How can I order a dedicated hepatic MRI when it is not available in our electronic order set?

How to Order a Hepatic MRI When Not in Your Electronic Order Set

Order "MRI Abdomen without and with IV contrast" instead—this is the standard appropriate imaging study for dedicated hepatic evaluation and is the terminology used in ACR guidelines 1.

Understanding the Correct Order Terminology

The term "hepatic MRI" or "liver MRI" may not exist as a discrete order in your electronic health record (EHR) system because:

• Standard radiology nomenclature uses "MRI Abdomen" as the anatomic region descriptor
• The liver is evaluated as part of abdominal MRI protocols
• Radiologists automatically focus on the liver when clinical indication specifies hepatic pathology

What to Order Based on Clinical Scenario

For Most Liver Lesion Characterization:

Order: "MRI Abdomen without and with IV contrast"

This is the ACR-recommended study for 1:

• Indeterminate liver lesions >1 cm (any initial imaging modality)
• Patients with known extrahepatic malignancy
• Chronic liver disease with incidental findings
• Small lesions <1 cm in high-risk patients

Alternative Acceptable Orders:

• "CT Abdomen with IV contrast multiphase" - equivalent alternative in most scenarios 1
• "US Abdomen with IV contrast" - for specific indications in chronic liver disease 1

Critical Technical Requirements

When ordering, ensure your indication specifies:

• Multiphase imaging is essential - single-phase studies are inadequate for lesion characterization 1
• Both pre- and post-contrast phases - the "without and with" designation is crucial
• Specific clinical question - state whether evaluating for HCC, metastases, or lesion characterization

Common Pitfalls to Avoid

1. Don't order "MRI Abdomen without IV contrast" - noncontrast MRI alone is insufficient for most hepatic pathology 1

2. Don't order single-phase CT - arterial hyperenhancement and delayed washout patterns require multiple phases 2

3. Don't add unnecessary "CT Abdomen without and with IV contrast" - the noncontrast phase adds no diagnostic value in most hepatic imaging 2

Practical Workflow Solutions

If "MRI Abdomen without and with IV contrast" is truly absent from your order set:

• Search for "MRI Abdomen" then select the contrast option in subsequent screens
• Use free-text ordering if available, specifying "MRI Abdomen with and without IV contrast for hepatic lesion characterization"
• Contact radiology directly to place the order with proper protocol
• Request IT to add this to your order set - this is a fundamental imaging study that should be readily available

Documentation Tips

In your order indication, include:

• Specific hepatic finding (e.g., "1.5 cm liver lesion on ultrasound")
• Relevant history (cirrhosis, malignancy, chronic liver disease)
• Clinical question (characterization, staging, surveillance)

This ensures radiologists apply appropriate liver-specific protocols and hepatobiliary contrast agents when indicated 2.