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Radiology for healthcare professionals
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Radiology for healthcare professionals
This page is only for clinicians and healthcare professionals to use in order to make a referral to our radiology services.
We will only accept external imaging referrals which meet the referral criteria in the latest RCR ‘Making the best use of clinical radiology’ guidelines (iRefer).
Referrals must only be made if the results of the examination are likely to affect the management of the patient and it is the referrer’s responsibility to read and act on the results, if required.
Doses for common X-Ray, CT and Fluoroscopy examinations
It is the responsibility of the referrer to make the patient aware that there is a risk associated with exposure to ionising radiation and to explain how they believe the benefit of information gained by having the examination, outweighs this risk.
Below is a list of typical effective doses for common X-Ray, CT and fluoroscopy examinations.
Limbs and joints (except hip) X-rays
- Equivalent period of natural background = <1.5 days
- Typical effective dose (mSv) range = <1
Chest (single PA film) X-ray
- Equivalent period of natural background = 3 days
- Typical effective dose (mSv) range = <1
Lumbar spine X-ray
- Equivalent period of natural background = 7 months
- Typical effective dose (mSv) range = 1-5
CT head
- Equivalent period of natural background = 1 year
- Typical effective dose (mSv) range = 1-5
CT abdomen/pelvis
- Equivalent period of natural background = 4.5 years
- Typical effective dose (mSv) range = 5.1 to 10
Barium meal
- Equivalent period of natural background = 16 months
- Typical effective dose (mSv) range = 1-5
Whole Body PET-CT
- Equivalent period of natural background = 7.6 years
- Typical effective dose (mSv) range = >10
Making a referral
When making a referral for an examination using ionising radiation, the following information is required:
- Unique patient identification including all of the following: patient name, date of birth, full address, and NHS number where possible.
- A full and relevant clinical history to enable the IR(ME)R practitioner to decide whether there is a sufficient net benefit to the patient from the examination. This must include details of previous relevant interventions or surgery, findings on clinical examination and the results of other relevant investigations including previous imaging.
- The clinical question to be answered and how the imaging requested will affect the patient’s future management. If a remote consultation has occurred, imaging tests should not be requested as a substitute for a clinical examination.
- Details on pregnancy status for individuals of childbearing potential, aged 12-55
It is essential that the identity of the patient being referred for an examination is double-checked to ensure the correct patient undergoes the correct examination. If the wrong patient undergoes an examination using ionising radiation, MSEFT is obliged to investigate and may be required to report the incident to the CQC.
It is the referrer’s responsibility to make sure that the same imaging examination (or a different imaging examination that may provide the same information) has not recently taken place (at MSEFT or elsewhere) unless there has been a change in the patient’s clinical condition which requires a repeat examination.
Nuclear Medicine
Who can make a referral?
All medically qualified doctors with GMC registration can make a referral for a nuclear medicine test. If you are a junior doctor the referring consultant in charge of the patient should be included within the request.
GPs can also make referrals for certain nuclear medicine investigations such as bone scans.
Non-medical referrers within the Trust can also refer for nuclear medicine examinations if approved in line with our imaging requests by non-medical referrers policy.
How to make a referral
For all referrals, please make sure that the patient is informed that they will be referred for a test before sending in the referral.
For many tests, a dose of radiopharmaceutical will be ordered in advance for each patient. Where patients cancel at short notice, we are unable to use the dose for another patient. All efforts will be made to process requests as soon as possible upon receipt.
The referrer must provide sufficient clinical information to justify the exposure, including provisional diagnosis, clinical history, and previous radiological history where applicable.
Examinations must be justified under IRMER for referrals involving ionising radiation (in line with iRefer). If any referrer is in doubt as to whether an investigation is required, or which examination is best, they should discuss the case with an appropriate IRMER practitioner, radiologist or nuclear medicine radiographer/technologist, prior to referral.
When insufficient information is given to justify an examination, the referrer will be contacted using the supplied contact details.
For external referrers without access to the electronic referral system, the referral form or clinical letter should be sent to the required department using the details below:
Basildon
Imaging appointments
Basildon University Hospital, Nethermayne, Basildon, Essex, SS16 5NL
Broomfield
Radiology appointments, Broomfield Hospital, Court Road, Broomfield,Essex, CM1 7ET
Alternatively you can email mse.mehtradiology@nhs.net.
Southend
Nuclear medicine, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY.
Referral criteria (nuclear medicine)
Glomerular Filtration Rate (GFR)
Indications will include:
- Calculation of carboplatin dose in chemotherapy.
- Assessment of potential live donors for kidney transplantation.
- Monitoring of patients receiving drugs that can cause nephrotoxicity.
- Assessment of renal function in chronic kidney disease including the evaluation and follow up of renal function in chronic glomerulonephropathies (such as diabetes mellitus and haemolytic uremic syndrome).
- Detection of renal failure in patients in whom serum creatinine results might be misleading, for example due to abnormal diet or musculature.
- Detection of renal failure in patients in whom missing a decline in renal function might be disastrous, for example in those with a single kidney, renovascular disease or a renal transplant.
