/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/,

/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98375-en.cckm

20180103

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Emergency Medicine

ED - Radiology Orders - Adult [844]

ED - Radiology Orders - Adult [844] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Radiology Orders - Adult [844]
Head
Altered Mental Status [136496]
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Altered Mental Status
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question ICH or mass
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Stroke [136708]
Stroke -Not to use with stroke code. If evaluating as part of stroke code, use this order set: ED
Adult [632].-Potential
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question intracranial bleed, skull fracture
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Page 1 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

MRA HEAD W/ O & MRA NECK W & W/ O & MRI
HEAD W & W/ O CONTRAST [R07007]
ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Question Stroke
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
Does patient have a pacemaker or defibrillator?
Allergy to Gadolinium (MRI) contrast?
For Scheduling purposes, is the patient claustrophobic
or require any form of sedation? Note: ordering
provider is responsible for prescribing oral anxiolytic or
ordering sedation services.
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Relevant Surgical History (Select all applicable or
None):
Implanted Devices? (Select all applicable or None):
History of Metal in Body? (Select all applicable or
None):
Has patient had a colonoscopy/endoscopy in the last 8
weeks?
Study Needed Within:
Last creatinine value? (will auto pull in date and value
in comment):
Last e-GFR value? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
Last patient height? (will auto pull in value and date in
comment):
Transport Method:
CT ANGIO HEAD, NECK W PERFUSION
[R07001]
ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Question Stroke
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Trauma [136565]
CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question intracranial bleed, skull fracture
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Page 2 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

CT CERVICAL SPINE W/ O IV CONTRAST
[R72125]
ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question cervical spine fracture or dislocation
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
CT MAXILLOFACIAL W/ O IV CONTRAST
[R70486]
ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Facial Trauma
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question facial fracture
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Chest
Pulmonary Embolism [136567]
Note: MRA Chest with Contrast should only be used for patients with a normal
radiograph and in whom PE is the only suspected diagnosis. MRA Chest with Contrast
should NEVER be done on a pregnant woman.
CT ANGIO CHEST PE PROTOCOL [R71275A] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question pulmonary embolism
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Page 3 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

MRA CHEST W OR W/ O CONTRAST [R71555] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Question pulmonary embolism
Relevant recent/past history?
Is patient pregnant?
Does patient have a pacemaker or defibrillator?
Allergy to Gadolinium (MRI) contrast?
For Scheduling purposes, is the patient claustrophobic
or require any form of sedation? Note: ordering
provider is responsible for prescribing oral anxiolytic or
ordering sedation services.
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Relevant Surgical History (Select all applicable or
None):
Implanted Devices? (Select all applicable or None):
History of Metal in Body? (Select all applicable or
None):
Has patient had a colonoscopy/endoscopy in the last 8
weeks?
Study Needed Within:
Last creatinine value? (will auto pull in date and value
in comment):
Last e-GFR value? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
Last patient height? (will auto pull in value and date in
comment):
Transport Method:
NM LUNG VENTILATION & PERFUSION SCAN
[R78588]
ONCE-RAD NEXT AVAILABLE, Routine
Relevant recent/past history?
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Question pulmonary embolism
For Scheduling purposes, is the patient claustrophobic
or require any form of sedation? Note: ordering
provider is responsible for prescribing oral anxiolytic or
ordering sedation services.
Is patient pregnant or breastfeeding?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Aortic Dissection [136589]
Page 4 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

CT ANGIO CHEST [R71275] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Chest pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question aortic dissection
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Abdominal
Kidney Stone/Nephrolithiasis [136590]
CT FLANK PAIN - UWH [243336]
CT FLANK PAIN [R99992] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms?
What specific question(s) would you like answered
by this exam? Please include relevant recent/past
history.
Last creatinine value? (will auto pull in date and
value in comment):
Last patient weight? (will auto pull in value and date
in comment):
Transport Method:
US KIDNEY LIMITED [R76775A] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Question nephrolithiasis / ureterolithiasis,
Question hydronephrosis
Relevant recent/past history?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Appendicitis (ADULTS) [136591]
CT ABDOMEN PELVIS W IV CONTRAST
[R07416]
ONCE-RAD NEXT AVAILABLE, STAT
Can pt be given oral contrast?
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question appendicitis
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
ED - Radiology Prep (Contrast) - Adult [133317]
exceedingly frail patients, cases with suspicion of high grade bowel obstruction, elderly or In
drink time for CT to 2 hours.UNSELECT G.I. lavage (GOLYTELY) and extend
Page 5 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

