When to Order Advanced Imaging: A Quick Guide for Primary Care Physicians

A Clinical Referral Resource from InView Imaging

Primary care physicians routinely balance the need to act decisively with the reality that many conditions evolve over time. Knowing when advanced imaging will meaningfully change patient management is essential—and often the key to avoiding delays in diagnosis, treatment, or referral.

At InView Imaging, we support Bay Area primary care physicians with fast, efficient scheduling; high-quality MRI, CT, PET/CT, ultrasound, X-ray, and DEXA; and direct access to fellowship-trained radiologists. Our community-based, physician-owned imaging model is designed to make advanced diagnostics both accessible and clinically meaningful.

This guide provides a practical, evidence-based framework to help PCPs determine when to order advanced imaging and which modality is most appropriate in common clinical situations.

The Role of Community-Based Imaging

Primary care physicians rely on imaging to:

• Confirm a suspected diagnosis
• Rule out serious or urgent conditions
• Guide referral decisions
• Monitor chronic medical conditions
• Support surgical or specialty planning

Because InView Imaging is physician-owned and locally operated, referring providers benefit from:

• Quick, easy schedulingwith minimal barriers
  • Open MRI (Concord)and wide-bore MRI (San Ramon) for comfort and accessibility
  • PET/CT in San Josefor oncology-focused evaluation
  • Efficient communicationwith radiologists
  • Clear, actionable reports
  • Patient-friendly staff and processes

  Our goal is to make advanced imaging seamless for physicians and comfortable for patients.

  Choosing the Right Modality: Quick Overview

  MRI

  Best for soft tissues, brain, spine, joints, nerves, ligaments.
  No radiation.

  CT

  Best for acute conditions, trauma, lungs, abdomen/pelvis, fractures, vascular concerns.
  Fast, highly detailed.

  Ultrasound

  Best for gallbladder, kidneys, pelvic structures, thyroid, testes, DVT evaluation.
  No radiation, cost-effective.

  X-ray

  Best initial study for many musculoskeletal and pulmonary concerns.
  Fastest and simplest exam.

  DEXA

  Bone mineral density evaluation.
  Osteoporosis screening and monitoring.

  PET/CT

  InView San Jose
  Best for oncology staging, surveillance, and metabolic characterization of masses.

  Clinical Scenarios: What to Order and When

  1. Low Back Pain

  Imaging is appropriate when:

  • Red flag symptoms (neurologic deficits, bowel/bladder dysfunction, saddle anesthesia)
  • Suspected infection or malignancy
  • Pain after trauma
  • Persistent symptoms after conservative management

  Best test: MRI lumbar spine

  Why InView:
  Open and wide-bore scanners improve comfort for patients with pain, anxiety, or mobility limitations.

  2. Knee Pain

  Image when:

Suspected ligament or meniscal tear

• Locking, catching, or mechanical symptoms
• Persistent pain despite PT or conservative care

Best tests:

• X-ray kneefirst (alignment, arthritis, fractures)
• MRI kneefor soft-tissue injury

3. Headache or Neurologic Changes

Image when:

• New, severe, or worsening headaches
• Focal neurologic deficits
• New headache in patient >50
• Symptoms concerning for mass, stroke, or demyelinating disease

Best tests:

• MRI brain
• CT headfor trauma or acute bleeding concerns

4. Abdominal or Pelvic Pain

Image when:

• Pain unexplained by exam or labs
• Suspected appendicitis, diverticulitis, renal colic, bowel obstruction
• Chronic pelvic pain
• Concern for hernia or mass

Best tests:

CT abdomen/pelvisfor acute pain

Ultrasoundfor gallbladder, renal, or gynecologic evaluation

MRI pelvisfor soft-tissue detail or endometriosis assessment

5. Soft Tissue Mass

Image when:

• Persistent, enlarging, or unexplained mass
• Concerning features on physical exam

Best tests:

• Ultrasoundinitially
• MRI with contrastfor deeper characterization

6. Chest Pain or Respiratory Symptoms

Image when:

• Persistent chest symptoms
• Suspected pneumonia, mass, or chronic lung disease
• Uncertain cause after initial workup

Best tests:

• Chest X-ray
• CT chestfor more detailed evaluation or persistent symptoms

7. Thyroid Nodules

Image when:

• Palpable thyroid abnormality
• Abnormal thyroid labs
• Symptoms of compression

Best test: Ultrasound thyroid

8. Osteoporosis Screening and Monitoring

Best test: DEXA scan

Indications:

• Women ≥65
• Postmenopausal women with risk factors
• Adults on chronic steroids
• Men ≥70
• History of fragility fractures

9. Cancer Diagnosis, Staging, or Surveillance

Best tests:

• PET/CT (InView San Jose)— primary tool for staging, surveillance, and evaluating metabolic activity
• CT chest/abdomen/pelvisdepending on cancer type
• MRIfor brain, liver, prostate, and MSK tumor evaluation

10. Vascular Concerns

Image when:

• Leg swelling or suspected DVT
• Carotid bruits
• PAD symptoms

Best tests:

Ultrasound Dopplerfor DVT

Carotid ultrasound

CT angiographyfor vascular mapping (when clinically indicated)

Red Flags: Image Immediately

Urgent, efficient imaging access at InView supports PCPs when patients present with:

• Acute neurologic deficits
• Suspected cauda equina syndrome
• Severe trauma
• Sudden vision loss
• Severe headache with neurologic findings
• Suspected abdominal emergency
• Concern for malignancy with rapid progression

While these may often require ED referral, many urgent outpatient scenarios can be accommodated quickly at InView Imaging depending on clinical need.

How InView Imaging Supports Primary Care Workflows

1. Quick, Easy Scheduling

Patients are scheduled with minimal wait and clear guidance, reducing delays in diagnosis and treatment.

2. Subspecialty Radiology Expertise 

InView’s radiology team includes experts in:

• Neuroradiology
• Musculoskeletal imaging
• Body imaging
• Oncology imaging
• Women’s imaging

Reports are clinically focused and tailored to your referral question.

Direct Radiologist Consultation

PCPs may consult InView radiologists directly for:

• Modality selection
• Study protocol guidance
• Clarification of findings
• Biopsy recommendations

4. Clear, Actionable Reporting

Reports include:

• Concise impressions
• Relevant findings, not unnecessary details
• Follow-up recommendations when appropriate

5. Patient-Centered Experience

Patients consistently note that InView provides:

• Comfortable MRI environments (open & wide-bore options)
• Friendly, supportive technologists
• Helpful staff
• Transparent pricing
• Locations close to home

A positive imaging experience improves adherence and supports the physician–patient relationship.

Final Thoughts: InView as a Clinical Partner

Advanced imaging is most effective when it enhances clarity, accelerates decision-making, and supports timely treatment. At InView Imaging, we work closely with primary care physicians to offer:

• High-quality imaging
• Easy, efficient scheduling
• Subspecialty interpretations
• Direct communication
• Patient-centered care

We see ourselves as partners in your care model—supporting your clinical decisions with precision, accessibility, and compassion.