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In this section : Imaging
Contraindications to MRI Magnetic Resonance Imaging Radiology
Home | Articles | Imaging | Radiology

Radiology

Last updated 9th April 2024

Imaging Available in This Hospital

  1. Plain x-ray, Ultrasound, Fluoroscopy, DEXA, CT, MRI
  2. We are a filmless, completely digital department, with all our images stored on PACS.
  3. Please consult the IRMER referrer’s checklist for a diagnostic imaging examination when requesting X-rays or scans.

Ionising Radiation Medical Exposure Regulations (IRMER)

  1. All examinations involving the use of Ionising Radiation MUST be ‘justified’ by the Radiology Department before they can go ahead. This is a non-negotiable legal requirement of the Ionising Radiation (medical Exposure) Regulations (IRMER).
  2. Therefore DO NOT request anything that will not be of net benefit to the patient.
  3. A useful investigation is one in which the result (positive or negative) will alter management and/or add confidence to the clinician’s diagnosis. We WILL challenge requests which we feel are not justified; so be prepared!
  4. Click here for Guide to IR(MER) for Referrers – document contains useful appendix showing doses of radiation & lifetime additional risk of fatal cancer associated with different radiological examinations

What Can You Refer For?

  1. If you are an FY1 or FY2 Doctor you will be entitled to refer for plain x-ray and ultrasound only.
  2. Middle grade medical staff are entitled to refer for imaging relevant to their specialty.
  3. CT and MRI requests will only be accepted from Consultants. However, Associate Specialists, Staff Grades, STs and middle grade staff can refer for scans appropriate to their specialty. Non Medical Referrers (NMR) can refer only if stated in their scope of entitlement.

Inpatients 9.00am-5.00pm Monday-Friday

  1. Pod the card to the Imaging Pod (Station 28). Phone duty senior radiographer on 33677 if request urgent. When the examination you have requested has been approved, our porters will bring the patient from the ward for x-ray.
  2. If you require a portable x-ray in the ward please contact the duty senior radiographer.
  3. Only request a portable x-ray if your patient is too ill to be transported to the x-ray department. Remember Portable x-rays present a radiation risk to other patients and staff in the ward.
  4. The range of x-rays we perform with a portable machine on the ward is restricted and image quality is far from ideal especially in larger patients who are required to lie directly on the x-ray detector. This is uncomfortable, especially for very ill patients.
  5. Where possible abdominal x-rays should be performed in the main x-ray department, unless in extreme circumstances.
  6. You will need to provide sufficient patient information (including CHI number and consultant) to enable us to book your patient onto our Radiology computer system. This will enable us to use a digital mobile x-ray machine to x-ray your patient, and you will then have access to the image at the patient’s bedside. The request form should be available in the ward for the radiographer. If you are a Locum, make sure your name is visible on OrderComms (OCM).
  7. If you require a CT or MRI on an in-patient, pod the request to Imaging department. The request will be justified by a Consultant Radiologist prior to booking. If the scan is urgent speak to the relevant Radiologist ASAP.

Inpatients 5.00pm-9.00am Monday-Friday and All Weekend

  1. Always phone on call radiographer on 33677 to request. This is an on call emergency service, imaging requests out-of-hours are only indicated if it will influence the management of the patient.
  2. Do not just pod a card to the Imaging Pod (Station 28) and assume it will be done.

Outpatients Requests

  1. If you require a general x-ray on a clinic patient, please complete a radiology request card and send the patient to the x-ray department. Please ensure that the patient is clear about whether they need to return to the clinic again, or if they are free to leave the hospital after the x-ray.
  2. By agreement: Dental / oral surgery / maxillary facial / orthopaedic plain x-rays are not reported by the Radiologists. If you request x-rays from any of these specialties it is your responsibility to ensure that a clinical evaluation of the resultant images is carried out.

Emergency Department

  1. If you request an x-ray on an ED patient; place the completed x-ray request card in the ‘x-ray docket’ on the wall in ED. Notify the Radiographer on Ext 33677 and the nursing staff will bring the patient to the x-ray department.
  2. If you require an urgent CT or ultrasound on an ED patient contact the relevant Radiologist.

Out of Hours

  1. During out-of-hours periods Monday to Friday 5pm-9am and all day Saturday and Sunday x-ray will be staffed by an on-call Radiographer who will be on site, and a consultant Radiologist who will be on-call from home.
  2. During these periods all requests for general x-ray should go through the on call radiographer on 33677.
  3. All urgent CT requests Monday-Thursday after 8pm, will go through Medica (Nighthawk). The only exception will be major trauma which will be handled by the DGRI Radiologist on call. Please refer to the document AUTHORISATION GUIDELINES FOR THE MEDICA OUT OF HOURS CT REPORTING SERVICE. Ultrasound requests should be made direct to the on call Radiologist (usually from the clinical consultant), via the switch board
  4. Imaging requests out-of-hours are only indicated if it will influence the management of the patient.

