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998540058-1.pmd

Department of Radiology & Imaging Services
1105 Central Expressway North• Allen, Texas 75013
Phone (972) 747-6141 • Fax (972) 747-6147
ICD-9 Code
 Send CD  Call Report  Call Patient Patient Phone: NUCLEAR MEDICINE
 XR IVP  with tomos  without tomos  Gastric Emptying Hepatobiliary/HIDA Scan FLUOROSCOPY
CONTRAST/ LABS
  Dobutamine  Lexiscan  Treadmill INTERVENTIONAL RADIOLOGY
For Cath and Interventional Radiology Contact ULTRASOUND
 Peripheral Arterial Doppler (with segmentals)  Renal Testicles Thyroid  Thyroid/FNA Biopsy Venous Doppler (for DVT)  R  L  Venous Doppler (Insufficiency)  R  L DEPARTMENT OF RADIOLOGY
AND IMAGING SERVICES
SPECIAL PREPARATIONS
These preparations must be followed completely to insure accurate test results. Inadequate preparations will result in reschedul-
ing of your exam. Please consult your physician before discontinuing any medications.
Barium Enema (BE)

Beginning at noon two days before exam, eat only clear broth, clear Jell-O, clear fruit juices, soft drinks,tea, coffee (without milk or cream) until exam is completed. DO NOT EAT SOLID FOOD, MILK OR MILK PRODUCTS.
The day before the exam, between 1:00 p.m. and 2:00 p.m. drink 12-16 ounces of water.
At 3:00 p.m., drink 10 ounces of cold Magnesium Citrate.
At 4:00 p.m., take 2 Dulcolax tablets.
At 5:00 p.m., have a cup of bouillon, gelatin and plain tea or coffee or clear juice.
Between 6:00 p.m. and 7:00 p.m., drink 12-16 ounces of water.
Do not eat breakfast on the day of the procedure. You may drink plain tea or coffee or clear fruit juices.
Upper GI / Small Bowel (UGI / SBS)
Do not eat, drink, or smoke after midnight the day before the exam until the exam is completed NOTE: If you have had a barium enema within the past seven days Take 4 oz. Neoloid or 2 oz. Castor oil at 2:00 p.m. on the day prior to the Upper GI exam.
CT SCAN (Head, neck, chest, spine): Do not eat or drink for three hours prior to your exam time if receiving contrast.
CT SCAN (Abdomen and / or pelvis): Nothing to eat 3 hours prior to exam time. Oral contrast will be needed in most
cases. Please pick up contrast the day before your exam and instructions will be given on a case-by-case basis.
Drink plenty of water.
Hepatobilliary Scan: Nothing by mouth for 8 hours prior to exam. Patient should be off of Pain medications for 10
hours prior to exam.
Thyroid Uptake / Treatment: Nothing to eat or drink 4 hours prior to dose and 1 hour after dose. Patient should be off all
thyroid medication for up to 30 days prior to scan. Please call Nuclear Medicine Dept. @ 972-747-6554 Intravenous Pyelogram (IVP) (Kidneys):
A.
Take 4 oz. of Neoloid or 2 oz. of Castor oil at 2:00 p.m. on the day prior to the exam.
Do not eat after midnight until after the exam is completed.
Renal Nuclear Scan: no prep
A.
Lasix Renal Scan - Patient should be off Lasix for 24 hours.
Captopril Renal Scan - Contact Nuclear Medicine.
MRI (MRCP): Nothing to eat or drink 8 hours prior to exam.
Sonogram (Abdomen, liver, gallbladder, pancreas): Nothing to eat or drink after midnight prior to the day ofexam. If you are
scheduled after 12:00 noon, do not eat or drink 8 hours prior to your exam time.
Sonogram (Abdomen with pelvis): Do not eat or drink after midnight until morning of exam at which time you must drink at
least four 8 oz. glasses of water 45 minutes prior to exam time.
10. Sonogram (Aorta): Nothing to eat or drink 8 hours prior to exam.
11. Sonogram (Pelvis): Drink four 8 oz. glasses of water at least 45 minutes prior to time of exam. DO NOT VOID! Your bladder
must be full when you arrive for your exam.
If you have had a previous allergic reaction to contrast, please notify the radiology nurse at (972) 747-6175 prior to
beginning your preparation.

If you are currently taking medication Glucophage (Metformin), please notify the radiology nurse at (972) 747-6175 before
beginning your preparation.

All patients over 65 years of age that require intravenous contrast material during the examination need to have
Creatinine prior to exam, (CT abd, pelvis, & IVP), MRI with contrast.

Attention Physician: For children and extremely elderly or debilitated patients, you may wish to consult a Radiologist
regarding preparation, you may call (972) 747-6187

DEPARTMENT OF RADIOLOGY
AND IMAGING SERVICES

Source: http://www.texashealthalliance.com/workfiles/PHA/Imaging/PatientOrderForm.pdf

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