ORDERS ARE GOOD FOR 1 YEAR. IF EXPIRED, WE NEED TO CALL THE REFERRING DOCTOR TO GET AN UPDATED ONE.

(Refer to the Training Refresher Materials section under the Tools drop down)

Auth requirements:

Health Choice/Health Choice Generations: OB US is 5-7 days TAT, DUPLEX/DOPPLER is 5-7 day minimum TAT

Tricare: All US, MG, BD, MRI & CT require auth- 14 days minimum TAT

Alignment: US- 7 days minimum TAT

Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT (In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping and Prostate and out of network for ALL CT except CT lung, CTA for PE, CTA runoff and patients over 400 lbs.  

Mercy Care/Mercy Care Advantage: US (Elastrography) cpt 76981 is a 14 day minimum TAT

Scan Health: ALL Breast Imaging - 7 day minimum TAT

Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.

Humana FL (Only) All modalities - Schedule 9 days out.  Add-Ons ONLY allowed if patient has referral/authorization number on hand.

To find a location that can perform one of the exams listed below please use the site search on the portal and choose the appropriate procedure.

Site search click here

STAT GUIDELINES

STATS we do try to accommodate same day next day, if it requires auth we schedule out 4 hours or next AM so auth has time to attempt to obtain.

We check the location most convenient to the pt but if we see no openings we offer surrounding sites that may have openings, if surrounding do not have openings as well we are ok to double book following the below guidelines.

*Agents do not have rights to double book so if this occurs they are reaching out to their leads to do the double booking at which time the leads can check thru to make sure it’s an ok spot to add.

If they double book  they should be notifying the patient they are being worked in and may have a wait and notate this was communicated.

A call must be placed to the site only if the following circumstances apply:

·         Clinic/modality is closing within the hour. Example you get call at 3:15pm and that modality closes at 4pm.

·         We are already double-booked and you are needing to add another exam. Example we have two 4pm and you need to add a 3rd (Triple Booking).

·         Only overbook non contrast spots.  Please ensure contrast coverage is available if you are booking a contrast exam.

·         If you are scheduling a specialty exam, there may be limits on certain exams such as: Arthrograms, Fluoro, Diagnostic Mammo’s, Nuc Med, Etc. You must call the site for approval.

·         If you are scheduling an exam that requires authorization please make sure you inform the patient that if authorization is not received by the time of the exam, their appointment   may be postponed. Allow 4 business hours’ time for auth to be obtained.

·         Same day Saturday appointments that require auth must already have auth on file or the patient will not be able to be seen. If exam requires authorization and it has not already been obtained please schedule for Monday to allow time to obtain STAT auth.  

When scheduling the below STAT exam, these cannot be done after 5pm or on weekends.

CTA CHEST WITH CONTRAST W/3D RECON AND THE DIAGNOSIS IS FOR PE (PULMONARY EMBOLISM)

US DUPLEX SCAN LOWER EXTREM VEINS BILATERAL

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (LEFT)

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (RIGHT)

US DUPLEX SCAN UPPER EXTREM VEINS BILATERAL

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (LEFT)

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (RIGHT)

OB ULTRASOUNDS FOR VIABILITY

If you are “postponing scheduling” until the next business day please send recap form to the Dr office to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

If you are “postponing scheduling” on a Friday until Monday please send recap form to the Dr office as well as call to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

Types of SimonMed MRI machines

COMMONLY MISCHEDULED PROCEDURES

Premedication Regimen

ASK PATIENT IF THEY ARE ALLERGIC TO IODINE. IF THEY ARE, PATIENT WILL NEED TO BE PRE-MEDICATED.

PRE-MEDICATION REGIMAN WILL BE PREDNISONE 50MG BY MOUTH AT LEAST 13 HOURS, 7 HOURS, AND 1 HOUR BEFORE INJECTION. DIPHENHYDRAMINE (BENADRYL) 50MG BY MOUTH 1 HOUR BEFORE INJECTION. NO OTHER PREP WILL BE ACCEPTED AND MUST BE TAKEN AT PRESCRIBED TIMES. DOCUMENTATION WILL BE NEEDED FROM THE REFERRING PROVIDER STATING THAT THE PATIENT HAS BEEN PRE-MEDICATED AND A LIST OF MEDICATIONS PRESCRIBED.

IF THE PT IS OVER THE AGE OF 60, IF PT IS DIABETIC OR IF PT HAS KNOWN KIDNEY PROBLEMS THEN THE PATIENTS NEEDS TO HAVE A BUN AND CREATININE BLOOD WORK DONE WITHIN THE LAST 6 WEEKS.

IT IS RECOMMENDED THAT PATIENT'S WHO ARE BREAST FEEDING PUMP AND DUMP FOR 24 HOURS AFTER ANY EXAM WITH CONTRAST. 

CT's and MRI's with contrast

CT and MRI contrast can be performed on the same day, so long as the patient doesn’t screen with any renal issues.  Additionally, only schedule up to 3 CT and/or MRI's with contrast per day. 

