When evaluating a patient with pain in the abdomen, it is essential to know whether the patient should have an imaging study of just the abdomen, the pelvis or both. Some physicians, uncertain as to which test to order, will simply request both abdomen and pelvis, hoping to make the diagnosis whatever the cause. This action leads to over-radiation, greater imaging expense and incidental findings that may lead to unnecessary testing. Ordering the best imaging test not only provides high value care, controls costs, and limits radiation, but also will allow you to obtain prior authorization “right out of the gate,” and thus avoid peer-to-peer calls.
The American College of Radiology has defined an abdominal imaging study as “beginning at the diaphragm and ending at the umbilicus (or posteriorly, at the iliac spines)”. A pelvis scan “begins at the umbilicus and extends below the pubis bone.” These landmarks are the same for ultrasound, CT, and MRI.
An abdomen only imaging study may be adequate for patients with right or left upper quadrant pain, while more generalized, peri-umbilical or lower abdominal pain requires imaging both the abdomen AND pelvis. When a provider requests both abdomen and pelvis CT for upper quadrant pain or for a mass in the liver, kidney, spleen, or pancreas that request may be denied in favor of a CT abdomen only scan, with half as much radiation as the combined CT abdomen and pelvis. Requesting the right test the first time will guarantee immediate authorization and avoid delays and peer-to-peer calls.
Lesson 12: Well-defined landmarks help differentiate whether you should request imaging of the abdomen, the pelvis, or both. RBM guidelines can provide clarification. For prompt authorization, request only the necessary scan.