Imaging Quick Tips
Departmental X-rays
  1. Review prior imaging/E-orders to check for duplication by another medical staff member à please call X-ray radiographers (56527 8am-6pm / 56927 after-hours) to expedite any existing request(s) if appropriate.
  2.  Complete an E-order (see below). Radiologist consultation/approval is not required. Include your pager or mobile contact number (mandatory).
    • E-orders. The “Current Clinical History (Mandatory)”is the ONLY field visible to Radiology’s information systems. Use this field for all request communication. Include exam indication, relevant clinical history and any specific instructions.
    • Always be specific entering the clinical history to correctly justify the examination requested. If the request is missing specific clinical details for the requested area of interest, delays may occur as the E-order will need to be re-submitted with adequate information. This is a medico-legal requirement.
    • “PRIORITY FOR DISCHARGE” included along with the clinical history will assist fast-tracking for patient flow purposes.
    • Be careful when trying to order Pathology and Radiology simultaneously in the same E-orders instance. The “Current Clinical History (Mandatory)” field is only active for the first order and will duplicate the information entered for following orders. The clinical history needs to be relevant and complete for all Radiology requests. Wherever possible, request Pathology and Radiology as separate E-order instances.
    • Once submitted, E-orders are unable to be amended. Please remember it is the responsibility of the requesting staff member to contact radiology in a timely fashion where out of date clinical information, duplicate request(s) or cancelled exams exist. This is so they can be correctly removed from the work lists to avoid unnecessary radiation exposure to the patient. Please phone X-ray radiographers (56527 8am-6pm / 56927 after-hours).
  3. To expedite clinically urgent inpatient x-rays, please phone X-ray radiographers (56527 8am-6pm / 56927 after-hours)
Emergency Department X-rays
  1. Imaging requests cannot be processed without the patient first having an active Medical Record Number (MRN).
  2. All patients require a completed E-order (or paper request) before any imaging can commence: this is a medico-legal requirement. This is relevant to all patient presentations, without exception.
  3. For E-orders See Departmental X-rays.
  4. To expedite Emergency Department X-Ray requests including trauma/resus, complete E-order first, then contact ED X-ray radiographers in person in the ED X-Ray office, by phone 56927 or by pager #8572
Mobile X-rays
  1. Complete an E-order with clinical history and the indication for mobile imaging (see Departmental X-rays).
  2. Print the Mobile X-ray Form from the nearest printer – take this to the patient’s bedside and leave it with the clinical notes for the Mobile Radiographer.
  3. Contact the Mobile Radiographer à pager #9032 from a hospital landline (not a mobile phone)à provide them with:
    • MRN and patient name
    • Ward and bed number
    • Location of the printed request
    • Reason for mobile imaging *

NB

  • Departmental imaging provides superior diagnostic quality and efficiency compared to mobile imaging. Always consider contacting X-ray radiographers (56527 8am-6pm/ 56927 after-hours) to expedite the transport of a patient to radiology for clinically urgent cases.
  • Mobile X-rays are limited to single projection, AP chest X-rays (rare exceptions may apply). These are non-standard examinations and, as such are only performed where the clinical condition of the patient inhibits their transportation to the Radiology department*  Staff shortages are not an appropriate reason to request mobile imaging for patients who require a nurse escort for transport to Radiology. Contact Patient Flow Manager (in-hours) or Acting Director Nursing (out-of-hours) if staffing levels on the ward are preventing a patient’s escort to Radiology. Inappropriate use of mobile x-rays can warrant radiation incident reporting to the EPA/investigation.
CT
  1. Complete E-order with indication and clinical history
  2. Page #22778 (24/7) and speak to CT registrar for approval
  3. Registrar will need to know
    • Reason for scan (ie. Top 2-3 working Differential Diagnoses)
    • eGFR, beta-hCG
    • ? Contrast allergy
      • pre-medication may be appropriate-> discuss with CT registrar; pre-medication protocol can be obtained from the CT radiographers.
  4. Ensure
    • Contrast questionnaire is completed prior to patient arrival in CT
    • Patient has appropriate cannula
      • 18G in CUBITAL FOSSA for CT angiogram (including CTPA)/multi phase studies/obese patients. If unable to insert an 18G, contact your seniors/anaesthetics for assistance.
      • 20G is acceptable for other patients
    • Patient is compliant -> otherwise consider sedation
  5. Note: If an ED trauma scan for non-contrast head or C-spine is needed, prefix request with “TRAUMA” in the e-order for it to be accepted without CT registrar approval and call CT radiographer #57606 for confirmation.
  6.  Reports
    • In-patient : ring 56522  & speak to inpatient CT reporting registrar
    • ED patients: page #22778
  7. Check the final CT report for changes once it has been approved by a Radiology consultant.

