How to write an order for a magnetic resonance imaging (MRI) scan of a mass on the left upper back near the neck/shoulder?

How to Write an Order for MRI of a Mass on Left Upper Back Near Neck/Shoulder

For a mass on the left upper back near the neck/shoulder region, order an MRI with contrast, specifically requesting "MRI neck/shoulder with contrast to evaluate mass in the left upper back near the neck/shoulder junction." 1

Key Components to Include in the Order

• Clinical indication: Specify "evaluation of mass in left upper back near neck/shoulder junction" 1
• Anatomical location: Clearly state "left upper back/neck/shoulder junction" 1
• Contrast requirement: Request with intravenous contrast unless contraindicated 1
• Relevant clinical information: Include:
  • Duration of mass presence (especially if ≥2 weeks) 1
  • Size of mass (particularly if >1.5 cm) 1
  • Consistency (firm, soft, fluctuant) 1
  • Any associated symptoms (pain, mobility changes) 1
  • Prior interventions or treatments 1

Contrast Considerations

• Always request contrast unless contraindicated, as it significantly improves:

  • Characterization of the mass (solid vs. cystic) 1
  • Delineation of lesion borders 1
  • Identification of potential primary sites 1

• Contraindications to contrast include:

  • Severe renal insufficiency (risk of nephrogenic systemic fibrosis) 1, 2
  • Known contrast allergy 1
  • Certain implantable medical devices 1

Technical Specifications

• Sequences to request:

  • T1-weighted sequences (pre-contrast) 3
  • T2-weighted sequences 3, 4
  • Post-contrast T1-weighted sequences 1

• Imaging planes:

  • Request imaging in multiple planes (axial, sagittal, coronal) 1, 4
  • Consider requesting oblique views if the mass is near the cervical spine 5

Common Pitfalls to Avoid

• Avoid ordering CT with and without contrast as this doubles radiation exposure with minimal added benefit 1
• Don't omit contrast unless specifically contraindicated, as non-contrast studies provide significantly less diagnostic information 1
• Avoid vague anatomical descriptions which may lead to incomplete imaging of the area of concern 1
• Don't forget to include relevant clinical history as this guides radiological interpretation 1
• Avoid requesting unnecessary additional imaging modalities (like PET/CT) as initial studies 1

Additional Considerations

• If the patient cannot tolerate MRI (claustrophobia, implanted devices), consider specifying "CT neck with contrast" as an alternative 1
• For patients with suspected malignancy, include information about risk factors or concerning features to help guide radiological interpretation 1
• If the mass is pulsatile, specifically mention this in the order as it may alter the imaging protocol 1