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Blood owing from the saturation band into have the correct phase angle for their real position and the imaging slice will have no time to diabetes symptoms signs in pregnancy cheap 500/5 mg glucovance with visa recover its z 88 6 diabetic vascular disease order glucovance 400/2.5 mg with mastercard. The to blood sugar quitting smoking purchase glucovance 400/2.5mg without prescription the number of sat bands you can use diabetic diet low sodium purchase glucovance with amex, but in practice chemical shift between fat and water is 3. If we look at the frequency spectrum from the known as gradient moment rephasing or ow compen human body we see two peaks, the larger one from sation. Extra gradient pulses with carefully calculated water protons and the smaller one to the right from strengths and durations are inserted into the pulse fats (gure 6. In As we will see in chapter 7, we use frequency-encoding contrast to spatial saturation bands, gradient moment in one direction, i. Due to the frequency dierence, the apparent position of fat signals is shifted by a number of pixels, but only in 6. It tends and dark bands on opposite sides of a structure, or as an to have high signal intensity at all contrasts, and that entire ghost image of the fat distribution in the anatomy can mask pathologies. This is called the chemical shift fact due to its structure, known as chemical shift arte artefact or chemical shift misregistration artefact. So to avoid an artefact you should ideally use detecting signals from protons (the nuclei of hydrogen a higher bandwidth. However, increasing the bandwidth atoms), but fat and water have very dierent struc also reduces the signal-to-noise ratio in the image, so it tures. While the gradient is switched on the stationary proton changes its frequency to match the eld strength at position x, and precesses at that frequency until the gradient is switched o. It therefore acquires a phase angle relative to protons at the isocen tre (gure 6. We need to remove this phase angle before applying the phase-encode gradient, so that the nal phase angle will depend only on the protons position in the phase-encode direction. This can be achieved by adding a negative lobe, equal in strength and duration to the slice select gradient, to rephase the static protons. The moving proton starts o at the same frequency as the stationary proton in position x, but as it moves in the direction of the gradient it experiences a changing magnetic eld (lets assume it is increasing). Its resonant fre quency will also increase to match the eld at each position, and as the frequency changes the moving proton will acquire a phase dierence relative to the static proton (gure 6. The rephase gradient doesnt correct this eect because (in simple terms) the moving proton starts from a dierent position during this gradient. It turns out that to correct the velocity-induced phase shift we have to make the rephase lobe twice as strong as the initial slice select lobe, and add a third positive lobe after it (gure 6. Notice that the phase of static protons is zero halfway through the second, negative lobe, but that the moving protons are not properly refocused until the end of the nal lobe. The gra dient area is more properly called the rst-order gradient moment, hence the term gradient moment nulling or gradient moment refocusing. This scheme for ow compensation works well provided the protons are owing at constant velocity. Constant velocity is known as rst-order motion (v dx/dt), and is a reasonably good model of blood ow in peripheral arteries and veins. However, in the larger arteries the blood is also accelerating and decelerating due to the heart beat, and has both second-order (acceleration, d2x/dt2) and third-order motion, known as jerk (d3x/dt3). Similar analysis of the second-order gradient moments (for accelerating protons) shows that four lobes are required with moments in the proportions 1:-3:3:-1, while for third-order motion six lobes with moments in the ratio 1:-2:1:-1:2:-1 are necessary. Thus it is possible to fully compensate for pulsatile blood ow using gradient moment nulling, but at the expense of a delayed echo time in order to t in all the gradient pulses. For this reason, most scanners only have rst-order motion compensation, but some have options for higher-order gradient moment nulling. Some texts call this chemical shift of the pulse of the sequence fat and water signals are in second kind, black line artefact, India ink or the phase with each other, but due to the small dierence phase cancellation artefact, which is the term we will in their Larmor frequencies they begin to dephase. The phase cancellation artefact appears as a black the echo is acquired when fat and water are exactly 90 6. This gives the by the 180 pulse, so that at the echo time they are back characteristic dark outline at fat/water interfaces, due in phase. Whether you want to avoid subcutaneous