All imaging indications
Browse every indication by body region. For interactive search, use the imaging guide.
Neuro · Head & Neck 110
- Headache, new-onset, no red flags MRI MRI Brain without contrast
- Acute focal neurologic deficit CT CT Head non-contrast + CTA Head/Neck + CT Perfusion
- Head trauma with GCS ≤ 14 or loss of consciousness CT CT Head without contrast
- First-time seizure (adult) MRI MRI Brain with and without contrast
- Thunderclap headache (worst of life) CT CT Head without contrast → LP if CT negative
- Transient focal neurologic symptoms (resolved) MRI MRI Brain with DWI + MRA Head and Neck
- New back pain with neuro deficit (suspected cord compression) MRI MRI entire spine without contrast
- Fall on anticoagulants CT CT Head without contrast
- Vertigo with neuro signs or persistent / atypical MRI MRI Brain (including IACs) with and without contrast
- Sudden sensorineural hearing loss MRI MRI Internal Auditory Canals with and without contrast
- Recurrent or complicated sinus pain CT CT Sinuses without contrast
- Visual field defect, galactorrhea, or pituitary symptoms MRI MRI Sella with and without contrast (pituitary protocol)
- Migraine without aura, recurrent No imaging recommended
- Cluster headache MRI MRI Brain with and without contrast (if first presentation or atypical)
- Suspected idiopathic intracranial hypertension MRI MRI Brain + MR Venography
- Suspected cerebral venous sinus thrombosis MRI MR Venography (or CT Venography if MRI unavailable)
- Suspected carotid or vertebral artery dissection CT CTA Head and Neck (or MRA neck with fat-saturated T1)
- Gait, dementia, and urinary incontinence triad MRI MRI Brain
- Cognitive decline / dementia work-up MRI MRI Brain with and without contrast
- Suspected multiple sclerosis or demyelinating disease MRI MRI Brain + Spinal Cord with and without contrast
- Suspected brain abscess MRI MRI Brain with and without contrast (including DWI)
- Suspected acute meningitis CT No imaging before LP if no contraindications; otherwise CT Head first
- Suspected encephalitis MRI MRI Brain with and without contrast (including FLAIR and DWI)
- Status epilepticus or new refractory seizure CT CT Head non-contrast + MRI Brain when stable
- Focal or refractory seizure work-up MRI MRI Brain (epilepsy protocol)
- Newly discovered intracranial mass MRI MRI Brain with and without contrast (full tumor protocol)
- Brain metastases evaluation MRI MRI Brain with and without contrast
- Stroke follow-up imaging MRI MRI Brain at 24-72 hours (or sooner if clinical change)
- Atypical or non-resolving facial weakness MRI MRI Face / Internal Auditory Canals with and without contrast
- Painful vision loss, suspected optic neuritis MRI MRI Brain + Orbits with fat-sat and contrast
- Trigeminal neuralgia, atypical features MRI MRI Brain + Brainstem with CISS/FIESTA sequences
- Postauricular pain and swelling, suspected mastoiditis CT CT Temporal Bones without contrast
- Chronic otitis media with retraction pocket, suspected cholesteatoma CT CT Temporal Bones without contrast (and MRI with DWI if extent unclear)
- Pulsatile tinnitus MRI MRA Brain + MRV (or CTA Head/Neck)
- Unilateral non-pulsatile tinnitus with hearing loss MRI MRI Internal Auditory Canals with and without contrast
- Deep neck space infection, suspected abscess CT CT Neck with IV contrast
- Suspected peritonsillar abscess CT Clinical diagnosis (drain at bedside); CT Neck with IV contrast if drainage fails or atypical
- Painful salivary gland swelling with meals US Neck Ultrasound (or CT Neck without contrast for stones)
- Parotid or major salivary gland mass US Ultrasound first, then MRI Neck with and without contrast
- Thyroid nodule (palpable or incidental on cross-sectional) US Thyroid Ultrasound (apply TI-RADS)
- Biochemical primary hyperparathyroidism (parathyroid adenoma localization) NM Parathyroid Sestamibi + Neck Ultrasound (4D-CT if discordant)
- Proptosis with Graves disease (suspected thyroid eye disease) MRI MRI Orbits with and without contrast (or CT Orbits if MRI contraindicated)
- Penetrating neck trauma (Zone II), hemodynamically stable CT CTA Neck with IV contrast
- Maxillofacial trauma CT CT Face without contrast
- Pediatric head trauma, low risk (PECARN low) Observation only — no imaging
- Pediatric head trauma, PECARN intermediate or high risk CT CT Head non-contrast (or observation per shared decision)
- Pediatric stridor (croup vs epiglottitis vs FB) XR AP and Lateral Soft Tissue Neck X-ray
- Pediatric suspected meningitis Lumbar puncture (CT head only if focal deficit, papilledema, immunocompromised, or signs of ICP)
- Pediatric posterior fossa tumor (medulloblastoma, ependymoma, JPA) MRI MRI Brain + Entire Spine with and without contrast
- Periorbital swelling with eye signs, suspected orbital cellulitis CT CT Orbits and Sinuses with IV contrast
- Proptosis without trauma, suspected orbital mass MRI MRI Orbits with and without contrast (fat-saturated)
- Acute proptosis or vision loss after facial trauma CT CT Orbits without contrast (emergent)
- Periorbital trauma with diplopia or enophthalmos, suspected blowout fracture CT CT Face (orbital floor)
- Vestibular schwannoma surveillance MRI MRI Internal Auditory Canals (annual / per growth pattern)
- Suspected dural arteriovenous fistula MRI MRA Brain + Catheter angiogram (DSA) for confirmation
- Suspected moyamoya disease (recurrent stroke / TIA in young patient) MRI MRA Brain + DSA for definitive diagnosis
- Recurrent thunderclap headaches, suspected RCVS MRI MRA Brain (repeat at 1-3 months to demonstrate reversibility)
- Acute neuro decline with hypertensive crisis or post-chemo, suspected PRES MRI MRI Brain (with FLAIR + DWI)
- Acute hydrocephalus (severe headache + decreased consciousness) CT CT Head non-contrast (then MRI when stable)
- Brain death ancillary testing NM Radionuclide cerebral perfusion (or transcranial Doppler / CTA)
- Skull base lesion, characterization MRI CT skull base (bone detail) + MRI Brain with and without contrast
- Midline clival or sacral lesion, suspected chordoma MRI MRI affected region with and without contrast (+ CT for bony detail)
- Dysphagia work-up XR Modified Barium Swallow / Videofluoroscopy + EGD
- Persistent adult neck mass / cervical lymphadenopathy US Neck Ultrasound (then CT / MRI Neck; PET-CT if unknown primary)
- Unilateral vocal cord paralysis (recurrent laryngeal nerve) CT CT Neck + Chest with IV contrast (entire nerve course)
- Subacute / chronic subdural hematoma evaluation MRI MRI Brain (with gradient echo / SWI for blood products)
- Cerebral amyloid angiopathy / recurrent intracranial hemorrhage work-up MRI MRI Brain with SWI / GRE
- Suspected Chiari I malformation MRI MRI Brain + Cervical Spine
