RADIOLOGY FAQs
How do I place an order for an IR procedure?
Under “orders” enter: Interventional radiology case order. For provider, select “IR Physician Resource SJ.” For procedure, select: “Miscellaneous IR request.” For procedure description, type the name of the procedure you are requesting. Then sign the order. This will allow the IR staff to see the order on their worklist. Additionally, if it is an emergent/urgent procedure, a call to the “Radiology Nurse” or IR attending will speed up the process as the worklist is not checked constantly due to staff being in and out of procedures.
My patient has kidney failure. Can they get a CT with contrast?
For patients without ESRD who have a GFR below 35, IV contrast is not recommended; however, if the clinical provider believes the benefits outweigh the risks, the study can be performed. In that case, it is recommended that the patient receive IV hydration prior to the study and usually after as well. Patients who are ESRD on regular dialysis may proceed with the study regardless of their GFR.
How do I get a VQ scan after hours?
If after hours, call the operator and ask to be connected to the on-call nuclear medicine technologist. If able to get IV contrast, CTA PE protocol is the preferred study.
How do I get an MRI after hours:
Please have the MRI safety form completed. Some people are not able to safely get an MRI, i.e. there are risks of severe injury to them, so make sure there are no contraindications prior to calling in the technologist. Then call the operator and ask to be connected to the MRI technologist on call. They will likely ask whether the form is completed and what the indication for the MRI is. There are few emergent reasons for an MRI, primarily suspected cauda equina, cord compression, or epidural abscess.
Does my patient need to be NPO for a paracentesis?
No. This goes for thoracenteses and PICC lines as well, and any procedure in which sedation is not required. FYI, most solid organ biopsies and abscess drains require sedation.
When is “fill in the blank” procedure going to happen?
For most non-radiology residents, the IR service is elusive and mysterious. What do they do? Are the radiology residents also IR residents? Who are the IR nurses and how do I get a hold of them?
To start, IR procedures are generally done either in the cath lab (bone marrow biopsies, fistulagrams, abscessograms, chole tube placement/exchange, embolizations, vertebroplasty, etc.); fluoroscopy suite (lumbar punctures, hip aspirations); ultrasound/CT suite (solid organ/lymph node biopsies, abscess drains). Cath lab procedure schedule is available on EPIC similar to the MAIN OR schedule. Alternatively, you can vocera “Radiology Nurse” to talk to the IR nurses or call cath lab at 22740. Radiology residents may or may not be involved in the IR procedure in question and generally have little to no information about procedures taking place in the cath lab.
Is there a way to get a midline or PICC line after hours or on the weekend?
The vascular access team should be contacted first, both during the week and during off hours, i.e. after 4pm on weekdays and anytime on the weekend. Vascular access is sometimes unable or unavailable to place lines, in which case IR can be contacted, however, on the weekend, line placement is limited.
Can you do “fill in the blank procedure” tonight/this weekend?
Depends. Most procedures will be done during the week during the day unless there is an emergent reason for the procedure. There is only one resident on site during the evening and weekends, and their primary responsibility is to read stat exams, answer diagnostic questions, and communicate critical findings.
A patient came to the ED because their dialysis graft/fistula is not working. Can they get a declot?
Yes! If after hours and the patient does not need emergent dialysis, they can go home and schedule an outpatient fistulagram/declot assuming there is no other reason to admit them. Just put in an IR case order request. If they need emergent dialysis, a temporary central line will need to be placed which is usually done by general surgery for immediate dialysis. After dialysis, that day or the following day, a fistulogram/declot can be performed by IR.
GI Bleed. What is the best study?
If stable, get a CTA abdomen/pelvis.
How do I order the contrast preparation for patients allergic to contrast requiring a CT?
Type in “Contrast” and select the order set “Rad IP Contrast Allergy Focused.” In most cases you will select the Prednisone/Diphenhydramine Contrast Premedication Panel which requires 13 hours premedication. There is also an option for a 4 hour emergency contrast prep.
MRI department hours:
Monday-Friday: 7am-8pm.
Saturday: 7am-
Sunday: Closed.
If emergent study needed outside of the above hours, fill out MRI safety form and call operator to get a hold of on call MRI tech.
NM department hours:
Monday-Friday: 7am-4pm, On call 4pm-9pm.
Saturday/Sunday: On call 7am-9pm.
Interventional Radiology:
Monday-Friday: 8am-5pm.
Saturday & Sunday: On call. Call Radiology Resident on vocera between 7am & 11pm. Otherwise, call hospital operator to connect you to the on call IR attending.
Radiology Resident Hours:
Sunday-Saturday: 7am-11pm.
Vocera:
Radiology Resident
Radiology Tech
Ultrasound Tech
MRI tech
Nuclear Medicine tech
“Radiology Nurse” = for the IR nurses (current IR nurses also reachable on vocera by name: Ed Sidler & Jamie Udal).
Questions regarding status/time of procedures, anticoagulation before/after, midlines,etc.