fat signal, improving the quality of the the artefact or not, its simply a case of choosing the maximum intensity projections (see gure 6. You need to know how much the fat image is shifted with respect to the water in order to know if the chemical shift artefact is a problem. The severity of the chemical shift eect depends on two things: the eld strength of the magnet and the receive bandwidth used for imaging. Some manufacturers quote the receive bandwidth in terms of the number of pixels by which fat will be shifted; this is the easiest way for operators to avoid the artefact! Others use hertz per pixel for the receive bandwidth; again this makes life easy as you just have to divide the chemical shift for your magnet strength by the bandwidth. Working out the chemical shift is a little more long-winded, so you might like to work it out for a range of bandwidths and either memorize them or have them in a handy notebook when you are at the console. Start by checking carefully in the manufacturers manuals whether the bandwidth is exactly as quoted or is it the value. In the latter case you need to double it in your calculation, as we will do in the following example. First work out the bandwidth in hertz per pixel; multiply by 1000 to get it into hertz, then divide by the frequency matrix. At the moment 256 is the commonest frequency matrix (although 512 is becoming much more popular), so in this example we will use 256. If the matrix is increased to 512, the shift will be more than ve pixels and will be more of a problem. The initial (inver the alternative technique is frequency-selective fat sion) 180 pulse inverts all the equilibrium magnetiza saturation, often known simply as fat sat or chemi tion, which then begins to recover towards the cal sat. As with the chemical shift arte fact, you might nd it useful to keep this information while in the second out-of-phase image (Soop) it is the in a handy notebook. We start with the chemical shift dierence: in hertz between fat and water, for example at 1. Fat and water are in phase imme By adding the two images, only the water signals diately after the excitation pulse, but we cant remain, while the subtraction of the out-of-phase acquire the signal immediately. The next time they image from the in-phase image produces a fat-only are in phase will be 1/220 s later, i. At eld strengths of 1 T and higher, the chemical shift is bigger and that improves H2O (a) (b) H2O the separation between the fat and water peaks. A fre impossible to saturate all the fat without affecting the quency-selective pulse is applied to the fat protons, fol water protons. At these them are easily shown using a cooking oil and elds it is possible to apply a good suppression pulse water phantom. Fill a deep plastic container one to just the fat, leaving the water protons unexcited, third full with water, adding a drop of gadolinium thanks to the higher chemical shift. Frequency-selec to reduce the T1, then carefully pour on some tive fat saturation pulses can be inserted before cooking oil until the container is two-thirds full. Under these cir see the chemical shift artefact, or try gradient-echo cumstances it is not possible to get a frequency scans with echo times for fat and water in and out selective pulse to adequately saturate all the fat of phase. Full details are In general partial volume artefacts occur in the slice given in chapter 12. This type of fat suppression is called select direction when the voxel size is rather large Proset on Philips scanners. Whenever a pulses can be used to saturate either fat or water, but voxel contains two or more tissues, the nal signal not all systems allow this. We can calcu late this for any mixture of n tissues as Partial volume artefacts occur wherever a voxel con S f1S1 f2S2 fnSn tains a mixture of tissue types. Considering that the typical voxel is 1 mm 1 mm 5 mm, it is easy to see where fn is the fraction of the voxel lled with tissue that in a structure as complex as the human body, most giving signal intensity Sn and fn 1. Chapter 5 deals averaged together using the signal intensity equa with the question of optimum resolution; in this section tion (gure 6. Unfortunately we cant do happens when the mixture of signals causes misleading the opposite to the thick slice, because we dont pixel intensities in the image. So the only Fortunately it is not too dicult to avoid the cure for partial volume artefact is to re-scan the area problem, by selecting a slice thin enough for the area with a higher resolution. Conversely 7 or duced in the transverse plane by inaccuracies in the 10 mm slices are appropriate for the liver, because it is 180 pulse. It doesnt the reason for nonrectangular slice proles is the have time to relax between the pulses, so its signal nature of selective excitation. However, you should bear in mind that large gaps tion pulse must be a sinc (sin(x)/x) function (gure reduce resolution, as tissues in the gap are not imaged at 6.

