For ordering exams from WSMI:

1. Order by Fax

Download the General Radiology or Special Imaging order form, print, complete and fax to WSMI at 514.939.9363

Requires Acrobat Reader

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, Ultrasound etc) & the anatomical region in question
• The patient’s clinical history
• The referring doctor’s signature and address
• In the case of a CT or MRI with contrast, we need the creatinine level within the last three (for cancer patients)  or six months (all others).

MRI, CT, 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. 

Exam Preparations

It is important that patients are aware of what kind of exam is being ordered and how they must prepare beforehand. Below are printable versions of the exam preparations.

• MRI, CT, and Ultrasound (abdominal, pelvic, endovaginal and musculoskeletal) requisitions MUST be faxed to the clinic before an appointment can be made. Please make sure that the patient’s name and telephone numbers are clearly indicated so that we may contact the patient within 24 to 48 hours for their appointment.
• If the patient is pregnant, radiation is not recommended.

Mammography

Rules for Mammo at WSMI

Mammogram Bilateral is a 20 minute exam

Spot compression is a 30 minute exam that must be done where the original mammogram was performed.

Mammogram Bilateral with implants is a 40 minute exam

Screening mammography is not done at Westmount Square Medical Imaging. Patients who require a screening mammogram must go to a designated Screening Center.

Preparation: No deodorant, antiperspirant, powder or colognes.

No caffeine 24 hours before the exam.

MAMMO – SPOT COMPRESSION

The request for spot compression  will be determined by the radiologist at WSMI following the review of the initial mammography performed at WSMI.  Spot compression exams should be done in the same clinic as the initial exam.

Preparation: No deodorant, antiperspirant or perfume.

No caffeine 24 hours before the exam.

Bone Densitometry

It is contraindicated to undergo barium examinations (such as Upper GI, Barium Enema) or Nuclear Medicine examinations less than 2 weeks before your bone density exam. It is also contraindicated to undergo an exam using iodinated contrast media or Nuclear Medicine examinations for up to one week before the exam.

Do not take calcium supplements for a period of at least 24 hours before your exam.

Upper G.I.

• Do not eat, drink as of midnight (night before your exam)
• Do not smoke as of 8:00 pm the eve of your exam.

Small Bowel

• Drink 10 ounces of chilled CITROMAG at 4 pm the day before your exam.
• Clear liquid diet (see below) as of 4 pm the day before your exam.
• Do not eat or drink after 10 pm the eve of your exam.

Definition of Liquid Diet
Drink 6 to 8 ounces of water per hour
Water
Filtered juice without pulp
Tea, coffee, herbal tea (sugar but no milk)
Beer (in moderation)
Clear broth or consommé
Gatorade
Jello

Barium Enema

The large bowel must be clean. The preparation begins 1 day before the exam:

• No eating after midnight 2 nights before the exam;
• The day before your exam:
• Clear liquid diet (see below) all day up to midnight;
• At 12:00 noon: take 4 Dulcolax tablets;
• At 3:00PM: take ½ a 45 ml bottle of oral Fleet with 4 glasses of water in 1 hour;
• At 8:00 PM: take the other ½ of the bottle of oral Fleet with 4 glasses of water in 1 hour;
• The morning of the exam: take 2 Dulcolax tablets with very little water;
• The day of your exam, you cannot drink or eat until after your exam.
• After the exam, you must drink a lot of water.

If you are a diabetic taking insulin or are suffering from renal illness, consult your physician regarding your medication. Diabetics can take 4 to 6 cans of ENSURE the day before the exam.

Definition of Liquid Diet
Drink 6 to 8 ounces of water per hour
Water
Filtered juice without pulp
Tea, coffee, herbal tea (sugar but no milk)
Beer (in moderation)
Clear broth or consommé
Gatorade
Jello

For constipation, the preparation will be extended for one day. Therefore, begin the prep at midnight 3 days before the exam; repeat the same prep both days.

CT Scan

Depending on the type of CT scan you will be undergoing, a preparation might be required. Any CT scan exam that requires an injection of iodine contrast, requires the results of your creatinine level. This is obtained from a simple blood test. You may also be required to drink a gastrograffin cocktail if you are having an abdominal/pelvic scan.

You will be informed as to what preparation applies to you depending on your exam. In all cases, you are asked not to eat or drink for 3 hours prior to the exam.

