MRI CONSULTATION REPORT

Name: Ina Gateway                            DOB: 01/10/41 10020231 mr018 abdomen/180-22-33 Referring Service, Clinic or Floor DATE: 03/20/91   [] Ambulatory [] Bed [] 02 [] OR [] Wheelchair [] Portable [] Isolation PROCEDURES REQUESTED MRI Abdomen PRIMARY DIAGNOSIS (REQUIRED) OUTPATIENT ICD-9 CODE

CLINICAL HISTORY PERTINENT TO THIS RADIOLOGY CONSULTATION (REQUIRED)

(INCLUDE PRECAUTIONS: DIABETES, ALLERGIES, ETC.) Serum Creatinine or BUN for CT, IVP, Angio P       L      P E      R A      I S      N E      T REQUESTING PHYSICIAN NAME   ATTENDING PHYSICIAN NAME Phone   Phone

Report will be sent to Physician's Office, Clinic, Floor & Medical Records

Address (Street, City, State) Date & Time Procedure Completed Technologist I.D. Part Exam Film Count KVP      Fluoro             Time MAS Distance MR Sequences Contrast Supplies & Comments   7 11 8 14 10 PCR

RADIOLOGY CONSULTATION REPORT

MRN: 180-22-33                      Name: Ina Gateway
Proc: MRI OF ABDOMEN (03/20/91)

MRI was performed on a GE Sigma 1.5 Tesla MRI machine. Axial images with TR of 500 and TE 15, slice thickness of 5 mm were taken from the dome of the diaphragm to the iliac wings. Also taken were axial images with TR 2000 and TE 30/80 with 5-mm thick sections. Coronal sections with TR 500 and TE 15. In addition, axial sections with TR 10 and TE 2.9 with 5-mm thick sections were also included.