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Kent and Vernon have developed perhaps the best summary of the matter of categorizing technique procedures as tonal diabetes yahoo answers 400/2.5 mg glucovance with mastercard, postural or segmental blood glucose fat burning zone buy genuine glucovance online. These conceptual models determine the nature of the analytical procedures employed blood sugar count glucovance 500/5mg fast delivery, the type of adjustments applied diet diabetes ketika mengandung glucovance 500/5 mg with mastercard, and the criteria for determining the success or failure of a given intervention. Subluxation is described in terms of alterations in specific intervertebral motion segments. I n segmental approaches, the involved motion segments may be identified by radiographic procedures which assess intesegmental dis relationships, or by clinical examination procedures such as motion palpation. Practitioners of postural approaches evaluated global subluxations using postural analysis and radiographic techniques which evaluated spinal curves and their relationship to the spine as a whole. Examples of techniques emphasizing a postural approach are Pettibon Spinal Biomechanics and Applied Spinal Bio-engineering. Tonal approaches emphasize the importance of functional outcomes, and acknowledge that clinical objectives may be achieved using a variety of adjusting methods. Examples of tonal approaches include Network Spinal Analysis and Torque-release Technique. In reviewing the preceding basic science and clinical models of the subluxation, it may be seen that the wide diversity of techniques in chiropractic may use different methods, but generally share the common objective of correcting spinal nerve interference caused by vertebral subluxation. Commonality and accountability may be achieved through the -214 development of models which emphasize clinical outcomes yet afford the practitioner flexibility in determining how those objectives are achieved. Such outcomes include, but are not limited to, evidence of functional integrity of the nervous system, and improvement in general health and quality of life indicators. Research resources should be directed toward the development of models and clinical strategies which result in more predictable and more efficient practice procedures. The chiropractor shall not use any mode of care which has been demonstrated by critical scientific study and field experience to be unsafe or ineffective in addressing vertebral subluxation and other malpositioned articulations and structures. Chiropractic Adjustment Modes the following recommendations refer to the application of techniques as employed in the correction of vertebral subluxation and other malpositioned articulations and structures. Muscle Energy Techniques: A variety of procedures fall under this classification including post-facilitation stretch, post-isometric relaxation, and reciprocal inhibition, among others. In addition, there are several chiropractic techniques that use procedures mechanically and physiologically similar to these as part of their therapeutic armamentarium. The rationale for such procedures is based on the concept of reciprocal innervation and inhibition between agonist and antagonist muscles. Care is directed at finding such sites and having the patient do movements and muscle contractions, typically against some kind of active resistance in order to cause a relaxation of a hypertonic muscle. Myofascial Ischemic Compression Procedures: Ischemic compression involves placing a sustained compressive force on a tight or contracted muscle. This is thought to relax the muscle and thereby reduce stress to any joints to which the muscle is attached. The chiropractic profession has employed myofascial ischemic compression procedures and other soft tissue procedures as part of a care regimen for a long time. Miscellaneous Soft Tissue Techniques: There are many different kinds of muscle work in widespread use. Some common techniques of muscle work include: massage (superficial, effleurage, petrissage, percussion), pressure point work (accupressure and shiatsu), -216 and deep tissue techniques (Rolfing). There is little controversy regarding the clinical utility of such procedures for relaxation and uncomplicated musculoskeletal dysfunction. Light massage has occasionally been used as a placebo control in manipulation studies. Exercise and Rehabilitation (1) Mobility and Stretching Exercise: Activity mobility maintenance and stretching by the patient are traditionally encouraged in chiropractic practice. Training, counseling and advice in stretching and mobility exercises are common, and various