Ultrasound Order Guide FAQs

There are three specialized order types dedicated to Radiology-Performed Musculoskeletal & Peripheral Nerve procedures.

To assess superficial lumps/bumps of the limbs, the correct order code is Ultrasound Soft Tissue (Radiology Performed)(Mass or Lump Evaluation), IMG6330. This order covers subcutaneous lumps / palpable masses, lipomas, fatty deposition, hematomas, seromas, collections, abscesses, foreign bodies, etc.

However, some important caveats exist:

• Ultrasound Soft Tissue is generally not to be used for the hands/feet, unless the clinical request is querying a foreign body or subcutaneous abscess.  Hand and foot palpable masses, i.e. ? ganglia, often arise from the nearby joints/tendon sheaths, and therefore, the appropriate musculoskeletal code should be used.
• Ultrasound Soft Tissue does not assess joints, bone, ligaments, tendons, bursa or nerves. Please use the Ultrasound Musculoskeletal or Peripheral Nerve code set if required.
• If the palpable abnormality is not located on the limbs, it should be ordered instead as a Limited exam of that anatomic location, i.e. Ultrasound Neck, Limited.

While there is significant overlap between Ultrasound Soft Tissue and MSK/Peripheral Nerve Ultrasound studies, placing an incorrect order can result in patients being rescheduled if the allocated Ultrasound resources do not match the patient’s needs.

Musculoskeletal and Peripheral Nerve Ultrasound orders are to be used for anything pertaining to the muscles, tendons, ligaments, joints, bones, bursa or nerves around the body. They are performed by specialist sonographers at our Parnassus Campus and reported by on-site MSK-trained Radiologists. They are more complex in nature and involve a dynamic assessment of the relevant anatomy.

In contrast, US Soft Tissue is for simple lumps/bumps of the extremities (including foreign bodies and abscesses), and does not assess the musculoskeletal or nervous system.

If the incorrect order is placed, patient care may be delayed due to the complex resources required.

Microbubble contrast agents can be injected to evaluate vessel or tube patency and characterize lesion enhancement. Ultrasound contrast agents (Lumason) are not nephrotoxic, as they contain gas, which is breathed out. Example indications include: assessment of renal or liver lesions, checking for perutaneous nephrostomy/ureteral patency, fallopian tube patency (HyCoSy), etc. They can be ordered as: US Abdomen Limited with Contrast IMG5488 or US Abdomen Complete with Contrast IMG5485. US Hysterosonogram with CONTRAST ENHANCED IMG6311 should be used for fallopian tube checks. Please call a radiologist to discuss the exam indication if you are uncertain if contrast is needed. 

US Hysterosonogram with CONTRAST ENHANCED IMG6311 ("HyCoSy") evaluates for fallopian tube patency under ultrasound. This procedure involves cannulating the cervix with an HSG catheter and instilling saline and ultrasound contrast agent. It can evaluate the endometrial lining and the fallopian tubes. This procedure will be performed by specially trained sonographers and radiologists. 

The correct exam to order to evaluate for breast abscess is US Chest/Mediastinum IMG521. This exam is intended for urgent or acute cases of suspected infection. This exam will be performed by the ultrasound section, rather than the breast imaging center. If you have any concern for a breast mass, please refer the patient to our breast imaging department.

Both Interventional Radiology and Ultrasound services can perform percutaneous drainage of an abscess, but only IR will place a drainage catheter for ongoing drainage. For ultrasound, this order is US Guided Abscess Drain IMG508 - this includes percutaneous aspiration of the abscess under ultrasound guidance. For placement of drainage catheters, please consult Interventional Radiology. 

Arterial Duplex or Doppler ultrasounds are performed by the Vascular Lab at UCSF.
Please select one of the following:

• Vascular Lab US Abdominal Imaging (Aorta/Renal/Mesenteric)
• Vascular Lab US Cerebrovascular Imaging (Carotid Arteries/TCD)
• Vascular Lab US Extremity Arterial (Imaging/Pressures)

These arterial Doppler exams are NOT performed by Radiology at UCSF.

Contact the Vascular Lab with questions about vascular ultrasound.