Requesting Radiology Studies 🩻

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.

Add to Tasks

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 — 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 — phone for urgent scan OOH · Pregnancy — discuss risk/benefit; prefer MRI if stable and alternative pathway
CTPA (CT pulmonary angiogram)	Emergency	D-dimer, Wells score, haemodynamic status, chest pain ± 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 — phone radiology OOH · Pregnancy — discuss VQ scan vs CTPA with radiology/senior; iodinated contrast allergy — 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 — discuss urgent timing with radiology · Pregnancy — specify LMP/β-hCG; eGFR for contrast per local policy
CT Chest/Thorax (± 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 — phone for urgent CT angiography protocol with both teams · 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 — 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 — 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 — discuss urgency with surgical and radiology teams
MRI Brain	Same-day	Neurological symptoms, ?stroke if CT negative, ?mass, ?MS, ?infection, pacemaker/implants/metal — safety checklist	?Stroke (CT-negative), ?mass, ?demyelination, ?infection	Acute cord compression or rapidly progressive deficit — discuss urgent MRI with radiology/neurology · MRI safety screening mandatory — 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 — phone for urgent MRI and neurosurgical review · 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 — phone for urgent scan and ENT/anaesthetics
Ultrasound Pelvis	Emergency	LMP, pregnancy test (β-hCG), pain, bleeding, discharge, examination, ?ectopic, ?ovarian pathology	?Ectopic pregnancy, ?ovarian torsion, ?PID, ?fibroids, ?pregnancy complications	Ectopic pregnancy or torsion suspected — phone for urgent scan and gynaecology review · 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 — 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 — 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 — 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 — 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 — phone for urgent scan OOH
Check: Pregnancy — 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 ± 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 — phone radiology OOH
Check: Pregnancy — discuss VQ scan vs CTPA with radiology/senior; iodinated contrast allergy — 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 — discuss urgent timing with radiology
Check: Pregnancy — specify LMP/β-hCG; eGFR for contrast per local policy

CT Chest/Thorax (± 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 — 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 — 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 — 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 — 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 — safety checklist
Clinical question(s): ?Stroke (CT-negative), ?mass, ?demyelination, ?infection
Phone if: Acute cord compression or rapidly progressive deficit — discuss urgent MRI with radiology/neurology
Check: MRI safety screening mandatory — 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 — 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 — phone for urgent scan and ENT/anaesthetics

Ultrasound Pelvis

Emergency

Include on request: LMP, pregnancy test (β-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 — 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 — 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 — 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 — phone cardiology/echo urgently

🧭 Workflow

1. Confirm imaging is indicated — 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 — 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 “phone if” — document verbal approval in the notes.
5. Keep the patient informed; recheck allergies, renal function, and pregnancy status before contrast.

📋 Every request checklist

Clinical history and examination findings relevant to the question.
Clear question — e.g. “?PE”, “?appendicitis”, “?NG tube position”.
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.

☎️ When to phone radiology

Emergency scans — 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 — ask before submitting a vague request.

📞 Example OOH script (SBAR)

Situation: “Hi, [Name], I'm [Your Name], intern on [ward/ED]. I need to discuss an urgent [study] for [age/sex].”
Background: “[Admission reason]. [Key history — e.g. thunderclap headache 2 h ago, on apixaban]. Vitals: [stable/unstable].”
Assessment: “Exam shows [findings]. Bloods: [eGFR, β-hCG if relevant]. I'm concerned about [differential].”
Recommendation: “Can you accept an urgent [CT brain non-contrast / CTPA / etc.] — clinical question: [?SAH / ?PE]. Patient [contrast allergy none / eGFR __].”
Document name of radiology doctor spoken to and time in the notes.

⚠️ Contrast, pregnancy & MRI safety

Iodinated contrast — check eGFR and local policy; discuss with radiology if eGFR reduced. Document metformin plan per local protocol if applicable.
Pregnancy — always document LMP/β-hCG; CTPA vs VQ in pregnancy is a radiology/senior decision.
MRI — complete implant/metal safety screening; pacemaker and some implants are contraindicated.
Avoid vague requests (“abdo pain”) — specify site, examination, and differential.

