RULES/ALERTS for RADIOLOGY REQUESTS on ORDERCOMMS

The clinical user, when making a request for a radiology exam, a list of questions/rules/alerts will pop--up based on the type of exam requested.

Exam/Location Specific Questions

I. “Read by Referrer" Exams—For example plain X-ray requests for limbs post fracture manipulation, fluoroscopy images in theatre, OPT etc. (not for Chest/abdo/spine plain x-rays) will have the following question:

a.  Report Required (Radiology)

Is a report required? Yes or no

II.  Female and of child bearing age (for relevant exams only-All CT, MRI, Fluroscopy, some plain X-rays, NM etc):

1.  Pregnancy (Radiology)

Is the patient pregnant? Yes or No.

If yes, EDD--- . For MRI exams the following message will appear: Please discuss the need for MRI with a radiologist.

III. Inpatient/A&E Examinations

a.  Infection (Radiology)

Does the patient suffer from infections which require barrier nursing:

No,

C.Diff, MRSA,

b.  Mobility (Radiology)

Mobility---

Chair

Bed

trolley/Portable(if poss)

IV. Outpatient Examinations

a.  Transport (Radiology)

Transport---Own transport, Medicar, Ambulance

V.  Questions for Exams Requiring Iodinated IV Contrast (CT with contrast, Angio, IVU, etc):

1.  Contrast Induced Nephropathy Risk Assessment (Radiology)

Blood Creatinine Levels were previously requested on ------. (user will be able to view the results). Do you wish to continue

  1. Yes (continue to next question--2)

b.  No (If answer is no the exam will be aborted—and user will be able to start again for a different exam etc)

2.  Contrast Induced Nephropathy Risk Assessment based on recent Creatinine Levels (link to local guidelines)

RCR Guidelines on IV contrast use: https://www.rcr.ac.uk/docs/radiology/pdf/BFCR(10)4_Stand_contrast.pdf

Options to choose from:

a.  Low risk (Creatinine <130)---Peri-procedural oral fluid hydration advised. Patient Informed.

b.  High Risk (Creatinine >130)---Need for IV contrast administration has been reassessed (I,e. The following has been considered--. Would a non-contrast exam suffice? Is an alternative investigation possible?) IV contrast exam is deemed necessary, peri-procedural IV fluids hydration as per local guidelines will be organised by the referring team.

c.  Not relevant—as patient is on dialysis

d.  Up-to-date Creatinine levels requested

3.  Diabetes (Radiology)--- (Iodinated contrast exams only –not MRI)

Is the patient Diabetic? Yes or No

  1. If Yes---Is the patient on ----Diet control, Insulin, Metformin or medication other than Metformin?
  2. If on Metformin---Please read the RCR advice re: Metformin and IV contrast.

RCR advice on IV contrast use:

https://www.rcr.ac.uk/docs/radiology/pdf/BFCR(10)4_Stand_contrast.pdf

Options: to choose from

a. The serum Creatinine is normal, --hence--no special precaution is required.

b. Serum Creatinine is abnormal but the need for IV contrast has been reassessed ((e.g. Would a non-contrast exam suffice? Is an alternative investigation possible?). IV contrast is deemed necessary, I will discuss with a Diabetologist regarding the whether it is appropriate to stop Metformin prior to exam.

VI. Questions for MRI Exams

1. Absolute contraindications to MRI (Radiology)

Does the patient have any electro-magnetic implants (which are MRI Hazards) such as:

Cardiac Pacemaker

Cardiac Defibrillator Implant

Cochlear Implants

Brain/Nerve/Bladder Stimulator etc

Answer: Yes, No, Patient not present

If answer is Yes:

Patient cannot have an MRI scan. Please discuss with radiologist regarding alternative test.

2. Possible Contraindication to MRI-- Safety Assessment Required (Radiology)

Does the patient have any possible contraindications to MRI---

Intracranial aneurysmal clips

Retained shrapnel

Metallic Prosthesis

Spinal rods

Heart surgery

Spinal surgery

Brain Surgery

Recent surgery

Shunts/vascular stents/vascular clips

Others

Answer: Yes, No, Patient not present.

If answer is yes : Please provide details with date and type of procedure/implant. MRI staff will do a safety assessment prior to MRI.

3. Metallic Intraorbital Foreign Body (MRI hazard) (Radiology)

Does the patient have a any history of a metallicIntraorbital foreign body (Please take relevant occupational history—welder etc)?

Answer: Yes, No, Patient not present

If answer is Yes? MRI will pursue with patient to ensure safety as per Intraorbital Foreign Body Policy for MRI.

4. Claustrophobia (Radiology)

Is the patient claustrophobic? Yes, No, Patient not present

a. If yes, Do you think patient will require oral sedation or GA (they will need to choose 1 of the options).

i.  If they choose Oral Sedation then message will appear: MRI department will discuss with patient and organise for oral sedation.

  1. If they choose GA then a message will appear: Please take relevant medical history and refer to Anaesthetic Dept for assessment."

5. MRI Safety Questionnaire Reminder (Radiology): Please ensure that the patient fills in and signs the MRI safety questionnaire. If the patient is unable to fill in/sign off a safety questionnaire, it is the responsibility of the referring doctor to sign it on behalf of the patient.

6. Patient Girth & MRI (Radiology) (This will appear forall examinations)Please ensure that thepatients maximum body circumferencedoes not exceed 170cms otherwise the patient will not fit in the MRI scanner

7. Exam Specific Girth & MRI (Radiology) This will appear for certain exams like cervical spine/neck etc).

Please ensure that the(body part requested - neck, knee, abdomenetc ) circumferencedoes not exceed (measurement in cms ) otherwise the patient will not fit in the MRI (coil type e.g neck/ knee/ body phased array)coil.

Max neck circumference = 45cm

Max knee circumference = 60cms

Max circumference for chest, pelvis, liver, MRCP, abdomen = 150cm

8. MRI Contrast (Gadolinium) (This will appear forall examinations that require Gadolinium)

Blood Creatinine Levels were previously requested on ------. (user will be able to view the results). Do you wish to continue

  1. Yes

c.  No (If answer is no the exam will be aborted—and user will be able to start again for a different exam etc)

If Yes—Please read Royal College of Radiologist guidance https://www.rcr.ac.uk/docs/radiology/pdf/BFCR(10)4_Stand_contrast.pdf

on use of Gadolinium in patients who:

·  Have impaired renal functions

·  Are peri-operative liver transplant

·  Are pregnant

·  Breast Feeding

VII.  Alert for exams requiring Bowel Prep (barium enema etc)

Bowel Prep Alert (Radiology):

NB: Please ensure that the patient can tolerate bowel prep. Guidelines link.

VIII.  Reminder for exams needing consent form:

Consent Form Reminder (Radiology)

NB: Please complete a consent form for this exam.

IX.  For any same exam requested within the last 6 months the following message will pop-up.

Repeat Exam Alert (Radiology):

This exam was performed on DD/MM/YYYY"

However, this should not prevent a further request being made, and should not require extra mouse clicks.

X.  All exams:

Royal College of Radiologists Guidance: Making best use of Radiology Services http://mbur.nhs.uk/index.asp

Dr. Neelam Dugar

Chairman of The UK PACS & Teleradiology Group

24/6/10