descriptions of chiropractic programs exist in the literature. Trials on exercise in chiropractic settings have not been published, but there is function and performance information available in exercise physiology and sports medicine literature. Conditioning and spinal stabilization programs are becoming more common for chiropractic management of low-back conditions. In addition, numerous programs are in place that involve job stimulation and work hardening protocols that are directed at chiropractic management and conditioning for specific tasks. Practitioners, especially within the field of sports chiropractic, teach and use these procedures frequently. Back school programs and patient education have traditionally been an integral part of chiropractic case management. Typical disease prevention programs, smoking cessation, weight reduction efforts and the like fit well within chiropractic practice scopes. Nutritional Counseling: Nutritional training is included in the chiropractic curriculum. As a general issue concerning scope of practice, there is little disagreement regarding the capability or qualifications of practitioners to counsel patients concerning nutritional matters. Electrical Modalities: Electrical modalities have been a part of chiropractic education in some colleges and they are included in scope of practice regulations in many jurisdictions. Thermal Modalities these include cryotherapy, infrared, hydrotherapy, hydrocollator and others. These procedures are recognized within the chiropractic scope of practice in most jurisdictions. Bracing and Supports Supports, braces, orthotics and the like may be useful components of chiropractic care. Traction Traction may be employed to stretch muscles, joints, and intervertebral discs. As chiropractic addresses health care from a perspective involving the role that body structure plays in overall physiologic function, many procedures emphasize manual care procedures such as adjusting and soft tissue work. However, the profession has traditionally maintained a strong interest in wellness care and disease prevention, as well as lifestyle and ergonomic issues. Therefore education, conditioning, nutrition, counseling and other approaches are often used by many practitioners. It should be emphasized that chiropractic practitioners are typically well trained in a variety of standard assessment procedures, as well as specialized neurological and structural evaluation protocols. There has traditionally been an emphasis in chiropractic practice on lifestyle, wellness, prevention, and other natural approaches to health care. It is not the intent of this document to exclude any particular technique or procedure, but rather to provide general guidelines for the assessment of the safety and effectiveness of generic methodologies utilized by the chiropractic profession. As a living document, this chapter will be subject to periodic review as new and innovative methodologies are developed and submitted for evaluation. Bronfort G, Nielsen N, Bendixt B, Madsen F, Weeks B: Chiropractic treatment of asthma: a controlled clinical trial. Cauwenbergs P: Vertebral subluxation and the anatomic relationships of the autonomic nervous system. Changjiang I, Yici W, Wenquin L, et al: Study on cervical visual disturbance and its manipulative treatment. In Mazzerelli J (ed): Chiropractic Interprofessional Research, Edizioni Minerva Medica, Torino Italy: 1985, 21-32. Cooperstein R: Innominate Vertical Length Differentials as a Function of Pelvic Torsion and Pelvic Carrying Angle. Cremata E, Plaugher G, Cox W: Technique System Application: the Gonstead Approach. Fuhr A, Smith D: Accuracy of Piezoelectric Accelerometers Measuring Displacement of a Spinal Adjusting Instrument. Gemmell H, Jacobson B, Heng B: Effectiveness of Toftness Sacral Apex Adjustment in Correcting Fixation of the Sacroiliac Joint: Preliminary Report. Gitelman R: A Chiropractic Approach to Biomechanical Disorders of the Lumbar Spine and Pelvis. Haldeman S (ed): Modern Developments in the Principles and Practice of Chiropractic, 2nd ed. Klougart N, Nilsson N, Jacobsen J: Infantile colic treated by chiropractors: a prospective study of 316 cases. Lopes M, Plaugher G, Ray S: Closed Reduction of Lumbar Retrolisthesis: A Report of Two Cases. Malik D, Slack J, Walk L, Brooks S: Effectiveness of Chiropractic Adjustment and Physical Therapy to Treat Spinal Subluxation. Mansel D, Cremata E, Carison J, Szlazak M: Effect of Unilateral Spinal Adjustments on Goniometrically-Assessed Cervical Lateral-Flexion End-Range Asymmetries in Otherwise Asymptomatic Subjects. In Sweere J (ed): Chiropractic Family Practice, Gaithersburg: Aspen Publishers, 1992.