🔗 Related topics

Interventional radiology consult Chest pain Shortness of breath Headache Stroke Abdominal pain Sepsis screening Echocardiography

Note Template

Ready-to-use clinical note structure

🕒 24 / 08 / 2026 — 14:08

ATRP re: imaging request
Patient: [age] [sex]
Location: [ward / ED]
Admission Dx: [reason for admission]

🧾 Indication:
• Study requested: [CXR / CT brain / CTPA / CT abdo / US / MRI — specify]
• Clinical question: [?PE / ?SAH / ?appendicitis / etc.]
• Urgency: [routine / same-day / emergency]

🩺 Context documented on request:
• History & exam: [relevant findings]
• Prior imaging reviewed: [yes — date / none available]
• Bloods: [eGFR __, β-hCG if relevant, D-dimer, troponin — as applicable]
• Allergies: [none / iodinated contrast / other]
• Anticoagulation / implants: [if relevant]

☎️ Radiology communication:
• Discussed with: [radiology doctor name / not required]
• Time: [__]
• Outcome: [scan accepted / deferred / alternative suggested]

📌 Plan:
• [Await result / further imaging / treat pending result]
• Patient informed of test and contrast risks if applicable

👤 [Your Name], [Role]
IMC: _______

Add to Tasks

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 — 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 — phone for urgent scan OOH · Pregnancy — discuss risk/benefit; prefer MRI if stable and alternative pathway

CTPA (CT pulmonary angiogram)

Emergency

D-dimer, Wells score, haemodynamic status, chest pain ± 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 — phone radiology OOH · Pregnancy — discuss VQ scan vs CTPA with radiology/senior; iodinated contrast allergy — 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 — discuss urgent timing with radiology · Pregnancy — specify LMP/β-hCG; eGFR for contrast per local policy

CT Chest/Thorax (± 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 — phone for urgent CT angiography protocol with both teams · 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 — 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 — 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 — discuss urgency with surgical and radiology teams

MRI Brain

Same-day

Neurological symptoms, ?stroke if CT negative, ?mass, ?MS, ?infection, pacemaker/implants/metal — safety checklist

?Stroke (CT-negative), ?mass, ?demyelination, ?infection

Acute cord compression or rapidly progressive deficit — discuss urgent MRI with radiology/neurology · MRI safety screening mandatory — 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 — phone for urgent MRI and neurosurgical review · 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 — phone for urgent scan and ENT/anaesthetics

Ultrasound Pelvis

Emergency

LMP, pregnancy test (β-hCG), pain, bleeding, discharge, examination, ?ectopic, ?ovarian pathology

?Ectopic pregnancy, ?ovarian torsion, ?PID, ?fibroids, ?pregnancy complications

Ectopic pregnancy or torsion suspected — phone for urgent scan and gynaecology review · 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 — 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 — 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 — phone cardiology/echo urgently

🕒 24 / 08 / 2026 — 14:08 ATRP re: imaging request Patient: [age] [sex] Location: [ward / ED] Admission Dx: [reason for admission] 🧾 Indication: • Study requested: [CXR / CT brain / CTPA / CT abdo / US / MRI — specify] • Clinical question: [?PE / ?SAH / ?appendicitis / etc.] • Urgency: [routine / same-day / emergency] 🩺 Context documented on request: • History & exam: [relevant findings] • Prior imaging reviewed: [yes — date / none available] • Bloods: [eGFR __, β-hCG if relevant, D-dimer, troponin — as applicable] • Allergies: [none / iodinated contrast / other] • Anticoagulation / implants: [if relevant] ☎️ Radiology communication: • Discussed with: [radiology doctor name / not required] • Time: [__] • Outcome: [scan accepted / deferred / alternative suggested] 📌 Plan: • [Await result / further imaging / treat pending result] • Patient informed of test and contrast risks if applicable 👤 [Your Name], [Role] IMC: _______