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Ultrasound (US) referrals
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Guidance
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Soft tissue lumps
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The majority of soft tissue lumps are benign & with
classical clinical signs of a benign lump, US isn't routinely
required. <5cm stable, soft, mobile, non-tender lumps
don't routinely need US.
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Consider referral to gynaecology or urology for lumps involving
any of the perineal structures - labia majora or labia minora;
close to the anal canal or penis.
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Abdominal / gynae pain
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Pain/bloating as the only symptom is not justification for
US.
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A specific clinical question / differential diagnosis is
required.
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Follow-up of benign lesions
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There is no role for US in follow-up or in treatment
monitoring.
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If there has been a clinical change, then re-scan is
acceptable.
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Goitre
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There is no necessity for follow up unless there has been
increase in size/ new features.
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Only refer if there has been an increase in size or new
features.
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Head and neck ultrasound
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US is not helpful for neck pain neck with no palpable discrete
mass, dysphagia or gurgling sounds, feeling of strangulation or
compression.
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Musculoskeletal ultrasound
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Pain as the only symptom is not a justification
for US.
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A specific clinical question / differential diagnosis is
required.
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Breast related concerns
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Please do not refer to US
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Please refer directly to the breast unit via choose and
book.
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Early pregnancy concerns
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Please do not refer to US
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Refer to Early Pregnancy unit (ext 5534)
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Later pregnancy concerns
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Please do not refer to US
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Refer to MB1 ward (ext 5031)
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Suspected DVT
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Please do not refer to US
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Refer to the DVT clinic (ext 5378)
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Haematuria
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Only accepted if patient is under 45 years of
age.
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Refer to the one-stop haematuria clinic in urology if patient is
over 45 years.
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X-ray referrals
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Guidance
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Coccyx XR for coccyx pain
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Coccyx x-rays are not justified for coccyx plain (RCR
guidelines). Normal appearances are often misleading, findings do
not affect management and radiation dose is significant.
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In cases of chronic intractable coccydynia, specialist referral
(e.g. pain clinic or orthopaedics) is suggested.
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Abdominal XR for renal stones
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Abdominal x-ray requests for renal stones, renal colic or
haematuria are not appropriate.
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Patient should be referred to urology or for an ultrasound
scan.
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Facial bones XR for nasal bone fracture
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X-rays are unreliable in the diagnosis of nasal fractures. Even
when positive they do not usually affect patient management.
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A referral to ENT/maxillofacial team is suggested.
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Chest XR for rib fracture
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Demonstration of a simple rib fracture does not usually alter
management.
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If a complication such as pneumothorax or infection is suspected
CXR is appropriate.
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Skull XR for trauma
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Skull x-rays are not justified in the context of trauma.
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If there is a suspicion of a head injury an urgent neuro
referral for appropriate assessment is recommended, or the patient
needs to attend A&E if they are having symptoms of a head
injury.
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Submandibular stone
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Plain film is not an appropriate referral.
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Initial referral to oral surgery is the recommended pathway
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Lumbar spine XR for low back pain / sciatica
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Plain film not justified for routine cases of low back pain with
or without sciatica.
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X-rays may be helpful for suspected osteoporotic collapse or
patients with red flags.
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