If you are diabetic, you must stop Glucophage or Metformin 48 hours before your CT scan.

VIRTUAL COLONOGRAPHY

You must pick up 900 mls of Readicat barium at the WSMI clinic before you begin your preparation.

The large bowel must be clean. The preparation begins 2 days before the exam:

2 days before your exam:

• Eat light meals for breakfast and lunch;
• Drink plenty of liquids (8 ounces of liquid every hour);
• For supper, begin a clear liquid diet (see below);

• Clear liquid diet all day up to midnight;
• Drink plenty of liquids (8 ounces of liquid every hour up until midnight);
• Drink 300 mls of Readicat for breakfast, lunch and dinner for a total of 900mls
• At 8:00AM: drink 10 ounces of chilled Citromag (available at any pharmacy). The laxative may begin working within 30 minutes to 3 hours depending on the individual;
• At 3:00PM: take ½ a 45 ml bottle of oral Fleet with 8 ounces of water;
• At 8:00 PM: take the other ½ of the bottle of oral Fleet with 8 ounces of water;
• Drink 8 ounces of water each hour until bedtime;

• If you take blood pressure or heart medication, Prednisone or other steroids, take it before 7:00AM with a sip of water only;
• After the exam, you must drink a lot of water.

• If you are taking INSULIN consult your physician regarding your medication. The dosage may need to be adjusted the day prior and the morning of the exam.
• Diabetics can take 4 to 6 cans of ENSURE the day before the exam.

• Call your doctor for an alternate preparation if you have kidney disease;

Definition of Liquid Diet
Drink 6 to 8 ounces of water per hour
Filtered juice without pulp
Tea, coffee, herbal tea (sugar but no milk)
Beer (in moderation)
Clear broth, consommé, Gatorade, Jello

Questions??? speak with our nurse !

CARDIAC SCORING

1. No exercise 24 hrs before the exam
2. No caffeine 12 hours prior to the exam.
3. No food 4 hours prior exam.

If your resting heart rate is in excess of 80 bpm, you must see your cardiologist who may prescribe medication to lower your heart rate temporarily for the exam. You cannot undergo the exam until your resting heart rate is 70 or lower.

Patients with severe arrhythmia cannot undergo the exam.

Patients with a dual chamber pacemaker cannot undergo this exam.

DO NOT stop your regularly prescribed heart medication.

CT ENTEROGRAPHY

• Drink 10 ounces of chilled citromag at 4 pm the day before the exam
• Clear liquid diet as of 4 pm the day before the exam
• Do not eat, drink after 10 pm the night before the exam

Definition of Liquid Diet
Drink 6 to 8 ounces of water per hour
Filtered juice without pulp
Tea, coffee, herbal tea (sugar but no milk)
Beer (in moderation)
Clear broth, consommé
Gatorade
Jello

MRI

• If you are claustrophobic you can arrive an hour before your scheduled appointment time and a light sedative can be provided.
• For all MRI Exams involving the neck and head please remove all makeup before the exam.

Arrive 30 minutes before the exam.

Arrive 45 minutes in advance
Fast 3 hours before the exam

A blood test must be performed prior to the day of exam to get creatinine level.

Fast 12 hours prior to the exam.

Arrive 45 minutes before the exam
Fast 3 hours before the exam
Do not wear any deodorant or antiperspirant on the day of the exam
Remember to bring your previous relevant reports and mammogram films on the day of the exam

Arrive 30 minutes before the exam
Fast 3 hours before the exam
Do not take any pain medication on the day of the exam.
Have someone with you, to drive you home, or arrange for public transportation.
You will be asked not to drive for a period of about 12 hours.

Abdominal Ultrasound

No food or drink 8 hours before the exam (unless this exam is accompanied with a pelvis). If you need to take any medication, you may do so with a little bit of water ONLY.

Abdominal ultrasounds should not be done after any barium tests or endoscopy tests for at least 4-5 days following.

Pelvic Ultrasound

Arrive with a full bladder. Drink at least 4 glasses of water (not carbonated) approximately 60 minutes before your exam.

Do not urinate.

Pelvic ultrasounds should not be done after any barium tests or endoscopy tests for at least 4-5 days following.

Endovaginal Ultrasound

Do not eat or drink 1 hour before the exam (unless the exam is accompanied with a pelvis ultrasound).

Endovaginal ultrasounds should not be done after any barium tests or endoscopy tests for at least 4-5 days following