Renal

Priority Description
1. P1 High probability of potentially life threatening condition
2. P2 High probability of condition potentially causing significant long term harm
3. P3 Possibility of potentially life threatening condition
4. P4 Possibility of condition potentially causing significant long term harm
5. P5 Unlikely to be life threatening or cause significant long term harm

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.

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?			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			Limited CT bladder (non-contrast)	1.5 mm B30f, 1.2 mm increment.	No contrast	CT bladder
Cause of PUJ obstruction, not from stones			Pre, arterial and delayed - Change to pre + combined dual bolus angio and delayed?	1.5 mm B30f, 1.2 mm increment.		CT IVU but renal angio YZT
Haematuria:
Asymptomatic Microscopic haematuria Low risk (<40 years, no other risk factor)		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
Symptomatic microscopic haematuria Low risk (<40 years, no other risk factor)		X	CT KUB non contrast , low dose	1.5 mm B30f, 1.2 mm increment.	No contrast	CT KUB
Symptomatic microscopic haematuria High risk (>40 years, smokers, occupational history, drugs, pelvic radiation, UTIs, LUTS, familial)		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 (<40 years, no other risk factor)		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(>40 years, smokers, occupational history, drugs, pelvic radiation, familial)		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)		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		X	CT kidneys (arterial) and chest, abdomen and pelvis (PV phase)	1.5 mm B30f, 1.2 mm increment.		CT renal staging
Renal cell cancer follow up		X	CT kidneys (arterial) and chest, abdomen and pelvis (PV phase)	1.5 mm B30f, 1.2 mm increment.		CT CAP + C + art renal
Potential live donor			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?
Potential transplant recipient			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?			CT renal angiogram	1.5 mm B30f, 1.2 mm increment.	Bolus track arterial (HU 100, 12 second delay)	CT renal angio
Hypertension, renal or adrenal?			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		X	Triple phase kidneys - Pre/art/nephrographic (90 s)	1.5 mm B30f, 1.2 mm increment.		Triple phase kidneys