Page 145 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
28 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Clinical urgency: Dependent on how urgently information is required for decisions to be made about ongoing treatment – e.g. to fit with date of next scheduled chemotherapy cycle.
Myeloma and Plasmacytoma
Plain X-rays continue to play a major role in the management of myeloma.
It remains unclear whether the extra sensitivity of MRI ‘skeletal survey’ for myelomatous lesions in routine cases (over traditional plain radiography) translates to worthwhile clinical benefit.
MRI is clinically indicated in the investigation of apparent solitary plasmacytoma.
There are a wide range of situations where MRI may be the investigation of choice in a patient with myeloma, and these will require consideration on a case-by-case basis.
Note that Tc-99bone scanning is very rarely helpful in the diagnosis of multiple myeloma. Clinical urgency: Imaging within 1-2 weeks desirable, to allow treatment decisions to be made.
Suspected Spinal Cord or Cauda Equina Compression
MRI whole spine is the favoured investigation.
Imaging objectives:
• To determine presence, extent and vertebral level of compression (incl. possible multiple sites)
• To identify sites of incipient compression
• To identify presence of soft-tissue tumour(s) contributing to presenting symptoms
• To assist in treatment decision making, including the potential role of surgery
Clinical urgency:
In most instances this imaging should be performed on the day the request is submitted. When requests are received after 4pm, imaging the following morning is usually acceptable.
Staging of Pelvic Tumours
For most primary malignancies of the pelvis (rectum, prostate, cervix) the major determinant of the subsequent treatment plan is the clinical stage. This is usually determined prior to definitive therapy, but is sometimes also indicated following definitive treatment (e.g. surgery) but prior to adjuvant treatment (e.g. radiation therapy). Pelvic MRI is usually preferred over CT.
Clinical urgency: Usually within 1-2 weeks desirable, to allow treatment decisions to be made.
Meningitis (Suspected)
See the Headache Guidelines and LP Guidelines.
The Suspected Meningitis imaging pathway in the Australian imaging guidelines supports our approach that CT before LP is only indicated if the patient has:
• an impaired conscious level
• neurological signs
• features of raised intracranial pressure
• seizures
• in very ill patients
• sinus or ear infections
Do not delay giving antibiotics to wait for a CT and/or LP to be performed. If bacterial meningitis is suspected and a LP cannot be performed immediately start antibiotics.
Clinical Urgency: If CT is indicated pre LP: 24 hour CT / 7 days a week