What is the correct format for writing an order for a bilateral renal ultrasound?

How to Write an Order for Bilateral Renal Ultrasound

Order a "Renal Ultrasound, Bilateral" or "Bilateral Renal Ultrasound" with specific indication and clinical question to guide the radiologist's interpretation and ensure both kidneys are imaged in longitudinal and transverse planes. 1

Essential Components of the Order

Basic Order Format

• Procedure name: "Renal Ultrasound, Bilateral" or "Bilateral Renal Ultrasound" 1
• Clinical indication: Always include the specific reason (e.g., "suspected hydronephrosis," "acute kidney injury," "flank pain," "hematuria," "renal insufficiency") 1
• Specific clinical question: State what you need answered (e.g., "evaluate for obstruction," "assess kidney size and echogenicity," "rule out hydronephrosis") 1

Technical Specifications to Include

• Both kidneys must be imaged: Explicitly state "bilateral" to ensure both kidneys are evaluated, as unilateral imaging may miss bilateral disease processes or absence of a kidney 1
• Include bladder imaging: Request bladder evaluation as part of the exam, since many renal pathologies have bladder findings (stones, outlet obstruction, retention) 1
• Imaging planes required: Both longitudinal and transverse views of each kidney should be obtained for comparison and complete assessment 1

Patient Preparation Instructions

• Bladder status: Ideally, patient should void before kidney imaging to avoid artifactual hydronephrosis from bladder distension, though a full bladder facilitates bladder scanning 1
• No special preparation: Unlike other abdominal ultrasounds, renal ultrasound requires no fasting or bowel preparation 2, 3

Sample Order Format

"Renal Ultrasound, Bilateral with bladder"

• Indication: [Your specific clinical indication]
• Clinical question: [What you need to know]
• Special instructions: "Image both kidneys in longitudinal and transverse planes; include bladder evaluation"

Common Clinical Indications to Specify

For Suspected Obstruction

• "Evaluate for hydronephrosis" in patients with flank pain, acute kidney injury, or suspected ureteral obstruction 1
• Note that absence of hydronephrosis does not rule out ureteral stones, especially small ones 1

For Renal Insufficiency

• "Assess kidney size and echogenicity" to differentiate acute from chronic kidney disease 2, 4
• Small echogenic kidneys indicate end-stage chronic kidney disease, while normal or enlarged echogenic kidneys suggest acute or subacute parenchymal disease 2, 4

For Suspected Renal Artery Stenosis

• "Duplex ultrasound of renal arteries" if renovascular hypertension is suspected 1, 5
• This requires Doppler capability to measure peak systolic velocity and renal-aortic ratio 1, 5

Critical Pitfalls to Avoid

Documentation Requirements

• Never omit the indication: Without clinical context, the radiologist cannot tailor the examination or provide meaningful interpretation 1
• Specify "bilateral": Simply ordering "renal ultrasound" may result in only one kidney being imaged 1
• Request bladder imaging: Many renal pathologies are diagnosed by bladder findings, and this is often omitted if not specifically requested 1

Technical Limitations to Communicate

• Patient obesity, bowel gas, narrow intercostal spaces, or abdominal tenderness may limit the examination 1
• An empty bladder limits bladder assessment 1
• If ultrasound is technically limited or equivocal, alternative imaging (CT or MRI) may be needed 1

Clinical Context Warnings

• Dehydration can mask hydronephrosis in obstructive uropathy 1
• Bladder distension can cause artifactual mild hydronephrosis in normal patients 1
• Both kidneys must be imaged to identify unilateral kidney or bilateral disease 1