Editing Renal


Priority Description<br />
1. P1 High probability of potentially life threatening condition <br />
2. P2 High probability of condition potentially causing significant long term harm <br />
3. P3 Possibility of potentially life threatening condition <br />
4. P4 Possibility of condition potentially causing significant long term harm <br />
5. P5 Unlikely to be life threatening or cause significant long term harm  <br />
<br />
{| class="wikitable"
|-
!Protocol code
!When to use 
|-
| ?Ca 2Wk
|| ? Cancer 2ww – use as normal – scan to be scheduled within 2 weeks 
|-
| Urgent
|| Urgent – use as normal – scan to be scheduled within 4 weeks 
|-
| COVID – Semi Urgent
|| Examination needs performing during next few months 
|-
| Routine
|| Do not use during Covid pandemic 
|-
| COVID P5 Cancel
|| Examination is P5 exam and will be cancelled and re refer back to clinician 
|-
| Cancel
|| Examination to be cancelled due to non-justification of examination only ( not due to COVID) 
|- 
| On hold
|| Use as normal

|}

All routine are reclassified as above.

{| class="wikitable"
|-
! Indication
! COVID Cancel
! COVID Urgent
! Brief description
! Slice thickness and reconstruction kernel
!Further details of contrast timing/explanation of what the radiographers do
! Abbreviation

|-
|
Renal stones?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
CT Kidneys Ureter Bladder (non-contrast, low dose)
||
1.5 mm B30f, 1.2 mm increment.
||
No contrast
||
CT KUB


|-
|
Follow up of VUJ stones
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
Limited CT bladder (non-contrast)
||
1.5 mm B30f, 1.2 mm increment.
||
No contrast
||
CT bladder


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Cause of PUJ obstruction, not from stones
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
Pre, arterial and delayed - Change to pre + combined dual bolus angio and delayed?
||
1.5 mm B30f, 1.2 mm increment.
||&nbsp;||
CT IVU but renal angio YZT


|-
|colspan="7"|
Haematuria:


|-
|
Asymptomatic Microscopic haematuria
Low risk (&lt;40 years, no other risk factor)
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->If persistent
||
Renal tract US, Plain KUB
BUT In persistent haematuria CT IVU
||
1.5 mm B30f, 1.2 mm increment.
||
CT IVU - Pre, bolus 5 minutes before, repeat bolus and 90 second scan
||
CT IVU


|-
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Symptomatic microscopic haematuria Low risk (&lt;40 years, no other risk factor)
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
CT KUB non contrast , low dose
||
1.5 mm B30f, 1.2 mm increment.
||
No contrast
||
CT KUB


|-
|
Symptomatic microscopic haematuria High risk (&gt;40 years, smokers, occupational history, drugs, pelvic radiation, UTIs, LUTS, familial)
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
CT IVU (contrast) and flexible cystoscopy
||
1.5 mm B30f, 1.2 mm increment.
||
CT IVU - Pre, bolus 5 minutes before, repeat bolus and 90 second scan
||
CT IVU


|-
|
Macroscopic haematuria (20% malignant) Low risk (&lt;40 years, no other risk factor)
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
CT KUB for stone diagnosis (non-contrast) and flexible cystoscopy
||
1.5 mm B30f, 1.2 mm increment.
||
No contrast
||
CT KUB


|-
|
Macroscopic haematuria (20% malignant) High risk(&gt;40 years, smokers, occupational history, drugs, pelvic radiation, familial)
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
CT IVU (contrast) and flexible cystoscopy
||
1.5 mm B30f, 1.2 mm increment.
||
CT IVU - Pre, bolus 5 minutes before, repeat bolus and 90 second scan
||
CT IVU


|-
|
Abnormality on ultrasound for characterisation
Follow up of Bosniak cysts (2F and greater)
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
Pre contrast and 90 second (nephrographic)

Or Pre, arterial and 90 seconds

I have been asked to add both of these and have been protocolling some as one, some as another. If you have a way to differentiate, please let me know
||
1.5 mm B30f, 1.2 mm increment.
||
Pre-contrast and 90 seconds
||
CT dual phase renal or triple phase renal


|-
|
Renal cell cancer staging
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
CT kidneys (arterial) and chest, abdomen and pelvis (PV phase)
||
1.5 mm B30f, 1.2 mm increment.
||&nbsp;||
CT renal staging


|-
|
Renal cell cancer follow up
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
CT kidneys (arterial) and chest, abdomen and pelvis (PV phase)
||
1.5 mm B30f, 1.2 mm increment.
||&nbsp;||
CT CAP + C + art renal


|-
|colspan="7"|
&nbsp;
|-
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Potential live donor
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
CT pre, renal angiogram and venous phase + topogram delayed
||
1.5 mm B30f, 1.2 mm increment.
||
Bolus track arterial and pv. Timings? HU threshold?
||&nbsp;

|-
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Potential transplant recipient
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
Non contrast abdomen and pelvis
||
1.5 mm B30f, 1.2 mm increment.
||
Old split bolus was 50 ml at 1.6 ml/s, pause 10 seconds, 50 ml at 4 ml/s, 50 ml flush at 4 ml/s
Now, just non con to look for iliac calcific atheroma
||Non con abdo pelvis

|-
|
Hypertension, renal artery stenosis?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
CT renal angiogram
||
1.5 mm B30f, 1.2 mm increment.
||
Bolus track arterial (HU 100, 12 second delay)
||
CT renal angio

|-
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Hypertension, renal or adrenal?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->
||
Pre adrenals and review for full adrenals + renal, otherwise just renal angio
||
1.5 mm B30f, 1.2 mm increment.
||
Bolus track arterial (HU 100, 12 second delay)
||
CT adrenals and renal angio

|-
|
Follow up RFA
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent -->X
||
Triple phase kidneys - Pre/art/nephrographic (90 s)
||
1.5 mm B30f, 1.2 mm increment.
||

||
Triple phase kidneys

|}