Page 149 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
32 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Always seek SMO advice before requesting (or suggesting) further imaging. MRI will not be performed on a patient’s or their relatives’ requests if there is no good clinical indication.
Clinical urgency:
If a candidate for thrombolysis:
If on anticoagulants and progressing:
Other strokes or suspected strokes*:
* There may also be other times when urgent CT may be indicated: seek SMO advice
Thyroid Disease
The National Community Radiology Access Criteria for thyroid ultrasound are:
• palpable nodules
• euthyroid goitre
Referral for ultrasound is not typically indicated:
• thryotoxicosis (with or without goitre)13
• goitre with hypothyroidism
The ‘Choosing Wisely’ recommendations include:
Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.
Don’t use nuclear medicine thyroid scans to evaluate thyroid nodules in patients with normal thyroid gland function
TIA
The TIA Imaging Pathway in the Australian guidelines recommends CT as the initial imaging
investigation of choice in TIA.
MRI may be better and, in future, may become the preferred option, but currently we cannot offer timely MRI in TIA patients; while an early CT allows antiplatelet therapy to be started.
MRI after a normal CT is restricted to patients with significant diagnostic uncertainty.
Clinical urgency:
1st TIA: CT8amto10pm/7daysaweek
After 10pm book a 0830 scan Recurrent TIAs within one week: 24 hour CT / 7 days a week
Trauma (See the Trauma Protocol for more details)
Chest X-ray:
CXR is critical to determine respiratory compromise requiring intervention and to exclude sites of life threatening haemorrhage. Plates should be on the trauma bed before the patient arrives. The image should be on the viewing screen within 7 minutes of the patient's arrival. Any symptomatic tension pneumothorax may be treated prior to CXR if the diagnosis is clear and the patient is compromised.
Pelvic X-ray:
This is mandatory in major blunt trauma patients. A pelvic fracture that is not clinically obvious can be the site of unexplained blood loss. A dislocated hip is an orthopaedic emergency can be missed in a patient with multiple injuries, especially if unconscious. Call orthopaedic registrar immediately.
Immediate CT whatever the time 24 hour CT / 7 days a week
CT 8am to 10pm / 7 days a week