Requesting Radiology Studies π©»
Guide for requesting radiology studies including CT thorax/chest, CTPA, CT brain, CT abdomen, CXR, MRI, and ultrasound. Indications, request forms, and communication with radiology.
Study reference
What to include, clinical questions, and when to phone radiology
| Study | Urgency | Include on request | Clinical question(s) | Phone if / check |
|---|---|---|---|---|
| Chest X-ray (CXR) | Same-day | Symptoms (cough, SOB, chest pain), examination (air entry, crepitations), recent CXR for comparison, ?heart failure, ?pneumonia | ?Pneumonia, ?pneumothorax, ?pleural effusion, ?heart failure, ?NG tube placement, ?line position | If tension pneumothorax suspected β do not wait for routine report |
| CT Brain (non-contrast) | Emergency | Time of onset / last seen well, GCS, neurological findings, ?stroke, ?SAH, ?trauma, ?seizure, anticoagulation status | ?Stroke, ?intracranial bleed, ?SAH, ?mass, ?trauma, ?altered consciousness | Thunderclap headache, reduced GCS, focal neurology, or anticoagulation + head injury β phone for urgent scan OOH Β· Pregnancy β discuss risk/benefit; prefer MRI if stable and alternative pathway |
| CTPA (CT pulmonary angiogram) | Emergency | D-dimer, Wells score, haemodynamic status, chest pain Β± SOB, risk factors (surgery, immobility, malignancy, OCP), recent CXR, eGFR if contrast | ?Pulmonary embolism, ?PE with haemodynamic instability | Unstable PE, massive PE, or high suspicion with contraindication to delay β phone radiology OOH Β· Pregnancy β discuss VQ scan vs CTPA with radiology/senior; iodinated contrast allergy β document |
| CT Abdomen/Pelvis | Same-day | Pain site and character, peritonism, ?appendicitis, ?diverticulitis, ?obstruction, LMP/pregnancy status, recent surgery, eGFR if contrast | ?Appendicitis, ?diverticulitis, ?bowel obstruction, ?perforation, ?abscess, ?trauma | Peritonism, sepsis, or suspected perforation β discuss urgent timing with radiology Β· Pregnancy β specify LMP/Ξ²-hCG; eGFR for contrast per local policy |
| CT Chest/Thorax (Β± contrast) | Emergency | Symptoms (pain, SOB), examination, ?pneumonia complications, ?mass, ?dissection, recent CXR, eGFR if contrast | ?Pneumonia complications, ?mediastinal mass, ?aortic dissection, ?trauma | Suspected aortic dissection β phone for urgent CT angiography protocol with both teams Β· Contrast allergy and renal function; pregnancy if contrast required |
| Ultrasound Abdomen | Same-day | Pain location (RUQ, flank), Murphy's sign, masses, recent LFTs, ?cholecystitis, ?hydronephrosis, ?AAA, fasting if RUQ/biliary | ?Cholecystitis, ?gallstones, ?hydronephrosis, ?AAA, ?liver pathology | Ruptured AAA or unstable cholecystitis β discuss urgently with radiology and surgical team |
| Ultrasound DVT | Same-day | Wells score, limb (which side), swelling/tenderness/erythema, risk factors, anticoagulation status | ?DVT lower limb, ?DVT upper limb, ?proximal thrombosis | Phlegmasia or massive PE suspected β phone for urgent scan and discuss anticoagulation |
| X-ray Abdomen (AXR) | Same-day | Pain site, vomiting/distension, last bowel motion, examination, ?obstruction, ?perforation (request erect if able) | ?Bowel obstruction, ?ileus, ?perforation, ?NG tube position | Suspected perforation or closed-loop obstruction β discuss urgency with surgical and radiology teams |
| MRI Brain | Same-day | Neurological symptoms, ?stroke if CT negative, ?mass, ?MS, ?infection, pacemaker/implants/metal β safety checklist | ?Stroke (CT-negative), ?mass, ?demyelination, ?infection | Acute cord compression or rapidly progressive deficit β discuss urgent MRI with radiology/neurology Β· MRI safety screening mandatory β pacemaker, cochlear implant, metallic foreign body |
| MRI Spine | Emergency | Symptoms, level, neurology (power, sensation, gait, bladder/bowel), ?cord compression, ?disc, ?infection, ?malignancy, MRI safety | ?Cord compression, ?cauda equina, ?disc herniation, ?infection, ?malignancy | Cauda equina or progressive cord compression β phone for urgent MRI and neurosurgical review Β· MRI safety screening; metal implants |
