Inclusions: (click for further info)
Exclusions: (click for further info)
If you have any queries or need clinical advice as to the appropriateness of the request, please contact the chosen provider for information. The provider is at liberty to refuse a request or phone the clinician for further details if they feel the imaging is inappropriate.
When considering ordering imaging, please consider the following:
The brief information below is a guide and does not replace the full advice, diagnosis and management that an outpatient referral can give. Please refer to the RCR iRefer Guidelines for further information.
CT Head: (click for further info)
CT Abdomen: (click for further info)
CT requests with contrast: (click for further info)
Pleural effusion suspected: (click for further info)
Pneumonia - follow up: (click for further info)
Change of bowel habit to looser stools with or without rectal bleeding persistent for 6 weeks: colorectal neoplasia:
(click for further info)
Colonoscopy is the firstline investigation in younger patients, avoiding radiation and enabling biopsy.
Fully prepared CT colonography, where available, is the radiological investigation of choice for detecting colorectal cancer and large polyps. It has similar accuracy to colonoscopy. Limited preparation CT colonography, although of slightly lower accuracy, is well tolerated by the older or frail patient. Please note GPs do not have direct access to either of these tests therefore please refer to secondary care consultant.
Ba enema is an alternative and is widely used for investigating change in bowel habit in the absence of rectal bleeding but limited access due to supply of Barium.
Characterisation of a solitary liver lesion identified on US e.g. haemangioma, metastasis, etc: (click for further info)
Palpable mass: (click for further info)
Dementia and memory disorders: (click for further info)
Structural imaging with MRI or CT should be used in the assessment of people with suspected dementia to exclude other cerebral pathology and help establish the subtype diagnosis. In a small minority of cases, imaging will show an alternative cause such as a tumour, hydrocephalus or subdural collection. The yield for these lesions is higher if imaging is restricted to those with a rapid or atypical presentation, patients with focal signs, history of gait ataxia, incontinence or head injury. MRI may be useful in acute dementias, including limbic encephalitis, and conditions such as Creutzfeldt-Jakob disease.
CT is generally adequate, MR only for specific problem solving
Only to be requested as part of full dementia assessment
GPs must request coronal views of the head
Headache: chronic + these features significantly increase the odds of finding abnormality on MRI or CT: (click for further info)
Imaging is not usually useful for isolated headache without abnormal neurological features (see clinical problem).
Cervical spine XRs or paranasal sinus imaging are usually unhelpful even when neck signs suggest origin from the neck as they do not alter management.
If features of subarachnoid haemorrhage, immediate referral to ED without imaging
Space occupying lesion: (click for further info)
Renal calculi in absence of acute colic: (click for further info)
Low dose unenhanced CT provides the best baseline assessment in patients with renal stone disease. AXR is less accurate but has a lower dose and is still adequate in routine practice to detect and follow up the majority of renal calculi, which contain calcium.
US is less sensitive than unenhanced CT for the detection of renal calculi. Both unenhanced CT and US can detect urate calculi.
If calculi can be identified on AXR or US, they should be followed up as such to minimise radiation dose from multiple CT examinations.
Renal Mass: (click for further info)
Pre- and post-contrast-enhanced CT is the firstline investigation for the characterisation of a a suspected solid or complex cystic renal mass.
Very small "minimally complex cysts" less than 2 cms are better followed up with ultrasound.
Suspected ureteric colic: (click for further info)
MDCT is the most accurate investigation in suspected ureteric colic and a low-radiation-dose CT technique should be used.
Urinary tract obstruction: diagnosis and causes: (click for further info)
Direct Access CT Referral Pathway: (click for further info)