- Suspected syringomyelia MRI MRI Spine (entire cord); identify cause (Chiari, post-traumatic, tumor)
- Suspected CSF leak (otorrhea, rhinorrhea, or spontaneous intracranial hypotension) CT CT Cisternography or MR Cisternography (heavily T2-weighted)
- Subacute neuropsychiatric symptoms + seizures, suspected autoimmune encephalitis MRI MRI Brain with and without contrast + LP (paraneoplastic antibodies)
- Cryptogenic stroke in young patient (< 50) MRI MRI Brain + MRA Head/Neck + Cardiac echo with bubble study
- Suspected primary CNS vasculitis (multifocal stroke, no usual risk factors) MRI MRA + DSA + LP
- Suspected spinal vascular malformation (slowly progressive myelopathy) MRI MRI Spine + Spinal DSA
- Persistent or new symptoms after spine surgery MRI MRI Spine with and without contrast
- Acute cranial nerve palsy (CN III, IV, VI, VII) MRI MRI Brain with and without contrast (thin section through brainstem)
- Transient global amnesia MRI MRI Brain with DWI (within 24-72 hours)
- Persistent unilateral facial numbness, suspected trigeminal schwannoma MRI MRI Brain with and without contrast (Meckel cave focus)
- Pediatric thyroid nodule US Thyroid Ultrasound (lower threshold for FNA than adults)
- Pediatric supratentorial brain tumor MRI MRI Brain + Spine with and without contrast
- Pediatric optic pathway glioma (often NF1 associated) MRI MRI Brain + Orbits with and without contrast
- Pediatric suprasellar mass, suspected craniopharyngioma MRI MRI Sella with and without contrast (+ CT for calcifications)
- Pediatric chronic headache (no red flags) No imaging unless red flags present
- Acute pediatric ataxia MRI MRI Brain with and without contrast (posterior fossa focus)
- Pediatric stroke (focal neuro deficit) MRI MRI Brain + MRA + cardiac echo + hypercoagulable
- Suspected acute disseminated encephalomyelitis (ADEM) MRI MRI Brain + Spine with and without contrast
- Head and neck cancer staging MRI MRI Neck + CT Chest + PET-CT (for nodal / distant disease)
- Thyroid cancer staging / surveillance post-thyroidectomy NM Whole-body Radioiodine scan + Neck Ultrasound
- Brain tumor post-treatment surveillance (radiation vs progression) MRI MRI Brain with perfusion + spectroscopy
- Glioblastoma pseudoprogression vs true progression (early post-radiation) MRI MRI Brain with perfusion (rCBV)
- Acute spinal cord injury after trauma MRI CT Cervical/Thoracic/Lumbar Spine + MRI Spine within 24-48 hours
- Acute para/quadraparesis without trauma, suspected spinal cord infarction MRI MRI Spine (entire cord) with DWI
- Back pain + fever + neurologic deficit, suspected spinal epidural abscess MRI MRI Entire Spine with and without contrast
- Acute back pain + neuro deficit on anticoagulation, suspected spinal epidural hematoma MRI MRI Spine without contrast (with gradient echo)
- Severe ear pain in diabetic / immunocompromised, suspected malignant (necrotizing) otitis externa CT CT Temporal Bones + MRI Brain (skull base extension)
- Septic thrombophlebitis of internal jugular vein after oropharyngeal infection (Lemierre syndrome) CT CT Neck with IV contrast + CT Chest (septic emboli)
- Functional / non-epileptic spell work-up MRI Video-EEG (ambulatory or epilepsy monitoring unit); MRI Brain to exclude structural
- Tuberous sclerosis complex (TSC) imaging surveillance MRI MRI Brain (cortical tubers, SEGA surveillance) + MRI/US Abdomen (renal AMLs)
- Port-wine stain in V1 distribution, suspected Sturge-Weber syndrome MRI MRI Brain with and without contrast (look for pial enhancement)
- Prenatal or neonatal forebrain anomaly, suspected holoprosencephaly MRI Prenatal Ultrasound + Fetal MRI (or postnatal MRI Brain)
- Suspected Dandy-Walker malformation (posterior fossa cyst, vermian agenesis) MRI MRI Brain
- Suspected septo-optic dysplasia (de Morsier syndrome) MRI MRI Brain with thin-section through sella + orbits
- Neurofibromatosis type 2 (NF2) surveillance MRI MRI Brain + Entire Spine with and without contrast (annual)
- Von Hippel-Lindau (VHL) disease surveillance MRI MRI Brain + Entire Spine + Abdomen surveillance per VHL Alliance protocol
- Orthostatic headache, suspected spontaneous intracranial hypotension MRI MRI Brain with contrast (SEEPS findings) + Spine MRI for CSF leak source
- Leukocoria in young child, suspected retinoblastoma MRI Ophthalmic Ultrasound + MRI Orbits with and without contrast
- Neonate with sensorineural hearing loss + microcephaly, suspected congenital CMV MRI MRI Brain + Head Ultrasound + Urine CMV PCR
- Sacral dimple, hair tuft, or tethered cord symptoms in child, suspected spinal dysraphism US Spinal Ultrasound (infant) or MRI Spine (older child)
- Altered mental status / encephalopathy — imaging triage CT CT head without contrast
- Focal neurologic weakness / new deficit — imaging triage CT Stroke protocol if acute; targeted MRI if subacute/chronic
Chest 69
- Acute dyspnea or pleuritic chest pain CT CT Pulmonary Angiogram (CTPA)
- Cough with fever or lower respiratory symptoms XR Chest X-ray PA + lateral
- Incidental pulmonary nodule CT CT Chest without contrast (low-dose)
- Acute tearing chest or interscapular pain CT CT Angiogram chest/abdomen/pelvis
- Hemoptysis CT CT Chest with IV contrast (CTA if massive)
- Chronic dyspnea, suspected interstitial lung disease CT High-resolution CT Chest without contrast
- Mediastinal widening or suspected mediastinal mass CT CT Chest with IV contrast
- Lung cancer screening (eligible smokers) CT Low-dose CT Chest without contrast
- COPD exacerbation XR Chest X-ray PA + lateral
- Severe asthma exacerbation XR Chest X-ray PA + lateral
- Pleural effusion, evaluation US Chest X-ray + Ultrasound (for thoracentesis guidance)
- Suspected pneumothorax XR Upright Chest X-ray (in expiration if subtle)
- Acute pulmonary edema XR Chest X-ray + Bedside Echo (for cardiac function)
- Suspected pulmonary hypertension US Transthoracic Echo first; CT Chest / V-Q if cause unclear
- Lung mass on imaging, work-up CT CT Chest with IV contrast (then PET-CT for staging)
- Recurrent productive cough, suspected bronchiectasis CT High-resolution CT Chest without contrast
- Pleural effusion with fever, suspected empyema CT CT Chest with IV contrast
- Suspected foreign body aspiration (adult or child) XR Chest X-ray (inspiratory + expiratory or decubitus)
- Suspected SVC syndrome CT CT Chest with IV contrast (bilateral upper extremity injection)
- Elevated hemidiaphragm, suspected paralysis XR Fluoroscopic sniff test (or Diaphragm Ultrasound)
- Posterior mediastinal mass MRI MRI Chest / Thoracic Spine with and without contrast
- Suspected pulmonary tuberculosis XR Chest X-ray PA + lateral (then CT Chest if complicated or atypical)
- Suspected lung abscess CT CT Chest with IV contrast
- Post-cardiothoracic surgery follow-up XR Chest X-ray (CT if complication suspected)