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Procedures which involve the use of ionizing radiation should be employed only when clinical need is established by the history and clinical assessment quit smoking diabetes symptoms purchase 500/5 mg glucovance mastercard. The potential benefits of a proposed imaging procedure should be carefully weighed against the risks and cost diabetes test otc discount 400/2.5 mg glucovance fast delivery. The most cost effective procedure which will provide the information needed should be employed whenever possible diabetes diet eggs 500/5mg glucovance with amex. Proceedinas of the Scientific Symposium on Spinal Biomechanics diabetes type 1 diagnosis code 400/2.5mg glucovance mastercard, International Chiropractors Association, 1989. Antos J, Robinson K, Keating J, Jacobs G: Interrater reliability of fluoroscopic detection of fixation in the cervical spine. Bale J, Bell W, Dunn V et al: Magnetic resonance imaging of the spine in children. Ball and Moore: Essential Physics for Radiographers, Blackwell Scientific Publications, 2nd Ed. Batzdorf U, Batzdorf A: Analysis of cervical spine curvature in patients with cervical spondylosis. Betge G: the value of cineradiographic motion studies in the diagnosis of dysfunction of the cervical spine. Bohlman H: Acute fractures and dislocations of the cervical spine: An analysis of three hundred hospitalized patients -306 and review of the literature. Castellvi A, Goldstein L, Chan D: Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Council on Chiropractic Imaging Handbook, International Chiropractors Association, 1992. Denis F, Winter R, Lonstein J: Pediatric spinal injuries, Proceedings of 22nd Annual Meeting of Scoliosis Research Society. DeSouza Dias L, Frost H: Osteoblastoma of the spine: A review and report of eight new cases. Eiken N: Roentgen Diagnosis of Bones, Chicago: Year Book Medical Publishers, 1975. Farfan H, Sullivan J: the relationship of facet orientation to intervertebral disc failure. Fielding J, Fietti V, Hughes J, Gabrielian J: Primary osteogenic sarcoma in the cervical spine. Friedlander G, Southwick W: Tumors of the spine, In Rothman R, Simeone F(eds): the Spine, 2nd ed. Gillet H: A cineradiographic study of the kinetic relationship between the cervical vertebrae. Graif M, Seton A, Nerubai J, Horoszowski H, Itzchak Y: Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations. Haldeman, S: Modern Development in the Principles and Practice of Chiropractic (ed. Henrys P, Lyne E, Lifton C, Salciccioli G: Clinical review of cervical spine injuries in children. Hensinger R, Lange J, McEwan G: Klippel-Feil syndrome: A constellation of associated anomalies. Jackson B, Harrison D, Robertson G, Barker W: Chiropractic Biophysics lateral cervical film analysis reliability. Janin Y, Epstein J, Carris R, Kahn A: Osteoid osteoma and osteoblastoma of the spine. Jenkinson S: Undescended scapula with associated omovertebral bone: Sprengells deformity. Kewalramani L, Tori J: Spinal cord trauma in children: Neurologic patterns, radiologic features, and pathomechanics of injury. Koentges A: Computerized axial tomography of the spine in the differential diagnosis of vertebral subluxations. Kopits S, Perovic M, McKusick P: Congenitalatlantoaxial dislocations in various forms, of dwarfism. Koyangi I, Isu T, Iwasaki Y, Akino M, et al: Radiological diagnosis of chronic spinal cord compressive lesion at thoraco lumbar junction. Martell W, Molt J, Cassidy J: Roentgenologic manifestations of juvenile rheumatoid arthritis. Martinez S, Morgan C, Gehwiler J, et al: Unusual fractures and dislocations of the axis vertebra. Masters B: A cineradiographic study of the kinetic relationship between the cervical vertebrae. McAfee P, Yuan H, Frederickson B, Lubicky J: the value of computed tomography in thoracolumbar fractures. Minderhound J, Braakman R, Pennig L: os odontoideum: Clinical, radiographic, and therapeutic aspects. Murray R, Jacobson H: the Radiology of Skeletal Disorders, New York: Churchill Livingstone, 1977. Nathan F, Bickel W: Spontaneous axial subluxation in a child as the first sign of juvenile rheumatoid arthritis. Novick G, Pavlov H, Bullough P: Osteochondroma of the cervical spine: Case reports. Pennecot G, Leonard P, Peyrot S, et al: Traumatic ligamentous instability of the cervical spine in children. Powers B, Miller M, Kramer R et al: Traumatic anterior atlanto-occipital dislocation. Schmorl G, Junghans H: the Human Spine in Health and Disease, New York: Grune and Stratton, 