| CT Head/Neck (soft tissue) | Same-day | Lump, pain, dysphagia, hoarseness, examination, ?abscess, ?mass, ?deep space infection, eGFR if contrast | ?Mass, ?abscess, ?deep neck infection, ?lymphadenopathy, ?trauma | Airway compromise or rapidly expanding neck swelling β phone for urgent scan and ENT/anaesthetics |
| Ultrasound Pelvis | Emergency | LMP, pregnancy test (Ξ²-hCG), pain, bleeding, discharge, examination, ?ectopic, ?ovarian pathology | ?Ectopic pregnancy, ?ovarian torsion, ?PID, ?fibroids, ?pregnancy complications | Ectopic pregnancy or torsion suspected β phone for urgent scan and gynaecology review Β· Always document pregnancy status and LMP |
| X-ray Limb | Same-day | Mechanism, pain site, deformity, neurovascular status, ?fracture, ?dislocation, ?open fracture | ?Fracture, ?dislocation, ?foreign body | Open fracture or neurovascular compromise β orthopaedic emergency pathway; imaging must not delay treatment |
| CT KUB (non-contrast) | Same-day | Flank/loin pain, urinalysis (blood), fever, ?calculi, ?obstruction, creatinine if contrast might be needed later | ?Renal calculi, ?ureteric obstruction, ?hydronephrosis | Obstructed infected system (pyonephrosis) or single kidney β discuss urgent urology/radiology |
| Echocardiogram | Same-day | Symptoms (SOB, chest pain, syncope), murmur, heart failure signs, recent ECG, ?endocarditis, ?tamponade, ?LV function | ?Valvular disease, ?LV function, ?pericardial effusion, ?endocarditis, ?pulmonary hypertension | Tamponade, critical aortic stenosis with instability, or endocarditis with complications β phone cardiology/echo urgently |
Chest X-ray (CXR)
Same-day- Include on request
- Symptoms (cough, SOB, chest pain), examination (air entry, crepitations), recent CXR for comparison, ?heart failure, ?pneumonia
- Clinical question(s)
- ?Pneumonia, ?pneumothorax, ?pleural effusion, ?heart failure, ?NG tube placement, ?line position
- Phone if
- If tension pneumothorax suspected β do not wait for routine report
CT Brain (non-contrast)
Emergency- Include on request
- Time of onset / last seen well, GCS, neurological findings, ?stroke, ?SAH, ?trauma, ?seizure, anticoagulation status
- Clinical question(s)
- ?Stroke, ?intracranial bleed, ?SAH, ?mass, ?trauma, ?altered consciousness
- Phone if
- Thunderclap headache, reduced GCS, focal neurology, or anticoagulation + head injury β phone for urgent scan OOH
- Check
- Pregnancy β discuss risk/benefit; prefer MRI if stable and alternative pathway
CTPA (CT pulmonary angiogram)
Emergency- Include on request
- D-dimer, Wells score, haemodynamic status, chest pain Β± SOB, risk factors (surgery, immobility, malignancy, OCP), recent CXR, eGFR if contrast
- Clinical question(s)
- ?Pulmonary embolism, ?PE with haemodynamic instability
- Phone if
- Unstable PE, massive PE, or high suspicion with contraindication to delay β phone radiology OOH
- Check
- Pregnancy β discuss VQ scan vs CTPA with radiology/senior; iodinated contrast allergy β document
CT Abdomen/Pelvis
Same-day- Include on request
- Pain site and character, peritonism, ?appendicitis, ?diverticulitis, ?obstruction, LMP/pregnancy status, recent surgery, eGFR if contrast
- Clinical question(s)
- ?Appendicitis, ?diverticulitis, ?bowel obstruction, ?perforation, ?abscess, ?trauma
- Phone if
- Peritonism, sepsis, or suspected perforation β discuss urgent timing with radiology
- Check
- Pregnancy β specify LMP/Ξ²-hCG; eGFR for contrast per local policy
CT Chest/Thorax (Β± contrast)
Emergency- Include on request
- Symptoms (pain, SOB), examination, ?pneumonia complications, ?mass, ?dissection, recent CXR, eGFR if contrast
- Clinical question(s)
- ?Pneumonia complications, ?mediastinal mass, ?aortic dissection, ?trauma
- Phone if
- Suspected aortic dissection β phone for urgent CT angiography protocol with both teams
- Check
