These fields match the EMR request form, used by referrers for ease of use.

Clinical question

What is the leading clinical diagnosis and differential diagnosis?

Patient presentation

Key history, examination findings

Blood and urine results (including HCG/pregnancy status)

Relevant past medical history

Medical / surgical history

Previous interventions

Clinician contact number

Phone or carried extension. List of approved ED callback numbers for radiology reg to follow up are documented in the intranet site.

Trauma: Brain / facial bones / cervical spine

1. Mechanism / height of fall

2. Site of tenderness / suspected injury

3. Presence of neurological deficits including GCS

Brain: Confusion, neurological deficit, seizure, syncope, infection

1. Onset + duration of symptoms

2. Nature of neurological deficits + GCS

3. History of previous malignancy

4. Infection risk factors (eg, IVDU, immunosuppressed)

CTPA

1. PE Risk factors

2. Wells score

3. Elevated d-dimer level (if performed)

4. Is the chest X-ray normal? (If CTPA is needed urgently and chest X-ray is to be skipped, please call duty registrar to facilitate urgent approval)

5. Is there suspicion for lower limb DVT?

In most circumstances, a chest x-ray should be performed prior to CTPA in chest pain / hypoxia workup to exclude other serious emergent conditions

CT Aorta / Aortogram (?dissection / acute aortic syndrome)

1. Is dissection / acute aortic syndrome among the top differential diagnoses?

2. Document history and examination findings suggestive of a dissection / acute aortic syndrome

3. Has CXR been performed? (required to assess for other pathologies unless there is high clinical suspicion)

In most circumstances, a chest x-ray should be performed prior to CT in chest pain / hypoxia workup to exclude other serious emergent conditions.

CT Chest (trauma)

1. Mechanism of injury

2. Localising symptoms

3. Name of senior ED clinician involved in requesting study

4. Has CXR been performed?

5. Is there clinical concern for vascular/mediastinal injury

In patients with significant risk factors for rib / vertebral fracture (high energy mechanism or medical comorbidities such as osteoporosis) workup with CT should be considered in discussion with supervising senior ED clinician.

CT Chest (infection / malignancy)

1. Clinical symptoms of malignancy or infection

2. Has a CXR been performed?

3. Past history, risk factors for malignancy or complex infection (eg IVDU, immunosuppressed)

CT abdomen / pelvis

1. Top differentials

2. Past surgical and relevant medical history

3. Blood results (as relevant to clinical question / differentials):

   • Infective markers

   • LFTs / lipase

   • Lactate 

   • Urine/blood HCG if female of reproductive age

4. Body habitus: document if weight very low (<50 kg) or high (>100kg)

Patients with high/low body habitus may benefit from altered scan protocol including use of oral contrast or adjusted CT settings.

Abdominal US

1. Fasting status + time last ate

2. Top differentials, supporting clinical features + blood test results

3. Past hx - cholecystectomy, appendicectomy, malignancy or bowel resection?

If US abdominal AND US pelvic gynaecological assessment needed, separate US pelvis requests required (will be booked in double-slot to permit appropriate sonographer time allocation)

CT KUB (Non-contrast study)

1. Previous history of renal colic / other urological hx?

2. Macroscopic haematuria and urine dipstick Hb

• CT KUB is primarily intended for workup of likely uncomplicated renal stone disease. It is non-contrast and is limited in exclusion of other pathologies.

• If complicating infection or other Ddx / other pathology suspected, consider CT abdomen or discussing the best test with the Radiology Duty Registrar

• If age <50 and within business hours, consider renal tract US

• If urgent surgical intervention may be required, call Radiology Duty Registrar to protocol urgently

CT IVP

1. Previous history of renal colic / other urological hx?

2. Macroscopic haematuria and urine dipstick Hb

3. Is there acute renal impairment?

4. Infective features or blood test results?

If age <50 and within business hours, consider renal tract US

Renal tract US

1. Macroscopic haematuria and urine dipstick Hb?

2. Is there acute renal impairment?

3. Infective features or blood test results?

4. Other salient history: Phx of renal colic / other urological hx / trauma?

Diagnostic sensitivity may be reduced in very high BMI. Consider other imaging modality such as CT if appropriate.

CT renal mass workup

1. Previous history of renal colic / other urological hx?

2. Macroscopic haematuria and urine dipstick Hb

3. Is there acute renal impairment?

4. Infective features or blood test results?

If age <50 and within business hours, consider renal tract US

Testicular US

1. Previous urological hx

2. Time of onset

3. Infective features + bloods

Call radiology duty registrar URGENTLY to organise exam if torsion is suspected

Female pelvic US

1. Urine/Serum HCG

2. Last menstrual period (LMP)

3. Past gynaecological history

4. Infective features / risk factors

Call radiology duty registrar URGENTLY to organise exam if torsion or ectopic pregnancy is suspected

Complete pelvic US assessment includes trans-vaginal ultrasound. If possible, please begin this discussion with patient at time of ordering (sonographers always formally obtain verbal and written informed consent prior to starting any examination).

Antenatal US

1. Main question / concern (relevant to GA)

2. Gestational age and EDD by US dating or LMP

3. Obstetric hx / maternal medical conditions

Call radiology duty registrar URGENTLY to organise exam if ectopic pregnancy is suspected

DVT US

1. Previous DVT/PE

2. Risk factors (clotting & other)

3. Clinical features - unilateral vs bilateral

Use DVT US request order (not venous doppler as EMR codes incorrectly to varicose veins study)

Arterial doppler US

1. Previous vascular disease history (specific previous sites of stenosis/occlusion)

2. Previous intervention, stenting, bypass procedures

3. Is acute limb ischaemia  suspected?

CT leg arteries runoff

1. Previous vascular history (specific previous sites of stenosis/occlusion)

2. Previous intervention, stenting, bypass procedures

3. Is acute limb ischaemia suspected?

If acute limb ischaemia is suspected, call radiology duty registrar URGENTLY

US AV fistula

1. Site / vessels involved in fistula

2. Previous issues and interventions

3. Nature of issue

   • Access problems?

   • High dialysis pressures?

   • Acute pain/ Haematoma/swelling?

   • Post dialysis bleeding?

Trauma / Injury

1. Mechanism of injury

2. Suspected injuries, site of focal tenderness

3. Prior surgery / injuries

4. Has X-ray imaging been performed?

Consider also performing X-ray assessment of region as part of complete workup

Soft tissue infection / collection US

1. Inflammatory markers

2. Previous hx of infection or inflammatory arthropathy

3. Risk factors for disseminated infection (IVDU, immunosuppressed)

Consider X-ray assessment of region as part of workup

Trauma

1. Mechanism of injury

2. Suspected injuries

3. Concern regarding solid viscera / active haemorrhage

If patient is unstable or needs urgent imaging call radiology duty registrar

Infection / Malignancy

1. Past malignancy / malignancy history

2. Risk factors for disseminated infection (eg IVDU, TB)

3. Inflammatory markers or tumour markers

CT cervical spine

See brain imaging section

CT Thoracic / lumbar spine

1. Mechanism of injury

2. Region of localisation

3. Previous documented injuries / intervention / surgeries

4. Neurological deficits

Foreign body / bone ingestion

1. Nature of swallowed body / bone

2. How long has it been there?

Neck space infection

3. Inflammatory markers

4. Previous hx of infection

5. Recent dental / ENT procedures

6. Risk factors for disseminated infection (IVDU, immunosuppressed)

If airway concern or patient unstable - call duty reg urgently to facilitate scan safely