1971. Scientific approach to the assessment and management of activity related spinal disorders. Sherk H, Nicholson J, Chung S: Fractures of the odontoid process in young children. Starr W: Spina bifida occulta and enlargement of the fifth lumbar spinous process. Sullivan C, Brewer A, Harris L: Hypermobility of the cervical spine in children: A pitfall in the diagnosis of clinical dislocation. Suzuki S, Yamamuro T, Shikata 3, Shimizu X, Iida H: Ultrasound measurement of vertebral rotation in idiopathic scoliosis. Taylor M, Skippings R: Paradoxical motion of atlas in flexion: a fluoroscopic study of chiropractic patients. Tini P, Wieser C, Zinn W: the transitional vertebra of the lumbosacral spine: Its radiological classification, incidence, prevalence, and clinical significance. Troyanovich S, Robertson G, Harrison D, Holland B: Intra and interexaminer reliability of the Chiropractic Biophysics lateral lumbar radiographic mensuration procuedure. Vernon H: Static and dynamic roentgenography in the diagnosis of degenerative disc disease: a review and comparative assessment. Walker B: the use computer-assisted tomography of the lumbar spine in a chiropractic practice. Wallace H,m Wagnon R, Pierce W: Inter-examiner reliability using videofluoroscope to measure cervical spine -312 kinematics: a sagittal plane (lateral view). Proceedings of the International Conference on Spinal Manipulation May 1992, pages 7-8. White J, Gardner V, Takeda H: Back pain in the pediatric patient: Assessment and differential diagnosis. Wiltse L, Widell E, Jackson D: Fatigue fracture, the basic lesion in isthmic spondylolisthesis. Wood J, Wagner N: A review of methods of radiographic analysis of cervical sagittal motion. Yochum T, Rowe L: Essentials of Skeletal Radiology, Baltimore: Williams and Wilkins, 1987. Maximum collimation of the primary beam is used to expose only necessary areas and to exclude the eyes, breasts, and gonads whenever possible.

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Preoperative imaging if endovascular or open repair is being considered Page 592 of 885 C diabetic eating plan order cheap glucovance on line. Aneurysm rupture usually occurs at a diameter of 5 cm or larger diabetic ulcer buy genuine glucovance line, whereas common iliac aneurysms that are less than 3 cm in diameter almost never rupture diabetes type 1 cure january 2012 safe 400/2.5 mg glucovance. Suspected/Screening for Visceral Artery Aneurysm (spleen diabetes diet type 1 cheap glucovance 400/2.5 mg line, 47 kidney, liver orintestines) imaging can include: A. Visceral Artery Aneurysms are defined by an increase of more than 50% of the original arterial diameter. Vascular specialist consultation is beneficial in order to determine the timeframeto intervention. May-Thurner Syndrome (Iliac Vein Compression Syndrome) is an uncommon condition of left common iliac vein compression by the overlying right common iliac artery. For follow-up, any requested imaging from the Table of Thoracic Aorta Imaging Options can be performed a. First year: 1 month, 3 months, 6months, 12 months, then annually Page 594 of 885 4. Evaluation of portal and hepatic veins prior to or following surgical intervention for portal hypertension C. Suspected hepatic vein thrombosis or Budd-Chiari syndrome [One of the following] 1. Possible portal vein thrombosis with negative or inadequate Doppler study of the portal vein 1. Evaluation of abdominal veins other than hepatic and portal 1 veins [One of the following] A. Seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure, Hypertension, 2003; 42(6):1206-1252. American Gastroenterological Association medical position statement: guidelines on intestinal ischemia, Gastroenterology, 2000; 118:951-953. Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance, Circulation, 2004; 90:16-21. Prior to colonoscopy (if requested by the physician who will be performing the endoscopy. Routine follow-up study after treatment, including evaluation for removal of drain Page 600 of 885 E. Routine follow-up study after treatment, including evaluation for removal of drain G. First year: 1 month, 3 months, 6months, 12 months, then annually Page 603 of 885 4. If no dilation for the aortic root or ascending thoracic aorta is found, there is no evidence-based data to support continued surveillance imaging 21-23 V. Initial scan at onset of abdominal pain but serum amylase and lipase are not >3 times normal but with severe abdominal pain and epigastric pain that increases rapidly in severity and persists without