PROC RECORD NAME
PATIENT INSTRUCTIONS
CT ABDOMEN AND CT PELVIS WITH CONTRAST
CT ABDOMEN AND CT PELVIS WITHOUT AND WITH CONTRAST
CT ABDOMEN COMBINED WITH CONTRAST
CT PELVIS COMBINED WITH CONTRAST
CT ABDOMEN COMBINED WITH WO CONTRAST
CT PELVIS COMBINED WITH WO CONTRAST
CT ABD/PELVIS BARIATRIC PROTOCOL WITH CONTRAST
CT ABDOMEN AND CT PELVIS CONTRAST PER RADIOLOGY PROTOCOL
CT ABD/PELVIS BARIATRIC PROTOCOL WITHOUT CONTRAST
MVH/AMC ONLY -- If patient is insulin dependent diabetic = Creatinine results within last 30 days
required. Obtain order for STAT creatinine from physician if necessary.
Nothing by mouth 4 hours prior to the exam. Obtain order for STAT creatinine from physician if
necessary. Please bring a list of your current medications, which should include both prescribed and
over the counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
Patient must arrive 2 hours prior to exam time for oral contrast. Registration will be the first 30 minutes.
Patient will be given oral contrast to drink upon arrival in the department. The drinking of contrast and
CT ABDOMEN AND PELVIS WITHOUT CONTRAST
MVH/AMC ONLY -- Nothing by mouth 4 hours prior to the exam. Please bring a list of your current
medications, whcih should include both prescribed and over-the-counter medications.
Patient must arrive 2 hours prior to exam time for oral contrast. Registration will be the first 30 minutes.
Patient will be given oral contrast to drink upon arrival in the department. The drinking of contrast and
scan will be a total of 90 minutes.
CT ABDOMEN COMBINED WO CONTRAST
CT PELVIS COMBINED WO CONTRAST
CT ABD/PELVIS BARIATRIC PROTOCOL WITHOUT CONTRAST
CT ABDOMEN WITHOUT CONTRAST
MVH/AMC ONLY -- Nothing by mouth 4 hours prior to the exam. Please bring a list of your current
medications, whcih should include both prescribed and over-the-counter medications.
CT ABDOMEN WITH CONTRAST
MVH/AMC ONLY -- If patient is insulin dependent diabetic = Creatinine results within last 30 days
required. Obtain order for STAT creatinine from physician if necessary.
Nothing by mouth 4 hours prior to the exam. Obtain order for STAT creatinine from physician if
necessary. Please bring a list of your current medications, which should include both prescribed and
over the counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
CT ABDOMEN WITHOUT AND WITH CONTRAST
CT ABDOMEN CONTRAST PER RADIOLOGY PROTOCOL
CT ABDOMEN AND CT PELVIS CONTRAST PER RADIOLOGY PROTOCOL
CT STENT GRAFT PROTOCOL
CTA ABDOMEN AND PELVIS WITH AND WITHOUT CONTRAST
CTA ABDOMEN AND PELVIS WITH CONTRAST
CTA ABDOMEN AND PELVIS CONTRAST PER RAD PROTO
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CTA CHEST AND ABDOMEN WITH CONTRAST
CTA CHEST AND ABDOMEN WITH AND WITHOUT CONTRAST
CTA CHEST AND ABDOMEN CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
CTA CHEST, ABDOMEN, PELVIS WITH AND WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
CTA CHEST, ABD, PELVIS CONTRAST PER RAD PROTOCOL
CTA CHEST, ABDOMEN, PELVIS WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
CTA HEAD WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CTA HEAD AND NECK WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CTA HEAD AND NECK CONTRAST PER RAD PROTO
CTA HEAD AND NECK WITH AND WITHOUT CONTRAST
CTA HEAD WITHOUT AND WITH CONTRAST
CTA NECK WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CTA CHEST WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CTA ABDOMEN WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CTA ABDOMEN WITH AIF RUNOFF WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CTA EXTREMITY LOWER LEFT WITHOUT AND WITH CONTRAST
CTA EXTREMITY LOWER RIGHT WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
CTA PELVIS WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CTA EXTREMITY UPPER WITHOUT AND WITH CONTRAST
CTA EXTREMITY UPPER LEFT WITHOUT AND WITH CONTRAST
CTA EXTREMITY UPPER RIGHT WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
CT ASSISTED ABSCESS DRAINAGE
CT GUIDED PERCUTANEOUS DRAINAGE
ABSCESS DRAINAGE
CT CARDIAC CALCIUM SCORING
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT CEREBRAL PERFUSION STUDY
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT SPINE CERVICAL WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT SPINE CERVICAL WITH CONTRAST
CT SPINE CERVICAL WITHOUT AND WITH CONTRAST
CT SPINE CERVICAL CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
CT CHEST HIGH RESOLUTION
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT CHEST PE PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT CHEST WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT CHEST WITH CONTRAST
CT CHEST WITHOUT AND WITH CONTRAST
CT CHEST CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary.
