Essentials in an imaging referral

• Include relevant clinical details in an imaging referral – including signs, symptoms and location of pain, provisional diagnosis, the clinical question being addressed, and red flags for particular conditions.
  
• Inclusion of these details in a referral will focus the investigation and assist in the radiologist's interpretation of results.
  
• MBS explanatory notes for diagnostic imaging have been updated and referrers are now asked to give more specific information in imaging requests.
  

Referral information directly impacts on patient care and safety.⁴ Including sufficient detail such as the provisional diagnosis and the clinical question being asked can help to ensure the imaging test is appropriate and focused.

Incidental findings discovered through medical imaging can cause uncertainty and lead to further investigations – for example, to exclude a serious disorder.⁵ Such an approach can result in a cascade of tests and procedures,⁵ where the harms – including patient anxiety and other costs – outweigh the benefit.

Most incidental findings are benign, have little or no clinical significance and do not always require further investigation.⁵ To assist in clinical decision-making, the American College of Radiology Incidental Findings Committee has published a standardised approach to managing incidental findings.⁵

• Preparation: Clear instructions for preparation required for the investigation.⁴
  
• Clinical question being addressed: A clear diagnostic question will help focus the radiologist's interpretation of results.⁴
  
• Provisional diagnosis: A provisional diagnosis on the request can help guide the protocol for imaging investigation. This will help to determine what conditions are being ruled in and ruled out.¹
  
• Relevant clinical details and family history: Can give clues as to the most likely diagnosis and area to focus on.¹
  
• Red flags (see below), alarm symptoms or warning signs: Note any red flags which can serve as indicators or warning signs for specific clinical suspicion.³
  
• Signature and date from requesting doctor.
  

Patients presenting with chronic abdominal pain due to clinically non-specific causes or suspected functional gastrointestinal disorders, are common in primary care. Red flags to watch out for in these patients, and to note in the referral, include:³

• age > 50 years
  
• anaemia
  
• awakening at night
  
• blood in stools
  
• family history of colorectal cancer, irritable bowel syndrome or coeliac disease
  
• fever
  
• pain through to the back
  
• unexplained weight loss.
  

Some of these 'red flags' for chronic abdominal pain may indicate that a referral is needed to a gastroenterologist for upper gastrointestinal endoscopy or colonoscopy as the next line of investigation – rather than diagnostic imaging.³

Refer to the WA Department of Health Diagnostics Imaging Pathways for detailed recommendations, and learn more about how they can be used to guide decisions about diagnostic imaging for your patients.

Changes have recently been made to the recommended information that should be included in requests for diagnostic imaging providers.

These changes have been made after a recommendation by the Diagnostic Imaging Clinical Committee, one of the clinical committees established by the Medicare Benefits Schedule (MBS) Review Taskforce.

These changes support better requesting. Greater clarity about what is expected when making a request for a diagnostic imaging service may help increase clinician awareness of high-value tests, minimise radiation exposure, and promote greater recognition of item descriptors.

Find out more at the MBS website: Form of a diagnostic imaging request' under Medicare Benefits Schedule - Note IN.0.6