Help!

Here's a list of potential situations you may face after-hours.

• Upload images from a disc

  • Sometimes, teams may ask you to read images from a disc. During normal business hours, there’s a secretary to help upload images directly onto PACS. After hours, inform the team that we can’t get it onto PACS, but can take a look in person in the reading room.

• Breast ultrasound

  • Occasionally there may be a request from ED to drain a collection related to a breast implant. 

  • Please see this document for instructions: https://drive.google.com/file/d/1QBr6N9ap_HF5OuKLwgkxkzFUf4Ab8cs3/view?usp=sharing

• Peds Upper GI

  • Occasionally a pediatrician at MSW will ask for a STAT upper GI case overnight.

  • This is an EMERGENCY and requires a resident to be called in to do it.

  • When the resident arrives, have them get in touch with the peds radiologist on call. 

  • Here is more information: https://sites.google.com/site/radrezslr/on-call/peds-on-call

• Contrast extravasations

  • This is mostly done to exclude compartment syndrome.

  • If concern for compartment syndrome, consult surgery. 

    • Findings: progressive swelling or pain, altered tissue perfusion as evidenced by decreased capillary refill at any time after the extravasation has occurred, change in sensation in the affected limb, and skin ulceration or blistering.

  • General algorithm:

• CT cystogram

  • If requested after hours, make sure to ask who is coming with patient/make sure someone (i.e. patient's care team) administers the contrast into Foley. Or if you have time, you can also volunteer to do it.

  • Guide here: https://drive.google.com/file/d/1_907BjjxtYXPnRN3eD9oSLNSGrQBiJPl/view?usp=sharing

• Epic is down/downtime

  • See here: https://drive.google.com/file/d/1Pmtr9VAC7tz7_0Q-pu5x4SIzaLQeoW7Q/view?usp=sharing

• Pregnant Appendicitis MRI

  • This is an emergent condition and warrants us calling in the on-call Body MRI person.

  • We can also see if the night attending will take a look and/or finalize it.

• Calling in an MRI Tech

  • The MRI techs are off site/on call from 11pm-7am.

  • During this time, if there is concern for one of the following things, we need to call in the tech. (source: http://radiology.mountsinai.org/attachments/article/107/MR-3%20Indications%20for%20Calling%20in%20the%20On-call%20MRI%20Tech.pdf)

    • Suspected cord compression or Cauda equina syndrome

    • Visual loss – i.e. optic neuritis, CCF, pseudotumor, and mass  

    • Carotid or vertebral artery dissection  

    • Normal head CT with high suspicion of acute infarct which requires PTA – 3 hr. window 

    • Rule out hip fracture in patient with strong clinical suspicion based on inability to bear weight and negative or indeterminate plain film.  

    • Suspected septic joint 

    • Appendicitis in pregnant patients 

    • Aortic dissection if CT with iodinated contrast cannot be used.

  • First, make sure the indication is appropriate, and the team has completed the MRI safety form – we want to make sure there are no doubts before waking up the techs.

  • Here are numbers for MRI Techs on call:

    • Morningside: https://docs.google.com/spreadsheets/d/1Zt47YWn8b3C5Hwn6UteCZt-fH7gjDhHG/edit#gid=689912911 

    • West: Page West MR Tech ON CALL pager 32194 by calling 212-523-2828. Click here for additional steps, and scroll down to "WEST MRI TECH ON-CALL".