- Blunt chest trauma with hemodynamic stability CT CT Chest with IV contrast
- Burn or smoke inhalation, airway concern CT CT Neck + Chest (with airway focus)
- Drowning, post-resuscitation XR Chest X-ray; CT if persistent hypoxemia or atypical
- Pediatric foreign body ingestion (button battery) XR AP and Lateral CXR + Abdominal X-ray
- Pediatric leukemia / lymphoma initial work-up XR Chest X-ray + Abdominal Ultrasound (anterior mediastinal mass concern)
- Pediatric community-acquired pneumonia XR Chest X-ray PA + lateral (avoid for mild outpatient cases)
- Suspected pulmonary sarcoidosis CT CT Chest with IV contrast (+ FDG-PET if active disease assessment)
- Diffuse alveolar hemorrhage CT CT Chest with IV contrast
- Diffuse cystic lung disease (LAM, LCH, BHD, LIP) CT High-resolution CT Chest without contrast
- ARDS evaluation and complications XR Chest X-ray (daily); CT Chest if etiology unclear or complication suspected
- Hospital-acquired or ventilator-associated pneumonia XR Chest X-ray (and CT Chest with IV contrast if complicated)
- Immunocompromised host with fever and lung findings (suspected invasive fungal) CT CT Chest with IV contrast
- Asbestos exposure surveillance XR Chest X-ray (then HRCT if abnormal or for definitive staging)
- Suspected pleural mesothelioma CT CT Chest with IV contrast + MRI Chest + PET-CT for staging
- Suspected pulmonary AVM (HHT, hypoxemia, paradoxical embolism) CT CTA Chest
- Post-pneumonectomy or post-empyema, suspected bronchopleural fistula CT Thin-slice CT Chest
- Pectus excavatum / carinatum, pre-surgical evaluation CT CT Chest (Haller index, sternal asymmetry)
- Tracheal stenosis (post-intubation, idiopathic, or neoplastic) CT Dynamic CT Trachea (inspiratory + expiratory)
- Lung transplant follow-up / suspected complication CT HRCT Chest (acute rejection: AR; chronic: BOS)
- Chest wall mass evaluation MRI CT Chest + MRI Chest Wall (for soft tissue characterization)
- Isolated rib pain after minor trauma XR PA + Lateral Chest X-ray (CT only for flail or complicated)
- Cystic fibrosis routine follow-up XR Chest X-ray annually; HRCT every 2-3 years (or with exacerbation)
- Chronic dyspnea, suspected chronic thromboembolic pulmonary hypertension NM V/Q scan first (sensitive); CTPA + right heart cath confirm
- Occupational lung disease (silicosis, coal worker pneumoconiosis) CT Chest X-ray + HRCT Chest
- Smoker with cystic lung disease, suspected pulmonary Langerhans cell histiocytosis CT HRCT Chest
- Diaphragmatic rupture after trauma CT CT Chest / Abdomen with IV contrast (multiplanar reformats)
- Burn with smoke inhalation concern CT Bronchoscopy is gold standard; CT Neck / Chest for parenchymal involvement
- Pediatric spontaneous pneumothorax XR Chest X-ray (upright if possible)
- Post-radiation pneumonitis (after thoracic radiation therapy) CT CT Chest with IV contrast
- Post-transplant lymphoproliferative disorder (PTLD) CT CT Chest / Abdomen / Pelvis + PET-CT
- Recurrent pneumonia in same location or incidental finding, suspected pulmonary sequestration CT CTA Chest (systemic arterial supply)
- Suspected congenital pulmonary airway malformation (CPAM/CCAM) MRI Prenatal US + Fetal MRI; postnatal CT Chest
- Peripheral pulmonary infiltrates + peripheral eosinophilia, suspected eosinophilic pneumonia CT CT Chest with IV contrast
- New respiratory symptoms on cytotoxic / targeted therapy, suspected drug-induced pneumonitis CT HRCT Chest without contrast
- Insidious dyspnea + 'crazy paving' on HRCT, suspected pulmonary alveolar proteinosis CT HRCT Chest + BAL (milky / opaque fluid is diagnostic)
- Adult expiratory wheezing or post-extubation stridor, suspected tracheobronchomalacia CT Dynamic (paired inspiratory + expiratory) CT Chest
- Milky pleural fluid post-thoracic surgery or in lymphoma, suspected chylothorax MRI Pleural fluid analysis (triglycerides > 110 mg/dL); lymphangiogram or MR lymphangiography if intervention planned
- Incidental mediastinal cyst, suspected bronchogenic cyst MRI MRI Mediastinum (T2 hyperintense fluid signal)
- Solitary pulmonary cavity work-up CT CT Chest with IV contrast
- Subacute / chronic dyspnea with antigen exposure, suspected hypersensitivity pneumonitis CT HRCT Chest (inspiratory + expiratory)
- Neonatal coughing / choking with first feed, suspected tracheoesophageal fistula XR Abdominal X-ray + Inability to pass NG tube + Bronchoscopy
- Prenatal or neonatal respiratory distress with chest mass on CXR, suspected congenital diaphragmatic hernia MRI Prenatal US + Fetal MRI + Postnatal CXR
- Pediatric stridor + dysphagia, suspected vascular ring CT Esophagram + CTA Chest
- Chest pain, adult — undifferentiated, imaging triage XR CXR (PA + lateral), then targeted CT by phenotype
- Acute dyspnea / shortness of breath, adult — imaging triage XR CXR (PA + lateral if upright, AP supine if not)
Abdomen · Pelvis 163
- Right lower quadrant pain, adult CT CT Abdomen/Pelvis with IV contrast
- Right upper quadrant pain US Ultrasound Right Upper Quadrant
- Acute flank pain CT CT Abdomen/Pelvis without contrast (stone protocol)
- Acute left lower quadrant pain CT CT Abdomen/Pelvis with IV contrast
- Abdominal distention with nausea and vomiting CT CT Abdomen/Pelvis with IV contrast
- Acute pelvic pain, female US Transvaginal + transabdominal pelvic Ultrasound
- Acute epigastric pain, suspected pancreatitis CT CT Abdomen with IV contrast at 48-72 hours (if severe)
- Acute abdomen with peritoneal signs, suspected perforation CT CT Abdomen / Pelvis with IV contrast
- Severe abdominal pain out of proportion to exam CT CTA Abdomen / Pelvis (arterial + portal venous)
- Flank pain with fever, suspected complicated pyelonephritis CT CT Abdomen / Pelvis with IV contrast
- Gross hematuria, painless CT CT Urogram + cystoscopy
- Acute scrotal pain (suspected testicular torsion) US Scrotal Ultrasound with Doppler
- Acute pelvic pain (female), suspected ovarian torsion US Pelvic Ultrasound with Doppler
- Pelvic pain or bleeding in early pregnancy US Transvaginal Pelvic Ultrasound
- Fever, jaundice, and RUQ pain (Charcot's triad) US RUQ Ultrasound first, then MRCP if obstruction
- Incidental adrenal mass CT CT Adrenal protocol (non-contrast + delayed contrast washout)
- Known IBD with acute flare or new concerning symptoms CT CT or MR Enterography
- Episodic crampy abdominal pain in a young child US Abdominal Ultrasound
- Projectile non-bilious vomiting in an infant US Pyloric Ultrasound
- RUQ pain with elevated LFTs, suspected common duct stone MRI MRCP (or EUS); proceed to ERCP if obstruction confirmed
- Suspected pancreatic mass CT CT Pancreas Protocol (pancreatic + portal phases) or MRI MRCP
- HCC surveillance (cirrhosis, hepatitis B, NAFLD high risk) US Abdominal Ultrasound + AFP every 6 months
- Indeterminate liver lesion on US or CT MRI MRI Liver with hepatobiliary contrast (Eovist) — LI-RADS
