ANNEX E

List of Diagnostic Radiology and Radiation Oncology Services by Category

Name of Hospital : ________________________________________________________

Address of Hospital : ________________________________________________________

Please tick (
) appropriate box/es.

Level One includes the following non-contrast x-ray examinations:

Abdomen Shoulder girdle
Chest for heart and lung Skull
Extremities Thoracic cage
Localization of foreign body Vertebral column
Pelvis

Level Two includes those examinations done in the level one category and any of the
following non-contrast and contrast x-ray examinations:
Barium enema (large intestines series) Oral cholegraphy
Cardiac esophogram Paranasal sinuses
Esophagography (barium swallow) Pelvimetry
Hysterosalpingography Scoliotic series
Imperforated anus Skeletal survey
Intravenous pylography Small intestinal series
Upper gastrointestinal series

Level Three includes those examinations done in the level one and two categories and the
following invasive procedures:
All Non-cardiac percutaneous procedure Pacemaker implants
Broncography Tomography
Cerebral angiography Sialography
Endoscopic retrograde cholangiographic Retrograde urography
pancreatography (ERCP) Lymphography
Fistulography Visceral and peripheral angiography
Operative and post operative Retrograde Cystography
cholangiography Myelography
Sinugraphy Others (pls. specify) ______________

Specialized examinations done with a dedicated x-ray unit equipment such as:
Digital Subtraction Angiography Mammography
Bone densitometry Percutaneous transluminal angioplasties
Cardiac catheterization Tumour localization and simulation
Computed tomography Others (pls. specify) ______________
Angiocardiography

Radiation Oncology radiation treatment doing specialized procedures such as:

Conventional Radiation Therapy 3D Conformal Radiation Therapy
Stereotactic Radiosurgey (SRS) Total Body Iradiation (TBI)
Intensity Modulated Radiation Therapy Others (pls. specify) ______________