 Ideally we should not schedule more than 4 MRI's (without contrast, with contrast or with and without contrast) per day.  Patient has to lay still with no movement.  If there is movement, tech has to start exam over again. 4 exams would have patient laying completely still for 2 hours. 

MRI of the abdomen and MRI of the breast with and without contrast cannot be scheduled on the same day due to both being dynamic contrast exams.

MRI's with Hoyer Lift - Phoenix High Field Open

AS OF 11/20/2023 Hoyer exams will be done on Mondays and Fridays and going forward for ALL modalities from the hours of 8:30am to 4:00pm.  Reminder that these exams must be in an hour long time slot.  If patient has multiple exams, one can be in an hour long time slot and the others can be in 30 minute time slot. Also, please DO NOT book Hoyer's at the same time. (Example: 9am MRI Hoyer and 9am Ultrasound Hoyer)

We offer a Hoyer lift at Phoenix High Field Open in Phoenix, AZ for patients that need special accommodations to get on the table. 

We must screen the patient to determine the following: Will the patient need the Hoyer Lift and is sitting in a wheelchair, will the patient be coming in on a stretcher, or is the patient coming in a wheelchair BUT can use a slide board.  All patients need to also come in sitting on their sling.  This is VERY important. Stretcher patients DO NOT NEED A SLING.  They will just need to by laying on a blanket or pull sheet (they usually are).

If you have a patient that needs this service, you MUST notate in the patient alerts and the accession. 

Hoyer Lift patients are scheduled Monday and Friday ONLY from 8:30am - 4:00pm due to needing enough staff to help with transferring the patient.  These exam requires 1 hour (60 minutes) for the exam.  If you cannot find a drop down in EXA that indicates Hoyer lift, select the appropriate exam and make sure to change the duration to 1 hour.  If there are multiple exams in the same modality, first exam needs to be schedule for 1 hour and the additional exams need to be scheduled in a 30 minute time slot. 

If the patient has multiple exams but different modalities, please schedule one after another.  Each in an hour to allow time to transfer.  (Example: MRI at 10am for an hour long and then Ultrasound at 11am for an hour long). 

Do not schedule at the same time as another Hoyer lift patient.  

If you need help doing this, please reach out to your lead or the lead support chat for assistance. 

MRI and Implanted Devices

Foreign Body or Metal Implants

If a patient indicates that they have an implant or hardware, we need to determine if it is MRI safe. Please refer to the below guide to see which type of implants require advanced screening and/or if patient is to bring their device ID card to appointment.

If an email needs to be sent, please follow the outline for conducting your communication

Outlook Email

TO: MR Safety Team (MRSafety@simonmed.com)

Please include the following information:

• PATIENT NAME

• MRN

• ACCESSION

• EXAM TYPE

• HARDWARE/IMPLANT INFORMATION (MAKE/MODEL/SERIAL NUMBER) THIS INFORMATION IS MANDATORY

Implants that Require Advance Screening

· Cardiac monitors/Loop recorders

· Stimulators (Nerve, Spine, Deep Brain, Sleep Apnea, Vagal Nerve, Peripheral Nerve, etc.)  NO STIMULATOR CAN BE SCHEDULED ON A STAND UP OR OPEN MRI machine.

*If the patient needs 2 MRI exams and has a stimulator, there needs to be a gap (1 hour+) between exams.  Contrast exams can be separated. This is due to the heat limit of the stimulator. 

· Implanted Medication Pumps

· Penile Implants

· Breast Tissue Expander (this is not the same as a breast implant)

· Shunts (VP or Spinal)

*If patient has a shunt, we need confirmation from the ordering provider or the neurologist who placed the shunt regarding whether it is still operational.  If the shunt is active, an X-ray is required for clearance BEFORE proceeding with the MRI.  An x-ray order must be placed by a physician; this is not a standing order.  If the shunt is no longer functioning, the X-ray can be bypassed, but we require both verbal and written confirmation directly from the provider. For the patient's safety, we cannot accept this confirmation from the patient themselves.  We will be happy to see and scan the patient once proper procedures are in place for their safety. 

*PT HAS SHUNT, UNKNOWN IF PROGRAMMABLE. THE VALVE NEEDS A SHUNT DIAL SETTING XRAY BEFORE THE MRI (NOT SHUNT SERIES!) AND NEED TO HAVE RADIOLOGIST CONFIRM THE XRAY WAS DONE PROPERLY BEFORE PT IS IN THE MRI TO PROVIDE A CLEAR VIEW OF THE VALVE. Please make sure the patient knows that if the shunt has a programmable valve and the MRI alters the settings with the magnetic field then the patient will have to go to their doctor after the appt to get the shunt valve setting reset. We will verify with the shunt dial x-ray if that is necessary.