 

Study Purpose
CT Brain Non-contrast: for ?bleeds/fractures

Contrast: to look for tumours/abscess

Angiogram arterial or venous phases to examine vessels (ie for aneurysm / venous sinus thrombosis)

CT Facial Bones For trauma to zygoma / maxilla / mandible ?#
CT C-spine For trauma ?#. Patient must be in a collar
CT Neck Looking for absess/tumour – will require contrast
CT Chest Looking for fractures only: non contrast

Looking for tumors/empyema: contrast (arterial phase)

Looking for PE: CTPA

CT Aortogram Images entire Aorta

Consists of a pre-con chest + aortogram with contrast

CT Abdomen
and Pelvis
Most commonly done with oral and intravenous contrast (portal venous phase): looking for acute surgical issues/tumours

If looking for lower GI pathology: long oral contrast is given (CT is acquired 9- mins after oral contrast)

CT KUB Non contrast: Looking for ureteric calculus

CT IVP (4 phases): non contrast, cortico-medullary phase, nephrogenic phase, pyelographic phase

CT Pelvis Non contrast: ?#

Contrast: ? tumor/absecess

CT Limbs Non Contrast unless looking for abscess/tumours
CT Pan-Scan Non contrast brain+c-spin+aortogram+PV abdo-pelvis

Facial bones not included unless specifically requested

 

Fluoroscopy
  1. Complete E-order. If submitting a paper request, drop off at radiology reception. The request must have
    • Name of referrer
    • Contact number – Pager or mobile(preferred)
    • Legible clinical history
    • Location
    • Other specifics: ?interpreter, ?issues with compliance
      Requests without this information will be INVALID. Contact radiology reception if a booked procedure needs to be cancelled or rescheduled.
  2. Speak to fluoroscopy registrar for all same-day inpatient requests (call radiology reception, 56522, and ask for fluoroscopy registrar)
    • Commonly performed procedures
      • Swallow studies (requires fasting for 4 hours prior to study), cystograms, tubograms, nasogastric/nasojejunal tube insertion (please send tube with the patient from the ward)
      • Lumbar puncture (no solid foods for 4 hours prior to study)
        • ?antiplatelet/anticoagulants
        • need INR/platelets checked with the last 7 days
        • ?chemotherapy administration – ensure readiness of chemotherapy with pharmacy, and availability of an MO to administer chemotherapy (provide mobile number)
      • ***Modified barium swallow: performed by speech pathologists. Do not send referral for these to radiology
  3. Anything that requires sedation cannot be performed in fluoroscopy.

NB:

