Duke Department of Radiology

http://www.radiology.duke.edu/

ADULT RADIOLOGY PREPS updated 03/07

(This information is to assist the referring provider, when referring patients to Duke Radiology.)

CONTENTS PAGES 1 2 3 4 5 6 7 8-9 10 11-12 BIOPSY AND DRAINAGE PROCEDURES CT SCANS GASTROINTESTINAL PROCEDURES GENITOURINARY PROCEDURES INTERVENTIONAL PROCEDURES MRI PROCEDURES MYELOGRAM/LUMBAR PUNCTURE NUCLEAR MEDICINE STEROID PREP ULTRASOUND PROCEDURES

OUTPATIENT BIOPSY AND DRAINAGE PROCEDURES

1.

NPO after midnight

2. Patients need to arrive 30 min. prior to the procedure and will need a driver after procedure.

3. Blood work is required before procedure: PT, a PTT, ABC, and a Basic Metabolic panel. ***If the patient is on blood thinners, they are not to take them 7 days prior to the procedure and labs must be drawn after blood thinners have been stopped. 4. ALL patients are scheduled.

For Ultrasound guided drainages and biopsies call 684-7437 with questions or to schedule. For CT guided drainages and biopsies call 684-7331 with questions or to schedule.

Revised 01/07

OUT PATIENT RADIOLOGY CT SCAN INFORMATION Patients may eat and take daily medications prior to
CT scan, unless having a Biopsy or Drainage Procedure. CT scans of the neck, head, spine, chest, or extremities may need IV contrast, but oral contrast will not be used. Patients may be in CT between one and two hours. IV CONTRAST INSTRUCTIONS: 1. A lab test called Creatinine is required for all CT patients. 2. Patients may need to have an IV placed to inject IV contrast Dye (X-Ray Dye). 3. If patient has an allergy to IV contrast dye, shellfish, or Iodine, please notify the referring physician to provide the steroid prep. *SEE STEROID PREP INSTRUCTIONS PAGE 10. ORAL CONTRAST INSTRUCTIONS: There are two types of oral contrast. One is Redi-Cat, which is the contrast that patients should be given if they have iodine allergies. The other contrast is Gastrografin, which is mixed with juice or soda. 1. Patients having abdominal and/or pelvic CT scans usually need oral contrast. ORAL CONTRAST MUST BE INGESTED AT LEAST ONE HOUR BEFORE SCHEDULED CT APPOINTMENT. If Clinic does not have oral contrast, the patient should arrive in CT one hour prior to their appointment to drink oral contrast. 2. Patients, who may be donating a kidney or liver, should not be given oral contrast to drink. If there are questions concerning this, please call the CT Teamleader at 681-4450. 01/07 TO SCHEDULE CALL: 684-7999 IF YOU HAVE QUESTIONS CALL: 681-4450

3 GASTROINTESTINAL (GI) Procedure Preps OUTPATIENT

1. Barium Swallow- NPO after midnight prior to exam 2. Upper GI or UGI with SBFT- NPO after midnight prior to exam

3. Enteroclysis (primary tube small bowel) LO-SO prep kit and NPO after midnight prior to exam. Prep kits are in YOUR clinic. 4. Barium Enema or Barium with Air Contrast- LO-SO prep kit and NPO after midnight prior to exam. Prep kits are in YOUR clinic. 5. Defecography - light breakfast morning of exam

Please call 684-7999 to schedule or if you have questions call 684-7257 (7:30a4:00p).

4 GENITOURINARY (GU) PROCEDURE PREPS

1.

IVP- Two (2.5 mg) ducolax tablets between 2 pm and 4 pm. DAY PRIOR to exam. Clear liquids after midnight. Creatinine needs to be drawn prior to scheduling.

2. ALL GU OUT PATIENT procedures are scheduled.

Please call 684-7697 (8:30-5:00) with questions regarding scheduling, preps or exams.

INTERVENTIONAL VASCULAR/NEURO Out patient

1. All vascular and neuro procedures are to be NPO 4 hours prior to the procedure.

2.

