Page 120 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
3 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Radiology Requests
Nuclear Medicine scans, CT and MRI should be authorised by the SMO before the test is ordered unless imaging has been recommended as standard practice in a guideline agreed with Radiology.
If the SMO does not sign the request form themselves, the SMO’s name must be written on the CT and MRI forms in the clinical details section or the test will not be done.
It is essential that this is done so that the Radiologist can discuss any abnormalities with the appropriate SMO and to ensure that the report is directed to the right SMO.
Radiology will take a zero tolerance approach to this. No SMO name = No scan. Emergency or after hours CT must always be discussed with the Radiology registrar on call. After hours MRI requests must be discussed with the on call Radiology SMO.
You can’t just FAX the request for a CT or MRI and expect it to be actioned.
Request forms should have adequate details and the main objective of the examination and:
• symptoms and signs, any relevant past history and results of prior imaging studies
• any allergies especially to X-ray contrast
• possible infection risks e.g. HIV/Hep B +ve
• coagulation factors prior to any invasive procedures, and
• a recent creatinine or eGFR if the examination may include contrast
Any invasive examination requiring IV contrast requires patient consent using the Radiology Department forms. Complete consent forms in good time. Do not forget to include a recent eGFR and insert an IV line. Not doing so may lead to cancellation or delay in doing the test. Remember that the eGFR should only be calculated if the creatinine is stable and in AKI will underestimate renal function.
Timing
While in an ideal world we would never have to wait for tests, we do not live in an ideal world. The time frames indicated in these guidelines are a reasonable compromise given our resources. Variation will usually require a SMO to SMO discussion.
Less urgent imaging can always be done as an outpatient.
Radiology has agreed to give a day and time for non-urgent scans to allow a patient to be discharged if they are only awaiting a scan and there is no other reason for them to be in hospital.
Patients should never be admitted just to try and fast-track investigations and ‘jump the queue’.
Note that overnight CT scans in ED must be batched:
• If a patient is having an urgent overnight CT scan then ALL other ED CT scans (previously
deemed sub-acute) must be batched with these and done, rather than kept until the morning.
• All ED staff must be vigilant for this, with the registrars and the nurse leaders making sure that the Radiology team know to do all the scans (including sub-acute heads and CTUs) so these
patients do not languish until morning.
• Failure to scan patients overnight results in inefficient care and delays the next day.
Repeat Imaging
Imaging should not be repeated without good clinical reasons.
Cumulative exposure to contrast adds to the risk of radiation related harm
Always check what recent imaging has been performed.
Consider whether it needs to be repeated and if the results will change management.
For some conditions (for example epilepsy) we have included indications for repeat imaging.