Reading Room & Technologist Directory

Procedure Service-Lines

Clinician Resource

Consultation and Outpatient Clinic Services

Questions? Feedback?

Please email andrew.klobuka@upmc.edu

University of Pittsburgh

Department of Radiology

UPMC Montefiore, Presbyterian, Shadyside

MUH/PUH Radiology Reading Room DirectoryRadiology Residents and Attendings are available 7 AM – 5 PM Mon-Fri

Abdominal 647-7274

Cardiac 647-4300

Chest 647-6940

Fluoroscopy/Abdominal Plain Film

647-8154

Head and Neck 647-7209

Interventional(Alternatively, page IR on duty via operator)

864-6329

Musculoskeletal(located on 5th floor MUH)(Covers ED spine imaging)

692-2073

Nuclear Medicine/PET 647-5988

Neuro (Covers non-ED spine imaging)

647-8985

Ultrasound 647-7934

MUH/PUH Radiology Technologist DirectoryAvailable 8 AM – 5 PM Mon-Fri and on call 24 x7 via the Operator

*Weekend availability varies

Questions regarding scheduling/timing of imaging studies may be directed to the respective technologist areas as listed below:

PUH X-ray 647-6927

PUH CT 647-7619

PUH MRI 647-3018

PUH Ultrasound 647-7379

Fluoroscopy 647-3577

Nuclear Medicine 647-7259

Interventional HUC 647-6936

Cardiac MRI 864-3333

MUH X-ray 145-2417

MUH CT 648-6064

MUH MRI 802-8324

MUH Ultrasound 802-6130

SHY Radiology Reading Room DirectoryRadiology Residents and Attendings are available 7 AM – 5 PM Mon-Sat

Abdominal (also available

7AM – 5PM Sat and Sun)

623-4094

Chest 623-4091 or 647-6940

Musculoskeletal 623-4096

Neuro 623-4071

Nuclear Medicine & PET 623-2284 & 623-4836

SHY Radiology Technologist DirectoryAvailable 8 AM – 5 PM Mon-Fri and on call 24 x7 via Radiology Resident

CT 623-2095

MRI 623-1032

X-ray/Fluoroscopy 623-2081

PET/CT 623-3357

Ultrasound 623-2229

Nuclear Medicine 623-2282

Interventional 623-2088

Peripheral Vascular Lab 623-2224

On-Call Radiology Resident5 PM – 8 AM, 7 days-a-week

PUH/MUH Pager: 6953SHY Pager: 38596

Resident On-Call Coverage Includes Prelim reads for:• All STAT inpatient CT and MRI exams• All ED Musculoskeletal CT/MRI after 10pm• Any inpatient study upon request• Any ED plain film upon request• Triage requests for STAT Ultrasound, Nuclear Medicine, and

Fluoroscopy studies

After-Hours Emergency Department Coverage5PM – 7AM, 7 days-a week

Questions regarding CT and MRI exams performed in the Emergency Department may be directed to the 24x7 attending Emergency Radiology Division as below:

412-578-9500

Helpful Tips

• Ask! Call us with any questions regarding the need for or utility of CT

and MRI contrast agents Call us with any questions regarding MRI safety of medical devices

or foreign bodies

• Tell! The history you provide when ordering a test is crucial for us to

protocol your imaging modality and study correctly. Consider including a specific clinical question in your history. For Example:

“56 y.o. F with history of breast cancer, concern for liver mets due to elevated LFTs and abdominal pain”

• How do I find preliminary reads? You will need to open the study in ClinicView (via MyApps or the

iSite link in the upper PowerChart toolbar) Right click on any image in the study of interest Select “Show Preliminary Report” NOTE: You cannot view Preliminary reports when opening imaging

studies through the PowerChart Radiology Tab

Helpful Tips

• Looking for a read on an outside study? Upload to EIMS- Contact Radiology Techs/ED techs for assistance

and to request permanent storage.

Call the reading room or page the On-Call Radiology resident to request a preliminary read.

Per system policy, only Non-UPMC CT or MRI studies less than 24 hours old for which the outside report is unavailable may be submitted for formal interpretation in iSite (order in PowerChart).

However, we are happy to review outside images in person or via phone and render preliminary interpretations to assist in clinical patient care and prevent duplication of studies.

Contrast Allergy Pre-medicationElective:• Preferred Regimen:

• Prednisone 50 mg PO: 13, 7, and 1 hour prior to exam PLUS diphenhydramine 50 mg PO or IV, 1 hour prior

• Alternative 1: • Hydrocortisone 200 mg IV: 13, 7, and 1 hour prior • PLUS diphenhydramine 50 mg PO or IV, 1 hour prior

• Alternative 2:• Methylprednisolone 32 mg PO: 12 and 2 hours prior

PLUS diphenhydramine 50mg PO or IV, 1 hour prior

Emergency (in order of decreasing desirability):1. Methylprednisolone 40 mg or Hydrocortisone 200 mg IV

• STAT and Q4 until study• Add Diphenhydramine 50mg IV, 1 hour prior

2. Dexamethasone 7.5 mg or Betamethasone 6.0 mg IV• STAT and Q4 until study• Add Diphenhydramine 50 mg IV, 1 hour prior• Useful in patients with allergy to Methylprednisolone

or those with asthma3. Diphenhydramine 50 mg IV alone

NOTE:• Evidence only supports the use of IV steroids at least 6 hours

prior to IV contrast administration

All cases of Emergency Pre-medication must be discussed with the Radiologist prior to completion of the study.

Ordering an Image Guided or Interventional Radiology Procedure Consult

When requesting a procedure, please call the corresponding division to discuss how we can best help your patient, the technical feasibility of a request, and risks/benefits.

