Page 118 - Registrar Orientation Manual 2016

Type:
Clinical Guideline
Document reference:
1257
Manual Classification:
Service Specific Radiology
Title:
Imaging Guidelines
Effective date:
7 July 2015
Facilitator sign/date
Paul Reeve
Head of Medicine
Sponsor authorised sign/date
Sabaratnam Muthukumaraswamy
CD Radiology
Version:
02
Page:
1 of 35
Document expiry date:
6 July 2018
 Waikato DHB, July 2015 Introduction
These guidelines for Radiology, Ultrasound, Nuclear Medicine, CT and MRI have been endorsed by the Clinical Director Forum and Management Executive Committee. They are intended to both rationalise and also ration the use of imaging in Waikato Hospital, particularly MRI, a limited resource.
Radiology will prioritise referrals according to these guidelines. Variation from these guidelines will require a SMO to SMO discussion. The guidelines focus on the conditions that are either (or both) common and acute. Requests for indications not covered by the guidelines may need discussion.
At the time these Waikato imaging guidelines were first drafted there were no national NZ imaging guidelines. National Radiology Referral Guidelines had originally been developed in 2001 but were removed from the Ministry website in 2010 in response to concerns about their currency.
As a result of feedback, the Ministry has now elected to replace the National Radiology Referral Guidelines with National Community Radiology Access Criteria. These were published in March 2015 and have replaced our own Midland DHBs Regional Clinical Access Criteria.
The National Community Radiology Access Criteria are primarily intended for use in primary care to guide referrals for and ensure access to imaging. The Criteria include time frames for prioritisation and wait times, with the aim of all routine imaging being performed within 6 weeks.
While the National Community Radiology Access Criteria identify the best practice management of a given condition, they do not take into consideration resource limitations, the need to manage demand for diagnostic imaging, or the access of primary care providers to specific types of imaging.
The criteria document notes that DHBs should have appropriate locally agreed clinical pathways for common conditions presenting to primary and secondary care and that pathways are expected to be developed according to broad clinical consensus and through primary and secondary care partnerships. The document notes that locally agreed clinical pathways supersede these criteria.
The National Community Radiology Access Criteria provide guidance only on referrals for X-rays, ultrasound and CT and not nuclear medicine or MRI. The approach is based on the imaging study rather than the clinical indication. The criteria are not comprehensive enough for hospital practice but they do help provide guidance for the appropriate use on common investigations like CXR.
As there are no national guidelines or pathways for secondary care we have had to develop our own imaging guidelines. We have used the Western Australian Imaging Guidelines to help do this. Note that we have varied from the Australian recommendations at times because of our more limited resources and specified CT over MRI when the Australian guidelines have given a choice.
The National Community Radiology Access Criteria note that “a useful investigation is one in which the result – positive or negative – may alter management and improve the outcome for the patient”.
Always ask whether the investigation meets these criteria. A significant number of radiological investigations do not fulfil these aims and may add unnecessarily to patient irradiation. Particular consideration is required before ordering tests with ionising radiation, especially in younger people.
Please note that inappropriate requests for both MRI and CT scanning in ED can delay patient flow, both for the patient awaiting an unnecessary scan and for patients who actually need scans. Imaging should never be requested as an alternative to performing an assessment of a patient.
Imaging will not be performed on a patient’s or relatives’ request if there is no good clinical indication. Having guidelines can help empower doctors to decline such requests. These guidelines also mean that the organization will take the risk if rationing limits access.