SIERRA NEVADA MEDICAL ASSOCIATES, INC. (IPA)
UTILIZATION GUIDELINES
RADIOLOGY GUIDELINES
HEAD - BRAIN
MODALITY
Nuclide Scan
Brain scans have been superseded by
the other modalities and have no
usefulness if the others are available.
In early brain abscess, brain scan may
be more sensitive. Avoid repetition or
contrast with CT if MRI is unavailable
or contraindicated.
CT
CT without contrast is the best way to
evaluate acute trauma and suspected
acute hemorrhage or hemorrhagic
infarction within the first 48 hours.
Bone artifacts diminish accuracy in the
posterior fossa
INDICATIONS
 Unavailability of CT and MRI.
MRI
MRI is the best way to evaluate the
brain when acute hemorrhage is not an
issue. If MRI is available and not
contraindicated, CT should be omitted
in all other circumstances.
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RAD - HEAD AND BRAIN
Acute head trauma with suspected
intracranial bleeding.
Suspected subarachnoid
hemorrhage.
Suspected hemorrhagic cerebral
infarction.
Contraindication to MRI, particularly
an uncooperative patient.
Suspected, but undiagnosed,
hemorrhage in posterior fossa or
brain stem.
Suspected, non-hemorrhagic
cerebral infarction: dementia,
suspected from multiple infarcts.
Suspected intracerebral aneurysms
or arteriovenous malformations.
Suspected sagittal sinus
thrombosis.
Suspected brain tumor, including,
particularly: meningiomas, posterior
fossa tumors, acoustic neuromas.
Suspected intracerebral
metastases: bulky tumors, tumor
seeding of meninges or any
intradural locus.
Suspected lymphoma.
Suspected intra-orbital or visual
pathway lesion.
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RAD - HEAD AND BRAIN
Suspected pituitary tumor or lesion.
Suspected intracranial infections
such as cerebritis, meningitis, when
lumbar puncture is not diagnostic,
particularly: brain abscess,
toxoplasmosis.
Suspected multiple sclerosis. (MRI
of the brain is the first choice over
MRI of the spine, or evoked
responses.)
NON-INDICATIONS:
Headaches
Tension headaches
Migraine.
Cluster headaches.
Dizziness
Vertigo
MRI and CT not approved unless
unique indications exist. Specific
indications need to be identified.
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