G.I. lavage (GOLYTELY) 236 G soln [103976] 1 L, Oral, ONCE For 1 Doses
Mix one 4 L container GI lavage powder with water
to fill line. Pour 1 Liter into graduated container and
add 30 mL iohexol to 1 Liter volume and mix.
Patient should drink 1000 mL over 60-90 minutes. If
scan is delayed have patient continue to drink slowly
until scan. May add Crystal Light lemonade powder
for flavor. Do NOT add ice.
iohexol (OMNIPAQUE) soln [785198] 30 mL, Oral, ONCE For 1 Doses
30 mL dose (ED): dilute in 1000 mL of Golytely
US ABDOMEN LIMITED [R76705] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Question appendicitis
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Small Bowel Obstruction [136592]
CT ABDOMEN PELVIS W IV CONTRAST
[R07416]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Can pt be given oral contrast?
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question small bowel obstruction
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
ED - Radiology Prep (Contrast) - Adult [133317]
exceedingly frail patients, cases with suspicion of high grade bowel obstruction, elderly or In
drink time for CT to 2 hours.UNSELECT G.I. lavage (GOLYTELY) and extend
G.I. lavage (GOLYTELY) 236 G soln [103976] 1 L, Oral, ONCE For 1 Doses
Mix one 4 L container GI lavage powder with water
to fill line. Pour 1 Liter into graduated container and
add 30 mL iohexol to 1 Liter volume and mix.
Patient should drink 1000 mL over 60-90 minutes. If
scan is delayed have patient continue to drink slowly
until scan. May add Crystal Light lemonade powder
for flavor. Do NOT add ice.
iohexol (OMNIPAQUE) soln [785198] 30 mL, Oral, ONCE For 1 Doses
30 mL dose (ED): dilute in 1000 mL of Golytely
Trauma [136624]
Page 6 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

CT ABDOMEN PELVIS W IV CONTRAST
[R07416]
ONCE-RAD NEXT AVAILABLE For Until specified,
STAT
Can pt be given oral contrast?
Current signs and symptoms? Trauma, Abdominal
pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question traumatic intraabdominal injury
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Mesenteric Ischemia [136625]
CT ANGIO ABDOMEN & PELVIS [R07030] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question mesenteric ischemia
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Cholecystitis [136626]
US ABDOMEN LIMITED [R76705] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? RUQ abdominal pain
What specific question(s) would you like answered by
this exam? Question cholecystitis or CBD obstruction
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Abdominal Aortic Aneurysm [136633]
CT ANGIO ABDOMEN [R74175] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question abdominal aortic aneurysm with
question of leak/rupture
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Page 7 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

US AORTA LIMITED [R76775B] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Question abdominal aortic aneurysm
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Kidney Transplant [136634]
US TRANSPLANT KIDNEY [R76776] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Renal Failure
What specific question(s) would you like answered by
this exam? Question resistive indices, question
hydronephrosis
Relevant recent/past history? History of renal
transplant
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
GU
Ectopic Pregnancy [136635]
US PREGNANCY < 14 WEEKS [R76801] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? *** Sided abdominal
pain in the context of pregnancy
What specific question(s) would you like answered by
this exam? Question ectopic pregnancy
Relevant recent/past history?
Is this to be done remotely (Not in Radiology)?
Transport Method: Floor Determined/Entered
Torsion (Ovarian) [136636]
US TRANSVAGINAL COMBINATION
W/DOPPLER [R07703]
ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Lower abdominal pain
What specific question(s) would you like answered by
this exam? Question torsion vs. ruptured cyst vs.
tubovarian abscess
Which side is to be imaged?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Testicular Torsion [136637]
Page 8 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

US TESTICLES/ PENIS [R76870] ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Testicular pain
What specific question(s) would you like answered by
this exam? Question torsion vs. epidydimytis vs.
orchitis
Which side is to be imaged?
Relevant recent/past history?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Hernia [136639]
CT ABDOMEN PELVIS W IV CONTRAST
[R07416]
ONCE-RAD NEXT AVAILABLE For Until specified,
STAT
Can pt be given oral contrast?
Current signs and symptoms? Abdominal pain
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history. Question strangulated bowel, bowel wall
edema, free fluid
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
ED - Radiology Prep (Contrast) - Adult [133317]
exceedingly frail patients, cases with suspicion of high grade bowel obstruction, elderly or In
drink time for CT to 2 hours.UNSELECT G.I. lavage (GOLYTELY) and extend
G.I. lavage (GOLYTELY) 236 G soln [103976] 1 L, Oral, ONCE For 1 Doses
Mix one 4 L container GI lavage powder with water
to fill line. Pour 1 Liter into graduated container and
add 30 mL iohexol to 1 Liter volume and mix.
Patient should drink 1000 mL over 60-90 minutes. If
scan is delayed have patient continue to drink slowly
until scan. May add Crystal Light lemonade powder
for flavor. Do NOT add ice.
iohexol (OMNIPAQUE) soln [785198] 30 mL, Oral, ONCE For 1 Doses
30 mL dose (ED): dilute in 1000 mL of Golytely
US ABDOMEN LIMITED [R76705] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
What specific question(s) would you like answered by
this exam? Question inguinal hernia
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Current signs and symptoms?
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Other
DVT [136640]
Page 9 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

US PERIPHERAL DOPPLER UNILATERAL
LEFT [R93971L]
ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Lower extremity pain
and/or swelling
What specific question(s) would you like answered by
this exam? Question DVT
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Upper or Lower Extremity?
Radiology Specialty Area:
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
US PERIPHERAL DOPPLER UNILATERAL
RIGHT [R93971R]
ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? Lower extremity pain
and/or swelling
What specific question(s) would you like answered by
this exam? Question DVT
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Upper or Lower Extremity?
Radiology Specialty Area:
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Abscess [136641]
US SUPERFICIAL [R76999A] ONCE-RAD NEXT AVAILABLE, STAT
What specific question(s) would you like answered by
this exam? Question abscess
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Current signs and symptoms?
Relevant recent/past history?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Page 10 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/2/2018 5:25:32 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org