CT CHEST AND ABDOMEN WITH AND WITHOUT CONTRAST
CT CHEST AND ABD CONTR PER RAD PROTOCOL
CT CHEST AND ABDOMEN WITH CONTRAST
MVH/AMC ONLY -- If patient is insulin dependent diabetic = Creatinine results within last 30 days
required. Obtain order for STAT creatinine from physician if necessary.
Nothing by mouth 4 hours prior to the exam. Obtain order for STAT creatinine from physician if
CT CHEST AND ABDOMEN WITHOUT CONTRAST
MVH/AMC ONLY -- Nothing by mouth 4 hours prior to the exam. Please bring a list of your current
medications, whcih should include both prescribed and over-the-counter medications.
Patient must arrive 2 hours prior to exam time for oral contrast. Registration will be the first 30 minutes.
Patient will be given oral contrast to drink upon arrival in the department. The drinking of contrast and
scan will be a total of 90 minutes.
*Plz note hours of operation of department when advising time to arrive.
GSH/UVMC ONLY - Nothing by mouth 4 hours priror to the exam. Please bring a list of your current
medications, which should include both prescribed and over-the-counter medications.
Please give patient a script for oral contrast that they can pick up from a GSH or UVMC pharmacy
respectively. Follow the instructions listed on the script (If AM test = Patient to drink one bottle of
contrast at bedtime. Patient to drink second bottle of contrast 1 hour before the test. If PM test =
Patient to drink one bottle of contrast at 7:00am. Patient to drink second bottle of contrast 1 hour before
test.). If the patient is not picking up the contrast, they need to arrive 2 hours prior to exam time for oral
contrast.
*Plz note hours of operation of department when advising time to arrive.
CT CHEST, ABD AND PELVIS WITH AND WITHOUT CONTRAST
CT CHEST, ABD, AND PELVIS CONTRAST PER RADIOLOGY PROTOC
CT CHEST, ABDOMEN AND PELVIS WITH CONTRAST
MVH/AMC ONLY -- If patient is insulin dependent diabetic = Creatinine results within last 30 days
required. Obtain order for STAT creatinine from physician if necessary.
Nothing by mouth 4 hours prior to the exam. Obtain order for STAT creatinine from physician if
CT CHEST ABDOMEN PELVIS WITHOUT CONTRAST
MVH/AMC ONLY -- Nothing by mouth 4 hours prior to the exam. Please bring a list of your current
medications, whcih should include both prescribed and over-the-counter medications.
Patient must arrive 2 hours prior to exam time for oral contrast. Registration will be the first 30 minutes.
Patient will be given oral contrast to drink upon arrival in the department. The drinking of contrast and
scan will be a total of 90 minutes.
*Plz note hours of operation of department when advising time to arrive.
GSH/UVMC ONLY - Nothing by mouth 4 hours priror to the exam. Please bring a list of your current
medications, which should include both prescribed and over-the-counter medications.
Please give patient a script for oral contrast that they can pick up from a GSH or UVMC pharmacy
respectively. Follow the instructions listed on the script (If AM test = Patient to drink one bottle of
contrast at bedtime. Patient to drink second bottle of contrast 1 hour before the test. If PM test =
Patient to drink one bottle of contrast at 7:00am. Patient to drink second bottle of contrast 1 hour before
test.). If the patient is not picking up the contrast, they need to arrive 2 hours prior to exam time for oral
contrast.
*Plz note hours of operation of department when advising time to arrive.
CT CORONARY ANGIOGRAM + 3D HEART
No nicotine or caffeine for 12 hours prior to exam. No erectile dysfunction medications for 48 hours
prior to exam. Other medications may be taken with small sips of water. Nothing to eat or drink 4 hours
prior to the exam. If patient is insulin-dependent diabetic, creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary. Please bring a list of your current
medications, which should include both prescribed and over the counter medications.
