Premier’s Stanson Health Clinical Criteria
Radiology utilization management criteria based on current scientific evidence and expert opinion.
Appendices
2 entries
CT – Computed Tomography
14 entries
CTA – Computed Tomography Angiography
10 entries
Echocardiography
3 entries
MRA – Magnetic Resonance Angiography
8 entries
MRI – Magnetic Resonance Imaging
23 entries
Nuclear & PET
13 entries
Oncology
49 entries
Updates
4 entries
Appendices 2 entries
CT – Computed Tomography 14 entries
CT Abdomen and Pelvis CT Cervical Spine CT Chest CT Colonography (Virtual Colonoscopy) CT For Bone Densitometry QCT CT Head CT Heart CT Lower Extremity (includes Arthrograms) CT Lumbar Spine CT Maxillofacial CT Neck Soft Tissue CT Orbit, Sella, Posterior Fossa, Ear CT Thoracic Spine CT Upper Extremity (includes Arthrograms)
CTA – Computed Tomography Angiography 10 entries
Echocardiography 3 entries
MRA – Magnetic Resonance Angiography 8 entries
MRA (Magnetic Resonance Angiogram) Abdomen MRA (Magnetic Resonance Angiogram) Carotid and Vertebral MRA (Magnetic Resonance Angiogram) Head MRA (Magnetic Resonance Angiogram) Lower Extremity MRA (Magnetic Resonance Angiogram) Pelvis MRA (Magnetic Resonance Angiogram) Spinal Contents MRA (Magnetic Resonance Angiogram) Thorax MRA Upper Extremity (Magnetic Resonance Angiogram)
MRI – Magnetic Resonance Imaging 23 entries
MR Elastography MR Spectroscopy MRI Abdomen MRI Bone Marrow Blood Supply MRI Brain MRI Breast with and without Contrast MRI Breast without Contrast MRI Cardiac Magnetic Resonance Imaging for Velocity Flow Mapping MRI Cervical Spine MRI Chest MRI Fetal MRI Functional of the brain with physician MRI Functional of the brain without physician MRI Heart for Morphology and Function MRI Lower Extremity Joint MRI Lower Extremity, Non Joint MRI Lumbar Spine MRI Orbit, Face, Neck MRI Pelvis MRI Temporomandibular Joint MRI Thoracic Spine MRI Upper Extremity Joint MRI Upper Extremity, Non Joint
Nuclear & PET 13 entries
Brain SPECT Cerebrospinal Fluid Flow SPECT (Single Photon Emission Computed Tomography) Infarct Avid Myocardial Imaging Kidney SPECT (Single Photon Emission Computed Tomography) MUGA (Multigated Radionuclide Angiography: Myocardial Perfusion, PLANAR includes Wall Motion and Ejection Fraction Myocardial Perfusion, SPECT includes Wall Motion and Ejection Fraction Parathyroid Nuclear Scintigraphy PET body PET for Brain Metabolism PET for Brain Perfusion PET of the Heart Radiopharmaceutical Localization of Inflammatory Process SPECT (Single Photon Emission Computed Tomography)
Oncology 49 entries
Acute Lymphoblastic Leukemia Acute Myeloid Leukemia Anal Cancer Bladder Cancer Bone Cancer Breast Cancer Carcinoid Central Nervous System Cancers Cervical Cancer Cholangiocarcinoma Chondrosarcoma Chordoma Chronic Myelogenous Leukemia CML Colon Cancer Esophageal Cancer Ethmoid Sinus Ewing Sarcoma Gall Bladder Cancer Gastric (Stomach) Cancer Gastrointestinal Stromal GIST Giant Cell Tumor of Bone Head and Neck Cancers (All types) Hepatocellular Hodgkin / Lymphoma Hypopharynx Cancers Kidney Cancer Laryngeal Cancer Lip Cancer Maxillary Sinus Cancers Melanoma Multiple Myeloma and Plasmacytomas Nasopharynx Cancers Neuroendocrine Tumors (NET) Non-small Cell Lung Cancer NSCLC Occult Primary Oral Cavity and Oropharynx Osteosarcoma Ovarian Cancer Pancreatic Adenocarcinoma Prostate Cancer Rectal Cancer Salivary Gland Tumors Small Cell Lung Cancer SCLC Soft Tissue Sarcoma Testicular Cancer Thymic Cancer Upper GU Tract Tumors (Renal Pelvis and Ureter) Urothelial carcinoma of the Prostate Uterine Cancer