Special Instructions

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1 FDA and ACR guidelines are as follows: Special Instructions Safety concerning NSF and gadolinium-based contrast agents (GBCA) Prior to administering MRI contrast (GBCA), any patient who answers yes to any of the following questions will undergo laboratory testing in order to measure renal function (egfr). Optim Imaging can provided the lab testing in the office. Ø Age > 60 Ø Renal Disease (including solitary kidney, renal transplant, renal tumor) Ø History of Hypertension (high blood pressure) Ø History of Diabetes Ø History of severe hepatic disease, liver transplant, or pending liver transplant Ø Compromising blood diseases If laboratory test for renal function (egfr--estimated Glomerular Filtration Rate) is abnormal measuring > 30ml/min/1.73m², then MRI contrast (GBCA) injection will not be given. The following items may be hazardous or require special attention before having an MRI exam. After certain surgeries, if you received a card with the manufacture and model number of the stent, insulin pump, heart valve or other implant; please make a copy and fax with MRI order to check for compatibility. If a card is not available, operative notes that show model number(s) may be required. Cardiac pacemaker (even if it has been removed) Brain aneurysm clip(s) Implanted insulin pump (COPY CARD) Implanted drug pump (COPY CARD) Neurostimulator (even if it has been removed) Ear implants (cochlear, stapes, incus) MUST HAVE CARD ****Cochlear implants cannot have MRI**** Heart Valve (COPY CARD) Heart Valve (COPY CARD) Penile implant (MUST HAVE CARD) Lumbar Surgery Metal in eyes if YES, for safety need x-rays. ( Can be done at Optim Imagimg).

2 To Schedule an appointment call : Optim Imaging (Savannah) office or Optim Medical Center / Tattnall (Reidsville) Musculoskeletal / Bone and Joints Upper Extremity Joint without contrast Shoulder Arthritis Labral Tear (may need MR Arthrogram) Elbow Avascular Necrosis (AVN) Tendon, Ligament or Cartilage Tear Wrist Fracture / Stress Fracture Tendinitis Impingement Internal Derangement Epicondylitis Upper Extremity Joint with contrast (Arthrography) (injection) Shoulder Labral Tear Ligmentous tear - wrist (injection) Elbow Loose Bodies Rotator cuff tear -Post Surgery (injection) Wrist after dislocation TFCC injury Upper Extremity Joint with and without contrast Shoulder Abcess Bone Elbow Ulcer Soft Tissue Wrist Cellulitis Infection Rheumatoid / Inflammation Arthritis Septic Arthritis Upper Extremity Non-Joint without contrast Humerus Forearm Tendon, Ligament or Cartilage Tear Hand Bursitis Fingers Tendinitis Upper Extremity Non-Joint with and without contrast Humerus Abcess Bone Forearm Ulcer Soft Tissue Hand Cellulitis Infection Fingers Lower Extremity Joint without contrast Hip Arthritis Labral Tear (may need MR Arthrogram) Knee Avascular Necrosis (AVN) Tendon, Ligament or Cartilage Tear Ankle Fracture / Stress Fracture Meniscal Tear Osteochondritis Dessicans (OCD) Internal Derangement Plantar Fasciitis Tarsal tunnel syndrome Lower Extremity Joint with contrast (Arthrography) (injection) Hip Labral Tear Labral Tear -Post surgery (injection) Knee Loose Bodies Meniscus - Post surgery (injection) Ankle after dislocation Unstable Osteochondral Lower Extremity Joint with and without contrast Hip Abcess Bone Knee Ulcer Soft Tissue Ankle Cellulitis Infection Septic Arthritis Lower Extremity Non-Joint without contrast Femur Fracture / Stress Fracture Tibia / Fibula Tendon, Ligament or Cartilage Tear Foot Bursitis Toe Tendinitis Lower Extremity Non-Joint with and without contrast Femur Abcess Bone Tibia / Fibula Ulcer Soft Tissue Foot Cellulitis Infection Toe Morton's Neuroma

3 Brain - Neuro Brain without Contrast Memory Loss Confusion Shunt Check Brain with and without Contrast Known or Suspected Tumor Infection Multiple Sclerosis Metastatic Disease Dizziness AVM Vertigo Headache Seizures Brain with and without Contrast for IAC Hearing loss Bell's Palsy Acoustic Neuroma Dizziness Vertigo Meniere's Disease Brain with and without Contrast for Pituitary Pituitary Lesion Elevated Prolactin Levels Brain MRA without Contrast Known or Suspected Aneurysm Circle of Willis- Intracranial circulation Stroke AVM Orbits with and without Contrast Infection Graves Disease Neoplasm Proptosis Visual Disturbance Loss of Vision Inflammation / Swelling Optic Neuritis Soft Tissue Neck with and without Contrast Neck Mass Vocal Cord Paralysis Adenopathy Known or Suspected lesion Thyroid, Parathyroid Infection Salivary gland mass MRA Neck with Contrast Carotid Vascular Tumor Bruit Cerebral Vascular Accident

4 Chest - Abdomen - Pelvis Brachial Plexus without Contrast Evaluate for entrapment Brachial Plexux pathology Brachial Plexus with and without Contrast Infection Neoplasm Chest Wall with and without Contrast Pectoralis Injury Sternoclavicular Joint Disease Abdomen without Contrast (MRCP) Biliary Obstruction Gallbladder Stones Jaundice Abdomen with and without Contrast Abdominal Complaints related to liver, spleen, pancreas and kidneys Abdomen with and without Contrast Crohn's disease Pelvis with and without Contrast Inflammatory bowel disease Ischemic bowel disease Pelvis without Contrast Coccyx Fracture Pelvic Fracture Pubic Arthralgia Sacral Fracture Sacroiliitis Sports Hernia Stress Fracture Muscle Tendon Tear Pelvis with and without Contrast Suspected pelvic mass Endometriosis Scrotal / Testicular / Penile Cancer Fibroids Hernia Uterine Mass Bladder / Rectal Cancer Ovarian Disease

5 Spines Cervical without contrast Degenerative Disease Post op Chiari Malformation Fracture Lordosis / Scoliosis Cervical with and without contrast Thoracic without contrast Degenerative Disease Compression Fracture (non-pathologic) Fracture Schmorl's Nodes Post -op greater than 6 months Thoracic with and without contrast Post- op less than 6 months Compression Fracture (pathologic) Lumbar without contrast Post-op greater than 2 years Degenerative Disease Lumbar with and without contrast Post-op less than 2 years

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