- Splenomegaly, work-up CT CT Abdomen with IV contrast (US first if pregnant or contrast contraindicated)
- Blunt abdominal trauma with LUQ tenderness, suspected splenic injury CT CT Abdomen / Pelvis with IV contrast
- Incidental renal mass CT CT Renal Mass Protocol (non-contrast + corticomedullary + nephrographic + excretory)
- Renal cell carcinoma staging CT CT Chest + CT/MRI Abdomen with IV contrast
- Suspected adrenal hemorrhage CT CT Abdomen with IV contrast (with non-contrast phase)
- Biochemical pheochromocytoma (catecholamines elevated) MRI MRI Abdomen (or CT Adrenal) + MIBG / DOTATATE if metastatic
- Bladder mass on imaging or hematuria CT CT Urogram + cystoscopy
- Elevated PSA, prostate evaluation MRI Multiparametric MRI Prostate (PI-RADS)
- Prostate cancer staging NM PSMA PET-CT (or CT + bone scan)
- Testicular cancer staging CT CT Chest / Abdomen / Pelvis with IV contrast
- Scrotal swelling, suspected varicocele US Scrotal Ultrasound with Valsalva and standing positioning
- Suspected inguinal hernia not palpable on exam US Groin Ultrasound (or CT Abdomen/Pelvis)
- Pelvic mass on exam US Pelvic Ultrasound (transvaginal + transabdominal); MRI for characterization
- Chronic pelvic pain, suspected endometriosis MRI Pelvic MRI (or specialized transvaginal US)
- Symptomatic uterine fibroids US Pelvic Ultrasound; MRI for surgical / UAE planning
- Postmenopausal bleeding US Transvaginal Pelvic Ultrasound (endometrial thickness)
- Female infertility evaluation XR Hysterosalpingogram (HSG) + Pelvic Ultrasound
- First-trimester pregnancy dating and viability US Transvaginal Pelvic Ultrasound
- Risk factors for placenta accreta spectrum (prior C-section, placenta previa) MRI Obstetric Ultrasound + MRI Pelvis (if US equivocal)
- Routine fetal anatomy scan (18-22 weeks) US Obstetric Ultrasound (anatomy survey)
- Fetal CNS or complex anatomic anomaly on screening US MRI Fetal MRI
- Pelvic inflammatory disease US Transvaginal Pelvic Ultrasound
- Tubo-ovarian abscess suspected US Transvaginal Pelvic Ultrasound (then MRI / CT if complicated)
- Suspected iron overload / hemochromatosis MRI MRI Liver T2* / R2* mapping
- NAFLD / steatohepatitis severity, fibrosis staging MRI MR Elastography (or transient elastography / FibroScan)
- Pancreatic cyst follow-up MRI MRI MRCP at follow-up interval (per ACR / Fukuoka)
- Upper GI bleed CT EGD; CTA Abdomen if obscure or unstable
- Lower GI bleed CT CTA Abdomen / Pelvis (if active); colonoscopy
- Obscure GI bleed (negative EGD and colonoscopy) CT CT Enterography or Video Capsule Endoscopy
- New-onset ascites, work-up US Abdominal Ultrasound + paracentesis under US guidance
- Blunt abdominal trauma, hemodynamically stable CT CT Abdomen / Pelvis with IV contrast
- Penetrating abdominal trauma, hemodynamically stable CT CT Abdomen / Pelvis with IV (± oral / rectal) contrast
- Pediatric urinary tract infection US Renal/Bladder Ultrasound (VCUG per AAP / NICE guidelines)
- Pediatric abdominal mass, suspected neuroblastoma US Abdominal Ultrasound + CT Chest/Abdomen + MIBG scan
- Pediatric flank mass, suspected Wilms tumor US Abdominal Ultrasound first, then CT or MRI Abdomen
- Pediatric palpable abdominal mass US Abdominal Ultrasound first
- Pediatric severe constipation, suspected obstruction XR AP / Upright Abdominal X-ray; Contrast Enema if concerning features
- Pediatric inflammatory bowel disease, flare or initial MRI MR Enterography
- Colorectal cancer screening Colonoscopy (or CT Colonography q5y as alternative)
- High-risk pancreatic cancer surveillance (familial / hereditary) MRI Annual MRI / MRCP (alternating with EUS)
- Esophageal cancer staging CT EUS + CT Chest / Abdomen + PET-CT
- Gastric cancer staging CT EUS + CT Chest / Abdomen / Pelvis + PET-CT (selective)
- Colorectal cancer staging CT CT Chest + Abdomen + Pelvis; MRI Pelvis for rectal cancer
- Lymphoma initial staging or response assessment NM FDG-PET / CT
- Ovarian cancer staging CT CT Chest / Abdomen / Pelvis with IV contrast (consider PET-CT)
- Cervical cancer staging MRI Pelvic MRI + FDG-PET / CT (for stage IB2+)
- Endometrial cancer staging MRI Pelvic MRI + CT Chest / Abdomen (for high-grade)
- Suspected esophageal perforation (Boerhaave, iatrogenic) CT CT Chest / Abdomen with IV + water-soluble esophagram
- Solid food dysphagia, suspected esophageal stricture XR Barium Esophagram + EGD with biopsy
- Suspected achalasia (long-standing dysphagia for liquids and solids) XR Barium Esophagram (bird's beak) + Esophageal manometry
- Gastric outlet obstruction (vomiting, succussion splash) CT CT Abdomen with IV contrast + EGD
- Sigmoid volvulus (coffee bean sign on AXR) CT CT Abdomen / Pelvis with IV contrast
- Cecal volvulus CT CT Abdomen / Pelvis with IV contrast
- Adult intussusception CT CT Abdomen / Pelvis with IV contrast
- Suspected toxic megacolon (UC, C. diff, ischemia) XR Supine + Upright AXR; CT Abdomen with IV if perforation concern
- Suspected anorectal abscess or perianal fistula MRI MRI Pelvis (perianal protocol)
- Ostomy complication (parastomal hernia, stenosis, leak) CT CT Abdomen / Pelvis with IV contrast
- Suspected primary sclerosing or primary biliary cholangitis MRI MRCP
- Suspected Budd-Chiari syndrome (hepatic vein occlusion) US Doppler US Liver → CT / MR Venography Abdomen
- Suspected portal vein thrombosis CT Doppler US + CT or MR Venography Abdomen
- Mirizzi syndrome (stone in cystic duct compressing CHD) MRI MRCP
- Liver adenoma vs focal nodular hyperplasia characterization MRI MRI Liver with hepatobiliary contrast (Eovist)
- Hilar cholangiocarcinoma (Klatskin tumor) MRI MRCP + CT Abdomen with IV contrast
- Suspected renal artery dissection CT CTA Abdomen
- Suspected renal vein thrombosis (flank pain, hematuria, AKI) CT Doppler US + CT or MR Venography Abdomen
- Hydronephrosis on US, etiology unknown CT CT Urogram or MR Urogram
- Urethral stricture or urethral injury XR Retrograde Urethrogram
- Suspected bladder rupture after trauma (gross hematuria + pelvic fracture) CT CT Cystogram (with retrograde contrast filling)
- Suspected renal trauma CT CT Abdomen / Pelvis with IV contrast (with delayed excretory phase)
- Vaginal bleeding in early pregnancy (threatened miscarriage) US Transvaginal Pelvic Ultrasound + β-hCG trend
- Suspected heterotopic pregnancy (IVF, IUP + ectopic) US Transvaginal Pelvic Ultrasound
- Suspected Mullerian duct anomaly (recurrent pregnancy loss, infertility) MRI MRI Pelvis
- Suspected vulvar carcinoma MRI MRI Pelvis + inguinofemoral nodes
- Cesarean scar pregnancy US Transvaginal Pelvic Ultrasound (with caution, color Doppler)
- Suspected polycystic ovary syndrome US Transvaginal Pelvic Ultrasound
- Antepartum bleeding (third trimester) US Obstetric Ultrasound (placental location, abruption)
