1.) Prep for Barium Enemas:

It is essential that patients be properly prepared for barium enemas. Failure to do so results in costly delays. Please see the standard prep at nursing stations or contact the Department of Radiology.

Antibiotic prophylaxis may be given to patients in the following high-risk groups:

• Prosthetic heart valves
• Conduits
• Cardiac patches
• Surgically created shunts

Prophylaxis recommended is 1) Ampicillin, 2 grams I.V. 30 minutes prior, or 2) Vancomycin, 1 gram I.V. 30 minutes prior and Gentamycin, 2 mg/kg I.V. 30 minutes prior to procedure.

DAY BEFORE EXAMINATION:

• 12:00 Noon - Eat clear liquid meal (things you can see through such as bouillon, fruit juice, tea, 7-Up, hard candies, plain Jello). No solid foods. No dairy products (milk, cream, or cheese). No antacids.
• *1:00 PM - Drink 1.5 oz. (45ml) chilled or iced *Fleets phospho soda. Follow immediately with one 8 oz. glass of water.
• 2:00 PM - Drink 8 oz.water
• 3:00 PM - Drink 8 oz.water
• 4:00 PM - Drink 8 oz.water
• 5:00 PM - Drink 8 oz.water
• 6:00 PM - Eat clear liquid meal (same as above). No solid foods. No dairy products. No antacids.
• 7:00 PM - Take 4 Dulcolex (bisacodyl) tablets, swallow whole with a full glass of water. Do not chew or dissolve tablets.
• 7-9:00 PM - Drink more water.

DAY OF EXAMINATION: No Breakfast

At 6:00 am, the morning of the examination, take a 2 quart tap water enema, slowly administered. Do not use soap packet contained in enema kit!!

*PATIENTS WHO ARE SALT RESTRICTED should take either Citrate of Magnesia or castor oil INSTEAD OF Fleets Phospho Soda.

*PATIENTS WITH RENAL (KIDNEY) FAILURE should take caster oil INSTEAD OF Fleets Phospho Soda.

*Outpatients may get the BARIUM ENEMA PREP KIT #2 or the individual components at their local pharmacy.

2.) Prep for Esophograms:

NPO after midnight. The presence of an NG tube may cause aspiration. It should be removed prior to the exam and replaced, if needed, afterwards.

3.) Prep for Upper GI and Small Bowel Series:

NPO after midnight, including medications. Passage of a NG tube should be done before procedure if patient is unable to, or will not drink.

**Remember that CT scans done with oral contrast can cause delay in subsequent UGI, small bowel series and other abdominal exams. Please clean out patient with laxatives after CT scan if they are getting another exam afterwards. The reverse is also true: barium studies will interfere with subsequent CT examinations, for at least 24 or more hours.

4.) Prep for CT scan:

1. Any CT with IV contrast- NPO (excluding oral contrast) if possible for 4 hours prior; BUN should be normal/Cr (1.5 or less, especially in diabetics).
2. Chest CT without IV contrast- No need for NPO status.
3. For routine oral contrast administration for abdominal and pelvic CT, pre-mixed dilute barium is available either from nursing on the floors/in the ED, or from the radiology front desk/the CT technologists. Usually, two bottles are given, and the patient should drink intermittently over the course of an hour, with the last ½ a bottle drunk immediately prior to CT. In selected situations, additional oral contrast will be given to the patient. For certain standard indications, such as suspected retroperitoneal hemorrhage or ureteral stones, no contrast is administered.
4. Patients needing IV contrast should have IV access PRIOR to their arrival in the CT suite.
5. In selected situations, central lines can be used for IV contrast administration, but usually the contrast cannot be given at a rapid rate. PICC lines will not be used for the introduction of IV contrast.

5.) Premedication protocol:

Guidelines for pretreatment of patients who have previously had non-life threatening allergic reactions to IV contrast agents.

1. 50 mg prednisone PO 13 hours prior to procedure.
2. 50 mg prednisone PO 7 hours prior to procedure.
3. 50 mg prednisone PO plus a single dose of 50 mg of benadryl PO or IV 1 hour prior to procedure.