All Request Forms

  1. Require LEGIBLE signature, grade, printed name, phone number and Consultant’s name; otherwise the form will be returned to you.
  2. Sufficient clinical history MUST be added to the request card to enable a Practitioner in the x-ray department to justify the examination.
  3. ALWAYS complete the section of the Radiology request card which asks ‘What question should the examination answer?’
  4. Indicate mode of transport on form – DO NOT send patients on chairs unless they are fully able to transfer on to an x-ray table if required.
  5. You MUST indicate any infective process status (e.g. MRSA, C. Diff)
  6. In women of child bearing age (age 12 -55) the possibility of pregnancy MUST be considered in x-ray examinations of the abdomen / pelvis.
  7. PLEASE notify the department IMMEDIATELY
    • if an examination is no longer required
    • if the patient’s condition or the management of the patient has changed, after you have submitted a Radiology Request.

Chest and Abdomen X-ray Requests

  1. These involve a significant radiation dose. Please do not request a CXR / AXR unless it will affect the management of the patient. A chest x-ray is protocol for? perforation
  2. Consider alternative imaging, such as ultrasound which may be more appropriate for certain pathologies.
  3. Do not request a CXR and AXR if you are planning to also request a CT of the abdomen.
  4. We do not routinely perform KUB requests for query renal stones or acute renal colic. These patients should have CT KUB performed.

CT Scan Requests

  1. MUST be signed by a clinician who is entitled to refer for CT.
  2. Give patient’s phone number if out-patient.
  3. Any history of previous contrast / iodine reaction / any other severe allergy?
  4. It is essential that you let us know if your patient is taking Metformin.
  5. Renal function (eGFR) needs to be checked.
  6. Please ensure that requests for In-Patient CT scans arrive in Radiology at the earliest possible opportunity in the day. CT examinations will require intravenous contrast agent with the exception of Ct heads(?stroke), KUB and High Resolution chest. Please arrange for cannulation at time of referral. CT requests are justified by a Consultant Radiologist prior to booking and will be prioritized relevant to the clinical information provided.

Ultrasound Requests

  1. Send the ultrasound request card to the department as early as possible in the day. There are a limited number of in-patient ultrasound slots available each day. The Radiology department staff will inform the ward of an appointment time for the scan and any specific preparation required (such as fasting or a full bladder).
  2. In-patient ultrasounds are normally carried out in the afternoon. However, if you require an urgent scan or a ‘portable’ ultrasound, please contact the Duty Radiologist.

MRI Request

  1. Can only be requested by Consultant by email to [email protected]
  2. Click here for contraindications to MRI
  3. If patient >250kg please also indicate abdominal girth
  4. Mention if kyphotic as sometimes unable to lie flat enough to fit in the head coil
  5. If confused or agitated then referrer to provide accurate history and sign consent form on patient’s behalf
  6. MR will not be possible If requires intubation
  7. Should warn patient that scanner is noisy and claustrophobic.
  8. Indicate referring specialist’s telephone number.

Images on PACS

  1. Any problems viewing images on PACS during normal working hours: contact PACS admin team Extn 33984. Out of hours problems, contact IT on call on 34100 or via switchboard.
  2. If you are viewing unreported images to decide on patient management, make sure you are using a diagnostic quality monitor (will be labeled as such).

Ask Advice From a Radiologist

  1. Radiology has developed a call centre to assist referrers who wish to contact a Radiologist concerning requests/reports for their patients.
  2. We hope the introduction of this system will allow referrers to discuss referrals/reports easily and reduce the need to come directly to Radiology, reducing person to person contact during this pandemic period, hopefully this will also reduce time spent locating the appropriate person to speak to.
  3. Using the number EXT 33861 you will be connected to one of four options
    • X-ray reception
    • Duty Radiologist
    • CT Radiologist​
    • MRI Radiologist
  4. Please continue to send REFERRALS via the pod system, on receipt these requests will be added to the Radiology computer system, where the modality Radiologist will be able to view them.
  5. For urgent reports/needs to be reported soon – please continue to use the system we have in place (e-mail to generic x-ray or call to x-ray reception, they will inform us).

Links

  1. IRMER – Have you Paused and Checked[pdf]
  2. EP2 Entitlement of Individuals to act as Referrers, Practitioners, Operators, and Medical Physics Experts and a description of their duties.[pdf]
  3. EP4 Referral Procedure and Referral Criteria[pdf]

Content by Louise Cox