Please have the following information ready to help facilitate communication and completeness of consultation:• Name & MRN

• Location (hospital, floor, room number)

• Primary & consulting services

• Your name/contact information, including after-hours

• Brief clinical HPI and rationale for procedure

• Current anticoagulation & time of last dose (aspirin, warfarin, heparin, factor II or Xa inhibitors, anti-platelet agents)

• PT/INR/PTT/Platelets/H&H

• Relevant imaging & prior procedures, when & where?

• When did the patient last eat?

• Can the patient give their own consent? If not, who does and what is their name/contact information?

Selected Abdominal Intervention (AI) Cases Place the desired “Ultrasound Guided” procedure order in

PowerChart and page the AI Fellow/PA (PUH or SHY) for all cases.AI (PUS) Fellow Pager (24x7): 10405.

PUH AI Daytime Desk Phone: 647-6926SHY: Rotating- page via operator or call reading room

Abscess/Fluid drainageCeliac plexus nerve blocks

Cholecystostomy tubesCT-guided lung biopsy

Fine Needle Aspiration (FNA)Image-guided visceral core biopsy

ParacentesisRenal tumor ablation

ThoracentesisThyroid biopsy

Selected Fluoroscopy CasesPlace the desired order in PowerChart. Call Fluoroscopy or page

the On-Call resident to discuss which study is highest-yield.

Barium/Gastrografin enemasDuotube advancement

EsophagramsFistulagram

Modified barium swallowSmall bowel follow-through

Upper GI series

Selected Interventional Radiology Services Place “IR Consult” order in PowerChart and specify procedure in

“Reason for Exam”. Page the IR on-call resident/fellow.

Arterial:• GI bleed management• Visceral aneurysm

embolization• Hemoptysis• Traumatic arterial injury• Arterio-venous

malformations

Hepatobiliary:• TIPS• Trans-jugular liver biopsy• Percutaneous biliary

drains/stents

Venous:• IVC Filter placement and

retrieval• Venous thromboembolism

and PE thrombolysis• Chronic venous occlusion• Venous insufficiency• Vascular malformations

Oncologic:• Chemo/Radioembolization of

hepatic tumors• Central venous ports• Tumor ablation: Microwave &

Cryo for renal/lung/bone• Tumor embolization

Palliative Care:• Ablation of painful non-

spinal bony metastasis• Celiac nerve blocks• Pleural/peritoneal drainage

catheters and shunts

Venous Access:• PICCs• Tunneled Dialysis Catheters• A-V fistula management

Miscellaneous Interventions:• Catheter/tube changes and upsizing/downsizing

• Chylothorax/Lymphatic malformation management• Intravascular foreign body retrieval

• Percutaneous G or G/J tubes• Nephrostomy tubes

• Uterine Fibroid embolization

Selected Neuroradiology/Spine Interventional Cases

Mon-Fri 8 AM – 5 PM: LP/Myelo PA-C: Pickle Phone: 578-9430Mon-Fri 8 AM – 5 PM: Spine Nurses: Pickle Phone:145-0748

Page Neuroradiology Procedure Fellow for all Cases

Diagnostic Services:• C1-C2 puncture• Cisternograms• Discography• Lumbar Puncture

• Fluid sampling/removal• Pressure measurement

• Myelography• Percutaneous

biopsy/aspiration of:• Spine• Intervertebral disc• Paraspinous soft tissue• Epidural space• Sacrum

Therapeutic Services:• Epidural blood patch• Epidural steroid injection• Facet joint injection• Lumbar puncture• Lumbar drains• Medial branch blocks• Peripheral nerve blocks

• Occipital• Pudendal

• Palliative• Sympathetic nerve

ablation • Spinal metastasis

ablation• Piriformis injection• RF ablation (rhizotomy) of

facet and SI joints• Selective nerve root blocks• SI joint injection• Sympathetic blocks• Synovial cyst decompression• Trigger point injections• Vertebro/kypho/sacroplasty

Selected Musculoskeletal Intervention Cases Place the desired “Ultrasound Guided” procedure order in

PowerChart and page the Musculoskeletal Imaging Fellow (for PUH or SHY) for all cases or contact the respective reading room.

M-F 8AM-5PM: SHY MSK PA-C Pickle Phone: 623-1331

ArthrogramsBone biopsies

Bone marrow biopsyCT/Fluoro-guided joint injections- steroid + anesthetic

Joint aspirationSoft tissue/muscle diagnostic ultrasound

Ultrasound-guided soft tissue/muscle biopsy

All procedures related to bone, muscle, or cutaneous/subcutaneous soft tissues are managed by

Musculoskeletal radiology.

For skull, spine, and paraspinal muscle procedures, please contact Neuroradiology.

Radiology Consults and Interventional Outpatient Clinics

• Ask! Challenging clinical scenario or patient not a surgical

candidate? We are happy to provide inpatient consultation and guidance regarding whether an image-guided procedure may benefit your patient.

All Procedural services are available to meet with, examine, and provide consultant notes/recommendations for any inpatient.

• Would my patient benefit from longitudinal Interventional outpatient follow-up?

Interventional Oncology • Ex: HCC, RCC, primary/metastatic lung and bone tumors

Biliary Disease Palliative Care IVC filter follow-up and retrieval including complex cases Uterine Fibroids Vascular Malformations Venous Disease Spinal Disease

• Chronic Pain, Degenerative Disease, Malalignment, Osteoporosis, Intracranial hypotension, Metastatic disease

• Consider placing our Clinics in the Patient “Depart”• IR Clinic: 647-5050• Spine Clinic: 647-3543• Fibroid Center: 641-4435

Klobuka, Krosin, Akbari, Freed 6.30.16