INVESTIGATIONS OF CHOICE [IOC] Diagnosis/ Disease Investigation of Choice All space occupying lesions MRI of brain Acute pancreatitis CT scan Acalculous cholecystitis HIDA scan Acoustic Neuroma Gd - enhanced MRI Anal fissure Local examination under LA Aneurysm Angiography Any paranasal sinus FESS Amyloidosis Abdominal fat biopsy/Rectal Biopsy + Congo red stain Any other condition of ear HRCT Aortic dissection Patient is stable – MRI Patient is unstable - TEE Any metastases/ Muscle/Soft tissue MRI Calculous cholecystitis USG Cardiotoxicity Following CT/RT - biopsy Cardiac tamponade ECHO Chronic subarachnoid Haemorrhage Flair MRI Congenital hypertrophic pyloric stenosis USG Chronic sinusitis CT scan Chronic pancreatitis ERCP CIN Cytology (pap) C1- C2 Jefferson's fracture Odontoid view Carotid stenosis Doppler / MR angio / CT angio CSF Rhinorrhea CT scan Diverticulosis Barium enema Diverticulitis CT scan Diffuse esophageal Spasm, Achalasia and any motility disorder of esophagus Manometry Down's syndrome ECHO DCIS Mammography Emergency in case of stable patient FAST Esophageal perforation Flexible endoscopy Extra adrenal pheochromocytoma MRI Gastric bleed Tc99 RBC scan >> Angiography Gastroesophageal reflux (GERD) Gold standard-24 hr pH mon¬itoring (Demeester score) Best - endoscopy Heart transplant rejection Biopsy Hirschsprung disease Rectal biopsy FNH of liver Tc99 sulfur colloid scan FAP Sigmoidoscopy Hydrocephalus Infants – USG Adults - MRI Head injures Parenchymal bleeds Subarachnoid hemorrhage Non contrast CT Insulinoma Intra operative endoscopic ultra sound (EUS) Intersititial Lung disease, bronchiectasis HRCT Lymphangiomyomatosis HRCT Le Fort's fracture CT scan Meningiomas Gd-enhanced MRI Minimal ascites USG Neuroendocrine tumours Somatostatin receptor scintigraphy(SRS) Nasopharyngeal Angiofibroma Contrast CT (Antral sign) Obstructive jaundice USG Osteoporosis DEXA scan Osteomyelitis Bone scan (Tc99 MDP) Ovarian reserve FSH Parathyroid glands Sestamibi scan, Tc-thallium scan subtraction Pre operative Insulinoma Intra arterial Ca+2 injection angiography Post menopausal, Uterine bleeding Fractional curettage Pneumo peritoneum X-ray abdomen in left lateral decubitus Pulmonary sequestration CT Angio Pheochromocytoma MIBG scan Pericardial effusion ECHO Pericarditis CT > MRI Pneumo thorax CXR PA view with full expiration Pulmonary embolism PTA (Gold standard) > Doppler > D-Dimer (screening) Recurrence of a tumor PET scan Reticulo endothelial system Tc99 sulfur colloid scan Recurrent GIST PET scan Rhabdo myosarcoma MRI Reversible myocardial Ischemia Thallium scan Superior sulcus tumor CE - MRI Subacute intestinal obstruction X-ray abdomen Schwannomas Gd-enhanced MRI Sella turcica Lateral view of x-ray skull Synovial pathology Gd-enhanced MRI Temporal bone CT scan Traumatic paraplegia MRI Thyroid & breast FNAC Toxoplasmosis IgA - ISAGA > IgM Advanced ren

