Direct Access MRI - Referral Guidance

  • Abdomen
  • Chest
  • Head / Brain
  • Lumbar Spine
  • Pelvis

  • Cancer - any patient with suspected cancer which meets the 2ww criteria should be referred by 2ww pathway (unless scan is requested by Radiologist following a suspicious plain film).
  • Children under 18 years of age.
  • Patients needing general anaesthetic, hospital inpatients and non-NHS patients.
  • Patients with implanted medical devices that are MRI contraindicated and in certain cases are MRI conditional.  Note: The referrer has the responsibility to provide information on all such devices.
  • Note: BMI restrictions dependent on weight limits of couch (please check with provider for thresholds).
  • Note: body parts not stated in the inclusions list are expressly excluded from this service provision.

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 Royal College of Radiologists iRefer Guidelines should be used to support decisions around clinical appropriateness - see National and NICE Guidance.
  • You will need to explain the findings to the patient, so be clear that the investigation is indicated and you know what to do with the result
  • Be aware that scans show incidental findings in a number of cases that can then lead to further possibly unnecessary imaging and associated financial cost and anxieties.

MRI CONTRA-INDICATIONS: Signing the referral form implies NONE of the below apply:

Cardiac pacemaker; metal in orbit; internal hearing device; intracranial vessel clip; valve replacement; metallic foreign body; claustrophobia

Gastrointestinal - iRefer MRI Diagnostic Guidance

Scan indicated: MRI Liver
Additional Information: The choice of MRI or CT depends on clinical context and local provision. MRI is more accurate than CT and will be preferable to evaluate an incidental lesion. If malignancy is suspected, CT is also helpful to assess extra-hepatic disease.
Other images or tests that should be done prior to undertaking this: Ultrasound
How to access scan indicated: Please see Services and Referrals section

Scan indicated:
  1. NOUS Abdomen
  2. CT Abdomen
  3. MRI Abdomen
Additional Information: US often solves the problem.  CT is used when US is inconclusive, and to provide more complete assessment of disease extent before definitive treatment.  If definite Neoplasm proceed to CT.  MRI may be helpful for distinguishing malignancy when ultrasound and CT are equivocal.
Other images or tests that should be done prior to undertaking this: NOUS before CTCT before MRI
How to access scan indicated: Please see Services and Referrals section
Musculoskeletal - iRefer MRI Diagnostic Guidance

Scan indicated: MRI
Additional Information: Local guidance coming soon.
Other images or tests that should be done prior to undertaking this: Local guidance coming soon.
How to access scan indicated: Please see Services and Referrals section
Neurological System - iRefer MRI Diagnostic Guidance

Scan indicated: MRI Head
Additional Information:

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

Other images or tests that should be done prior to undertaking this: None
How to access scan indicated: Please see Services and Referrals section

  • Recent onset and rapidly increasing frequency and severity of headache
  • Headache causing patient to wake from sleep
  • Associated dizziness, lack of co-ordination, tingling or numbness
  • Headache precipitated by coughing, sneezing or straining
  • Patients with malignancy or who are immunocompromised
  • Recent onset headache in patients older than 50.
Scan indicated: MRI Head
Additional Information:

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.

Other images or tests that should be done prior to undertaking this: None
How to access scan indicated: Please see Services and Referrals section

Scan indicated: MRI Head
Additional Information:

MRI is the investigation of choice. Diffusion-weighted images are helpful for investigation of brainstem ischaemia.

Other images or tests that should be done prior to undertaking this: None
How to access scan indicated: Please see Services and Referrals section

Scan indicated: MRI Head
Additional Information:

MRI is more sensitive for early tumours and may distinguish between tumour and abscess. It will resolve exact position (useful for surgery), characterise tumours and is particularly helpful for posterior fossa lesions. MRI may miss calcification. 

Other images or tests that should be done prior to undertaking this: None
How to access scan indicated: Please see Services and Referrals section
Direct Access MRI Referral Pathway

       

 

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