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/clinical/cckm-tools/content/order-sets/hod/radiation-oncology/name-123025-en.cckm

201712335

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,HOD,Radiation Oncology

Rad Onc - MRI View Ray Planning - Procedure [5535]

Rad Onc - MRI View Ray Planning - Procedure [5535] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Radiation Oncology


RAD ONC - MRI View Ray Planning - Adult - Procedure [5535]
MRI
Radiation Oncology ViewRay/CT Planning [RADONC0012] [182626]
Radiation Oncology ViewRay/CT Planning
[RADONC0012]
Routine
Consent obtained from patient?
Does Patient have a Pacemaker or Implanted
Defibrillator?
Does Patient have Implanted Devices?
History of Metal in Body?
Relevant Surgical History?
Colonoscopy/Endoscopy in Last 8 Weeks?
Is Patient Claustrophobic?
Is There a Possibility of Pregnancy:
Use Gadolinium Contrast?
Diagnosis:
Page MD for Setup:
Physics Present at MR/CT: Yes
Is Planning CT Required?
Patient Position - Body:
Patient Position - Other:
Target Site:
Other Directions to ViewRay Therapists:
Other Directions to CT Therapists:
Instructions for Patient:
Pregnancy Test [183923]
HCG, QUALITATIVE, URINE [UPREG] Status: Standing, Expires:4/1/18 MANUAL,Count:1,
Normal, Routine
MRI Contrast Agents [183906]
UW Department of Radiology
Contract Corner
URL: https://www.radiology.wisc.edu/fileShelf/contrastCorner/gadcalc.php
gadoxetate disodium (EOVIST) 0.25 MOL/L
injection [131458]
10 mL, Intravenous, ONCE For 1 Doses, Radiation
Oncology
gadobenate dimeglumine (MULTIHANCE) 529
MG/ML injection [107266]
0.5 mL/kg, Intravenous, ONCE For 1 Doses, Radiation
Oncology
gadobenate dimeglumine (MULTIHANCE) 529
MG/ML injection [107266]
0.2 mL/kg, Intravenous, ONCE For 1 Doses, Radiation
Oncology
gadofosveset (ABLAVAR) injection [791517] Intravenous, ONCE For 1 Doses, Radiation Oncology
Patient Care Orders
Nutrition [182629]
NPO for Procedure - Hold Diet [DIE0007] CONTINUOUS NPO, Routine
NPO For Which Procedure? Radiation Oncology
Modifiers: NPO EXCEPT MEDICATIONS
Radiation Oncology
Medications - General
Swallow Contrast [182697]
barium sulfate (E-Z-PASTE) 60% esophageal
cream RADIOLOGY ONLY [791511]
30 mL, Oral, ONCE For 1 Doses, Radiation Oncology
Laboratory
Pre Laboratory Order [182634]
CREATININE [CRET] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Radiation Oncology
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 11/30/2017 5:38:50 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

HCG, QUALITATIVE, URINE [UPREG] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Radiation Oncology
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 11/30/2017 5:38:50 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org