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⭐ Best Practice Recommendations
Incidental Findings — All Guidelines
Liver · Renal · Adrenal · Thyroid · Pancreas · Adnexal · Pulmonary · Vascular · Spine
2026 ARI Quality Reporting Measures
Summa & MIPS measures · 2026
🏷️ Reporting & Scoring Systems
📋 Institutional / Quality
🔬 Diagnostic References
📂 ACR Incidental Findings White Papers
ACR Incidental Adnexal Findings on CT/MRI
2020
ACR Incidental Mediastinal & Cardiovascular Findings
2018
ACR Incidental Pituitary Findings
2018
ACR Incidental Pancreatic Cysts
2017
ACR Incidental Adrenal Masses
2017
ACR Incidental Renal Mass
2018
ACR Incidental Liver Lesion
2017
ACR Incidental Thyroid Findings
2015
ACR Incidental Vascular Findings
2013
ACR Incidental Splenic & Nodal Findings
2013
ACR Incidental Gallbladder & Biliary Findings
2013
ACR Incidental Abdominal Findings
2010
🩸 Interventional Radiology
📝 Documentation & Coding
💊 Medications & Prep
🩸 Trauma Grading (AAST)
🧠 Stroke & Neurointerventional
🦴 MSK & Other Procedures
📋 Protocols
🧠 CT — Head & Neck
Head Without Contrast
CT Brain
Head Without/With Contrast
CT Brain with contrast
IAC / Temporal Bones
High-res bone
Sinuses — Axial
Paranasal sinuses
Sinuses — Coronal
Paranasal sinuses
Sinuses Image Guided (Medtronic)
WRH surgical nav
Sinuses Image Guided (BrainLab)
Summa surgical nav
Maxillofacial With Contrast
Mass or inflammation
Maxillofacial Without Contrast
Trauma
Orbits With Contrast
Soft tissues
Orbits Without Contrast
Trauma / bones
Neck With IV Contrast
Soft tissue neck
Neck Without IV Contrast
Soft tissue neck
Neck — Parathyroid
3-phase, parathyroid tumor
CTA Head
Intracranial vessels
CTA Head & Neck
Arch to vertex
CTA Neck
Carotid / vertebral arteries
CT Venogram Head
Dural venous sinuses
🫁 CT — Chest
Chest With Contrast
Portal venous phase
Chest Without Contrast
Routine non-contrast
Chest ENB
Electromagnetic navigation bronchoscopy
High Resolution Chest (HRCT)
Pulmonary fibrosis; insp + exp + prone
HRCT — Endobronchial Valve
Emphysema valve placement
Chest Low Dose Screening
Lung cancer screening; Lung-RADS required
Chest Low Dose Diagnostic
Nodule follow-up
CTA Chest (PE Protocol)
Pulmonary embolus, chest pain
CTA Chest — Attention Aorta
Aortic dissection / injury
CTA Chest — EKG Gated
Coronary, triple rule-out, aorta
CT Esophagography
Esophageal perforation
🫄 CT — Abdomen & Pelvis
Abdomen/Pelvis With Contrast
Routine oral & IV; portal venous
Abdomen/Pelvis Without Contrast
Renal colic, flank pain
Abdomen/Pelvis Without — Low Dose
Known renal calculi; DLP <650
Abdomen/Pelvis Dual Phase
Hypervascular liver lesion
Abdomen/Pelvis Triphasic
Hypervascular liver lesion (triphasic)
Abdomen/Pelvis Pancreas Protocol
Suspected or known pancreatic mass
Hemangioma Protocol
Known liver lesion; 5-phase
Adrenal Washout
Known adrenal lesion; 3-phase
Abdomen/Pelvis Split Bolus
Hematuria, renal mass
CT Urogram
Hematuria, renal mass; 3-phase
CT Cystogram
Bladder mass, hematuria; Foley required
CT Colonography
Supine + prone; bowel prep required
CT Small Bowel Enterography
Volumen oral contrast; NPO 6–8 hrs
CTA GI Bleed
3-phase; arterial + delayed
CTA Abdominal Aorta
AAA, renal/mesenteric arteries
CTA Aorta — Post Stent Graft
Endoleak surveillance
CTA Aorta With Bilateral Run-Off
Arch or above-renal to feet
CTA DIEP