All patients need to arrive 30 min. prior to the procedure and will need a driver after the procedure. Blood work is required before procedures: PT, PTT, ABC, and a Comprehensive Metabolic Panel.

3.

4. If scheduled for lab work prior to exam have patient go to the 1D clinic at Duke South Hospital at least 1 hours before scheduled procedure.

5. See the steroid prep sheet (page 10 of this document ) for any patient with a contrast allergy. 6. Referring physician needs to determine: a. If current medications can be continued until time of procedure. Medications should be taken with sips of water only. b. If patient is diabetic proper insulin dosing for NPO status is needed. c. When to stop and when to start back on anti-coagulant therapy. 7. ALL patients are scheduled. Please call 684-7315 7:00-5:30pm MondayFriday.

With questions or to schedule call 684-7315. Revised 1/23/07

6 MRI PROCEDURE PREPS

For most MRI scans the patient can be on a normal diet and take their routine medications. EXCEPTION: Patients for MRCP exams must be NPO for 4 hours prior to exam. It is acceptable for the patient to drink water. Patients should bring their current medications and/or a list of their current medications, in case contrast is ordered as part of the MRI scan. Patients may have an IV started to inject IV contrast, if ordered.

DO NOT WEAR ANY JEWELRY (BEST TO LEAVE AT HOME). For scheduling call 684-7999 For questions call 684-7254. When you are scheduling your patient for an MRI please consider the following: Does your patient . . . 1. have a pacemaker If yes, an MRI is absolutely contraindicated 2. have breast tissue expanders/soft tissue expanders? If yes, an MRI is absolutely contraindicated 3. have an allergy to MRI contract? If yes, please order a steroid prep. (Note: This is not an iodine based agent; it is a gadolinium based agent) 4. breastfeeding? If yes, she will not be able to breastfeed for 48 hours. She will need to pump her breast milk prior to receiving contrast or give formula. 5. have history of metal in his/her eyes as a result of grinding or welding? If yes, please order orbital screen x-ray to check for metal fragments. 6. have any of the following: a. metal heart valves b. metal chips in brain c. metal implants in ears d. any kind of stent If yes, to any of these, patient will need implant identification card. Note: for stents, patient must be 6 weeks post-op.

7 7. pregnant? If yes, please call MRI at 68407254 to discuss. have metal pins or any other metal in his/her body? If yes, please call MRI at 684-7254 to discuss. 8. have claustrophobia? If yes, please order sedation medication which will need to be taken one hour prior to scan. If patient wants sedation at our facility, he/she will need a driver, who must remain with him until the procedure is completed. 9. wear a foil back medication patch? If yes, it will need to be removed prior to scan. Note: MRI scan may cause burn.
Updated 3/2/07

Myelography/Lumbar Puncture
1. 2. Patient needs to be NPO 4 hours prior to exam. Lab work needed: PT & PTT if patient is on anticoagulants.

3.

If scheduled for lab work prior to exam have patient go to the 1D clinic at Duke South Hospital at least 1 hours before scheduled procedure. See steroid prep sheet (page 10 of this document) for any patient with a contrast allergy. All patients need to arrive 30 minutes prior to the procedure and will need a driver after the procedure.

4. 5.

6.

There are many contraindications to myelography concerning patient medications. Tricyclic antidepressants, monoamine oxidase inhibitors, analeptics, CNS stimulants, and other antipsychotics are contraindicated drugs. Please call 684-7315 with ANY questions concerning these drugs and the contraindications.

7.

ALL patients are scheduled by calling 684-7315; Monday through Friday 7:00 to 5:30pm.