· Cochlear implants

Implants that can go to any SimonMed Location – Bring ID card to Appointment

*If a patient has the Sleep Apnea Implant Inspire, they CANNOT be scanned on 3T, Open, or Stand Up MRI Scanners.  SCW and Maricopa in AZ are ok

· Stents

· Heart Valves

· Aneurysm Coils and Clips (placed after 2000 in the US)

· Embolization Coils

· Glaucoma valves, eye stents, eyelid springs

· IVC filter

· Septal Occludes (ASD, VSD, and PFO) and LAA closures (examples: Watchman, AtriClips, or Amplatzer Amulet)

Implants that can go to any SimonMed Location – No Implant ID needed

*Cardiac stents do not need prior clearance as they are considered MRI safe

· Spine hardware and fusions

· Joint replacements

· Bone screws, rods, plates, and pins

· IUDs and birth control devices

· Surgical staples and clips (Gallbladder, hernia, biopsy clips, etc.)

· Vascular access ports

· Dental implants and braces

· Cataract lenses

· Urolift

External Items

· Glucose monitors and insulin pumps – will be removed for the MRI – recommend coordinating with the patient for the MRI to be on their regular "swap" day (every 14 days)

· Piercings and jewelry – must be removed

· Hearing aids – must be removed

· Hair extensions with metallic fibers or metal clips – must be removed

· Medication patches with a foil back – must be removed

**If a patient has a bullet and/or bullet fragments in their body, they will need to have a clearance x-ray before the MRI.  Referring doctor would need to send in an order for the x-ray.  Have patient come in 1 hour before their MRI to have x-ray completed. 

**If patient needs 2 MRI exams and has a stimulator, there needs to be a gap (1 hour) between exams.  Contrast exams can be separated. This is due to the heat limit of the stimulator. 

**If patient has a shunt, we need confirmation from the ordering provider or the neurologist who placed the shunt regarding whether it is still operational.  If the shunt is active, an X-ray is required for clearance BEFORE proceeding with the MRI.  X-ray order must be placed by a physician, this is not a standing order.  If the shunt is no longer functioning, the X-ray can be bypassed, but we require both verbal and written confirmation directly from the provider. For the patient's safety, we cannot accept this confirmation from the patient themselves.  We will be happy to see and scan the patient once proper procedures are in place for their safety. 

**PT HAS SHUNT, UNKNOWN IF PROGRAMMABLE. THE VALVE NEEDS A SHUNT DIAL SETTING XRAY BEFORE THE MRI (NOT SHUNT SERIES!) AND NEED TO HAVE RADIOLOGIST CONFIRM THE XRAY WAS DONE PROPERLY BEFORE PT IS IN THE MRI TO PROVIDE A CLEAR VIEW OF THE VALVE. Please let patient know that if the shunt has a programmable valve and the MRI alters the settings with the magnetic field then the patient will have to go to their doctor after the appt to get the shunt valve setting reset. We will verify with the shunt dial xray if that will be necessary.

SIMONMED DOES NOT PERFORM MRI'S ON PATIENTS WITH IMPLANTED DEFIBRILLATORS.

If a patient has the Sleep Apnea Implant Inspire, they CANNOT be scanned on a MRI 3T, Stand up or Open machine.  This can only be scheduled on a 1.5T.  In Arizona, only at Sun City West and Maricopa.

MRI Pacemaker

Transfer to the Pacemaker Queue Team to Schedule

Currently able to perform at the AZ Desert Ridge SimonMed Location.

Alternative could be a nearby hospital or another facility unless the referring provider can have the exam changed to a CT. 

Please do not transfer calls to the Pacemaker Team for other implanted device scheduling like stimulators, defibrillators etc.

CARDIAC MRI'S

Can only be performed at SimonMed Carnegie Hill New York and SimonMed La Cienega California.

If you have patients that would like to schedule a Cardiac MRI at one of these two locations, please transfer the caller

Carnegie Hill - 212.369.9200

La Cienega - 310.623.1150

MRI's should be either without contrast or with and without contrast.  The only time an MRI can be done with contrast only is an Arthrogram or if the patient just had the same body part without contrast in the last 2 week and our radiologist recommends it in the report.

If an order is received for an MRI with contrast (not an Arthrogram), a call needs to be made to the referring physician to ask for a revised order based off the radiologist recommendation for the best pictures.  We will scan the body part without contrast, inject contrast and rescan the body part and compare.

MRI Safety Preparation:

All MRI patients will be asked to change into a gown for their MRI examination.

This policy has been put in place to enhance patient safety and reduce the risk of accidents during MRI procedures. It is crucial that we adhere to this policy consistently and ensure that all patients are informed and guided accordingly.

The primary reason for implementing the gown policy is as follows:

1.       Metallic objects: Street clothes or personal garments may contain metallic objects, such as zippers, buttons, or underwire, which can pose a significant hazard in the MRI environment due to the strong magnetic fields generated by the MRI machine. These objects can potentially cause injury to the patient or damage the MRI equipment.

2.       Consistency in imaging quality: Clothing with certain patterns, prints, or materials may create artifacts in the MRI images, compromising the quality and accuracy of the diagnostic results. By having patients wear standardized gowns, we can maintain consistent image quality across all MRI examinations.

3.       Patient comfort and modesty: Providing patients with clean, comfortable gowns helps ensure their comfort and modesty during the MRI procedure, which can contribute to a more positive patient experience.

