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Sections
Body
Body CT Protocols
Chest
CT Lung Screen (Risk and Benefits)
CT Chest With or Without (Routine)
CT Chest, Abdomen, and Pelvis With or Without (Routine)
CT Parathyroid for UTRGV
CTA Chest Pulmonary Embolism
CTA Chest Abdomen Pelvis (Aortic Dissection)
CT Chest Hi Resolution/ILD
CT Chest Super Dimension
CT Chest Tracheomalcia
Abdomen & Pelvis
CT Abdomen Pelvis With or Without (Routine)
CT Abdomen Pelvis Without (Renal Stone)
CTA Abdomen Pelvis (Aortic Aneursym)
CTA Abdomen Pelvis (Aortic Stent Graft/Endoleak)
CTA Abdomen Pelvis (GI Bleed)
CTA Abdomen Pelvis (Mesenteric Ischemia)
CT Abdomen (Multiphasic Liver)
CT Abdomen (Renal Mass/Renal Donor)
CTA Abdomen (Renal Artery Angio)
CTA Abdomen Pelvis (Breast Microsurgery)
CTA Breast Reconstruction Planning (DIEP Mapping)
CT Abdomen (Pancreatic Mass)
CT Abdomen Pelvis (CT IVP)
CT Pelvis (Routine)
CT Pelvis (Cystogram)
CT Abdomen Pelvis (Adrenal Mass)
CT Abdomen Pelvis (Enterography)
Other
CTA Runoff
Body MRI Protocols
Abdomen
MR Abdominal Pain
MR Enterography
MR Liver (Routine/Dotarem)
MR Liver (Eoviust)
MRCP
MR Pancreas
MR Pregnancy Appendicitis
MR Renal (W/ Contrast – Routine)
MR Renal (W/O Contrast)
Pelvis
MR Defecography
MR Pelvis (Female Uterus)
MR Pelvis (Female Non-Uterus)
MR Placenta Accreta
MR Perianal Fistula
MR Prostate
MR Rectal Cancer
MR Urethra
Other
MR Adrenal
Neuro
Neuro CT Protocols
Head & Neck
CT Head w/o
CT Head With
CT Head Stereotactic/Stryker
CT Facial Bones
CT Sinus
CT Orbits
CT Temporal Bones
CT Soft Tissue Neck
Vascular
CTA Head and Neck
CTA Head
CTA Neck
CT Venogram Head
Spine
CT Cervical Spine
CT Thoracic Spine
CT Lumbar Spine
CT Sacrum/Coccyx
Neuro MRI Protocols
Brain
MR Brain Routine w/o
MR Brain Routine w & w/o
MR Brain Tumor Protocol
MR Brain MS/Demyelinating Disease
MR Brain Epilepsy Protocol
MR Pituitary Routine
MR Pituitary Dynamic
MR Brain Neonate/Pediatric (In Progress)
Head & Neck
MR TMJ (Temporomandibular Joint)
MR IAC
MR Orbits
MR Trigeminal/Skull Base
MR Soft Tissue Neck (In Progress)
MR Face/Sinus (In Progress)
MR Oral Cavity/Nasopharynx (In Progress)
MR Larynx (In Progress)
Spine
MR Cervical Spine
MR Cervical Spine – Craniocervical Junction Trauma
MR Thoracic Spine
MR Lumbar Spine
MR Brachial Plexus
MR Lumbosacral Plexus
Vascular
MRA Head/Cow
MRA Neck
MRV Head
MSK
MSK CT Protocols
Upper Extremity
CT Shoulder (Arthrogram)
Lower Extremity
CT Foot
Other/Generic
CT Whole Body Myeloma Screening
MSK MRI Protocols
Upper Extremity
MR Sternum / Sternoclavicular Joint
MR Scapula
MR Pectoralis Major
MR Shoulder (Routine)
MR Shoulder (Arthrogram)
MR Latissimus Dorsi Tendon
MR Elbow (Routine)
MR Elbow (Arthrogram)
MR Elbow (Arthrogram OCD)
MR Elbow (Arthrogram UCL)
MR Elbow (Arthrogram Combined UCL/OCD)
MR Elbow (FABS for BICEPS)