any relief 3. Suspected pancreatitis and ultrasound findings do not explain symptoms(gallstones, common duct, etc) 4. Evaluation of patients with suspicion of pancreatic ductal anomalies that may predispose patients to pancreatitis 7. Pancreatic lesions of any size with concerning features (mural nodules, dilated duct, pain, positive cytology, jaundice, worsening diabetes, etc. No further imaging, regardless of size, if imaging is diagnostic for benign findings, including any of the following: i. Biochemical evaluation to determine functional status and exclude pheochromocytoma prior to biopsy/resection 2. Consider biochemical assays to determine functional status and exclude pheochromocytoma prior to biopsy/resection X. New renal mass suspected or detected on prior imaging (For renal cell cancer, see Renal cell or Kidney carcinoma below) [One of the following] A. Routine follow-up study after treatment, including evaluation for removal of drain 7. Evaluation of elevated liver function tests and non-diagnostic 99,100 ultrasound A. Unilateral leg edema with venous Doppler excluding venous insufficiency or varicose veins [One of the following] A. Monitoring response to treatment for locally advanced, unresectable or metastatic lung cancer Page 614 of 885 3. Monitoring response to chemotherapy for locally advanced, unresectable or metastatic cancer Every 2 cycles (6 to 8 weeks) 2. New/worsening signs or symptoms related to the pelvis Primary Peritoneal Mesothelioma: C. Familial pancreatic cancer (two or more first degree relatives or any combination of 3 or more first/second degree relatives) d. Monitoring response to chemotherapy only if abdomen/pelvis previously involved with disease every 2 cycles (6 to 8 weeks) 3. Sarcoma may present with any of the following histologies: Myxoid/round cell liposarcoma, epithelioid sarcoma, angiosarcoma, leiomyosarcoma, endometrial stromal sarcoma, rhabdomyosarcoma, clear cell sarcoma, hemangiopericytoma and undifferentiated sarcoma. Further imaging indicated to follow up on previously seen abnormalities or new signs/symptoms related to the abdomen/pelvis 2. Restaging after completion of primary treatment chemotherapy, surgery or radiation therapy, if abdomen/pelvis were previously involved 3. Ocular/Orbital Melanoma Every 6 months for 2 years, then annually for 3 years L. Monitoring response to chemotherapy every 2 cycles (6 to 8 weeks) Page 624 of 885 3. Monitoring response to chemotherapy for locally advanced, unresectable or metastatic cancer every 2 cycles (6 to 8 weeks) 6. Muscle invasive transitional cell cancer of the bladder and upper urinary tracts every 3 months for 2 years, then annually for 3 additional years d. Stage I seminoma treated with radiotherapy and/or chemotherapy once at 3 months after completion of treatment, then at 6-12 months, and then annually till year 3 c. Residual mass 3cm once at 3-6 months after completion of all therapy, no further imaging indicated. Monitoring response to chemotherapy only for known metastatic disease every 2 cycles (6 to 8 weeks) 3. Surveillance advanced imaging is not indicated for routine asymptomatic surveillance 5. Monitoring response to chemotherapy for known metastatic or unresectable disease every 2 cycles (6 to 8 weeks) 4. Tumor detected incidentally or incompletely treated surgically and one of the following high risk features: i. Patients receiving immunotherapy or maintenance therapy every 3 months Page 630 of 885 3. Surveillance advanced imaging is not indicated for routine asymptomatic surveillance D. Monitoring response to chemotherapy only for patients with known bulky (> 5 cm) nodal disease at initial diagnosis every 2 cycles (6 to 8 weeks) 3. End of therapy evaluation for patients with known bulky (> 5 cm) nodal disease at initial diagnosis 4. Surveillance Advanced imaging is not indicated for routine asymptomatic surveillance. Advanced imaging may be considered for elevated tumor markers if an ultrasound is indeterminate and/or ovarian malignancy is suspected. If stress test is positive for reversible ischemia, or if duration of diabetes is >25 years and patient has additional cardiac risk factors, then diagnostic left heart catheterization can be performed 2. Abdominal Lymphadenopathywith clinical or laboratory findings suggesting benign etiology, and no history of malignancy: A. American College of Radiology Appropriateness Criteria Acute (Nonlocalized) Abdominal Pain and Fever or Suspected Abdominal Abscess.

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