- The evaluation of single kidney function in conjunction with relative renal function measurements from static or dynamic radionuclide imaging, including patients about to undergo renal surgery.
- Complex urological problems or long-term urological conditions such as diversions.
- Assessment of kidney function as part of the work up for receiving a liver transplant.
Additional instructions
Please indicate if the patient has ascites, oedema or other expanded body space and the severity
Dosage
Effective dose = 0.05
Dose range = <1
Bile acid malabsorption (SeHCAT) study
Indications will include:
- Assessment of ileal function
- Investigation of inflammatory bowel disease and chronic diarrhoea
- Study of enterohepatic circulation.
Additional instructions
Ideally patients should avoid taking bile acid sequestrants the day before the first appointment and for the following 7 days as these may interfere with the test results.
Dosage
Effective dose = 0.3
Dose range = <1
Bone scan
Indications will include:
- Osteoid osteoma
- Primary: osteosarcoma, secondary: metastases
- Inflammatory arthropathies
- Osteomyelitis, discitis, septic arthritis
- Avascular necrosis, reflex sympathetic dystrophy
- Osteomalacia, Paget’s disease
- Fracture, insufficiency fracture, Charcot’s joint, shin splints, non-accidental injury (NAI)*
- Postoperative periprosthetic or fixation device complication
- Osteoarthritis
- Rhabdomyolysis, myositis ossificans
- An abnormality on a plain radiograph that requires investigation as to its cause.
- Bone Pain
- An unexpected abnormality in calcium metabolism e.g. raised calcium and alkaline phosphatase.
Additional instructions
*Bone scintigraphy may be unhelpful in the context of NAI as it can be difficult to date an injury with confidence for legal purposes.
The referral should identify sites of clinical tenderness / pain.
Dosage
Effective dose = 3.9 + CT dose if SPECT-CT
Dose range = 1-5
Cardiac perfusion scan
Indications will include:
- To assess presence and degree of coronary obstruction in patients with suspected coronary disease.
- To aid management of patients with known coronary disease:
- To determine the likelihood of future coronary events, i.e. post myocardial infarction or related to proposed non-cardiac surgery.
- To guide strategies of myocardial revascularisation by determining the haemodynamic significance of coronary lesions.
- To assess the adequacy of percutaneous and surgical revascularisation.
- To assess myocardial viability and hibernation, particularly with reference to plan myocardial revascularisation.
- To assess the haemodynamic significance of known or suspected anomalocoronary arteries and muscle bridging.
- To assess the haemodynamic significance of coronary aneurysms in Kawasaki’s disease.
Additional instructions
None.
Dosage
Effective dose = 5.5 – 13.5 + CT dose
Dose range = 5.1 to 10 / >10
DaTSCAN
Indications will include:
- To help differentiate essential tremor from Parkinsonian syndromes.
- To differentiate Parkinsonian syndromes from drug induced Parkinsons and vascular pseudoparkinsonism.
- To differentiate between Lewy Bodies Dementia and Alzheimer’s.
Additional instructions
Prior to the investigation patients should avoid taking any medications or drugs of abuse which could significantly influence the visual and quantitative analysis of DAT binding ligands - a list of medications needs to be provided.
Dosage
Effective dose = 4.6
Dose range = 1-5
Gastric emptying
Indications will include:
- Suspected gastroparesis in diabetic patients
- After gastric surgery
- When taking medication that affects gastric motility.
Additional instructions
Certain drugs stopped two days prior to scan:
- Opiates
- Prokinetic agents
- Atropine, Nifedipine, Progesterone, Octreotide, Theopyline, Benzodiazepine, Phentolamine.
Dosage
Effective dose = 0.9
Dose range = <1
Gastrointestinal bleed
Indications will include:
- Evaluation of upper and lower gastrointestinal bleeding.
Additional instructions
Contraindicated in patients receiving blood products.
Dosage
Effective dose = 3.6
Dose range = 1-5
Gallbladder scan (HIDA)
Indications will include:
- Cystic duct obstruction in acute or chronic cholecystitis.
- Post-op biliary leak.
- Congenital conditions - choledochal cyst.
- the assessment of biliary dyskinesia or sphincter of Oddi dysfunction.
- Differentiation of neonatal hepatitis from biliary atresia.
Additional instructions
None
Dosage
Effective dose = 2.4
Dose range = 1-5
Liver and spleen
Indications will include:
- Residual spleen function (e.g. after splenectomy).
- Location of ectopic tissue.
- Nature of abnormalities.
- To help distinguish hepatic adenoma from follicular nodular hyperplasia.
Additional instructions
None
Dosage
Effective dose = 0.7 – 1.8
Dose range = <1 / 1-5
Lung V/Q scan (ventilation/ perfusion)
Indications will include:
- Diagnosis of pulmonary embolism
- Assessment of regional ventilation and perfusion.
Additional instructions
The patient should have a clear chest X-Ray within 48 hours, or 24 hours for pregnant patients, and this must be made available.