- Bilious vomiting in infant, suspected malrotation with midgut volvulus XR Upper GI Series (emergent)
- Pediatric distal bowel obstruction in newborn, suspected Hirschsprung XR Contrast Enema
- Premature infant with abdominal distention, suspected necrotizing enterocolitis XR Abdominal X-ray (serial every 6-8 hours)
- Persistent neonatal jaundice (suspected biliary atresia) NM Abdominal Ultrasound + HIDA scan (phenobarbital prepped)
- Suspected retroperitoneal hematoma CT CT Abdomen / Pelvis with IV contrast (arterial + delayed phases)
- Suspected bowel injury after blunt trauma CT CT Abdomen / Pelvis with IV contrast (oral if stable)
- Pancreatic injury after trauma (mechanism + clinical) CT CT Abdomen with IV contrast + MRCP if duct injury suspected
- Pelvic fracture with blood at urethral meatus, suspected urethral injury XR Retrograde Urethrogram (before Foley placement)
- Pediatric ingestion of multiple magnets XR AP + Lateral Abdominal X-ray (urgent — surgical / endoscopic removal)
- Vesicoureteral reflux work-up XR Voiding Cystourethrogram (VCUG)
- Pediatric urolithiasis (flank pain) US Renal / Bladder Ultrasound
- Non-palpable undescended testis US Inguinal Ultrasound first (MRI for non-palpable / abdominal testis)
- Pediatric hydrocele (scrotal swelling, transilluminates) US Scrotal Ultrasound
- Lymphoma response assessment NM FDG-PET / CT (Deauville score per Lugano criteria)
- HCC post-treatment response (TACE, ablation, transplant work-up) MRI MRI Liver with hepatobiliary contrast (LI-RADS treatment response)
- Pancreatic adenocarcinoma staging CT Pancreas Protocol CT + EUS (+ diagnostic laparoscopy for borderline cases)
- Cholangiocarcinoma staging (intrahepatic, hilar, distal) MRI MRCP + CT Abdomen with IV contrast + EUS for distal
- Gallbladder mass / cancer staging CT CT Abdomen with IV contrast + MRCP
- Anal cancer staging MRI MRI Pelvis + CT Chest / Abdomen + PET-CT
- Testicular cancer surveillance CT CT Chest / Abdomen / Pelvis + serum tumor markers
- Bladder cancer staging (muscle-invasive) CT CT Urogram + CT Chest + MRI Pelvis (VI-RADS)
- Ovarian cancer recurrence (rising CA-125) CT CT Chest / Abdomen / Pelvis + PET-CT
- Endometrial cancer recurrence CT CT Chest / Abdomen / Pelvis + Pelvic MRI
- Immune checkpoint inhibitor adverse event (colitis, pneumonitis, hypophysitis) CT Modality-specific: CT for colitis / pneumonitis; MRI brain for hypophysitis
- Fever, RUQ pain, elevated LFTs, suspected pyogenic liver abscess CT CT Abdomen with IV contrast or RUQ Ultrasound
- Endemic exposure + cystic liver lesion, suspected hydatid disease MRI MRI Abdomen (or CT Abdomen with contrast)
- Family history or hypertension + bilateral renal cysts, suspected ADPKD US Renal Ultrasound (Ravine criteria) or MRI Abdomen for TKV
- Massive cystic hepatomegaly, suspected polycystic liver disease MRI CT or MRI Abdomen
- Incidental horseshoe kidney CT CT or MRI Abdomen
- Intermittent flank pain or recurrent UTI, suspected UPJ obstruction (adult) US Renal Ultrasound + MAG3 diuretic renogram
- Posterior urethral valves follow-up (boy, post-resection) US Renal Ultrasound + VCUG for residual reflux
- Dysmenorrhea + menorrhagia + bulky uterus, suspected adenomyosis US Transvaginal Ultrasound + MRI Pelvis if equivocal
- Secondary amenorrhea or recurrent pregnancy loss after instrumentation, suspected Asherman syndrome US Saline Infusion Sonohysterography (SIS) or HSG
- Recurrent pregnancy loss (≥ 2 consecutive), imaging work-up MRI Transvaginal US + Saline Infusion Sonohysterography + MRI Pelvis (Mullerian anomaly)
- First-trimester bleeding + markedly elevated β-hCG, suspected gestational trophoblastic disease US Transvaginal Pelvic Ultrasound
- Postpartum or post-abortion bleeding, suspected retained products of conception US Transvaginal Pelvic Ultrasound with color Doppler
- History of mid-trimester loss or short cervix, suspected cervical incompetence US Transvaginal Ultrasound for cervical length (CL)
- Polyhydramnios or oligohydramnios on routine US US Detailed Obstetric Ultrasound + AFI / SDP measurement
- Monochorionic-diamniotic twins with discrepant fluid / growth, suspected twin-twin transfusion syndrome US Obstetric Ultrasound + serial AFI / fetal Doppler
- Acute prostatitis + persistent fever / pelvic pain, suspected prostatic abscess US Transrectal Ultrasound or MRI Prostate
- Acute prostatitis (men with fever + pelvic / perineal pain + dysuria) Clinical diagnosis; imaging only for failed therapy or abscess concern
- Tubal dilation on imaging (hydrosalpinx) US Transvaginal Pelvic Ultrasound
- Primary amenorrhea + cyclic pelvic pain, suspected hematometra / imperforate hymen US Transabdominal Pelvic Ultrasound
- Persistent fever + LUQ pain, suspected splenic abscess CT CT Abdomen with IV contrast
- Acute LUQ pain with embolic source, suspected splenic infarction CT CT Abdomen with IV contrast
- Recurrent cholangitis + intrahepatic ductal dilation, suspected Caroli disease MRI MRCP
- Recurrent idiopathic pancreatitis, suspected pancreas divisum MRI MRCP (consider secretin-enhanced)
- Neonatal duodenal obstruction or adult dyspepsia, suspected annular pancreas MRI Upper GI Series + MRCP
- Incidental misty mesentery / mesenteric mass, suspected sclerosing mesenteritis CT CT Abdomen with IV contrast
- Neonatal bilious vomiting, suspected duodenal atresia XR Abdominal X-ray (double bubble sign)
- Prenatal or neonatal sacrococcygeal mass, suspected sacrococcygeal teratoma MRI Prenatal US + Fetal MRI + Postnatal MRI Pelvis
- Pediatric liver mass + elevated AFP, suspected hepatoblastoma MRI MRI Abdomen + AFP + CT Chest for staging
- Antenatal hydronephrosis on prenatal US US Postnatal Renal Ultrasound at 48 hours-1 week + 4-6 weeks
- Suspected appendicitis in a child US Graded compression ultrasound
- Cushing's syndrome — imaging localization after biochemical confirmation MRI Pituitary MRI (ACTH-dependent) or adrenal CT (ACTH-independent)
- Primary aldosteronism (Conn syndrome) — adrenal imaging CT Adrenal CT (thin-section, multiphase)
- Insulinoma — pre-operative localization imaging CT Multiphase pancreas-protocol CT or MRI
- Neuroendocrine tumor (NET) — staging and surveillance imaging NM Ga-68 DOTATATE PET-CT + multiphase CT/MRI
- Living renal donor — pre-operative imaging CT CT angiography of the kidneys (renal donor protocol)
- Renal transplant — post-operative imaging and complications US Doppler ultrasound of the transplant kidney
- Living liver donor — pre-operative imaging CT Multiphase CT or MRI of the liver (donor protocol)
- Liver transplant — post-operative imaging and complications US Doppler ultrasound of the liver and hepatic vessels
- Fever of unknown origin (FUO) — imaging workup CT Contrast-enhanced CT chest/abdomen/pelvis; FDG-PET-CT if non-diagnostic
