Requesting Radiology Studies 🩻
Guide for requesting radiology studies. Indications, appropriate imaging, request forms, and communication with radiology department.
🧠 General Principles
- Ensure the study is clinically indicated — consider how the result will impact management.
- Always check if the patient has had prior imaging that could answer the clinical question.
- Provide a clear and concise clinical question — "rule out X", "assess for Y".
- Indicate urgency clearly — routine, urgent, or emergency (e.g. ?PE with haemodynamic instability).
📋 What to Include in a Good Request
- Relevant clinical history — symptoms, findings, differential diagnosis.
- Pertinent examination findings or bedside test results.
- Relevant lab results (e.g. d-dimer, troponin, eGFR for contrast studies).
- Any previous imaging or interventions.
- Clear question to be answered (e.g. "Exclude appendicitis", "Assess NG tube placement").
- Allergy status and renal function (especially for contrast-enhanced studies).
🖼️ Modalities & Common Indications
- X-ray — Chest pain, trauma, NG tube placement, suspected obstruction.
- Ultrasound (US) — RUQ pain (?cholecystitis), suspected DVT, hydronephrosis.
- CT — Abdo pain (?appendicitis, diverticulitis), trauma, ?PE, stroke.
- MRI — Neurological symptoms, MSK soft tissue concerns, spinal cord pathology.
📋 Common Studies Reference
- See table below for commonly requested studies with specific information requirements and recommended clinical questions.
- Always include relevant clinical context, examination findings, and previous imaging when available.
⚠️ Pitfalls to Avoid
- Vague requests (e.g. "abdominal pain" without further details).
- Omitting contraindications (e.g. renal impairment, pacemaker).
- Not discussing urgent scans directly with radiology (e.g. out-of-hours CT brain).
- Failing to state pregnancy status for relevant patients.
☎️ Communication Tips
- If urgent, contact radiology registrar or consultant directly.
- Use SBAR (Situation, Background, Assessment, Recommendation) when discussing.
- Be respectful — radiology colleagues appreciate well-formulated requests.
- Check if verbal approval is required before submitting certain studies.
📦 Additional Notes
- For contrast-enhanced studies, ensure recent renal function is available.
- Document verbal approvals or escalations clearly in the notes.
- Keep patients informed about what the test entails and potential risks (e.g. contrast reaction).
Radiology Studies Reference
Common studies, required information, and clinical questions
| Study | Specific Info on Request | Clinical Question(s) |
|---|---|---|
| Chest X-ray (CXR) | Symptoms (cough, SOB, chest pain), examination findings (reduced air entry, crepitations), recent CXR for comparison, ?heart failure, ?pneumonia | ?Pneumonia, ?pneumothorax, ?pleural effusion, ?heart failure, ?NG tube placement, ?line position |
| CT Brain | Time of symptom onset/last seen well, GCS, neurological findings, ?stroke, ?trauma, ?seizure, anticoagulation status | ?Stroke, ?intracranial bleed, ?mass, ?trauma, ?altered consciousness, ?seizure |
| CTPA (CT Pulmonary Angiogram) | D-dimer result, Wells score, haemodynamic status, chest pain + SOB, risk factors (recent surgery, immobility, malignancy), recent CXR | ?Pulmonary embolism, ?PE with haemodynamic instability (urgent), ?chest pain + SOB |
| CT Abdomen/Pelvis | Pain location and character, examination findings (peritonism, masses), ?appendicitis, ?diverticulitis, ?obstruction, recent surgery, eGFR if contrast | ?Appendicitis, ?diverticulitis, ?bowel obstruction, ?perforation, ?abscess, ?trauma |
| CT Chest | Symptoms (chest pain, SOB), examination findings, ?pneumonia complications, ?mass, ?dissection, recent CXR, eGFR if contrast | ?Pneumonia complications, ?mediastinal mass, ?aortic dissection, ?trauma |
| Ultrasound Abdomen | Pain location (RUQ, flank), examination findings (Murphy's sign, masses), recent LFTs, ?cholecystitis, ?hydronephrosis, ?AAA | ?Cholecystitis, ?gallstones, ?hydronephrosis, ?aortic aneurysm, ?liver pathology |
| Ultrasound DVT | Wells score, clinical signs (swelling, tenderness, erythema), risk factors (recent surgery, immobility, malignancy), which limb | ?DVT lower limb, ?DVT upper limb, ?thrombosis, ?swollen leg |
| X-ray Abdomen (AXR) | Pain location, ?obstruction symptoms (vomiting, distension), last bowel movement, examination findings, ?perforation | ?Bowel obstruction, ?ileus, ?perforation (erect), ?foreign body, ?NG tube position |
| MRI Brain | Neurological symptoms and findings, ?stroke (if CT negative), ?mass, ?MS, ?infection, pacemaker/metal implants, recent CT if available | ?Stroke (if CT negative), ?mass, ?MS, ?infection, ?neurological deficit |
| MRI Spine | Neurological symptoms, level of concern, ?cord compression, ?disc herniation, ?infection, ?malignancy, pacemaker/metal implants | ?Cord compression, ?disc herniation, ?infection, ?malignancy, ?trauma |