CT CORONARY ANGIO + 3D HEART + SCORING
CT 3D HEART
CT 3D HEART WITH CONGENITAL HEART DISEASE
No nicotine or caffeine for 12 hours prior to exam. No erectile dysfunction medications for 48 hours
prior to exam. Other medications may be taken with small sips of water. Nothing to eat or drink 4 hours
prior to the exam. If patient is insulin-dependent diabetic, creatinine results within last 30 days required.
Obtain order for STAT creatinine from physician if necessary. Please bring a list of your current
medications, which should include both prescribed and over the counter medications.
CT CORONARY ANGIOGRAM
CT CORONARY ANGIO + CALCIUM SCORING
No nicotine or caffeine for 12 hours prior to exam. No erectile dysfunction medications for 48 hours
prior to exam. Other medications may be taken with small sips of water. Nothing to eat or drink for 4
CT DENTASCAN WITHOUT CONTRAST
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT EXTREMITY LOWER BILATERAL WITHOUT CONTRAST
CT EXTREMITY LOWER LEFT WITHOUT CONTRAST
CT EXTREMITY LOWER RIGHT WITHOUT CONTRAST
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT EXTREMITY LOWER BILATERAL WITH CONTRAST
CT EXTREMITY LOWER LEFT WITH CONTRAST
CT EXTREMITY LOWER RIGHT WITH CONTRAST
CT EXTREMITY LOWER BILATERAL WITHOUT AND WITH CONTRAST
CT EXTREMITY LOWER RIGHT WITHOUT AND WITH CONTRAST
CT EXTREMITY LOWER BILATERAL CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order
for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT EXTREMITY LOWER LEFT CONTRAST PER RADIOLOGY PROTOCOL
CT EXTREMITY LOWER RIGHT CONTRAST PER RADIOLOGY PROTOCOL
CT EXTREMITY LOWER LEFT WITHOUT AND WITH CONTRAST
CTA EXTREMITY LOWER WITHOUT AND WITH CONTRAST
CT GUIDED CYST ASPIRATION
CT GUIDED CYST ASPIRATION
CT GUIDED BIOPSY
CT CT-GUIDED NEEDLE BIOPSY
CT GUIDED TISSUE ABLATION
CT CT-GUIDED TISSUE ABLATION VISCERAL
CT HEAD STEALTH PROTOCOL
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT HEAD WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order
for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT HEAD WITHOUT CONTRAST
CT POSTERIOR FOSSA WITHOUT CONTRAST
CT HEAD (URGENT-ANTICOAGULATED HEAD INJURY PATIENT)
CT-HEAD STROKE ALERT W/O
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT HEAD WITH CONTRAST
CT HEAD WITHOUT AND WITH CONTRAST
CT POSTERIOR FOSSA WITH CONTRAST
CT HEAD STEALTH PROTOCOL WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order
for STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
HEARTSAVER
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT HEMATURIA PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT INTERNAL AUDITORY CANAL WITHOUT AND WITH CONTRAST
CT INTERNAL AUDITORY CANAL WITH CONTRAST
CT INTERNAL AUDITORY CANAL CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
CT INTERNAL AUDITORY CANAL WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT DENTASCAN WITHOUT CONTRAST
CT MAXILLOFACIAL AREA WITHOUT CONTRAST
CT MAXILLOFACIAL / SINUS WITHOUT CONTRAST
CT SINUSES WITHOUT CONTrAST LIMITED
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT MAXILLOFACIAL AREA WITH CONTRAST
CT MAXILLOFACIAL / SINUS WITH CONTRAST
CT MAXILLOFACIAL AREA WITHOUT AND WITH CONTRAST
CT MAXILLOFACIAL / SINUS WITHOUT AND WITH CONTRAST
CT FACIAL BONES WITH CONTRAST
CT FACIAL BONES WITH AND WITHOUT CONTRAST
CT MAXILLOFACIAL AREA CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT NASOPHARYNX PROTOCOL WITHOUT CONTRAST
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT NASOPHARYNX PROTOCOL WITH CONTRAST
CT NASOPHARYNX PROTOCOL WITHOUT AND WITH CONTRAST
CT NASOPHARYNX PROTOCOL CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
CT ORBIT WITHOUT CONTRAST
CT ORBIT / SELLA / IAC WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT ORBIT WITH CONTRAST
CT ORBIT / SELLA / IAC WITH CONTRAST
CT ORBIT WITHOUT AND WITH CONTRAST
CT ORBIT WITHOUT AND WITH CONTRAST
CT ORBIT CONTRAST PER RADIOLOGY PROTOCOL
CT POSTERIOR FOSSA WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT PELVIS BONE
CT PELVIS WITHOUT CONTRAST
MVH/AMC ONLY -- Nothing by mouth 4 hours prior to the exam. Please bring a list of your current
medications, whcih should include both prescribed and over-the-counter medications.