- Sepsis without identified source — imaging workup CT CT chest/abdomen/pelvis with IV contrast
Musculoskeletal 98
- Acute ankle pain after injury XR X-ray Ankle 3 views
- Knee pain with locking, clicking, or instability MRI MRI Knee without contrast
- Shoulder pain with weakness or impingement MRI MRI Shoulder without contrast
- Low back pain without red flags No imaging recommended < 6 weeks
- Suspected osteomyelitis MRI MRI of affected region with and without IV contrast
- Acute monoarticular joint pain and swelling US Joint aspiration (US-guided when needed)
- Soft tissue infection with concern for abscess US Soft tissue Ultrasound
- Hip pain after fall, elderly, X-ray negative MRI MRI Hip without contrast
- Radicular leg pain or neurogenic claudication MRI MRI Lumbar Spine without contrast
- Radicular arm pain or neck pain with neuro symptoms MRI MRI Cervical Spine without contrast
- Adult hip pain with normal X-ray MRI MRI Hip without contrast
- Suspected avascular necrosis of hip MRI MRI Hip without contrast
- Suspected stress fracture (running, military, dancers) MRI MRI of affected region
- Femoroacetabular impingement / hip labral tear MRI MR Arthrogram Hip
- Atraumatic knee pain in adult XR X-ray Knee 3 views (weight-bearing if OA); MRI if persistent or mechanical symptoms
- Suspected Achilles tendon rupture US Ultrasound Achilles (or MRI if surgical planning)
- Plantar fasciitis (refractory) US Ultrasound Plantar Fascia (or MRI foot)
- FOOSH injury with snuffbox tenderness, suspected scaphoid fracture XR X-ray Wrist 4 views (scaphoid); MRI if X-ray negative
- Suspected carpal tunnel syndrome Clinical exam + EMG/NCS; Ultrasound or MRI if atypical
- Lateral or medial epicondylitis (tennis / golfer's elbow) US Ultrasound or MRI Elbow if refractory
- Low back / sacral pain in elderly, suspected insufficiency fracture MRI MRI Pelvis (or CT pelvis / bone scan)
- Inflammatory back pain, suspected sacroiliitis MRI MRI Sacroiliac Joints (STIR / T1 post-contrast)
- Adolescent hip pain, suspected slipped capital femoral epiphysis XR AP Pelvis + Frog-leg lateral hip X-ray
- Child 4-10 with hip pain or limp, suspected Perthes XR AP Pelvis + Frog-leg lateral hip X-ray
- Suspected developmental dysplasia of the hip in infant US Hip Ultrasound (< 4-6 months); X-ray Hip (> 4-6 months)
- Suspected skeletal metastases NM Bone Scan (Tc-99m MDP) or whole-body MRI
- Multiple myeloma, suspected or staging CT Whole-body Low-dose CT or Whole-body MRI
- Soft tissue mass, characterization MRI MRI of affected region with and without contrast
- Polytrauma, hemodynamically unstable US FAST + Supine CXR + AP Pelvis X-ray at bedside
- Polytrauma, hemodynamically stable CT CT 'pan-scan' (head + cervical spine + chest + abdomen/pelvis)
- Cervical spine trauma, alert with no neuro deficit Apply NEXUS or Canadian C-spine rule (image only if rules suggest)
- Cervical spine trauma, obtunded or with neuro deficit CT CT Cervical Spine + MRI if ligamentous injury suspected
- Thoracic / lumbar spine trauma CT CT Thoracic + Lumbar Spine (reformats from CT torso when available)
- Pelvic ring or acetabular trauma CT AP Pelvis X-ray + CT Pelvis with reformats
- Knee dislocation (high-energy) CT Reduction + X-ray, then CTA / ABI to rule out arterial injury
- Hand or foot laceration with retained foreign body concern XR X-ray (radiopaque FB); Ultrasound for radiolucent FB
- Suspected non-accidental trauma (child < 2) XR Skeletal Survey + CT Head + Ophthalmology consult
- Adolescent idiopathic scoliosis screening / monitoring XR Standing PA Scoliosis Series (full spine)
- Toddler with limp after minor trauma (toddler's fracture) XR X-ray Tibia (AP + lateral)
- Pediatric extremity injury with growth plate concern XR X-ray affected joint (comparison views if unclear)
- Pediatric elbow injury (supracondylar fracture concern) XR X-ray Elbow (AP + lateral, comparison if needed)
- Pediatric bone pain with limp or refusal to bear weight, suspected osteomyelitis MRI X-ray (baseline) + MRI affected region with and without contrast
- Melanoma staging (high-risk or metastatic) NM FDG-PET / CT + Brain MRI (for advanced disease)
- Massive rotator cuff tear with arthropathy MRI X-ray Shoulder + MRI Shoulder
- AC joint injury / separation XR X-ray Shoulder (Zanca view; weighted views rarely needed)
- Adhesive capsulitis (frozen shoulder) Clinical diagnosis; MRI Shoulder if atypical
- Recurrent anterior shoulder dislocation, suspected Bankart / Hill-Sachs MRI MR Arthrogram Shoulder
- Proximal long head biceps tendon rupture (Popeye sign) US Ultrasound or MRI Shoulder
- Ulnar-sided wrist pain, suspected TFCC injury MRI MR Arthrogram Wrist
- Wrist ganglion cyst US Ultrasound Wrist
- Skier's thumb (UCL of MCP joint) MRI MRI Thumb (or US for screening)
- Midfoot pain after injury, suspected Lisfranc injury XR Weight-bearing X-ray Foot + MRI if X-ray normal
- Recurrent ankle sprains in adolescent, suspected tarsal coalition CT CT or MRI Foot
- Forefoot pain, suspected Morton neuroma US Ultrasound or MRI Forefoot
- Post-ACL reconstruction follow-up / re-injury MRI MRI Knee
- Painful total knee arthroplasty XR X-ray Knee + WBC-labeled scan or MRI MARS protocol
- Painful total hip arthroplasty XR X-ray Hip + MRI MARS or WBC-labeled scan
- Suspected periprosthetic joint infection NM WBC-labeled scan + MRI MARS (and joint aspiration)
- Periprosthetic fracture (around hip / knee arthroplasty) XR X-ray + CT for surgical planning
- Painful bone mass, suspected primary bone sarcoma (osteosarcoma, Ewing) MRI X-ray + MRI affected region + CT Chest + Bone scan
- Soft tissue mass > 5 cm or deep, suspected sarcoma MRI MRI affected region + CT Chest
- Post-traumatic or post-operative limb stiffness, suspected heterotopic ossification XR X-ray + Bone scan (active disease) or CT for surgical planning
- Recurrent monoarthritis, suspected gout / tophus burden CT Dual-energy CT or Ultrasound for urate crystals
- Rheumatoid arthritis activity / damage assessment XR X-ray Hands and Feet (or MRI for early disease activity)
- Suspected psoriatic arthritis XR X-ray hands / feet + MRI for early disease
- Cervical myelopathy (clumsy hands, gait dysfunction, hyperreflexia) MRI MRI Cervical Spine
- Acute back pain with saddle anesthesia or bowel/bladder dysfunction MRI MRI Lumbar Spine — emergent
- Suspected acute compartment syndrome Clinical + compartment pressures (imaging adjunctive only)
- Crush injury with rhabdomyolysis concern Clinical + CK (imaging for vascular / compartment evaluation as needed)
- Open fracture pre-operative assessment XR X-ray + CTA if vascular injury suspected
- Adolescent kyphosis, suspected Scheuermann disease XR Standing lateral spine X-ray
- Pediatric cervical spine trauma XR Plain X-rays first (CT if clinical / imaging concerns)