4.       Compliance with safety protocols: Adhering to the SimonMed gown policy demonstrates our commitment to following established safety protocols, ensuring a safer environment for both patients and healthcare professionals.

simonone MRI

If you receive a call for a simonONE MRI please do not schedule, reschedule or cancel.

Transfer to 877-653-3558 for a dedicated simonONE scheduler or you can send an email to simonONE@simonmed.com

For further scheduling information, please see the link on the home page of the SimonMed portal.

MRI Protocols

MRI Whole Body Screening (No contrast)

Drop down in EXA: MR Screening body (SCNBD) & MR Screening Neuro (SCNNE) Must schedule under both accessions

Includes: MRI Chest, MRI Abdomen, MRI Pelvis, MRI Head, MRI Neck, MRI Lumbar Spine Sagittal Images

Prep: No Special Prep

Please reference the screening questions for required notes that are needed in the accession.

If patient answers YES to being diagnosed with cancer within 5 years, they cannot be under active surveillance or undergoing treatment to have exam. 

Self-Pay Only* (Simplicity will populate self-pay rate based on the self-pay rate insurance used).

  *Some orders will be notated to bill to a company account - okay to register under company account and not self-pay.

  *If patient has Medicaid insurance they do not have the option to be self-pay.  They will need to be redirected back to their provider. 

Physician order required. 

(See example of order form below)

MRI Whole Body Screening Plus (No contrast)

Drop down in EXA: MR Screening Body Plus (SCNBP) & MR Screening Neuro Plus (SCNNP) Must schedule under both accessions

Includes: MRI Chest, MRI Abdomen, MRI Pelvis, MRI Prostate, MRI Female Pelvis, MRI Head, Neuroquant, MRA Head, MRI Neck, MRA Neck, MRI Lumbar Spine Sagittal Images

Prep:  Females: No Special Prep

          Males: Please abstain from ejaculation for 72 hours prior to the exam. Eat light meals the day prior to and on the day of the exam. Do not eat solid food 4 hours before your scheduled exam time. Please only drink water the day of your exam and drink enough to be well hydrated. To enhance the quality of the prostate evaluation, a fleet enema is necessary 2 hours before the exam to clear the rectum of stool and air. Please arrive 30 minutes before your scheduled appointment time to be screened for safety. You will be encouraged to use the restroom just before your exam to ensure the best possible results. You will be required to change into MRI safe attire before your exam. Please attempt to wear 100% cotton underwear. If you have any electronic or metallic devices implanted, please call your scheduled location for additional instructions. If possible, please have your implant card available when calling so we may better assist you.

**If patient does not have a prostate gland due to cancer, the enema would be helpful to exclude tumor recurrences.

** No need for a prep if the patient has an ostomy

If patient answers YES to being diagnosed with cancer within 5 years, they cannot be under active surveillance or undergoing treatment to have exam.

Prior Biopsy? (FOR MALE PROSTATE ONLY)

                If the patient has had a biopsy in the last 6 months we need the results of that biopsy.

                You should identify what facility the biopsy was done so we can put in a Medical Records Request to obtain

                This attempt should be documented in the accession following the normal flow below:

                Priors: Have you had previous exams in this area or biopsy

Where?

Request using Medical Records portal, add the Ticket # in the exam notes

***Please see the updated screening questions template here on the KB for additional question to be asked for this exam.***  

Self Pay Only* (Simplicity will populate self-pay rate based on the self-pay rate insurance used).

    *Some orders will be notated to bill to a company account - okay to register under company account and not self-pay.

    *If patient has Medicaid insurance they do not have the option to be self-pay.  They will need to be redirected back to their provider.

Physician order required. 

(See example of order form below)

To find a location that can perform one of the exams listed below please use the site search on the portal and choose the appropriate procedure.

Site search click here

MRI PELVIS

For MRI Pelvis we need to ensure we are choosing the correct drop down based on what the referring is looking for.  There are multiple headings in EXA for Pelvic.   Please see the following document to help determine correct drop down. 

MRI Knee Zimmer/Oxford Protocol (7692)

Drop Down in EXA: Knee without contrast Oxford/Zimmer Protocol (Please choose correct side)

Duration: 30 minutes       

Neurogram

Will generally be a wrist and forearm, or an elbow and humerus, or a knee/tib fib depending on the diagnosis and what nerves are being looked at.  Will 99.9% always be 2 studies.  

Must be scheduled when a rad is onsite so that images can be reviewed and confirm to be good to use. So schedule only during rad hours.

In AZ only schedule at Mountain View on the 3T Siemens Wide Bore                     

Sports Hernia MRI (MRI pelvic)

If the Pelvic MRI order indicates this exam for a Sports Hernia, it MUST be scheduled on a 1.5T machine (preferred Sun City West, Surprise Stadium Village, Deer Valley or North Gilbert Superstition) regardless of 3T provider preferences. 

