Order Exams

To order an exam at Westmount Square Medical Imaging, please use the following guidelines.

If the patient is pregnant, radiation is not recommended.

To expedite the processing of your order please ensure that you provide the following information on the requisition:

• Patient's name (maiden)
• Date of Birth
• Patient Phone number
• The modality (MRI, CT scan, Ultrasound etc) & the anatomical region in question
• The patient's clinical history (clearly written)
• The referring doctor's signature, practice number and complete address

It is important that patients are aware of what kind of exam is being ordered and how they must prepare beforehand. In this section you will find the printable examination preparations for your patients.

1. Order by Fax

Download the General Radiology or Special Imaging order form, print, complete and fax at (514) 939-9363.

MRI, CT scan, and Ultrasound (abdominal, pelvic, endovaginal and musculoskeletal) requisitions MUST be faxed to the clinic by the physician or the patient before an appointment can be made.

Digital Mammography

Attention! Screening mammography is not done at Westmount Square Medical Imaging. We cannot accept a requisition for mammography on which the expressions "dépistage" or "screening" are either circled, checked or written. Instead, please order either a "routine" or a "diagnostic" mammogram.

Please advise your patients which had previous mammograms in another clinic that they must bring their mammographic films the day of their exams.

Depending on the age of your patients and circumstances, an ultrasound might be recommended instead of a mammography. Below are the rules at WSMI:

Bone Densitometry

In order to comply with the RAMQ rules, your patient cannot undergo more than 1 bone densitometry every 366 days. Exception to this rule are allowed in case your patient has specific conditions such as high dose of steroid, biphosphonates, renal transplant, dialysis or is neuro-polytraumatic), in this case you can order a bone densitometry every 6 months for the first 18 months of the treatment.

Also, unless it is to assess a trauma or a fracture, RAMQ does not cover thoracic, lumbar, pelvic or hip X-rays a week before or within a month after the bone densitometry is undergone by your patient.

It is contraindicated to undergo barium examinations (such as Upper GI, Barium Enema, and Virtual Colonoscopy), a PET scan or Nuclear Medicine examinations less than a week before your bone density exam.

It is also recommended that your patients don't take calcium supplements the day of their exams.

Ordering Form

Patient's Preparation

Barium exams

WSMI offers a complete range of barium examinations such as Barium Swallow (oesophagus), Barium Meal or Upper G.I. (stomach), Small Bowel Follow Through (small intestine) and Barium Enema (colon).

Only the Barium Swallow (done alone) does not require the patient to prepare. It is very important for the quality of these examinations that your patients follow the preparation specific to our clinic.

Ordering Form

Patient's Preparation - Upper G.I.
Patient's Preparation - SBFT
Patient's Preparation - Barium Enema

CT Scan

In the case of a CT scan with contrast-agent injection (iodine), you must provide us with the creatinine level (blood report) of your patient done within the last three (for cancer patients) or six months (all others). Since we need this level before your patient obtains an appointment it is important to send it with your exam requisition.

Depending on the type of CT scan your patient will be undergoing, a preparation might be required. Generally, the preparation for contrast-agent injection examination is of 3 hours of complete fasting. Your patients will be advised upon the coordination of their appointment.

If your patient is diabetic, they must stop taking Glucophage or Metformin 48 hours before their CT scan.

Ordering Form

Patient's Preparation

Virtual Colonoscopy

This examination utilizes CT scan technology to acquire images of your patient's colon, instead of a camera. It is important that you request either "Virtual Colonoscopy" or "CT colonoscopy" in order to differentiate it from a regular colonoscopy.

Your patient must pick up 900 ml of Readi-Cat barium at WSMI before they begin their preparation.

Ordering Form

Patient's Preparation

Cardiac Scoring

This examination utilizes CT scan technology to acquire images.

Your patient resting heart rate must be 70 bpm or lower to undergo this exam, please prescribe Beta blockers if it is more than 80 bpm.

Contra-indications:
• Patients with severe arrhythmia cannot undergo the exam.
• Patients with a dual chamber pacemaker cannot undergo this exam.

You must advise them NOT to stop their regularly prescribed heart medication.

Ordering Form

Patient's Preparation

CT Enterography

This examination utilizes CT scan technology to acquire images of your patient's small bowel.

Ordering Form

Patient's Preparation

MRI

In the case of a MRI with contrast-agent injection (gadolinium), you must provide us with the creatinine level (blood report) of your patient done within the last six months for all patients 18 years old and younger, 60 years old and older, and under the following conditions for all others:

• If they are diabetic.
• If they are hypertensive.
• If they have suffered a heart attack or a stroke.
• If the have any kidney disease.
• If they take any blood thinners (e.g. Coumadin)
• If they had undergone chemotherapy in the last 3 months.
• If they had an organ transplant (e.g. renal, liver, heart)

Depending on the type of MRI your patient will be undergoing, a preparation might be required. Generally, the preparation for contrast-agent injection examination is of 3 hours of complete fasting. 12 hours of fasting is required in the case of MRCP. Your patients will be advised upon the coordination of their appointment.

If your patient is claustrophobic, a light sedative can be provided. In such a case your patient will not be allowed to drive 8 hours after the test and must be accompanied.

For breasts MRI, your patient must bring all images of their previous mammograms, ultrasound and other MRIs if they were performed in another clinic.

Ordering Form

MRI questionnaire

Patient's Preparation

Ultrasound

WSMI offers a wide range of ultrasound examinations such as Doppler's, thyroid and neck, breast, musculoskeletal, abdominal, pelvic, endovaginal, prostate and testicles.

Although it is important to provide our radiologists with the previous reports for a better comparison, your patients MUST bring their previous imaging for breast and musculoskeletal if theses films were done at another clinic.

Generally, only the abdominal, pelvic and endovaginal ultrasounds require a preparation.

Ordering Form

Patient's Preparation