- Congenital clubfoot (talipes equinovarus) Clinical exam; X-rays only for severity / surgical planning
- Pediatric leg length discrepancy XR Standing X-ray legs (scanogram) or low-dose CT scanogram
- Pediatric vascular malformation (slow-flow or high-flow) MRI MRI affected region (time-resolved MRA if high-flow)
- Multiple myeloma response and surveillance MRI Whole-body MRI or FDG-PET / CT
- Soft tissue sarcoma staging MRI MRI primary site + CT Chest (and PET-CT in selected cases)
- Diabetic foot deformity, suspected Charcot neuroarthropathy MRI X-ray Foot + MRI Foot with and without contrast
- Bone pain or elevated alk phos in older adult, suspected Paget disease of bone NM Skeletal survey or Tc-99m MDP bone scan + targeted X-rays
- Incidental ground-glass bone lesion, suspected fibrous dysplasia XR X-ray + CT for characterization (ground-glass matrix)
- Adolescent / young adult with nocturnal pain relieved by NSAIDs, suspected osteoid osteoma CT CT or thin-slice X-ray (lucent nidus with surrounding sclerosis)
- Expansile lytic bone lesion in adolescent / young adult, suspected aneurysmal bone cyst MRI MRI affected bone (fluid-fluid levels in expansile lesion)
- Epiphyseal lytic lesion in young adult, suspected giant cell tumor of bone MRI X-ray + MRI affected joint + Chest CT (for pulmonary metastases)
- Incidental ring-and-arc calcified lesion, suspected enchondroma vs chondrosarcoma MRI X-ray + MRI affected bone
- Bony protuberance with cortical continuity, suspected osteochondroma XR X-ray (often sufficient) + MRI to measure cartilage cap
- Painful joint without fracture on X-ray, suspected bone marrow edema syndrome MRI MRI affected joint
- Acute severe shoulder pain, suspected calcific tendinitis XR X-ray Shoulder (calcium deposits in rotator cuff)
- Painful joint with hemorrhagic effusion, suspected PVNS / tenosynovial giant cell tumor MRI MRI affected joint (T2 blooming from hemosiderin)
- Painful joint with multiple loose bodies, suspected synovial chondromatosis MRI MRI affected joint
- Adolescent athlete with anterior knee pain at tibial tubercle XR Clinical diagnosis; X-ray Knee + Ultrasound for atypical / refractory
- Pediatric heel pain with running / jumping (calcaneal apophysitis) XR Clinical diagnosis; X-ray Foot to exclude other causes
- Adolescent athlete (gymnast, dancer) with low back pain, suspected pars defect MRI MRI Lumbar Spine (STIR for early stress reaction)
- Athlete with chronic groin pain (sports hernia / athletic pubalgia) MRI MRI Pelvis (dedicated athletic pubalgia protocol)
- Lateral hip pain in middle-aged woman (greater trochanteric pain syndrome) US Ultrasound or MRI Hip
- Lateral knee pain in distance runner (iliotibial band syndrome) Clinical diagnosis; MRI Knee for atypical / refractory cases
- Anterior knee pain worse with stairs / squatting (patellofemoral pain) Clinical diagnosis; X-ray (sunrise view) + MRI for refractory
- Sudden back pain in osteoporotic adult, suspected vertebral compression fracture MRI MRI Thoracic / Lumbar Spine (STIR for acute edema)
- Fall in elderly patient — imaging triage XR Region-targeted XR / CT based on point tenderness + mechanism
Vascular 43
- Unilateral leg swelling, pain, or erythema US Lower extremity venous Doppler Ultrasound
- AAA screening US Abdominal aorta Ultrasound
- Carotid bruit or TIA / minor stroke (symptomatic) US Carotid Duplex Ultrasound + CTA Neck (or MRA Neck)
- Lower extremity claudication, suspected PAD US Arterial Doppler + Ankle-Brachial Index (ABI)
- Critical limb ischemia (rest pain, tissue loss) CT CTA Aorta + Lower Extremity Runoff
- Resistant hypertension or unilateral small kidney, suspected renal artery stenosis US Renal Doppler + CTA or MRA Renal Arteries
- Incidental visceral artery aneurysm (splenic, hepatic, SMA) CT CTA Abdomen (or MRA)
- Suspected cerebral arteriovenous malformation CT CTA / MRA Brain → DSA for definitive characterization
- Known AAA surveillance US Abdominal Aorta Ultrasound at interval based on size
- Post-EVAR surveillance / suspected endoleak CT CTA Aorta
- Left leg DVT in young woman or recurrent LLE DVT (suspected May-Thurner) MRI CT or MR Venography Pelvis
- Chronic pelvic pain worse with standing, suspected pelvic congestion MRI Pelvic Ultrasound (with Doppler) + MR Venography Pelvis
- Chronic limb swelling, suspected lymphedema NM Lymphoscintigraphy or MR Lymphangiography
- Upper extremity swelling, suspected DVT (catheter or effort) US Upper Extremity Venous Doppler Ultrasound
- Suspected thoracic outlet syndrome (neurogenic or vascular) MRI MRI Brachial Plexus + provocative-position MRA / Venography
- Extensive iliofemoral DVT (candidate for thrombolysis) CT Lower Extremity Doppler + CT or MR Venography Pelvis
- Vascular malformation (low-flow venous / lymphatic / high-flow AVM) MRI MRI affected region (with time-resolved MRA for high-flow)
- Acute limb ischemia (pain, pallor, paresthesia, paralysis) CT CTA Aorta and Lower Extremity Runoff
- Popliteal aneurysm screening (AAA patients) or palpable popliteal pulse US Doppler Ultrasound Popliteal
- Post-catheterization groin pseudoaneurysm US Doppler Ultrasound Femoral
- Dialysis AV fistula or graft dysfunction US Doppler Ultrasound AV access
- Leriche syndrome / aortoiliac occlusive disease CT CTA Aorta and Lower Extremity Runoff
- Mesenteric venous thrombosis CT CT Abdomen with IV (portal venous phase emphasis)
- Splenic vein thrombosis (often pancreatitis-related) CT CT Abdomen with IV contrast
- Suspected vertebrobasilar insufficiency MRI MRA Head and Neck (or CTA)
- Subclavian steal syndrome (arm exertion → neuro symptoms) US Doppler US + CTA / MRA Aortic Arch
- Acute aortic intramural hematoma CT CTA Chest / Abdomen / Pelvis
- Penetrating aortic ulcer CT CTA Aorta
- Chronic aortic dissection surveillance CT CTA Aorta annually (or MRA to limit radiation)
- Suspected large-vessel vasculitis (Takayasu, GCA) MRI MRA / CTA Aorta and branches; FDG-PET for inflammatory activity
- Fibromuscular dysplasia (renal, carotid, cerebral) screening CT CTA / MRA renal + neck + cerebral
- Postpartum fever + flank/abdominal pain, suspected ovarian vein thrombosis CT CT Abdomen / Pelvis with IV contrast
- Penetrating extremity injury with vascular concern (hard / soft signs) CT CTA Extremity
- IVC filter complication (migration, fracture, perforation, thrombosis) CT CT Abdomen with IV contrast
- Fever + back / abdominal pain in patient with aortic graft, suspected graft infection NM CT Angiogram + FDG-PET/CT
- Pancreatitis with delayed GI bleed or new pain, suspected splenic artery pseudoaneurysm CT CTA Abdomen
- Distal limb ischemia in young heavy smoker, suspected Buerger disease MRI CTA / MRA Extremity (segmental occlusion + corkscrew collaterals)
