MRI Ordering Instructions and Guidance


• MRI questions can be answered by a technologist by calling 452-7676 or 452-7504

• Call OneCall (452-6234) to schedule MRI exams.

• SRHC does have an open MRI available for claustrophobic patients at the Medical Arts Building.

• Not all MR scans can be performed on the open MRI. The majority of routine scans are able to be performed on the open MRI.

• Pediatric patients may require anesthesia sedation which is scheduled by OneCall(452-6234)

• The majority of MR exams require no prep.

• Exceptions requiring prep are MR Enterography and MRCPs. These exams require patients to be NPO for 6 hrs prior to exam. Many times these scans are able to be performed without NPO status but proper prep is preferred for optimum quality.

• MR Enterography should not be scheduled/performed on the same day as EGD or colonoscopy.

ACR Guidelines are followed when patients are to receive Gadolinium based contrast agents(GBCA). These guidelines are as follows:
     • patient age 60 or greater
     • patient has history of diabetes
     • patient has history of hypertension

These patients require a Serum Creatinine level no older than seven(7)days.

Patients with normal GFR(60+) will be administered standard dose of GBCA based on weight.

Patients with GFRs between 30-60 will be evaluated on a case by case basis by the radiologist on duty to determine efficacy of GBCA administration. If GBCA is used, a partial or half dose of Multihance contrast will be administered.

Patients on dialysis or with GFR less than 30 will not receive contrast.

All MR scans are evaluated independently prior and/or during scanning by technologists and on duty radiologist to determine if contrast may or may not be necessary to acquire optimum exam results.

 

MRI of the Brain: (Specify if Orbits or IACs)

 

May be ordered WO or WO/W contrast
Contrast is not required to r/o CVA
Contrast is required to evaluate for tumors and inflammation.

 

MRA of the Brain:

 

Ordered routinely WO contrast only.

Exceptions may be certain cases where evaluation of pseudotumor cerebri or AVM are being evaluated. These are evaluated on a case by case basis when necessary by the on duty radiologist.

 

MRI of the Cervical / Thoracic / Lumbar Spine

 

MRI of the spine is routinely ordered WO unless certain conditions apply.

MRI of the spine is to be scanned WO/W if:

• Patient has a history of surgery to the area of the spine to be imaged.
• Patient has a recent history of cancer and primary or metastatic disease is suspected.
• Patient is being evaluated for discitis or osteomylitis.
• In certain cases involving Multiple Sclerosis contrast may be used in the cervical and thoracic spines.
• When evaluating SI joints additional order for MRI of the Pelvis is necessary.

Patients receiving GBCAs for spinal imaging are subject to contrast guidelines as stated above.

 

MRI of the Abdomen (Liver, Adrenals, Renal)

 

• order WO if evaluating for adrenal adenoma vs. malignancy
      - these patients should have already had a questionable CT exam.
• order WO/W if evaluating malignancy.

 

MR Enterography

 

• scheduled at SF campus only
• patients need to be NPO 6 hrs prior to exam.
• Patient must arrive 1.5 hrs prior to exam to register and drink Volumen.
• routinely ordered on patients between the ages of 12-45 to decrease radiation exposure.
• MR Enterography should not be scheduled/performed on the same day as EGD or colonoscopy.
• ACR contrast administration guidelines apply. (see guidelines above)

 

MRI of the Pelvis

 

• order WO contrast for pain or fx
• order WO/W contrast if evaluating for primary or metastatic cancer.

 

MRI of the Hip

 

• Order WO contrast routinely for hip pain.

 

MRI of the Knee

 

• Order WO contrast

 

MRI of the Ankle

 

• Order WO contrast

 

MRI of the Foot

 

• Order WO contrast for foot pain.
• Order WO/W contrast for osteomyelitis.
• Note on order what part of foot to evaluate. ie: toes, mid foot, heel. It may be difficult to evaluate the entire foot due to large fields of view.
• ACR contrast administration guidelines apply. (see guidelines above)

 

MRI of the Shoulder

 

• Order WO contrast for shoulder pain or possible rotator cuff tear or tendonitis.
• If a MR Shoulder arthrogram is ordered fluoroscopy must be scheduled also to guide the joint injection of GBCA.
• ACR contrast administration guidelines apply. (see guidelines above)
• MR Shoulder arthrogram is utilized to evaluate SLAP lesions in the labrum.

 

MRI of the Elbow

 

• Order WO contrast

 

MRI of the Wrist

 

• Order WO contrast

 

MRI of the Hand

 

• Order WO contrast

 

MRI of the Upper Extremity (humerus, forearm)

 

• Order WO contrast
• Order WO/W if evaluating known or suspected mass/tumor.

 

MRI of the Lower Extremity (femur, tib / fib)

 

• Order WO contrast
• Order WO/W if evaluating known or suspected mass/tumor.

 

MRA of the Carotids

 

• Routinely order WO/W contrast.
• Schedule at Santa Fe
• MRA of Carotids includes aortic arch to circle of Willis.
• ACR contrast administration guidelines apply. (see guidelines above)
• Can be performed WO only if necessary due to renal failure.

 

MRA of the Abdomen, Renal Arteries, SMA, Etc.

 

• Order With contrast
• ACR contrast administration guidelines apply. (see guidelines above)
• Can be performed in certain cases WO contrast if necessary due to renal failure.

 

MRA of the Lower Extremities (Runoff)

 

• Order With contrast
• ACR contrast administration guidelines apply. (see guidelines above)
• Can be performed in certain cases WO contrast if necessary due to renal failure.

 

MRA of the Chest

 

• Order With contrast
• ACR contrast administration guidelines apply. (see guidelines above)

 

All MR scans are evaluated independently prior and/or during scanning by technologists and on duty radiologist to determine if contrast may or may not be necessary to acquire optimum exam results.