  • Fluoroscopy is not performed after hours. The only rare exception is for emergency procedures (i.e. retrograde urethrogram for trauma patients).
  • Do not interrupt procedures in the fluoroscopy room to consult with the fluoroscopy registrar, as this may compromise patient care and privacy. Please leave a message with radiology reception or attempt contact at a later time.
Angiography
  1. Complete Paper Request + Procedure Form (can be sourced from radiology reception) + Pathology Form
    •  All 3 forms need to be completed and delivered to Radiology Reception Interventional Requests Folder for the request to be considered valid.
    • Include (legibly written):
      • Name
      • Contact number of referrer
      • Clinical history
      • Location of patient
    • Provide information about patient compliance/anticoagulation/antiplatelets/INR + platelets (with date)
    • Patients who require sedation/GA should be fasted
    • These requests will be reviewed by the fluoroscopy or angiography registrar
    • If the patient is from another hospital or nursing home, the relevant NUM should contact Radiology Nurse T/L or NUM to organize nurse escort.
    • When approved the Angiography booking clerk will contact the ward or referrer with appointment time and preparation. The registrar will advise the requesting team regarding any cessation of medication(s).
  2. For URGENT requests, the team must contact the Interventional radiology Fellow or Consultant Interventional Radiologist for the day to organize booking. Radiology Reception #56522
    • For EMERGENCY cases from ED, the ED consultant will contact the IR Fellow or Consultant to organize the patient to be transferred directly to the angiography suite. A post procedure bed must be arranged by referring team.
    • Non-emergency cases from ED are only able to be performed when a post procedure bed has been arranged and is available.
    • Any additional requests need approval by the Interventional Radiologist for the day and will be accommodated where possible.
Interventional Procedures
(CT/ultrasound guided)
  1. Complete Paper Request + Procedure Form + Pathology Form 
    • All 3 forms need to be completed and delivered to Radiology Reception Interventional Requests Folder for the request to be considered valid.
    • Include (legibly written):
      • Name
      • Contact number of referrer
      • Clinical history
      • Location of patient
    • Provide information about patient compliance/anticoagulation/antiplatelets/INR + platelets (with date)
    • Ensure infection status (e.g. MRSA, VRE, etc. is clearly written)
  2. Speak to fluoroscopy registrar after putting in request. (Phone Radiology Reception 56522, and ask for fluoroscopy registrar).
  3. If an urgent interventional procedure is required after hours, contact the On-Call Consultant Interventional Radiologist.
Ultrasound
  1. Complete E-order. No approval needed.
  2. Be sure to include the indication, clinical history and any specific instructions. Include a pager or mobile contact number.
  3. TOE
    If a TOE is required, it may only be performed if a TTE has been done and was shown to be unhelpful (contact Clinical Measurementsà56044 for further details). If urgent (within 12 hours) you may have to contact TOE/TTE registrar (direction from clinical measurements) → inform them also of the infective status of patient (e.g. MRSA, VRE, etc.)
MRI
  1. Complete E-order. MUST have:
    • Contact mobile and/or pager number
    • mention status of safety form and e-GFR
    • Urgency of study (i.e. Semi-urgent/non-urgent)
      Requests without this information will be INVALID.
      E-orders for MRI scans requested following review by a Specialty team, should be submitted by that Specialty team (with contact number provided), rather than by ED staff.
  2. MRI safety form to be delivered to MR Radiographer
  3. All reasonable MR requests with sufficient clinical history will be automatically approved at 9.30am, 12pm and 3pm after placing e-order (i.e. Don’t need to ring MRI Fellow).
  4. For life/cord-threatening issues, come to MRI and speak to MRI Fellow.
  5. After 3pm, if MRI needs to be done same day à call MRI Fellow
  6. Cancelling MRI à inform MRI reception

If an MRI is required after hours, please ring On-call MRI Fellow/Registrar

Nuclear medicine
  1. Place an E-order (NM *body part*) and include indication, clinical information and relevant investigations
  2. Include pager number in case of the need for more information.
PET
  1. If requesting an inpatient study, call 8890 9324 and communicate the type of scan required, the indication, clinical history and relevant investigations previously completed.
  2. The receptionist will fax a request form (specific for the scan required) and a ward questionnaire – these may be signed by yourself in place of the specialist as long as a pager number is included.
  3. Ensure height and weight are included on the form
  4. Once forms are completed, fax back to the PET reception desk or deliver in person (these will be forwarded to the Director for the appropriate protocol).
  5. Expect ~1 week time-frame for scan to take place
Outpatient Scans
  1. Fill out imaging request form and bring it to Radiology reception.
  2. For angiography procedures, take the forms to angiography suite
  3. For TTE, take form to Clinical Measurements, not Radiology
Requesting imaging at Auburn
  • From 9 AM – 5 PM, a radiology consultant and a registrar are on-site at Auburn Hospital. Call 13312 (8759 3312). After hours, please page #22778.
  • Place E-order then ring the radiology registrar directly for any CT/fluoroscopy requests
    • Non-urgent fluoroscopy will not be performed at Auburn Hospital
    • No MRI service at Auburn Hospital
  • Ultrasound requests – no need for approval from radiology registrar
Key contact numbers

Important radiology contact numbers:

Note: The numbers listed below, and other Imaging contacts, can be easily accessed via the Dialpad feature in the App (filter on “Imaging”)

#22778 – Emergency CT registrar

56522 – Radiology reception

56533 – Nuclear Medicine reception

57606 – CT radiographers

56527 – inpatient X-ray radiographers (8am-6pm)

56927 – inpatient X-ray radiographers (afterhours)

56927 – ED X-ray radiographers

#9032 – mobile radiographer

59324 – inpatient PET