- Contrast allergy and renal function; pregnancy if contrast required
Ultrasound Abdomen
Same-day- Include on request
- Pain location (RUQ, flank), Murphy's sign, masses, recent LFTs, ?cholecystitis, ?hydronephrosis, ?AAA, fasting if RUQ/biliary
- Clinical question(s)
- ?Cholecystitis, ?gallstones, ?hydronephrosis, ?AAA, ?liver pathology
- Phone if
- Ruptured AAA or unstable cholecystitis β discuss urgently with radiology and surgical team
Ultrasound DVT
Same-day- Include on request
- Wells score, limb (which side), swelling/tenderness/erythema, risk factors, anticoagulation status
- Clinical question(s)
- ?DVT lower limb, ?DVT upper limb, ?proximal thrombosis
- Phone if
- Phlegmasia or massive PE suspected β phone for urgent scan and discuss anticoagulation
X-ray Abdomen (AXR)
Same-day- Include on request
- Pain site, vomiting/distension, last bowel motion, examination, ?obstruction, ?perforation (request erect if able)
- Clinical question(s)
- ?Bowel obstruction, ?ileus, ?perforation, ?NG tube position
- Phone if
- Suspected perforation or closed-loop obstruction β discuss urgency with surgical and radiology teams
MRI Brain
Same-day- Include on request
- Neurological symptoms, ?stroke if CT negative, ?mass, ?MS, ?infection, pacemaker/implants/metal β safety checklist
- Clinical question(s)
- ?Stroke (CT-negative), ?mass, ?demyelination, ?infection
- Phone if
- Acute cord compression or rapidly progressive deficit β discuss urgent MRI with radiology/neurology
- Check
- MRI safety screening mandatory β pacemaker, cochlear implant, metallic foreign body
MRI Spine
Emergency- Include on request
- Symptoms, level, neurology (power, sensation, gait, bladder/bowel), ?cord compression, ?disc, ?infection, ?malignancy, MRI safety
- Clinical question(s)
- ?Cord compression, ?cauda equina, ?disc herniation, ?infection, ?malignancy
- Phone if
- Cauda equina or progressive cord compression β phone for urgent MRI and neurosurgical review
- Check
- MRI safety screening; metal implants
CT Head/Neck (soft tissue)
Same-day- Include on request
- Lump, pain, dysphagia, hoarseness, examination, ?abscess, ?mass, ?deep space infection, eGFR if contrast
- Clinical question(s)
- ?Mass, ?abscess, ?deep neck infection, ?lymphadenopathy, ?trauma
- Phone if
- Airway compromise or rapidly expanding neck swelling β phone for urgent scan and ENT/anaesthetics
Ultrasound Pelvis
Emergency- Include on request
- LMP, pregnancy test (Ξ²-hCG), pain, bleeding, discharge, examination, ?ectopic, ?ovarian pathology
- Clinical question(s)
- ?Ectopic pregnancy, ?ovarian torsion, ?PID, ?fibroids, ?pregnancy complications
- Phone if
- Ectopic pregnancy or torsion suspected β phone for urgent scan and gynaecology review
- Check
- Always document pregnancy status and LMP
X-ray Limb
Same-day- Include on request
- Mechanism, pain site, deformity, neurovascular status, ?fracture, ?dislocation, ?open fracture
- Clinical question(s)
- ?Fracture, ?dislocation, ?foreign body
- Phone if
- Open fracture or neurovascular compromise β orthopaedic emergency pathway; imaging must not delay treatment
CT KUB (non-contrast)
Same-day- Include on request
- Flank/loin pain, urinalysis (blood), fever, ?calculi, ?obstruction, creatinine if contrast might be needed later
- Clinical question(s)
- ?Renal calculi, ?ureteric obstruction, ?hydronephrosis
- Phone if
- Obstructed infected system (pyonephrosis) or single kidney β discuss urgent urology/radiology
Echocardiogram
Same-day- Include on request
- Symptoms (SOB, chest pain, syncope), murmur, heart failure signs, recent ECG, ?endocarditis, ?tamponade, ?LV function
- Clinical question(s)
- ?Valvular disease, ?LV function, ?pericardial effusion, ?endocarditis, ?pulmonary hypertension
- Phone if
- Tamponade, critical aortic stenosis with instability, or endocarditis with complications β phone cardiology/echo urgently
π§ Workflow
- 1. Confirm imaging is indicated β will the result change management? Is prior imaging (PACS) enough?