MRI BIOGEN ADULHELM

Drop Down in Exa: Brain ADUHELM WITHOUT  (7447)

Schedule on 3T

Duration: 30 minutes

MRI BREAST (1149)

DROP DOWN: BREAST BILATERAL W & WO CONTRAST W/ 3D RECON

Prep: No lotions, oils, or deodorants in the breast or underarm area. Nothing to eat 2 hours prior.  Wear 100% cotton undergarments.

Ask if the patient has Breast Implants (If yes, are they Saline or Silicone) Some locations cannot perform, check the banner. Notate if MRI is for breast implant rupture.

Any history of breast cancer? (If yes, have you had a mastectomy? If yes, do you have tissue expanders? If yes not MRI Safe)

**If a patient has been diagnosed with breast cancer, please ignore these rules and get the patient in ASAP.

Weight limits for Breast MRI’s are different from other exams due to the Breast coil, no exceptions. See weight limits below:

Wide Bores 550 lbs.

All other scanners 250 lbs.

• Regarding patients with abnormal Breast MRI results that recommend Diagnostic Mammogram and/or breast ultrasound, these recall exams need to be scheduled at a location with a Rad on site.  In AZ and NV, it should be scheduled at a site with an on-site rad because the rad can go personally scan and look for subtle findings to biopsy. In Flagstaff, Tucson, Prescott/Prescott Valley, CO and FL they can go anywhere because there may not be a close enough site with a onsite rad.  Review QGenda Rad Schedule on the SimonMed portal page.  If you need help, please reach out to leadership for assistance.  

SECOND LOOK BREAST ULTRASOUND

• • • • SHOULD BE HANDLED BY THE WOMENS CARE COORDINATOR*****     Transfer to WCC Queue

      • BREAST-BILATERAL IN RIS PULL DOWN FOR BILATERAL

      • BREAST-UNILATERAL IN RIS PULL DOWN FOR UNILATERAL MAKE SURE TO CHOOSE LEFT OR RIGHT

      • SCHED FOR 30 MINUTES (2 Blocks)

      • NO PREP

      • THESE ARE RECOMMENDED AFTER A DIAGNOSTIC/ULTRASOUND OR BREAST MRI HAS ALREADY BEEN DONE

      • THESE MUST BE BOOKED AT THE SITE WHERE THE READING RAD WILL BE WHO ORIGINALLY READ THE DIAGNOSTIC/ULTRASOUND OR BREAST MRI 

      • PLEASE MAKE SURE TO CHECK THE SITES BANNERS AND SCHEDULING BLOCKS TO ENSURE THEY ARE AT THE RIGHT TIME AND CORRECT ROOM

      • PLEASE REFER TO THE BANNERS AND SCHEDULE BLOCKS AT THE SITE YOU ARE SCHEDULING FOR AND KEEP IN MIND A RAD HAS TO BE PRESENT SO THESE CANNOT BE DONE TOO EARLY OR TOO LATE.

MRI ARTHROGRAMS

Schedule the injection (30 minutes). 

Drop Down: (body part) Arthrography w/Fluoro Needle Guidance Left/Right

Then schedule MRI to follow (30 minutes). 

Drop Down: MR (Body part) with contrast Left/Right 

Each location schedules these at different times.  Be sure to check the locations schedule for marked Arthrogram blocks.  

• ASK THE PATIENT IF THEY CURRENTLY TAKE COUMADIN(WARFARIN). IF YES, INFORM THE PATIENT THEY WILL NEED TO COMPLETE INR LAB WORK WITHIN 24 HOURS OF THEIR SCHEDULED EXAM AND BRING THE RESULTS WITH THEM. THE PATIENT DOES NOT NEED TO BE SCREENED FOR ANY OTHER MEDICATIONS OR BLOOD THINNERS. WE SHOULD NOT INFORM THE PATIENT TO DISCONTINUE ANY MEDICATIONS INCLUDING COUMADIN(WARFARIN).

Notes: Each location schedules these at different times. Be sure to check the locations schedule for marked Arthrogram blocks.  Arthrograms are scheduled with contrast only.  

**If a patient calls in, or if you receive an order asking for an Arthrogram or an Injection to be performed by Dr. Hiscok, These need to be scheduled at Sun City West ONLY.

MRI Enterography (ABDOMEN/PELVIS ENTEROGRAPHY) 

Drop Down: ABDOMEN AND PELVIS ENTEROGRAPHY WITH AND WITHOUT CONTRAST (2331) 

Patient Prep: The patient needs to be NPO for 6 hours prior to the exam. The patient needs to arrive 45 min. prior to scan time. 

MRCP:

Drop Down: ABDOMEN WITHOUT CONTRAST W/MRCP (6117) OR ABDOMEN WITH AND WITHOUT CONTRAST W/MRCP (6118) 

Duration: 30 MINUTES

PREP: NPO 4 hours

**MRCP With Secretin we don’t do these exams.

MRI EOVIST (Abdomen MRI) (LIVER)

DROP DOWN: ABDOMEN with & without EOVIST (1360)

DURATION: 30 MINUTES

PREP: NPO 4 hours

MRI TWILIGHT SEDATION

*IV Sedation cannot be done for any type of Abdominal exams, Breast exams, and extremity exams such as Elbows, Forearms, Wrist, Hands & Fingers.

