One of the responsibilities of a junior doctor on the wards is requesting appropriate imaging for patients, for diagnostic or monitoring purposes. It is an important skill to properly request imaging, to optimise efficiency and avoid undue delay.
Components of a request form
- Patient details
- Clinical details - signs and symptoms? previous imaging results? blood tests?
- Clinical questions to be answered - specific finding to look for? provisional and differential diagnosis?
- Investigation requested - modality?
- Mode of transport - are there mobility problems?
- Background medical information - medical (renal disease, cardiac disease, diabetes, metformin, allergies), contraindications (pregnancy, metal)
- Referrer (requesting clinician) details
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Providing clinical details
Written requests (include only relevant headings)
- Scenario (PMH) e.g. Laparotomy 3/7 ago for bowel cancer
- Presenting Complaint e.g. Increasing SOB and cough
- On Examination e.g. RR 20, HR 100, Sats 90%
- Tests Done e.g. ABG normal
- Indication e.g. Wells Score 6
- Query e.g. ?PE ?Pneumonia
- Request e.g. CTPA please
- Introduce your name, role and team. E.g. Hi, I’m X, one of the junior doctors from obstetrics.
- Patient details. E.g. I would like to discuss a 30-year-old lady who is 32 weeks pregnant.
- Hospital number.
- Query. E.g. We suspect that she might have a PE.
- History. E.g. She was admitted yesterday with preeclampsia. Today she complained of shortness of breath and pleuritic chest pain. There are no signs of leg swelling but she has a previous history of unprovoked VTE.
- Request. E.g. We think that she probably needs a leg Doppler. Do you think this is the way to go? or We are not sure what the most suitable imaging in her case is. What would you recommend?
Know your patient
- clinical condition?
- previous imaging?
Know why you are requesting the investigation
- might it change management?
- Give a structured, concise history focusing on
- relevant background (chronic conditions, known diagnoses)
- current admission
- main signs and symptoms
- investigations already performed
- provisional diagnosis
Have information readily available
- patient’s NHS/hospital number (for the radiologist to look at previous imaging)
- relevant investigation results such as eGFR (ensure renal function adequate if contrast needed)
- Ask for advice if unsure about appropriateness of imaging, or unsure about which modality to use
- 'order’ an investigation - it is a ‘request’
- give the reason as ‘my consultant requested it’
- ‘shop around’ for different radiologists