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INVESTIGATIONS OF CHOICE [IOC]

Diagnosis/ Disease

Investigation of Choice

All space occupying lesions

MRI of brain

Acute pancreatitis

C T s c an

Acalculous cholecystitis

HIDA scan

Acoustic Neuroma

Gd - enhanced MRI

Anal fissure

Local examination under LA

Aneurysm

Angiography

Any paranasal sinus

FESS

Amyloidosis

Abdominal fat biopsy/Rectal Biopsy + Congo red stain

Any other condition of ear

HRCT

Aortic dissection

Patient is stable MRI

Patient is unstable - TEE

Any metastases/ Muscle/Soft tissue

MRI

Calculous cholecystitis

USG

Cardiotoxicity

Following CT/RT - biopsy

Cardiac tamponade

ECHO

Chronic subarachnoid
Haemorrhage

Flair MRI

Congenital hypertrophic pyloric stenosis

USG

Chronic sinusitis

CT scan

Chronic pancreatitis

ERCP

CIN

Cytology (pap)

C1- C2 Jefferson's fracture

Odontoid view

Carotid stenosis

Doppler / MR angio / CT angio

CSF Rhinorrhea

CT scan

Diverticulosis

Barium enema

Diverticulitis

CT scan

Diffuse esophageal Spasm, Achalasia and any

motility disorder of esophagus

Manometry

Down's syndrome

ECHO

DCIS
Emergency in case of stable patient

Mammography

Esophageal perforation

Flexible endoscopy

Extra adrenal pheochromocytoma

MRI

Gastric bleed

Tc99 RBC scan >> Angiography

Gastroesophageal reflux (GERD)

Gold standard-24 hr pH monitoring (Demeester score)

Best - endoscopy

FAST

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Heart transplant rejection

Biopsy

Hirschsprung disease

Rectal biopsy

FNH of liver

Tc sulfur colloid scan

FAP

Sigmoidoscopy

Hydrocephalus

Infants USG
Adults - MRI

Head injures
Parenchymal bleeds
Subarachnoid hemorrhage

Non contrast CT

Insulinoma

Intra operative endoscopic ultra sound (EUS)

Intersititial Lung disease, bronchiectasis

HRCT

Lymphangiomyomatosis

HRCT

Le Fort's fracture

CT scan

Meningiomas

Gd-enhanced MRI

Minimal ascites

USG

Neuroendocrine tumours

Somatostatin receptor scintigraphy(SRS)

Nasopharyngeal Angiofibroma

Contrast CT (Antral sign)

Obstructive jaundice

USG

Osteoporosis

DEXA scan

Osteomyelitis

Bone scan (Tc MDP)

Ovarian reserve

FSH

Parathyroid glands

Sestamibi scan, Tc-thallium scan subtraction

Pre operative Insulinoma

Intra arterial Ca+2 injection angiography

Post menopausal, Uterine bleeding

Fractional curettage

Pneumo peritoneum

X-ray abdomen in left lateral decubitus

Pu l mo n ar y s eq u e st ra ti on

CT Angio

Pheochromocytoma

MIBG scan

Pericardial effusion

ECHO

Pericarditis

CT > MRI

Pneumo thorax

CXR PA view with full expiration

Pulmonary embolism

PTA (Gold standard) > Doppler > D-Dimer (screening)

Recurrence of a tumor

PET scan

Reticulo endothelial system

Tc sulfur colloid scan

Recurrent GIST

PET scan

Rhabdo myosarcoma

MRI

Reversible myocardial Ischemia

Thallium scan

Superior sulcus tumor

CE - MRI

Subacute intestinal obstruction

99

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X-ray abdomen

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Schwannomas

Gd-enhanced MRI

Sella turcica

Lateral view of x-ray skull

Synovial pathology

Gd-enhanced MRI

Temporal bone

CT scan

Traumatic paraplegia

MRI

Thyroid & breast

FNAC

Toxoplasmosis

IgA - ISAGA > IgM

Advanced renal TB

CECT

Ca prostrate

DRE + PSA
(IOC) Trans rectal USG (Gold)

Ca bladder

Malignant cell cytology in urine Cystocopy

Early renal TB

IVP

Functional kidney diseases (perfusion)

MAG 3 > DTPA

Neural tube defects :Best

Amniotic fluid Acetyl cholinesterase

Next best

Amniotic fluid AFP

Earliest

USG (810 weeks)

Screening

Maternal serum AFP

Polycystic kidney disease

USG

Posterior urethral valve

MCU (VCU)

Renal cortical mass

Tc DMSA

Renal calculi

Non contract CT

Renal hypertension

Spiral CT

Renal cell carcinoma

Vascular thrombosis Color Doppler

Structural kidney diseases

DMSA

Ureteric colic & stones

Plain CT

Vesico ureteric reflux

MCU (VCU)

99

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