Drop Downs in Exa

*Please take note that the codes in Exa are not the only body parts that can be performed with IV Sedation, they are simply the codes that have been added. More are being added as needed. If the body part you are scheduling does not have an IV Sedation drop down yet in EXA you may use the regular body part code and notate the accession.

• Please advise the patient that this is only Twilight Sedation & not every patient goes to sleep

• Every sedation exam will NEED to be scheduled for 1 HOUR.  (MUST be entered manually for the 1-hour duration if you cannot find sedation in the drop down)

• Only 1 exam per patient per day since the IV 10mg Valium only lasts up to 30 minutes & we do not double dose. So if patient has multiple exams that would require sedation, those exams will need to be scheduled on different days. 

• 10mg/2ml IV Valium is used for this Twilight Sedation procedure. It is administered intravenously (IV).  WE DO NOT USE CONSCIOUS SEDATION (PROPOFOL) AND GENERAL ANESTHESIA.  Those will have to be done at the hospital.  This procedure is ONLY for claustrophobic patients who failed with an oral sedative.

• This is NOT for people in pain or minors.

• If patient wants to schedule for sedation and the order does not state sedation, we MUST call referring doctor for new revised order to include sedation.

Preparation:

NPO 6 hours prior and No medications 6 hours prior. (This includes any Narcotics)

PAIN PATCHES NEED TO BE DISCONTINUED FOR 24 HRS . Prescribed pain patches can only be removed under the supervision of the prescribing physician. Patient will need to provide documentation by exam date or we will not be able to perform exam. (This includes if the patient refuses to remove)

They will need to bring a Driver with them 18 years of age or older.  This is important because there is paper work the driver will fill out at time of check-in.  Also, the driver needs to be present in the lobby waiting while the exam is being done.  This is for the patient's safety.  The techs will not scan the patient if the driver is not currently present.  Patients will be rescheduled if this prep cannot be fully met.

PATIENT TO CHECK IN 15 MINUTES PRIOR    

Self-pay price is the same as whatever the MRI is, there is not any added pricing for the sedation.

Prostate MRI

 Drop Down: PROSTATE WITH AND WITHOUT CONTRAST (6405)

Duration: 30 MINUTES

Prep: Please abstain from ejaculation for 72 hours prior to the exam. Eat light meals the day prior to and on the day of the exam. Do not eat solid food 4 hours before your scheduled exam time. Please only drink water the day of your exam and drink enough to be well hydrated. To enhance the quality of the prostate evaluation, a fleet enema is necessary 2 hours before the exam to clear the rectum of stool and air. Please arrive 30 minutes before your scheduled appointment time to be screened for safety. You will be encouraged to use the restroom just before your exam to ensure the best possible results. You will be required to change into MRI safe attire before your exam. Please attempt to wear 100% cotton underwear. If you have any electronic or metallic devices implanted, please call your scheduled location for additional instructions. If possible, please have your implant card available when calling so we may better assist you.

**If patient does not have a prostate gland due to cancer, the enema would be helpful to exclude tumor recurrences.

** No need for a prep if the patient has an ostomy

Locations that perform: (NOTE: Only 3T Sites can perform this exam) If patient is not safe for 3T can be performed at Desert Ridge.

*IF a tech states that they cannot perform this exam, Please have them call Kevin Oliver directly.

Prostate Parametric with Dynacad can be done and Dynacad needs to be notated. 

Prior Biopsy? 

                If the patient has had a biopsy in the last 6 months we need the results of that biopsy.

                You should identify what facility the biopsy was done so we can put in a Medical Records Request to obtain

                This attempt should be documented in the accession following the normal flow below:

                Priors: Have you had previous exams in this area or biopsy

Where?

Request using Medical Records portal, add the Ticket # in the exam notes

***Please see the updated screening questions template here on the KB for additional question to be asked for this exam.***  

MRI Prostate Cyberknife Protocol (Schedule on 3T only)

Schedule as MRI Prostate w/wo contrast (6405)

You must list “Cyberknife protocol” in the notes.

Prep: Please abstain from ejaculation for 72 hours prior to the exam. Eat light meals the day prior to and on the day of the exam. Do not eat solid food 4 hours before your scheduled exam time. Please only drink water the day of your exam and drink enough to be well hydrated. To enhance the quality of the prostate evaluation, a fleet enema is necessary 2 hours before the exam to clear the rectum of stool and air. Please arrive 30 minutes before your scheduled appointment time to be screened for safety. You will be encouraged to use the restroom just before your exam to ensure the best possible results. You will be required to change into MRI safe attire before your exam. Please attempt to wear 100% cotton underwear. If you have any electronic or metallic devices implanted, please call your scheduled location for additional instructions. If possible, please have your implant card available when calling so we may better assist you.

**If patient does not have a prostate gland due to cancer, the enema would be helpful to exclude tumor recurrences.

** No need for a prep if the patient has an ostomy

Prior Biopsy?