- 2. Complete the request with a clear clinical question, relevant history, examination, and results (see checklist below).
- 3. Set urgency β routine, same-day, or emergency; use the study reference table above for typical urgency.
- 4. Phone radiology if emergency, out-of-hours, or the table notes βphone ifβ β document verbal approval in the notes.
- 5. Keep the patient informed; recheck allergies, renal function, and pregnancy status before contrast.
π Every request checklist
- Clinical history and examination findings relevant to the question.
- Clear question β e.g. β?PEβ, β?appendicitisβ, β?NG tube positionβ.
- Prior imaging reviewed / attached if available.
- Urgency stated (routine / same-day / emergency).
- Allergies (especially iodinated contrast) and renal function (eGFR) for contrast studies.
- Pregnancy status / LMP where relevant (CT, CTPA, pelvis imaging).
- Anticoagulation, pacemaker, or implants for MRI safety.
βοΈ When to phone radiology
- Emergency scans β stroke, SAH, unstable PE, dissection, cauda equina, ectopic, etc.
- Out-of-hours requests that cannot wait until morning reporting.
- When local policy requires verbal approval before ordering (e.g. some contrast CT protocols).
- If unsure which study or protocol β ask before submitting a vague request.
π Example OOH script (SBAR)
- Situation: βHi, [Name], I'm [Your Name], intern on [ward/ED]. I need to discuss an urgent [study] for [age/sex].β
- Background: β[Admission reason]. [Key history β e.g. thunderclap headache 2 h ago, on apixaban]. Vitals: [stable/unstable].β
- Assessment: βExam shows [findings]. Bloods: [eGFR, Ξ²-hCG if relevant]. I'm concerned about [differential].β
- Recommendation: βCan you accept an urgent [CT brain non-contrast / CTPA / etc.] β clinical question: [?SAH / ?PE]. Patient [contrast allergy none / eGFR __].β
- Document name of radiology doctor spoken to and time in the notes.
β οΈ Contrast, pregnancy & MRI safety
- Iodinated contrast β check eGFR and local policy; discuss with radiology if eGFR reduced. Document metformin plan per local protocol if applicable.
- Pregnancy β always document LMP/Ξ²-hCG; CTPA vs VQ in pregnancy is a radiology/senior decision.
- MRI β complete implant/metal safety screening; pacemaker and some implants are contraindicated.
- Avoid vague requests (βabdo painβ) β specify site, examination, and differential.
Note Template
Ready-to-use clinical note structure
π 16 / 10 / 2026 β 15:32 ATRP re: imaging request Patient: [age] [sex] Location: [ward / ED] Admission Dx: [reason for admission] π§Ύ Indication: β’ Study requested: [CXR / CT brain / CTPA / CT abdo / US / MRI β specify] β’ Clinical question: [?PE / ?SAH / ?appendicitis / etc.] β’ Urgency: [routine / same-day / emergency] π©Ί Context documented on request: β’ History & exam: [relevant findings] β’ Prior imaging reviewed: [yes β date / none available] β’ Bloods: [eGFR __, Ξ²-hCG if relevant, D-dimer, troponin β as applicable] β’ Allergies: [none / iodinated contrast / other] β’ Anticoagulation / implants: [if relevant] βοΈ Radiology communication: β’ Discussed with: [radiology doctor name / not required] β’ Time: [__] β’ Outcome: [scan accepted / deferred / alternative suggested] π Plan: β’ [Await result / further imaging / treat pending result] β’ Patient informed of test and contrast risks if applicable π€ [Your Name], [Role] IMC: _______
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