Thread by @PamelaJohnsonMD

Doctors, APPs, residents & fellows: Do you know which abdomen CT protocol to choose when ordering? If not, read this quick #tweetorial to ensure that your orders optimize patient care quality, safety & value. @mmahesh1 @RadiologyACR @guptaarjun90 @m_e_nielsen @aapmHQ @ImageWisely

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Quick question to gauge your understanding.
What is abdominal CT with & without IV contrast?

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Abdomen CT with & without contrast involves a non-contrast scan (no IV, no PO) followed by 1 or more scans after IV contrast infusion. This protocol delivers 2⃣-4⃣x more radiation vs abdomen CT with IV contrast & is more expensive for patients & payers.
jacr.org/article/S1546-…

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The most widely used protocol is CT AP with IV contrast. Why is IV important? Because the contrast enhancement of vessels & organs enables us to make many diagnoses that are not apparent on a noncontrast scan.
When does CT with & wo IV add value? Read on.

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Abdomen CT with & without IV contrast is appropriate for
1⃣ focal liver mass evaluation
2⃣ adrenal nodule evaluation
3⃣ hematuria* or renal mass evaluation
4⃣ gastrointestinal bleeding*
5⃣ s/p AAA endovascular stent
Reference: choosingwisely.org/clinician-list…

*include pelvis for GI bleeding, aortoiliac stents and hematuria.

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Otherwise, if patients don't have contraindications to IV contrast, order CT abdomen +/- pelvis with IV contrast. The best resource for questions about imaging test or protocol is your radiologist. Give us a call & we will help you pick the best exam and the correct protocol.