                If the patient has had a biopsy in the last 6 months we need the results of that biopsy.

                You should identify what facility the biopsy was done so we can put in a Medical Records Request to obtain

                This attempt should be documented in the accession following the normal flow below:

                Priors: Have you had previous exams in this area or biopsy

Where?

Request using Medical Records portal, add the Ticket # in the exam notes

***Please see the updated screening questions template here on the KB for additional question to be asked for this exam.***  

MRI Prostate Screening    (Do not confuse with standard MRI prostate)  *Order should indicate Screening*

Drop down: MRI Prostate without contrast (screening) (6404)

Exam is only 10-15 minutes

Prep: Please abstain from ejaculation for 72 hours prior to the exam. Eat light meals the day prior to and on the day of the exam. Do not eat solid food 4 hours before your scheduled exam time. Please only drink water the day of your exam and drink enough to be well hydrated. To enhance the quality of the prostate evaluation, a fleet enema is necessary 2 hours before the exam to clear the rectum of stool and air. Please arrive 30 minutes before your scheduled appointment time to be screened for safety. You will be encouraged to use the restroom just before your exam to ensure the best possible results. You will be required to change into MRI safe attire before your exam. Please attempt to wear 100% cotton underwear. If you have any electronic or metallic devices implanted, please call your scheduled location for additional instructions. If possible, please have your implant card available when calling so we may better assist you.

**If patient does not have a prostate gland due to cancer, the enema would be helpful to exclude tumor recurrences.

** No need for a prep if the patient has an ostomy

Prior Biopsy?

                If the patient has had a biopsy in the last 6 months we need the results of that biopsy.

                You should identify what facility the biopsy was done so we can put in a Medical Records Request to obtain

                This attempt should be documented in the accession following the normal flow below:

                Priors: Have you had previous exams in this area or biopsy

Where?

Request using Medical Records portal, add the Ticket # in the exam notes

***Please see the updated screening questions template here on the KB for additional question to be asked for this exam.***  

MRI Elbow - Fever View (Mostly performed on athletes but not always)

This view is also known as the "Stress View"

MRI Brain w/Synthetic

Drop Down:

Brain without contrast w/Synthetic (10026)

Brain with and without contrast w/Synthetic (10027)

Duration: 30 minutes (2 blocks)

PREP: Patient must wear 100% cotton underwear.  All patients will be required to change into a gown and short regardless of what clothes they arrive to the center with. 

Locations that perform:

AZ Mountain View (Vida wide bore)

AZ Thomas

AZ Goodyear

AZ Rome Towers

CA San Vincente

CA Irvine

IL Streeterville

MRI Brain with Cine Flow

Drop Down:

Brain with and without contrast w/cine flow (7484)

Brain without contrast w/cine flow (2256) 

Duration: 60 minutes

Urogram

Drop down: MR Abdomen and Pelvis Urogram w/wo contrast (9053)

Duration: 60 Minutes

Prep: NPO 4 Hrs. 

Do not schedule them on an open MRI

Be sure not to mistake for CT Urogram.

Defograms 

Drop down: Defecography (6766)

DURATION: 60 MINUTES

Prep: Nothing by mouth 6 hours prior to exam. Patient to administer 2 enemas prior to exam. Use one, one hour prior to table time and second use just before leaving to come to the exam. Male patients will have 180 ml of ultrasound gel injected into the rectum prior to start of exam. Female patients will have 180 ml of ultrasound gel injected into the rectum, and 30 ml injected into the vagina. Will be instructed to empty bladder prior to exam.  Patient must wear 100% cotton underwear.  All patients will be required to change into a gown and shorts regardless of what clothes they arrive to the center with.

MRI ELASTOGRAPHY  (Order may read MRI Liver Iron Protocol/Liver Lab)

Drop Down: Abdomen w & w/o contrast w/ liver Elastography (7689)  OR Abdomen w/o contrast w/ liver Elastography (7688)

Duration: 30 MINUTES

Prep: NPO 4 Hours 

Notes: If the diagnosis is for Liver mass, lesion, or tumor we cannot schedule 

IF THE ORDER STATES FAT FRACTION OR IRON QUATIFICATION, NO EXTRA TIME IS NEEDED BUT WE MUST LIST THIS IN THE NOTES.

Locations that perform: Only performed in Arizona

MRI Rectum Cancer Staging or Fistula Protocol 

Drop down: Rectum/Fistula Protocol w & w/o contrast (7802)  OR Rectum/Rectal Cancer w & w/o contrast (7805)

Duration: 45 Minutes

Prep:   

Rectum for Rectum Cancer Staging

Use two enemas (brand not important) prior to exam.

Use one, one hour prior to table time and second use just before leaving to come to exam.

NPO 6 Hours prior

The patients will have 120 ml of ultrasound gel injected into the rectum prior to start of exam. 

Rectum Fistula Protocol

Use two enemas (brand not important) prior to exam.

Use one, one hour prior to table time and second use just before leaving to come to exam.

NPO 6 Hours prior

Notes: Preferred on 3T machine.