- Multi-system vasculitis with renal / GI / neurologic involvement, suspected polyarteritis nodosa CT CT or MR Angiogram Abdomen (microaneurysms in renal / mesenteric)
- Massive iliofemoral DVT with limb ischemia, suspected phlegmasia CT Lower extremity Doppler US + CT/MR Venography
- Ulnar-sided hand ischemia after repetitive trauma, suspected hypothenar hammer syndrome MRI CT / MR Angiography Hand or Doppler US
- Young athlete with calf claudication, suspected popliteal artery entrapment MRI Dynamic (plantar flexion stress) CTA or MRA Lower Extremity
- Intermittent calf claudication without atherosclerosis, suspected cystic adventitial disease MRI MRI Popliteal Region (cyst in adventitia)
- Sciatic distribution claudication or buttock mass, suspected persistent sciatic artery CT CTA / MRA Pelvis and Lower Extremity
Breast 27
- Breast cancer screening, average risk MG Screening mammogram (2D + tomosynthesis)
- Palpable breast lump MG Diagnostic mammogram + targeted Ultrasound
- Palpable breast mass, age < 30 US Targeted Breast Ultrasound (mammogram only if suspicious on US)
- Palpable breast mass, age ≥ 30 MG Diagnostic Mammogram + Targeted Ultrasound
- Focal persistent breast pain US Targeted Ultrasound + Diagnostic Mammogram if ≥ 30
- Pathologic nipple discharge (bloody, unilateral, single duct) MG Diagnostic Mammogram + Subareolar Ultrasound (MRI if negative)
- Suspected breast implant rupture MRI Breast MRI (silicone-sensitive sequences) — or Ultrasound
- Lactating breast mass, fever, suspected mastitis or abscess US Breast Ultrasound
- Male breast lump (gynecomastia vs malignancy) MG Diagnostic Mammogram + Ultrasound
- High-risk breast cancer screening (BRCA, > 20% lifetime risk) MRI Annual Breast MRI + Annual Mammogram (alternating every 6 months)
- Mammographic abnormality requiring diagnostic workup MG Diagnostic Mammogram + Tomosynthesis + Targeted Ultrasound
- Post-treatment breast cancer follow-up MG Annual Mammogram (± MRI for high-risk)
- Architectural distortion on screening mammogram MG Diagnostic Mammogram + Tomosynthesis + Targeted Ultrasound
- Diffuse breast skin thickening MG Diagnostic Mammogram + US + Breast MRI
- Suspected inflammatory breast cancer (erythematous warm breast) MRI Diagnostic Mammogram + Breast US + Breast MRI + biopsy
- Eczematous nipple changes, suspected Paget disease MRI Diagnostic Mammogram + Breast MRI
- Rapidly growing breast mass, suspected phyllodes tumor US Ultrasound + Diagnostic Mammogram (then excisional biopsy)
- Suspicious microcalcifications on mammogram MG Magnification mammographic views + Stereotactic biopsy
- New bilateral mammographic asymmetry / focal asymmetry MG Diagnostic Mammogram + Tomosynthesis + Targeted US
- Isolated axillary lymphadenopathy on imaging US Axillary US + biopsy; search for primary
- Mammographically dense breasts (BI-RADS C/D) — supplemental screening US Whole-breast Screening Ultrasound (or Breast MRI for high-risk)
- Post-mastectomy reconstruction surveillance Clinical exam (no routine imaging if no symptoms)
- Oil cysts / dystrophic calcifications post-surgery or trauma, suspected fat necrosis MG Diagnostic Mammogram + targeted Ultrasound
- Palpable subcutaneous cord on breast, suspected Mondor disease US Diagnostic Mammogram + Ultrasound (tubular avascular structure)
- Lactating woman with breast mass, suspected galactocele US Breast Ultrasound
- Architectural distortion on screening mammogram, suspected radial scar / complex sclerosing lesion MG Diagnostic Mammogram + Tomosynthesis + Targeted Ultrasound; Stereotactic biopsy
- Mucocele-like lesion on imaging or core biopsy MG Diagnostic Mammogram + Targeted US + Stereotactic biopsy
Cardiac 35
- Stable exertional chest pain, low-to-intermediate risk CT Coronary CTA
- New-onset heart failure US Transthoracic Echocardiogram
- Heart failure with preserved ejection fraction, etiology unclear MRI Cardiac MRI
- Suspected infective endocarditis US TTE first; TEE if TTE negative and clinical suspicion remains
- Valvular heart disease evaluation US Transthoracic Echocardiogram
- Pre-TAVR planning CT ECG-gated Cardiac CTA + CT Vasculature
- Cardiac mass on echocardiogram MRI Cardiac MRI
- Pericardial effusion / suspected tamponade US Transthoracic Echocardiogram
- Suspected constrictive pericarditis MRI Cardiac MRI (or CT for calcifications)
- Suspected myocarditis MRI Cardiac MRI (Lake Louise criteria)
- Suspected cardiac amyloidosis MRI Cardiac MRI + Tc-99m PYP scan
- Hypertrophic cardiomyopathy, evaluation MRI Echocardiogram + Cardiac MRI
- Asymptomatic intermediate-risk patient, cardiovascular risk stratification CT Coronary Artery Calcium Score (non-contrast CT)
- Suspected cardiac sarcoidosis MRI Cardiac MRI + FDG-PET (cardiac sarcoid protocol)
- Adult congenital heart disease follow-up MRI Cardiac MRI + TTE
- Stable angina with intermediate risk, functional ischemia testing NM Stress Echo or Nuclear MPI (SPECT) or Stress Cardiac MRI
- Atrial fibrillation pre-cardioversion / pre-ablation US Transesophageal Echocardiogram
- VT or aborted SCD in known structural heart disease MRI Cardiac MRI (LGE for arrhythmogenic substrate)
- Pre-AF ablation pulmonary vein anatomy CT Cardiac CT (gated)
- Cryptogenic stroke, source of embolism US TEE with bubble study
- Suspected arrhythmogenic right ventricular cardiomyopathy MRI Cardiac MRI (RV-focused with cine + LGE)
- Suspected LV non-compaction MRI Cardiac MRI
- Suspected anomalous coronary artery (young athlete syncope) CT Coronary CTA
- Post-MI left ventricular thrombus surveillance MRI Cardiac MRI (LGE) or contrast TTE
- Vasospastic / Prinzmetal angina Provocative coronary angiography (ergonovine / acetylcholine)
- Acute MI complications (VSD, free wall rupture, papillary muscle) US TTE first; cardiac MRI for delayed assessment
- Pediatric pulmonary hypertension US Echocardiogram (TTE); cardiac MRI for definitive
- Suspected congenital heart disease in neonate / infant US Echocardiogram (TTE) ± Cardiac MRI for complex anatomy
- Anthracycline cardiotoxicity surveillance US Echocardiogram (TTE) with strain imaging
- Chest pain + ST changes + apical akinesis after emotional / physical stress, suspected Takotsubo US Transthoracic Echocardiogram + LV ventriculogram on cath
- Heart transplant surveillance / suspected rejection or vasculopathy MRI Endomyocardial biopsy + Coronary CTA (or surveillance angiography) + Cardiac MRI
- Post-infarct LV aneurysm vs pseudoaneurysm MRI Cardiac MRI (LGE for scar transmurality + wall continuity)
- Bicuspid aortic valve + aortopathy screening MRI Transthoracic Echocardiogram + CTA / MRA Aorta
- Patent ductus arteriosus (neonatal premature or adult incidental) US Echocardiogram (TTE)
- Syncope, adult — when imaging is indicated No routine imaging; selective CT head / echo / CTPA by phenotype