Patient Forms & Information

Computed Tomography (CT Scan)
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Abdomen (Gallbladder, Liver and/or Pancreas)

Do NOT have anything to eat or drink 3 hours before you examination.

Adrenals

Do NOT have anything to eat or drink 3 hours before you examination.

Calcium Scoring (Heart)

Patient must be over 18 years old

Carotid Arteries

Do NOT have anything to eat or drink 3 hours before you examination.

Enterography (Small Bowel)

Do NOT have anything to eat or drink 3 hours before you examination. Arrive 1 ½ hours prior to your appointment. You will be drinking a dilute oral contrast mixture prior to the scan.

Esophagus

Do NOT have anything to eat or drink 3 hours before you examination.

Lung Screening (Heart)

Patient must be over 18 years old

IAC’s (Inner Auditory Canal)

Do NOT have anything to eat or drink 3 hours before you examination.

Neck (Soft Tissue)

Do NOT have anything to eat or drink 3 hours before you examination.

Parotid Gland

Do NOT have anything to eat or drink 3 hours before you examination.

Pelvis

Pick up an Oral Contrast kit from any SJRA office the day before your procedure. Kit must be started at 8pm the evening before your study. Do NOT have anything to eat or drink 3 hours before you examination.

Prostate

Pick up an Oral Contrast kit from any SJRA office the day before your procedure. Kit must be started at 8pm the evening before your study. Do NOT have anything to eat or drink 3 hours before you examination.

Prostate for Seed Implant

No Prep

Renal (Kidney)

Do NOT have anything to eat or drink 3 hours before you examination.

Stone Study (r/o Gallstone, Kidney Stone)

Do NOT have anything to eat or drink 3 hours before you examination.

Thyroid

Do NOT have anything to eat or drink 3 hours before you examination.

Urogram

Do NOT have anything to eat or drink 3 hours before you examination. If 3D Imaging is desired, your prescription must state “with 3D Reconstruction” and this must be pre-certified by your insurance if applicable.

Virtual Colonoscopy

The following non-prescription medications are available from your local pharmacy and should be obtained prior to beginning the CT Colonoscopy preparation:

  • Magnesium Citrate – One (1) 10 oz bottle
  • Dulcolax (Bisacodyl) – Four (4) tablets (5 mgs. each)
  • Dulcolax (Bisacodyl) – One (1) suppository

On the day before your test:

  • 8 AM Have a clear liquid breakfast without milk products. This meal may include: clear broth or bullion, clear or strained fruit juices such as grape or apple juice, clear jello or gelatin, black coffee or tea with sugar but without milk or milk products, non-carbonated beverages, orange, raspberry or lemon ice (no sherbet). No milk products, fruits or vegetables.
  • 12 Noon Have a clear liquid lunch without milk products, using the same guidelines as breakfast
  • 1 PM Drink a full 8 oz glass of water. Repeat this every hour until bed time.
  • 4 PM Drink the bottle of Magnesium Citrate- this can be chilled to make it easier to drink. Also drink one 8 ounce glass of water.
  • 6 PM Have a clear liquid supper, using the same guidelines as breakfast and lunch.
  • 8 PM Take the 4 Ducolax tablets with 8 ounces of water. Do not chew the tablets. These tablets usually produce a bowel movement in 6-12 hours.

On the day of your CT Colonoscopy examination:
After removing the foil, the Ducolax (Bisacodyl) suppository should be inserted rectally 2 hours prior to arriving at the Radiology Department. While lying on your side with thigh elevated, insert the suppository into the rectum and gently push in as far as possible. Try to keep the suppository in for 20 minutes even if the urge for evacuation is strong. Bowel evacuation usually occurs within 15 to 60 minutes. You may take your normal medications with a small amount of water. Nothing else should be taken by mouth.

Please discuss this preparation with your doctor if you have chronic diarrhea, Inflammatory Bowel Disease such as Ulcerative Colitis or Crohns Disease or a large amount of rectal bleeding.


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