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Top Tips for GP referrals to diagnostic imaging

Imaging requests should include a specific clinical question to answer and contain sufficient information to support the suspected diagnosis.

Referrals to hospital clinicians under2ww pathway(urgent suspected cancer) do not need to be referred for diagnostics (e.g. US or CT). The hospital clinician will ensure all diagnostics are requested as part of the patient's workup.

For referral guidanceplease refer to the Royal College of Radiologists (RCR) guidelines "Making the best use of clinical radiology" - iRefer - hard copy books and available online at https://www.irefer.org.uk/

TheDuty Radiologist(ext 8435) service is provided Monday to Friday, 9am - 5pm by a Consultant Radiologist, for clinical discussions, radiological advice / opinion.

 


Ultrasound (US) referrals

 


Guidance

Soft tissue lumps

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.

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.

Abdominal / gynae pain

Pain/bloating as the only symptom is not justification for US.

A specific clinical question / differential diagnosis is required.

Follow-up of benign lesions

There is no role for US in follow-up or in treatment monitoring. 

If there has been a clinical change, then re-scan is acceptable.

Goitre

There is no necessity for follow up unless there has been increase in size/ new features.

Only refer if there has been an increase in size or new features.

Head and neck ultrasound

US is not helpful for neck pain neck with no palpable discrete mass, dysphagia or gurgling sounds, feeling of strangulation or compression.

Musculoskeletal ultrasound

Pain as the only symptom is not a justification for US.

A specific clinical question / differential diagnosis is required.


Breast related concerns

Please do not refer to US

Please refer directly to the breast unit via choose and book.

Early pregnancy concerns

Please do not refer to US

Refer to Early Pregnancy unit (ext 5534)

Later pregnancy concerns

Please do not refer to US

Refer to MB1 ward (ext 5031)

Suspected DVT

Please do not refer to US

Refer to the DVT clinic (ext 5378)

 

Haematuria

Only accepted if patient is under 45 years of age.

Refer to the one-stop haematuria clinic in urology if patient is over 45 years.

 


X-ray referrals

 


Guidance

Coccyx XR for coccyx pain

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.

 

In cases of chronic intractable coccydynia, specialist referral (e.g. pain clinic or orthopaedics) is suggested.

Abdominal XR for  renal stones

 

Abdominal x-ray requests for renal stones, renal colic or haematuria are not appropriate.

Patient should be referred to urology or for an ultrasound scan.

Facial bones XR for nasal bone fracture

X-rays are unreliable in the diagnosis of nasal fractures. Even when positive they do not usually affect patient management.

A referral to ENT/maxillofacial team is suggested.

Chest XR for rib fracture

Demonstration of a simple rib fracture does not usually alter management.

If a complication such as pneumothorax or infection is suspected CXR is appropriate.

 

Skull XR for trauma

Skull x-rays are not justified in the context of trauma.

 

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.

 

Submandibular stone

Plain film is not an appropriate referral.

Initial referral to oral surgery is the recommended pathway

 

Lumbar spine XR for low back pain / sciatica

Plain film not justified for routine cases of low back pain with or without sciatica.

X-rays may be helpful for suspected osteoporotic collapse or patients with red flags.

 

 

CT referrals

 

Guidance

CT colon referrals

These are only accepted from authorised centres.

If referring please ensure a recent GFR/ renal function test has been undertaken.