imaging referral

IR(ME)R - practitioner vs operator

• practitioner - justifies the exam - benefits outweigh the radiation risk

• operator - carries out exam

• radiographers always operators but not always practitioners

who is responsible for justification and what are the referral formats

• practitioner

• only requests in the UK, no ‘orders’

• incomplete / inappropriate referrals can be and should be rejected

• paper, digital or both but many are digital - paper often from external referrers - depends on trust

patient details required on a referral

• full name, dob, address, nhs number and hospital number

• identification of the patient

• gender and pregnancy status - NOT required

• hospital number is specific to every hospital

referrer details

• name

• consultant or gp

• signature and specialism

• no signature = no image

non medical referrers and who can refer for ionising radiation

• advanced practise nurse and AHPs can but only within a set scope of practice narrower than medical staff

• local policy dependent - all doctors can refer and dentists for dental imaging but PA’s don’t

what’s different about patients with neutropenia

• some patients such as neutropenic patients are more prone to infection

• many on chemotherapy who have neutropenia

• infections = harder to treat

• matters for infection control

unjustified requests

• imaging that can’t change care

• rib fractures without shortness of breath

• unspecific low back pain unless history of prostate cancer - treatment: exercise

• coccyx injury, nasal bone injury and undisplaced fractures of toes 2-5

• soft tissue lumps with the exception of breast lumps

• radiolucent foreign bodies such as fish bones unless in the top middle part of throat

CT with contrast (eGFR) and MRI - dangers / risks - why do CT and MRI referrals need extra information?

• CT - contrast dye is cleared from the body by the kidneys and if kidneys aren’t working well, the dye can harm

• referral needs an eGFR (blood test showing how well kidneys work) from a recent time - without = can’t safely give the dye

• MRI - scanner is a very strong magnet so metal in body can be dangerous

• previous procedures and implants = some can be moved, heated or damaged by the magnet

• possible shrapnel = e.g someone working with grinding metal can have tiny pieces in the eye where the magnet can pull on them and cause blinding

• ceramic and titanium = generally fine - orthopaedic implants - still to be checked

additional patient info?

• patient referral location eg ward, clinic or gp

• allergies

• additional needs

• patient mobility

• oxygen requirements

• infection status

• special status eg private patient

referral clinical info

• referrers must identify the modality and exam required

• should be a clinical question of how imaging may change management