| CT Head/Neck | Clinical findings (lump, pain, dysphagia, hoarseness), examination findings, ?mass, ?infection, eGFR if contrast | ?Mass, ?infection, ?abscess, ?trauma, ?lymphadenopathy |
| Ultrasound Pelvis | LMP, pregnancy test result, symptoms (pain, bleeding, discharge), examination findings, ?ectopic, ?ovarian pathology | ?Ectopic pregnancy, ?ovarian pathology, ?PID, ?fibroids, ?pregnancy complications |
| X-ray Limb | Mechanism of injury, pain location, examination findings (deformity, swelling, tenderness), ?fracture, ?dislocation | ?Fracture, ?dislocation, ?trauma, ?foreign body, ?osteomyelitis |
| CT KUB (Kidneys, Ureters, Bladder) | Pain location (flank, loin), urinalysis results, ?renal calculi, ?obstruction, recent creatinine if contrast needed | ?Renal calculi, ?ureteric obstruction, ?hydronephrosis, ?mass |
| Echocardiogram | Symptoms (SOB, chest pain), examination findings (murmur, heart failure signs), recent ECG, ?heart failure, ?valvular disease | ?Heart failure, ?valvular disease, ?endocarditis, ?pericardial effusion, ?LV function |
Chest X-ray (CXR)
Specific Info on Request
Symptoms (cough, SOB, chest pain), examination findings (reduced air entry, crepitations), recent CXR for comparison, ?heart failure, ?pneumonia
Clinical Question(s)
?Pneumonia, ?pneumothorax, ?pleural effusion, ?heart failure, ?NG tube placement, ?line position
CT Brain
Specific Info on Request
Time of symptom onset/last seen well, GCS, neurological findings, ?stroke, ?trauma, ?seizure, anticoagulation status
Clinical Question(s)
?Stroke, ?intracranial bleed, ?mass, ?trauma, ?altered consciousness, ?seizure
CTPA (CT Pulmonary Angiogram)
Specific Info on Request
D-dimer result, Wells score, haemodynamic status, chest pain + SOB, risk factors (recent surgery, immobility, malignancy), recent CXR
Clinical Question(s)
?Pulmonary embolism, ?PE with haemodynamic instability (urgent), ?chest pain + SOB
CT Abdomen/Pelvis
Specific Info on Request
Pain location and character, examination findings (peritonism, masses), ?appendicitis, ?diverticulitis, ?obstruction, recent surgery, eGFR if contrast
Clinical Question(s)
?Appendicitis, ?diverticulitis, ?bowel obstruction, ?perforation, ?abscess, ?trauma
CT Chest
Specific Info on Request
Symptoms (chest pain, SOB), examination findings, ?pneumonia complications, ?mass, ?dissection, recent CXR, eGFR if contrast
Clinical Question(s)
?Pneumonia complications, ?mediastinal mass, ?aortic dissection, ?trauma
Ultrasound Abdomen
Specific Info on Request
Pain location (RUQ, flank), examination findings (Murphy's sign, masses), recent LFTs, ?cholecystitis, ?hydronephrosis, ?AAA
Clinical Question(s)
?Cholecystitis, ?gallstones, ?hydronephrosis, ?aortic aneurysm, ?liver pathology
Ultrasound DVT
Specific Info on Request
Wells score, clinical signs (swelling, tenderness, erythema), risk factors (recent surgery, immobility, malignancy), which limb
Clinical Question(s)
?DVT lower limb, ?DVT upper limb, ?thrombosis, ?swollen leg
X-ray Abdomen (AXR)
Specific Info on Request
Pain location, ?obstruction symptoms (vomiting, distension), last bowel movement, examination findings, ?perforation
Clinical Question(s)
?Bowel obstruction, ?ileus, ?perforation (erect), ?foreign body, ?NG tube position
MRI Brain
Specific Info on Request
Neurological symptoms and findings, ?stroke (if CT negative), ?mass, ?MS, ?infection, pacemaker/metal implants, recent CT if available
Clinical Question(s)
?Stroke (if CT negative), ?mass, ?MS, ?infection, ?neurological deficit
MRI Spine
Specific Info on Request
Neurological symptoms, level of concern, ?cord compression, ?disc herniation, ?infection, ?malignancy, pacemaker/metal implants
Clinical Question(s)
?Cord compression, ?disc herniation, ?infection, ?malignancy, ?trauma
CT Head/Neck
Specific Info on Request
Clinical findings (lump, pain, dysphagia, hoarseness), examination findings, ?mass, ?infection, eGFR if contrast
Clinical Question(s)
?Mass, ?infection, ?abscess, ?trauma, ?lymphadenopathy
Ultrasound Pelvis
Specific Info on Request
LMP, pregnancy test result, symptoms (pain, bleeding, discharge), examination findings, ?ectopic, ?ovarian pathology
Clinical Question(s)
?Ectopic pregnancy, ?ovarian pathology, ?PID, ?fibroids, ?pregnancy complications
X-ray Limb
Specific Info on Request
Mechanism of injury, pain location, examination findings (deformity, swelling, tenderness), ?fracture, ?dislocation
Clinical Question(s)
?Fracture, ?dislocation, ?trauma, ?foreign body, ?osteomyelitis
CT KUB (Kidneys, Ureters, Bladder)
Specific Info on Request
Pain location (flank, loin), urinalysis results, ?renal calculi, ?obstruction, recent creatinine if contrast needed
Clinical Question(s)
?Renal calculi, ?ureteric obstruction, ?hydronephrosis, ?mass
Echocardiogram
Specific Info on Request
Symptoms (SOB, chest pain), examination findings (murmur, heart failure signs), recent ECG, ?heart failure, ?valvular disease
Clinical Question(s)
?Heart failure, ?valvular disease, ?endocarditis, ?pericardial effusion, ?LV function