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INVESTIGATIONS OF CHOICE [IOC]
Diagnosis/ Disease Investigation of Choice
All space occupying lesions MRI of brain
Acute pancreatitis CT scan
Acalculous cholecystitis HIDA scan
Acoustic Neuroma Gd - enhanced MRI
Anal fissure Local examination under LA
Aneurysm Angiography
Any paranasal sinus FESS
Amyloidosis Abdominal fat biopsy/Rectal Biopsy + Congo red stain
Any other condition of ear HRCT
Aortic dissection
Patient is stable – MRI
Patient is unstable - TEE
Any metastases/ Muscle/Soft tissue MRI
Calculous cholecystitis USG
Cardiotoxicity Following CT/RT - biopsy
Cardiac tamponade ECHO
Chronic subarachnoid
Haemorrhage
Flair MRI
Congenital hypertrophic pyloric stenosis USG
Chronic sinusitis CT scan
Chronic pancreatitis ERCP
CIN Cytology (pap)
C1- C2 Jefferson's fracture Odontoid view
Carotid stenosis Doppler / MR angio / CT angio
CSF Rhinorrhea CT scan
Diverticulosis Barium enema
Diverticulitis CT scan
Diffuse esophageal Spasm, Achalasia and any
motility disorder of esophagus
Manometry
Down's syndrome ECHO
DCIS Mammography
Emergency in case of stable patient FAST
Esophageal perforation Flexible endoscopy
Extra adrenal pheochromocytoma MRI
Gastric bleed Tc99
RBC scan >> Angiography
Gastroesophageal reflux (GERD)
Gold standard-24 hr pH monitoring (Demeester score)
Best - endoscopy

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Hearttransplantrejection Biopsy
Hirschsprung disease Rectal biopsy
FNH of liver Tc
99
sulfur colloid scan
FAP Sigmoidoscopy
Hydrocephalus
Infants – USG
Adults - MRI
Head injures
Parenchymal bleeds
Subarachnoid hemorrhage
Non contrast CT
Insulinoma Intra operative endoscopic ultra sound (EUS)
Intersititial Lung disease, bronchiectasis HRCT
Lymphangiomyomatosis HRCT
Le Fort's fracture CT scan
Meningiomas Gd-enhanced MRI
Minimal ascites USG
Neuroendocrine tumours Somatostatin receptor scintigraphy(SRS)
Nasopharyngeal Angiofibroma Contrast CT (Antral sign)
Obstructive jaundice USG
Osteoporosis DEXA scan
Osteomyelitis Bone scan (Tc
99
MDP)
Ovarian reserve FSH
Parathyroid glands Sestamibi scan, Tc-thallium scan subtraction
Pre operative Insulinoma Intra arterial Ca+2 injection angiography
Post menopausal, Uterine bleeding Fractional curettage
Pneumo peritoneum X-ray abdomen in left lateral decubitus
Pulmonary sequestration CT Angio
Pheochromocytoma MIBG scan
Pericardial effusion ECHO
Pericarditis CT > MRI
Pneumo thorax CXR PA view with full expiration
Pulmonary embolism PTA (Gold standard) > Doppler > D-Dimer (screening)
Recurrence of a tumor PET scan
Reticulo endothelial system Tc
99
sulfur colloid scan
Recurrent GIST PET scan
Rhabdo myosarcoma MRI
Reversible myocardial Ischemia Thallium scan
Superior sulcus tumor CE - MRI
Subacute intestinal obstruction X-ray abdomen

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Schwannomas Gd-enhanced MRI
Sella turcica Lateral view of x-ray skull
Synovial pathology Gd-enhanced MRI
Temporal bone CT scan
Traumatic paraplegia MRI
Thyroid & breast FNAC
Toxoplasmosis IgA - ISAGA > IgM
Advanced renal TB CECT
Ca prostrate
DRE + PSA
(IOC) Trans rectal USG (Gold)
Ca bladder Malignant cell cytology in urine → Cystocopy
Early renal TB IVP
Functional kidney diseases (perfusion) MAG – 3 > DTPA
Neural tube defects :-
Best Amniotic fluid Acetyl cholinesterase
Next best Amniotic fluid AFP
Earliest USG (8–10 weeks)
Screening Maternal serum AFP
Polycystic kidney disease USG
Posterior urethral valve MCU (VCU)
Renal cortical mass Tc
99
DMSA
Renal calculi Non contract CT
Renal hypertension Spiral CT
Renal cell carcinoma Vascular thrombosis – Color Doppler
Structural kidney diseases DMSA
Ureteric colic & stones Plain CT
Vesico ureteric reflux MCU (VCU)
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