MR Elbow (Flexed Elbow Valgus External Rotation “FEVER” sequence/position)
MR Elbow (Nonarthrogram or Saline Only Arthrogram OCD)
MR Elbow (Nonarthrogram or Saline Only Arthrogram Combined UCL/OCD)
MR Elbow (Non-Arthrogram UCL or Saline only UCL Arthrogram)
MR Elbow (Triceps Tendon)
MR TMJ (Temporomandibular Joint)
MR Wrist (Routine)
MR Wrist (Arthrogram)
MR Hand (Trauma/Injury/Tendons/Unspecified pain)
MR Hand (Infection/Mass/Tumor)
MR Hand (Rheumatology/Arthritis)
MR Thumb (Routine / collateral ligaments)
MR Finger
Lower Extremity
MR Pelvis (Bony)
MR Pelvis (Infection)
MR Pelvis (Rapid Trauma)
MR Athletic Pubalgia (Sports Hernia)
MR Sacrum/SI Joints
MR Hip (Routine)
MR Hip (Arthrogram)
MR Knee (Routine)
MR Knee (Arthrogram)
MR Ankle (Routine)
MR Ankle (Arthrogram)
MR Foot (Midfoot)
MR Foot (Forefoot)
MR Foot (Forefoot for Morton’s Neuroma)
MR Foot (Forefoot Infection / Osteomyelitis)
MR Foot (Hindfoot Infection / Osteomyelitis)
Other/Generic
MR HIP MARS (Metal Artifact Reduction Sequences)
MR KNEE MARS (Metal Artifact Reduction Sequences)
MR Long Bones Tumors Infection
Whole Body MRI for Myeloma
MSK US Protocols
Upper Extremity
Shoulder
Elbow
Wrist
Lower Extremity
Hip
Knee
Ankle
Nuclear Medicine
Cardiac
Muga
Muga First pass
Myocardial PYP
Nuclear Stress – Dobutamine
Nuclear Stress – Exercise Treadmill
Nuclear Stress – Lexiscan
Policy for Lexiscan_Adeno w Unstable Angina and CV Instability
Thallium – Myocardial Viability Study
Thalllium Stress Testing
Venogram Imaging
Endocrine
I-131 Hyperthyroid Therapy
Parathyroid
Thyroid Uptake and Scan
Gastrointestinal
Accessory Spleen
Adult Gastro Esophageal Reflux
Gastric empty
Gastric empty – 2HR protocol
Gastric empty-4HR
Gastro Esophageal Study
GI Bleed
Hemangioma
HIDA with CCK
HIDA without CCK
Liver Spleen
Meckles
Pediatric Gastro Esophageal Reflux
Salivary
Sphincter of ODDI
Genitourinary
Renal Captopril
Renal with Lasix
Renal without Lasix
Testicular Scan
VCUG voiding cystogram
Infection / Inflammation
Gallium scan
WBC
Neuro
Brain – Diamox Protocol
Brain Death
Brain Ictal Inter Ictal
Cisternogram
CSF Leak
DatScan
VP Shunt Patency
Oncology
I-123 MIBG
I-131 Cancer Ablation
I-131 Whole Body with Thyrogen
Lymphoscintigraphy
Octreoscan
Prostascint
Quadramet
Scintimammography
Sir-Spheres
Zevalin
Pulmonary
Lung Scan (Vent & Perf)
Skeletal
Bone Marrow Imaging
Bone Scan-Three Phase
Bone Scan-Whole Body
DEXA
Women's Imaging
Contact LIP for Protocols
Modalities
CT
CT Head w/o
CTA Head and Neck
CT Cervical Spine
CT Abdomen Pelvis With or Without (Routine)
CT Lung screen
CTA Runoff
CT Whole Body Myeloma Screening
CT Abdomen Pelvis Without (Renal Stone)
CT Thoracic Spine
CTA Head
CT Head With
CT Head Stereotactic/Stryker
CTA Neck
CT Lumbar Spine
CTA Abdomen Pelvis (Aortic Aneursym)
CT Chest With or Without (Routine)
CT Chest, Abdomen, and Pelvis With or Without (Routine)