It is advised to avoid the use of intravenous iodine contrast agents in patients with a history of moderate or severe/life-threatening contrast reactions. In these instances, please contact the Radiologist to discuss alternative imaging strategies.

6.) Body CT Protocols:

1. Protocols for each specific patient will be tailored as needed by the Radiologist. The more history which is provided, the better the study can be set up to address the clinical issues.
2. The use of IV and PO contrast (usually dilute barium) is to be determined by the Radiologist.
3. Oral Gastrograffin (ie, water soluble iodinated oral contrast) should be given to a trauma patient via NG tube, however this should not delay the CT scan in marginally stable patients. Oral Gastrograffin should also be given when there is a suspicion of bowel perforation.

7.) MAGNETIC Resonance Imaging (MRI):

1. There are limiting factors to a patient having an MRI. There are questions that need to be asked as there are certain surgical implantable devices that are not MRI compatible. Please call the MRI staff to ask if a device in question is MRI compatible or not. Pacemakers, cardiac wires, and defibrillators are absolutely NOT MRI compatible, NOR are many intracerebral aneurysm clips (some new aneurysm clips might be MRI compatible and this needs to be discussed with the Radiologist). However, most patients who have had surgery, e.g. open heart surgery, valve replacement, orthopedic surgery, abdominal surgery, can undergo MRI, especially if it has been at least 6 weeks or more following the procedure. Please consult with the appropriate body imager or neuroradiologist regarding these patients, if there are any specific questions regarding their suitability to undergo MRI studies.
2. Please do not go into the MRI room with any metallic devices (i.e. stretchers, oxygen canisters) due to the strong magnetic field (it’s always on!). An oxygen delivery system is installed in the MRI scanner suite and NO oxygen canister should be brought into the MRI scanner suite. Do not enter the MR scanning suite until you are allowed entry beyond the safety partition by a Radiologist or other MR staff members.
3. If a patient codes while in MRI, the MR Technologist pulls the MRI bed that the patient is lying on OUT of the MRI room.
4. MRI studies are exquisitely motion sensitive, hence the patient should be capable of holding completely still for approximately 30 to 45 minutes.

8.) Nuclear Medicine Preparations:

There are many different preparations for the different types of Nuclear Medicine tests. The patient’s doctor should call the Nuclear Medicine Department with their request and the staff will inform him/her of the appropriate preparation for the test.

9.) Special Procedures:

1. The patient needs to be AAO x 3 to give informed consent or the next of kin (not any available relative) needs to available to give consent.
2. The patient needs recent lab work (within the last 48 hours if not anticoagulated, the last 24 hours if they are) including CBC, SMAC, PT/PTT/INR.
3. The patient needs to be NPO starting midnight prior to the procedure.
4. The patient needs to be off anticoagulants a time period necessary to have the medication adequately cleared from the patient’s system (i.e. 4-5 half lives for heparin)
5. Any patient that needs an emergency procedure needs to be consulted/evaluated by the Radiology Resident.

10.) IVP (Excretory Urogram):

No solids for 4 hours before the exam; fluids adlib; encourage PO fluids in diabetics

11.) Ultrasound (Sonography):

• All OB-GYN patients should not void starting two hours prior to the exam; they should be finished drinking 20 oz. of water, ½ hour before the exam. A “full” bladder is not required for an endovaginal ultrasound.
• For upper abdominal sonograms (including imaging of the liver, aorta, pancreas, spleen, etc.), patients should be NPO after midnight. Oral medication may be administered with a small amount of water.
• For gallbladder sonograms, patients should be NPO after midnight, and should have no fatty foods for 12 hours prior to the test.
• Amniocentesis preparation is the same as OB-GYN
• Pelvic sonogram preparation is the same as OB-GYN

12.) Pregnant Patient:

13.) Imaging–Guided Biopsies:

1. For spine or other potential head/neck biopsies, consult with the Neuroradiology Attending on service.
2. For all other potential biopsies (i.e. abdominal, pelvic, thoracic), consult with the Body Imaging Attending who is on the “biopsy service” that day. The Radiology front desk will know how to reach that particular person. Biopsies CANNOT be scheduled over the phone; a DIRECT conversation MUST take place, and all relevant films should be brought to the consulting Radiologist.