Deep inferior epigastric perforators; breast reconstruction planning
CTA Lower Extremities
Inguinal region through feet; peripheral arterial disease
CTA Upper Extremities
Aortic arch through fingertips; upper extremity arterial disease
CTA PAP Flap
Profunda artery perforator; breast reconstruction planning
🦴 CT — Spine
🦵 CT — Extremities
CT Shoulder
Without contrast
CT Elbow
Without contrast
CT Wrist
Without contrast; scaphoid note included
CT Hand
Without contrast
CT Pelvis (Bones)
Without contrast; iliac crests to trochanters
CT Hip
Without contrast; acetabulum to trochanter
CT Knee
Without contrast
CT Ankle
Without contrast; 64-MDCT & 16-MDCT params
CT Foot
Without contrast; 64-MDCT & 16-MDCT params
CT Sternum
Without contrast
CT Sternoclavicular Joints
Without contrast
Extremities With IV Contrast
Infection, abscess, or mass
🧠 MRI — Neurologic
Brain — Routine
Standard brain MRI
Brain — Tumor / Mass / Mets
With contrast; 3D MPRAGE post-gad
Brain — MS / Demyelinating
3D FLAIR; 5-min gad delay
Brain — Seizure (Dr. Rossi)
3T preferred; SPACE sequences
Brain — Refractory Seizures
Non-Rossi; patients <70 y.o.
Brain — Stroke
Routine + optional MRA/perfusion
Brain — AVM
Routine + intracranial MRA & MRV
Brain — Aneurysm
Routine + intracranial MRA
Brain — CSF Flow Study
NPH, Chiari, aqueductal stenosis
Brain — Traumatic Brain Injury
Subacute TBI; SWI + 3D FLAIR
IAC / 7th & 5th Neuralgia
Bell's palsy, trigeminal neuralgia; CISS
Pituitary Gland
Dynamic post-gad coronal
Cervical Spine — Routine
Skull base through T1–2
Cervical Spine — Syrinx
Add axial T1 & T2 spoiled GE
Cervical Spine — Post Op
Routine without Gad
Cervical Spine — Tumor / Infection
With Gad; fat-sat post-contrast
Thoracic Spine — Routine
Vitamin E marker at C-T junction
Thoracic Spine — Tumor / Infection
With Gad; fat-sat post-contrast
Lumbar Spine — Routine
Angled axial blocks through disc spaces
Lumbar Spine — Post Op / With Gad
Pre & post Gad axials over entire spine
Spine — CSF Flow
2D phase contrast; pulse gating
Abbreviated Total Spine Survey
Cord compression, mets, infection
Orbits
Whole brain + orbital sequences
Neck
Soft tissue neck with Gad
TMJ
Bilateral open & closed positions
🦵 MRI — Musculoskeletal
Knee — Routine
PD Fat Sat; do not angle sagittals
Knee — Arthrogram
Post-injection T1 & T2 Fat Sat
Shoulder — Routine
Coronal, sagittal, axial PD
Shoulder — Arthrogram
Post-injection; includes ABER view
Brachial Plexus
Large bilateral + small unilateral FOV
Pectoralis Major
Shoulder coil; pectoralis insertion
Wrist — Routine
Plain films needed; smallest FOV
Wrist — Arthrogram
Post-injection T1 & T2 Fat Sat
Hand — Routine
High-res axial PD
Hand — Arthritis
Bilateral; screening inflammatory arthritis
Digit
Thumb: scan in plane of thumb
Hips
Bilateral body coil + unilateral small FOV
Hip — Arthrogram
Post-injection; axial oblique
Pelvis — Bony
Routine hips covering entire pelvis
Quadriceps / Thigh
Bilateral large + unilateral small FOV
Adductor Detachment / Athletic Hernia
Axial oblique through symphysis
Sacroiliac Joints
Oblique coronal & axial; with Gad
Sacrum
Axial, coronal, sagittal
Lumbosacral Plexus
Coronal oblique T1 Fat Sat + STIR
Extremity Mass
X-rays + skin marker required; Gad on all
Extremity Infection
Pre & post Gad; Fat Sat axials
Thigh (Other Than Mass)
Bilateral large + unilateral small FOV