CTA Abdomen Pelvis (Aortic Stent Graft/Endoleak)
CT Sacrum/Coccyx
CT Venogram Head
CT Facial Bones
CT Sinus
CTA Abdomen Pelvis (GI Bleed)
CT Parathyroid for UTRGV
CTA Chest Pulmonary Embolism
CTA Abdomen Pelvis (Mesenteric Ischemia)
CT Orbits
CT Temporal Bones
CT Abdomen (Multiphasic Liver)
CTA Chest Abdomen Pelvis (Aortic Dissection)
CT Chest Hi Resolution/ILD
CT Abdomen (Renal Mass/Renal Donor)
CT Soft Tissue Neck
CTA Abdomen (Renal Artery Angio)
CT Chest Super Dimension
CT Chest Tracheomalcia
CTA Abdomen Pelvis (Breast Microsurgery)
CT Abdomen (Pancreatic Mass)
CT Abdomen Pelvis (CT IVP)
CT Pelvis (Routine)
CT Pelvis (Cystogram)
CT Abdomen Pelvis (Adrenal Mass)
CT Abdomen Pelvis (Enterography)
MRI
MR Sternum / Sternoclavicular Joint
MR Pelvis (Bony)
MR Adrenal
MR Abdominal Pain
MR Defecography
MR Brain Routine w/o
MRA Head/Cow
MR Cervical Spine
MRI Breast W/WO
MR Pelvis (Infection)
MRI Breast Implants W/WO
MR Cervical Spine – Craniocervical Junction Trauma
MR Brain Routine w & w/o
MR Pelvis (Female Uterus)
MR Enterography
MR Long Bones Tumors Infection
MR Liver (Routine/Dotarem)
MR Pelvis (Rapid Trauma)
MR Scapula
MR Pelvis (Female Non-Uterus)
MR Brain Tumor Protocol
MRA Neck
MR IAC
MR Thoracic Spine
MRI Breast Biopsy
MR Lumbar Spine
MR Orbits
MR Brain MS/Demyelinating Disease
MR Athletic Pubalgia (Sports Hernia)
MR Placenta Accreta
MR Liver (Eoviust)
MR Pectoralis Major
MR Shoulder (Routine)
MRCP
MR Sacrum/SI Joints
MR Perianal Fistula
MR Brain Epilepsy Protocol
MR Trigeminal/Skull Base
MRV Head
MR Brachial Plexus
MR Lumbosacral Plexus
MR Soft Tissue Neck (In Progress)
MR Pituitary Routine
MR Prostate
MR Pancreas
MR Shoulder (Arthrogram)
MR Hip (Routine)
MR Rectal Cancer
MR Pregnancy Appendicitis
MR Face/Sinus (In Progress)
MR Pituitary Dynamic
MR Oral Cavity/Nasopharynx (In Progress)
MR Urethra
MR Hip (Arthrogram)
MR Renal (W/ Contrast – Routine)
MR Elbow (Routine)
MR Elbow (Arthrogram)
MR Knee (Routine)
MR Renal (W/O Contrast)
MR Brain Neonate/Pediatric (In Progress)
MR Larynx (In Progress)
MR Knee (Arthrogram)
MR Ankle (Routine)
MR Elbow (Arthrogram OCD)
MR Elbow (Arthrogram UCL)
MR Ankle (Arthrogram)
MR Foot (Midfoot)
MR Elbow (Arthrogram Combined UCL/OCD)
MR Elbow (FABS for BICEPS)
MR Foot (Forefoot)
MR Foot (Forefoot for Morton’s Neuroma)
MR Elbow (Nonarthrogram or Saline Only Arthrogram OCD)
MR Foot (Forefoot Infection / Osteomyelitis)
MR Foot (Hindfoot Infection / Osteomyelitis)
MR Elbow (Nonarthrogram or Saline Only Arthrogram Combined UCL/OCD)
MR Elbow (Non-Arthrogram UCL or Saline only UCL Arthrogram)
MR Elbow (Triceps Tendon)
MR Wrist (Routine)
MR Wrist (Arthrogram)
MR Hand (Trauma/Injury/Tendons/Unspecified pain)
MR Hand (Infection/Mass/Tumor)
MR Hand (Rheumatology/Arthritis)
MR Thumb (Routine / collateral ligaments)
MR Finger
Ultrasound
Hip
Shoulder
Elbow
Knee
Wrist
Ankle
