Do I order this image with or without IV contrast?

The American College of Radiology recommends that unenhanced CT images be used for the following indications through the  ABIM’s Choosing Wisely campaign:

Screen Shot 2018-07-06 at 1.40.14 PM.png

In addition:

Screen Shot 2018-07-06 at 1.44.33 PM.png

When contrast is required or will allow for best visualization, RadConsult has made a super-helpful chart organized by rule-out diagnosis:

Contrast required Best with IV contrast, but not required  No IV contrast needed
-any CT angiography (aorta, PE study, carotids/vertebrals, brain)
-adrenal mass assessment*
-aortic dissection*
-cardiac CT (except calcium scoring)
-liver mass assessment*
-pancreatic mass assessment*
-renal mass assessment*
-abdominal pain generally
-any time infection is suspected
-follow-up malignancy exam (usually)
-mediastinal mass (usually)
-postoperative (usually)
-aortic aneurysm size assessment (for intraluminal detail, contrast needed)
-pulmonary nodule followup
-fractures and many osseous lesions
-brain (nearly always; talk to your radiologist if you have questions)
-renal colic
-suspicion for intra-abdominal, retroperitoneal, or other large hemorrhage
-ventral hernia (oral contrast may be helpful)

* Be sure to understand that for these studies, a non-contrast scan is usually part of the protocol, exposing your patient to at least double the radiation dose.





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