Patient must arrive 2 hours prior to exam time for oral contrast. Registration will be the first 30 minutes.
Patient will be given oral contrast to drink upon arrival in the department. The drinking of contrast and
scan will be a total of 90 minutes.
*Plz note hours of operation of department when advising time to arrive.
GSH/UVMC ONLY - Nothing by mouth 4 hours priror to the exam. Please bring a list of your current
medications, which should include both prescribed and over-the-counter medications.
Please give patient a script for oral contrast that they can pick up from a GSH or UVMC pharmacy
respectively. Follow the instructions listed on the script (If AM test = Patient to drink one bottle of
contrast at bedtime. Patient to drink second bottle of contrast 1 hour before the test. If PM test =
Patient to drink one bottle of contrast at 7:00am. Patient to drink second bottle of contrast 1 hour before
test.). If the patient is not picking up the contrast, they need to arrive 2 hours prior to exam time for oral
contrast.
*Plz note hours of operation of department when advising time to arrive.
CT PELVIS WITH CONTRAST
CT PELVIS WITHOUT AND WITH CONTRAST
CT PELVIS CONTRAST PER RADIOLOGY PROTOCO
MVH/AMC ONLY -- If patient is insulin dependent diabetic = Creatinine results within last 30 days
required. Obtain order for STAT creatinine from physician if necessary.
Nothing by mouth 4 hours prior to the exam. Obtain order for STAT creatinine from physician if
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT SELLA WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT SELLA WITHOUT AND WITH CONTRAST
CT SELLA CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
CT SOFT TISSUE NECK WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT SOFT TISSUE NECK WITH CONTRAST
CT SOFT TISSUE NECK WITHOUT AND WITH CONTRAST
CT SOFT TISSUE NECK CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
CT SPINE LUMBAR WITHOUT AND WITH CONTRAST
CT SPINE LUMBAR CONTRAST PER RADIOLOGY PROTOCOL
CT SPINE LUMBAR WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
CT SPINE LUMBAR WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT SPINE THORACIC WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT SPINE THORACIC WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
CT SPINE THORACIC CONTRAST PER RADIOLOGY PROTOCOL
CT SPINE THORACIC WITHOUT AND WITH CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT STEREOTACTIC LOCALIZATION
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT STONE PROTOCOL
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CT EXTREMITY UPPER BILATERAL WITHOUT CONTRAST
CT EXTREMITY UPPER LEFT WITHOUT CONTRAST
CT EXTREMITY UPPER RIGHT WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.
CT EXTREMITY UPPER BILATERAL WITH CONTRAST
CT EXTREMITY UPPER LEFT WITH CONTRAST
CT EXTREMITY UPPER RIGHT WITH CONTRAST
CT EXTREMITY UPPER BILATERAL WITHOUT AND WITH CONTRAST
CT EXTREMITY UPPER LEFT WITHOUT AND WITH CONTRAST
CT EXTREMITY UPPER RIGHT WITHOUT AND WITH CONTRAST
CT EXTREMITY UPPER RIGHT WITHOUT AND WITH CONTRAST
CT EXTREMITY UPPER RIGHT CONTRAST PER RADIOLOGY PROTOCOL
CT EXTREMITY UPPER LEFT CONTRAST PER RADIOLOGY PROTOCOL
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT LANDMARX SINUSES
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
CTA HEAD VENOUS STUDY WITH AND WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam.
If patient is insulin dependent diabetic = creatinine results within last 30 days required. Obtain order for
STAT creatinine from physician if necessary.
Please bring a list of your current medications, which should include both prescribed and over the
counter medications.
If patient is allergic to IV contrast/iodine, ordering physician will need to order pre-medication for
patient.
CT CHEST WITHOUT CONTRAST
Nothing by mouth 4 hours prior to the exam. Please bring a list of your current medications, which
should include both prescribed and over the counter medications.