Dosage
Effective dose = 2.2 – 2.8 + CT dose if SPECT-CT
Dose range = 1-5
Lung perfusion scan
Indications will include:
- Pre-operative estimation of relative pulmonary function in patients requiring pneumonectomy.
Additional instructions
None.
Dosage
Effective dose = 1.1 - 2.2
Dose range = 1.5
Lymphatic scan
Indications will include:
- Assessing lymphatic drainage in the investigation of lymphoedema.
Additional instructions
None.
Dosage
Effective dose = 0.09 – 0.18
Dose range = <1
Kidney scan (MAG3/DTPA) ± indirect micturating cystogram
Indications will include:
- Pelvi-ureteric or other obstruction.
- Post-surgical assessment / follow up.
- Assessment of renal perfusion and function (any age).
- Assessment of renal perfusion and function in patients aged <10 years when vesicoureteric reflux is suspected.
- Followed by indirect micturating cystogram to follow up the progress of vesico-renal reflux.
Additional instructions
- Please indicate if diuresis required.
- For reflux studies, patient should be toilet trained.
Dosage
Effective dose = 0.7
Dose range = <1
Kidney scan (DMSA)
Indications will include:
- Renal scarring post UTI age >3 months.
- Location of ectopic kidneys.
- Query absence of kidney.
- Relative kidney function pre-nephrectomy.
- Relative kidney function pre-renal biopsy.
- Assessment of functional renal tissue post-surgical intervention.
- Structural information as alternative to IVU or CT (contrast sensitivity or nephropathy).
Additional instructions
None.
Dosage
Effective dose = 0.7
Dose range = <1
Meckels
Indications will include:
- Meckel’s diverticulum.
- Rectal bleeding.
Additional instructions
- Please indicate if infants require sedation and nursing support.
- A recent barium examination within 24 hours may obscure a small bleeding site so delay meckels scans until after this.
Dosage
Effective dose = 5.2
Dose range = 5.1 to 10
MIBG scan
Indications will include:
- Neuroectodermal tumour.
- Adrenal medullary tumours.
Additional instructions
Withdraw (under medical agreement) from:
- opioids, cocaine, tramadol 7-14 days,
- Tricyclic antidepressants 7-21 days,
- sympathicomimetics (brochodilators, decongestants and diet aids) 7-14 days,
- antihypertensive/cardiovascular agents 14-21 days,
- ACE inhibitors 14 days,
- antipsychotics, phenothiazines (antiemetic/antiallergenic agents) 21-28 days.
Dosage
Effective dose = 5.2
Dose range = 5.1 to 10
Octreotide scan
Indications will include:
- Gastroenteropancreatic neuroendocrine tumours (carcinoid, insulinoma, gastrinoma, non-functioning islet cell carcinoma).
Additional instructions
Stop Octreotide therapy (Sandostatin) under medical advice:
- 6-8 weeks if intramuscular injection
- 3 days if subcutaneous injection.
Dosage
Effective dose = 5.9 - 11.9
Dose range = 5.1 to 10 / >10
Parathyroid
Indications will include:
- To aid in localisation of abnormal parathyroid glands in patients diagnosed biochemically with primary hyperparathyroidism.
Additional instructions
Patients must have had multinodular goitre ruled out by ultrasound before they may have an isotope parathyroid scan.
Dosage
Effective dose = 8.1 + CT dose if SPECT-CT
Dose range = 5.9 - 11.9
Sentinel lymph node (breast)
Indications will include:
- Identification of sentinel lymph node for biopsy 20 minutes - 24 hrs preop.
- T1 and T2 stage invasive breast carcinoma. With high risk and microinvasive ductal carcinomas in situ. With good prognostic group tumours (tubular, medullary, mucinous, papillary). Following primary chemotherapy.
Additional instructions
- Surgical team must discuss directly with department.
Dosage
Effective dose = 0.1
Dose range = <1
Sentinel lymph node (melanoma)
Indications will include:
- Identification of sentinel lymph node for biopsy 20 minutes - 24 hrs preop.
Additional instructions
- Surgical team must discuss directly with department.
Dosage
Effective dose = 0.2
Dose range = <1
Thyroid scan (Tc99m)
Indications will include:
- To differentiate between Graves disease, toxic nodular goitre and subacute thyroiditis.
- Hot or cold nodule.
- Ectopic thyroid tissue.
Additional instructions
None
Dosage
Effective dose = 1.0
Dose range = 1-5
Thyroid scan (I-131 or I-123)
Indications will include:
- Thyroid cancer remnants, post-ablation.
- Thyroid cancer metastases, post-ablation.
Additional instructions
- Oncologist should arrange thyrogen injections or withdrawal of thyroid medication.
- Oncologist should arrange blood test on day / day before scan appointment to check TSH levels.
Dosage
Effective dose = 6.1 –14.3
Dose range = 5.1 to 10 / >10.
Contact us
Basildon - call 0300 443 0126 option 3.
Broomfield - call 0300 443 0126 option 1.
Southend - call 0300 443 0126 option 2.