MARS PROTOCOL- Metal artifact reduction, reduces shine

Must be done on a 1.5T or 1.2T MRI unit, Notate protocol in notes

CANNOT BE SCHEDULED ON A 3T

MRI Visionaire Protocol

Drop Down: MRI Knee without contrast (7679) (Please choose correct side)

Notate Visionaire 

*Schedule a 2 View Femur X-ray same day as the MRI.  Schedule 1 hour before MRI.

                This must be done same day or it can affect the patients planned surgical date.

MRI Knee Lima Protocol (7678)

Drop Down in Exa: Knee without contrast Lima Protocol (Please choose correct side)

Duration: 30 minutes

ALAR PROTOCOL: 

Notate protocol in notes: Cervical Spine MRI

Drop downs: 

Cervical Spine without contrast (61)

Cervical Spine with and without contrast (964) 

3T preferred 

WAND: Notate protocol in notes

To look for brain tumors, All sites can perform this protocol

Drop downs: 

• Brain without contrast (995)

• Brain with and without contrast (958)

MRI Brain without contrast ARIA protocol (10155)

Duration:30 minutes

This exam will need to be marked STAT in the accession for every exam regardless if order indicates 

If patient is not safe for 3T, it can be performed at Maricopa

For patients undergoing the treatment of Alzheimer's Disease with a monoclonal antibody drug (Leqembi/Kisunla), a series of MRI Brain exams is ordered for ARIA monitoring.

Drop Down in EXA- MR BRAIN WITHOUT CONTRAST ARIA PROTOCOL (10155)

Order Example:

SWI - Susceptibility Weighted Imaging: Notate protocol in notes

Used to detect Blood Clots, Hemorrhage, or Calcium

Drop Down:

Brain without contrast (995)

Brain with and without contrast (958)

Duration: 30 minutes

MRI Brain with TBI

Drop Down:  

Brain TBI without contrast (7443) 

Brain TBI with and without contrast (7444)

Duration: 30 minutes

DTI- Diffusion Tensor Imaging, Evaluates Neural pathways such as motor- skills & speech

Notate protocol in notes

Drop down:

Brain without contrast (995)

Brain with and without contrast (958)

Duration: 30 minutes

Lesionquant/MS: Notate protocol in notes

MS protocols are only to be done on sites that have space or cube in order to do the 3D Lesionquant sequence. 

Drop down:

Brain without contrast (995)

Brain with and without contrast (958)

Duration: 30 minutes

Neuro Quant 

Neuroquant Protocol (7019)- BRAIN MRI WITH THE FOLLOWING DIAGNOSIS:

• Seizure

• Trauma (Brain)

• Dementia

• Memory Loss

• Cognitive Impairment

Functional MRI  (7034)

Drop down: MR Brain Functional FMRI

Put notes in the clinical and tech section “FUNCTIONAL MRI”    

Duration: 45 minutes 

MRI Spectroscopy 

MRI Brain Spectroscopy with and without contrast (409)

MRI Brain Spectroscopy with contrast (1260)

MRI Spectroscopy (without contrast) (957)

Duration: 30 minutes

MRI Thoracic Outlet Syndrome or R/O TOS

The order will mention Thoracic Outlet Syndrome or R/O TOS.

This may be ordered as:

MRI Brachial Plexus (Chest, neck or shoulder) with and without contrast (must be 60 min. in duration)

Or 

MRA Chest with and without contrast (must be 30 minutes in duration)

This can also be ordered with both exams combined. If so these will need to be scheduled for an 1 hour total with 2 accessions.

• They will sometimes order either a Brachial Plexus and or MRA of the chest you can schedule according to what is ordered.

MRI ZUK Protocol (Knee replacement) Notate protocol in notes

Drop down:

Knee without contrast (7640)

Knee with and without contrast (7634)

Duration: 30 minutes

MRI FETAL BRAIN

DROP DOWN: BRAIN W/O CONTRAST (995)

SCHEDULED: 30 Minutes   

No Prep

DBS PROTOCOL: (This is for Pre Op Only, Please do not confuse it for Post Op)

You might also hear doctors call this Dr. Ponce DBS Protocol, they are the same thing

Always put in the notes Clinical notes and in Tech notes: DBS PROTOCOL

Drop down:

Brain without contrast (995)

Brain with and without contrast (958)

Duration: 30 minutes

KFP PROTOCOL: Schedule Monday- Friday Only

These will be scheduled as MRI BRAIN W/O CONTRAST (995) & MRA HEAD W/O CONTRAST (10070)  NOTE KFP PROTOCOL

Always put in the notes Clinical notes and in Tech notes: KFP PROTOCOL

RELIEVANT STUDY PROTOCOL:

These are ordered by: Dr. Christopher Yeung, Anthony Yeung and Dr. Justin Field at DISC (Desert Institute for Spine Care)

These can be scheduled at any site, Notate protocol in the Clinical notes and Tech Notes: RELIEVANT STUDY PROTOCOL

If a tech calls and says they do not know what this protocol is please direct them to Bobbi Remme so she can provide them with the protocol form.