Leg (Other Than Mass)
Bilateral large + unilateral small FOV
Ankle / Foot — Routine
Plain films if for bone; hindfoot = ankle
Foot — Neuroma
Routine + coronal T1 Fat Sat pre & post
Foot — Infection
Axial = long axis; coronal = short axis
Elbow — Routine
Set off axial; include bicipital tuberosity
Elbow — Arthrogram
Post-injection T1 & T2 Fat Sat
Elbow / Arm — Bicep Rupture
Large FOV 200–250 cm sagittal
Forearm
Axial, sagittal, coronal PD Fat Sat
Total Body — Multiple Myeloma
Coronal T1 + STIR; head to toe
🫄 MRI — Abdominal
Liver — Routine
Dynamic multiphase; single breath hold
Spleen
Same as routine liver; 15-min delay
Liver — Eovist
Hepatoma, cirrhosis, mets; 20-min imaging
Pancreas
MRCP + dynamic multiphase
Biliary System — MRCP
3D triggered + in/out phase; liver included
Renal
In/out phase; dynamic + subtraction images
MR Urogram
IV Lasix required; nursing needed
Adrenal Gland
In/out phase GE axial & coronal
Abdomen — Nonspecific
Abdominal pain; diaphragm to iliac crests
MRI Enterography
Prone; Volumen 3×450 ml; optional glucagon
Pelvis — Soft Tissues / Bladder CA
DWI; post-gad if requested
Pelvis — Perianal Fistula
No rectal gel; angled to anal canal
Pelvis — Congenital Uterus
Müllerian anomaly; angled along uterus
Pelvis — Endometriosis
T1 Fat Sat + T2*; no-fat-sat sequences
Pelvis — Urethral Diverticulum
Large + small FOV; SPACE if available
Pelvis — Uterine Artery Embolization
Angled to long axis of uterus
Pelvis — Pelvimetry
Oblique inlet coronal T1
Pelvis — Placenta
T1 GE + T2 TSE breath hold; 3 planes
Rectal / Cervix Staging
3T; 120 ml rectal gel; axial oblique to tumor
MR Defecography
COE & Barberton only; SSFP cine dynamic
Prostate
3T; DWI b1400; multiphase post-gad
Scrotum
Small flex coil; pre & post Gad
Penile MRI
Position sagittally; in/out phase + DWI
Abdomen/Pelvis — Appendicitis in Pregnancy
SSFSE breath hold; wide coronal FOV
Abdominal Wall Mass
Area of interest only; palpable marker
MRI Chest
Prone for anterior structures
🩸 MRI — MRA / Vascular
MRA — Circle of Willis
3D TOF combined MOTSA
MRA — Carotid (With Contrast)
Arch to Circle of Willis post-gad
MRA — Carotid (Non-Contrast)
2D or 3D TOF; bifurcation focus
MR Venogram — Head
Dural venous sinuses; 2D TOF
MRA — Inferior Vena Cava
2D axial MRA; 30-sec delay post-gad
MRA — Renal Arteries
3D TOF post-gad; coronal subtraction
MRA — Renal Arteries (Donor)
Timing bolus; 3D TOF + coronal T1
MRA — Renal Veins
10-sec delay; 5 cc test bolus
MRA — Portal Vein
2D TOF sat bands; double-dose post-gad
MRA — Thoracic Aorta
Cardiac gating; candy-cane para-sagittal
MRA — Aortic Arch & Great Vessels
Para-sagittal CareBolus
MRA — Abdominal Aorta
Coronal 3D CareBolus
MRA — Peripheral Lower Extremity Run-Off
Renal to ankle; 2-phase injection
🎀 MRI — Breast
📄 Other Reference
📷 Radiography & Ultrasound
☢️ On-Call & Emergency Procedures
🔗 Helpful Links & Info
ACR Contrast Reaction Protocol
Emergency reference
Sugano's Tech Tips
Phone Directory for Tech Areas
Phone Numbers for Neurologists
Reference Articles
Summa Telephone Directory
CareOne Sign-off — WRH (Off-site)
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Dr. Unger — CTA Abdominal Wall for Flaps (DIEP)
📁 ARI Documents
📊 Quality & Compliance
2026 ARI Quality Reporting Measures
Summa & MIPS measures · 2026
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