RADIOLOGY REQUISITIONS:

The Radiology Staff assists the Hospital’s Medical Staff, including the House Staff, with their patients’ clinical work-ups. In order to facilitate this, it is the responsibility of the patient’s physician to properly complete the radiology requisition stating the pertinent clinical information and indications for the examination. Requisitions, which lack the necessary patient data, cannot be processed and will cause a delay in patient care.

Such requisitions must have the ATTENDING and ORDERING physician’s names and BEEPER NUMBERS, and, unless specific orders are to the contrary, such a requisition will permit the staff to prepare the patient for the proper radiographic procedure in accordance with the Department’s recommended instructions:

• Requisitions MUST now be submitted electronically via the computer system. The House Staff should enter this information into the computer in order to facilitate his/her patient’s care. Additionally, an order for the examination must be written in the patient’s chart.
• Requisitions must include a concise but complete and relevant history, with the reason(s) for the examination, important physical and laboratory findings, results of any previous imaging examinations, and any relevant previous surgery. Also include referring physician’s name and page number. Rule out pathology (ex: R/O appendicitis) is not sufficient history and cannot be accepted since it breaches compliance. Rather, the “Indication” section should include the pertinent clinical signs or symptoms for which the study is being requested.
• Requisitions should include the patient’s mode of transportation, e.g. stretcher.
• Requisitions should note prominently that precautions are needed for handling appropriate patients (ex: TB, Hepatitis, etc).
• It is the referring physician’s responsibility to order preparations on the floor (descriptions of the preparations follow below).
• Portable examination requests (plain radiographic and sonographic studies) are utilized only when there is an absolute need for them – not for convenience. An unnecessary portable examination delays the necessary or stat portable studies for other patients. Remember that portable examinations are often limited and do not provide the radiographic detail that is found on conventional radiographic studies!

STAT EXAMINATIONS:

Stat examinations during the regular working day, especially angiograms, CT scans, sonograms, upper GI series, MR studies, and barium enemas and other fluoroscopic procedures, MUST be discussed, either in person or on the phone, with the Radiologist(s) in the appropriate subspecialty areas. On call (after hours, as well as on weekends and holidays), they MUST be discussed initially with the in-house on call Radiology Resident. The requesting physician will then know when the examination will be performed and will be informed regarding any appropriate preparations for the examination. Most plain radiographic studies, especially chest radiographs, usually do not have to be discussed with the radiology faculty or residents, but should be called in to the Radiology Department or to the appropriate radiologic technologist. Please note that routine Special Procedure examinations (i.e. vascular and interventional radiology studies) require a scheduled appointment with the Radiologist.

For Radiation Oncology emergencies (e.g. spinal cord compression), please call Radiation Oncology, or after hours page the Radiation Oncology Attending on call. Do not call or page the main Radiology Department or the Radiology Resident on call.

It is good patient care to make sure that the patient understands what type of examination is being performed before he or she is sent to the Radiology Department. Proper patient preparation is a prerequisite to obtaining a successful study. A few key issues that, when appropriately addressed, can avoid delays and prevent iatrogenic patient injury include: patient’s mental status for obtaining INFORMED CONSENT (immediate next of kin may be required), the need for NPO status, recent or previous radiographic study (some tests interfere or will delay other tests), coagulation status (PT, PTT, INR; is your patient on blood thinners?), renal function status (BUN, Creatinine), and pregnancy status. When considering an MRI examination for your patient, remember that they are being exposed to a continuous strong magnetic field, so that pacemakers and certain metallic implants (for example, ferromagnetic aneurysm clips or metallic orbital foreign bodies) are absolute contraindications to this procedure.

Specific issues, which come up frequently in this regard, are:

• Checking as to whether the patient has had recent radiographic studies (inpatient or outpatient) that may preclude the need for further imaging.
• Assessing the functional status of a patient prior to requesting imaging studies, e.g. double-contrast barium enema.
• Checking for a prior contrast reaction history (to iodinated contrast, prior to CT or IVU, or to gadolinium, prior to MRI; also see the pre-medication section).
• Checking for a beta HCG result prior to performance of CT, fluoroscopy, or selected plain film studies.
• Checking for a history of renal failure prior to iodinated IV contrast administration (note that dialysis patients CAN undergo these procedures, but this requires coordination with the patient’s next dialysis session).

Please use the Radiology Staff as consultants to aid you in your requests for diagnostic or therapeutic examinations.

DAILY 7:30-8:00 AM AND 12:00-1:30 PM CONSULTATIONS, MON-FRI:
During radiology conferences, which occur at the above times, and during the lunch hour, a designated radiologist is available within the main radiology department for consultation regarding any and all problems or questions. The Radiology front desk, at x2374, will let you know how to reach this person, or you can find them in the main department after consulting with the front desk. Please do not call or page other Radiology faculty during this time, unless it is an absolute emergency that a specific Radiologist needs to be made aware of.

EMERGENCY CASES:
During regular working hours, please contact the Radiologist in the appropriate subspecialty area. After 4:00 pm or on weekends or hospital holidays, contact the ON CALL Radiology Resident for all emergency Radiology studies (see comments above). The in-house on call Radiology Resident is the INITIAL person to consult regarding ALL urgent/emergency radiologic procedures and studies.