9 NUCLEAR MEDICINE Studies That Need Patient Preparation PET Brain scan - - - - - - -- - - - - - - - - - NPO 4 hours prior to study Localization scan - - - - - - - - - - NPO 4 hours prior to study NUCLEAR MEDICINE Bone Scans - - - - - - - - - - - - - Gastric Emptying Liquid - - - - - Gastric Emptying Solid - - - - - - Gastric Reflux - - - - - - - - - - - - Hepatobiliary - - - - - - - - - - - - - I-131 Therapy - - - - - - - - - - - - Meckels Scan - - - - - - - - - - - - MIBG- - - - - - - - - - - - - - - - - - Schilling Test - - - - - - - - - - - - - Thyroid Metastases- - - - - - - - - Thyroid Uptake Scan - - - - - - - NUCLEAR CARDIOLOGY Rest only - - - - - - - - - - - - - - - Rest and Exercise MUGA - - - Myocardial Perfusion - - - - - - - No Prep NPO 2 hours prior to study (wear clothes suitable for exercising) NPO 3 hours prior to study (wear clothes suitable for exercising) Well hydrated NPO 4 hours prior to study NPO 4 hours prior to study NPO 4 hours prior to study NPO 4 hours prior to study NPO 1-2 hours prior to study (females 12-60 y.o. Beta HCG) NPO 4 hours prior to study Prep with SSKI 1 day prior to study NPO 4 hours prior to study NPO 1 hour prior to study Call 684-7220 prior to scheduling

To schedule call 684-7999 or with questions 684-7220.

10 CONTRAST ALLERGY STEROID PREPARATION PROTOCOLS 13-HOUR PREP (Greenberger Protocol) Prednisone 50 mg po (by mouth) q6 hours x 3 doses starting 13 hours prior to scan 13 hours + 7 hours + 1 hour prior to scan

EMERGENCY PREP Hydrocortisone 200 mg IV Q4 hours x 2 doses Benadryl 25-50 mg IV one-hour prior to scan STEROID EQUIVALENCIES SINGLE DOSE 50 mg Prednisone 8 mg Decadron (Dexamethasone) 200 mg Solu-Cortef (Hydrocortisone) 40 mg Solu-Medrol (Methylprednisolone) TOTAL DOSE 150 mg Prednisone 24 mg Decadron (Dexamethasone) 600 mg Solu-Cortef (Hydrocortisone) 120 mg Solu-Medrol (Methylprednisolone)

Reviewed by Dr. Erik Paulson 1-7-07

11 ULTRASOUND-ADULT PATIENT PREPS

(1) No special instructions (2) NPO after midnight (minimum 6-8 hours) (3) 32 oz. of fluid one hour before appointment time, patient is not to void after drinking EXAMS Prep Abdomen 2 Abscess Search Pelvis 1 Abscess Search Upper 1 2 Aorta Appendix 1 Ascites Search 1 Bladder 3 Bile Ducts 2 Carotid 1 Chest Wall (mark effusion) 1 Venous/Lower Uni 1 Venous/Lower Bil 1 Venous/Upper Uni 1 Venous/Upper Bil 1 Endovaginal 1 Extremity Arterial Lower /Unilateral 1 Extremity Arterial Lower /Bilateral 1 Extremity Arterial Upper/Unilateral 1 Extremity Arterial Upper/ Bilateral 1 Gallbladder 2 Graft (Hemodialysis or Access) 1 Graft( Unilateral Arterial Lower) 1 Graft (Bilateral Arterial Lower) 1 Groin 1 Hernia/ Muscle Soft Tissue 1 Hysterosonogram 1 IVC 2 Kidney 1 Liver 2

12 (1) No special instructions (2) NPO after midnight (minimum 6-8 hours) (3) 32 oz. of fluid one hour before appointment time, patient is not to void after drinking EXAMS Prep Liver Doppler 2 Muscle Soft Tissue 1 OB 1st Trimester 1 OB 1st Trimester multiple gestation 1 OB 2nd & 3rd Trimester 1 OB 2nd & 3rd Trimester (mult gest) 1 OB Follow UP 1 OB Doppler 1 OB limited 1 Pancreas 2 Pancreas Transplant 1 Parathyroid 1 Pelvic 3 Penile 1 Popliteal Arteries 1 Popliteal Space (baker's cyst) 1 1 Renal As ordered by Dr. Renal & Biopsy 1 Renal Transplant As ordered by Dr. Renal Transplant Biopsy 2 Retroperitoneum 2 RUQ (Liver and Gallbladder) Spleen 1 Testicle 1 Thyroid 1 Vein Mapping 1 Venous Insufficiency (reflux ) 1

Scheduling Call 684-7999 Any questions Call 684- 7431