology, and ultrasound. However, emergency department requests for nonenhanced CT of head, orbits, face, and spine on patients in the ED require simply an order.

• Neurologic MRI - page operator for neuro fellow
  
• Neurointerventional - page operator for neurointerventional fellow
  
• Musculoskeletal MRI - page operator for body fellow
  
• Body Interventional - page operator for interventional fellow
  
• Nuclear Medicine - page operator for nuclear medicine resident

Monday-Thursday 5 pm to midnight, Friday 5 pm to Sunday 11:59 PM:

Contact the 2nd year radiology resident for the following:

• extremity ultrasound
• neonatal head ultrasound
• adult fluoroscopy
• CT of head, neck, spine, and extremities emergency wet reads of plain films

Contact the 3rd year radiology resident for all other ultrasound, CT, pediatric fluoroscopy, and all VA studies.

Monday to Thursday midnight to 8 am:

Contact the 3rd year radiology resident for all US, CT, fluoroscopy, and emergency wet reads of plain films.

::   What patient preparation is required for a study?

• Abdominal and aortic: Six hour fasting
  
• Pelvis: Requires a full bladder, i.e. have the patient drink 4 glasses of water one hour prior to exam or give intravenous fluid.
  
• Renal Requires full bladder. Drink 3 glasses of water one hour prior to exam.
  
• Other US: No preparation
  

• Access: Inpatients must have 20 G or larger peripheral IV in forearm or proximal, preferably antecubital. As a last resort, a Cordis may be used. PICC lines and triple lumen central lines may not be used for CT angiograms.
  
• Renal insufficiency: Creatinine must be less than 1.5 for patients with suspected renal insufficiency. Patients older than seventy must have had a recent creatinine. To minimize the risk of contrast-induced nephropathy, ensure adequate hydration. Although n-acetylcysteine is not specifically recommended, published doses are 600 mg PO bid the day of and the day prior to CT, or 150 mg/kg IV 30 minutes prior to the exam and 50 mg/kg over four hours after the exam (each in 500 mL NS).
  
• Allergy: Prior anaphylaxis from iodinated contrast medium precludes repeat administration of contrast, unless 1.) contrast-enhanced CT is the only method of diagnosis and 2.) the case is discussed with a radiologist. Premedication is required for patients with prior minor reaction to iodinated constrast, multiple allergies, asthma, and any prior episode of anaphylaxis. Premedication regimen: 50 mg oral prednisone 13, 7, and 1 hour prior to study as well as 50 mg oral Benedryl 1 hour prior to study.
  
• Rectal cancer protocol: Two Fleets enemas prior to the exam.
  

An MRI safety screening form must be completed by the patient. If the patient is unable to complete the form, the requesting physician must complete the form. Further information on MRI safety and a list of MRI-compatible devices is available on www.mrisafety.com (registration required for link on the left to the "list"). The following is a nonexhaustive list of possible contraindications: cardiac pacemaker, internal pacing wires, venous umbrella, aortic clips, prosthetic heart valve, brain clips, cochlear implants, insulin pump, schrapnel, metal fragment exposure to eye, neurostimulator, pregancy, intrauterine device.

UGI and SBFT:
1. Patient to be NPO from 9 pm night prior to study.
2. Additionally, if a barium study has been performed in the past three days, drink a glass of water every hour from noon to 7 pm the night prior to the study (8 glasses).

IVP:
1. Light dinner at 5 pm night before study.
2. 6 pm - 1 Dulcolax tablet. If weight greater than 150 lbs, take and additional tablet.
3. Morning of exam: clear liquid breakfast and one glass of water.
4. See creatinine requirements and iodine allergy issues under CT prepartation.

Barium Enema:
1. Day before exam: Breakfast okay. 11 AM - one glass water, 12 noon - liquid lunch, 1 pm - one glass water, 2 pm -one glass water, 3 pm - one glass water, 6 pm - 10 oz bottle of cold Magnesium Citrate, 7 pm - clear liquid dinner, 8 pm - 4 Dulcolax tablets with one glass water, 9 pm - one glass water, 10 pm - one glass water
2. NPO after midnight prior to exam

Avoid deodorant, perfumes, powders, ointments, etc. to the chest, breast, and axilla.

::   How do I get the results of a study?

• Lastword, under Results/Graphs, choose Radiology.
  
• If a study has a dictated report yet to be transcribed, use ARTAS to listen to the dictation:

  1. Dial 650-725-7617
  2. At the prompt, dial "20#"
  3. Enter the 8 digit MR# (include the check-digit), followed by "#". The most recent dictation will start to play.
  4. To go to the next dictation, hit "8"
  

• To get a faxed copy of the report, call the file room at 723-6717 or medical records.

• Meditech.
  
• To listen to a dictated report yet to be transcribed:

  1. Dial: 7-8278 (650-497-8278)
  2. At the prompt, hit "12345#"
  3. Enter the 7 digit MR# (no check-digit), followed by "#"
  The most recent dictation will start to play
  4. To go to the next dictation, hit "8"
  

• CPRS.
  
• To listen to a dictated report:

  1. Dial 877-502-0321 or within the hospital 60515
  2. At location prompt 4# for Palo Alto
  3. Then 9 followed by last four digits of YOUR SSN
  4. Then 3 to listen. Then PATIENT SSN.
  

::   How do I schedule an outpatient study?

Stanford: Call central scheduling at 723-6855 or 498-7019.
LPCH: Call central scheduling at 497-8376 or 724-8133.
VA: Call 64489 or 65959. For nuclear studies call 66095.

::   How can I obtain films or get copies of reports?

::   How can I see a study on PACS?

::   What are the effects of radiation during pregnancy?