When requesting a CT scan for an inpatient, there are some steps to take to ensure that it happens in the timeliest manner possible and patient safety is maintained. Failure to follow this guidance may result in cancellation of
the CT request.

Aims

• To improve inpatient scan efficiency; aiding inpatient care/safety and efficient discharge
• Ensure compliance with IRMER legislation
• To prevent wasted appointments to CT due to lack of/incorrect patient-prep; improving patient experience and journey
• To reduce the number of cancelled appointments and need for repeat requests to be made by referrers

Referrer responsibility:

This is the legal responsibility as outlined in the Ionising Radiation (Medical Exposure) Regulations and in accordance with LTHT procedures.

It is the referrer’s responsibility to gain the patient’s verbal consent by discussing the imaging request with the patient, counselling them of the radiation risk vs. benefit as well as the potential need for an injection of iodinated contrast media during their examination.

An OrderComms request must be completed by an appropriate staff member who is authorised to act as a referrer under IRMER. This OrderComms request is a legal document and must be fully completed and accurate as per IRMER legislation Regulation 6(2), 6(5a), 10(5) and 2.

Within this referral it is necessary to provide as much information as possible; including a previous allergy to contrast, urgency, pregnancy status and the most recent up to date blood test (eGFR) for kidney function; including date of result.

If you have identified a contrast allergy, please follow up the OrderComms request with a call to the on duty radiology registrar. 0113 20(68948) SJUH or 0113 39(25207) General LGI, or Ext 23780 Neuro LGI

A suitable cannula (see appendix 1) must be sited for any studies requiring a contrast injection and should be sited in advance of a referral being submitted to ensure that imaging can be completed promptly.

The responsibility to cancel any requests that are no longer required rests with the referrer.

Radiology process

A Radiologist or the on duty Radiology Registrar will review the OrderComms request and authorise or reject the referral request. They will assign a CT protocol and urgency based on the clinical history which has been provided.

If you need to escalate or upgrade urgency due to clinical need then the referrer needs to contact the on duty radiology registrar. 0113 20(68948) SJUH or 0113 39(25207) General LGI, or Ext 23780 Neuro LGI

Any rejections can only be seen in OrderComms due to limitations of computer systems; all efforts will be made to contact and discuss any issues with the referrer prior to a rejection.

The Radiographers will contact the ward to organise appointment times and confirm transportation, cannula and any handover of care requirements we need to be aware of.

Routine scanning occurs between 8-5pm Monday-Friday. All other hours are classified as ONCALL and require a separate/additional discussion to ensure that these lists can be prioritised appropriately.

Bleep 80-5138 SJUH, 80-2342 LGI.

All patients: requirements

All patients referred for CT should be aware of the need for CT; advised of the risk vs. benefits of CT and iodinated contrast injection (if appropriate) and happy to proceed

In pregnancy cases; radiation risks should be discussed in relation to the foetus and mother risk vs. benefit.

Fit for transfer to CT (or appropriate escort/team); anticipated time in department ≥30 minutes

Out of hours all patients will require an escort to CT

Please note CT do not have access to routine monitoring, nursing care or ward medications. Any unstable or unwell patients should be reviewed RE fitness to attend CT, CT informed and a suitable escort provided if required.

Heavy coats or clothing with multiple zips/jewels should be removed on the ward wherever possible and appropriate, and patients changed into a gown or other non-metallic clothing

Hearing aids or glasses should not be removed

Continue all routine medications and patient comforts (food and hydration) unless instructed otherwise by CT directly.

Standard waiting times:

NB: this is only applicable if the patient-prep has been completed prior to referral and assuming that all CT systems are operational.

Routine: Target to be performed within 48-72hours; excluding out of hours - done within normal working hours only (8-5pm M-F).

Soon: Target to be performed within 24hours; excluding out of hours - done within normal working hours only (8-5pm M-F).

Urgent: Target to be performed within 12hours; including out of hours. Referrals prioritised as urgent by the Radiologists will automatically be added to oncall.

Immediate: Target to be performed within 4hours; including out of hours. Referrals prioritised as immediate by the Radiologists will automatically be added to oncall.

If after 3 working days, the scan has not been able to be carried out due to patient-prep which is avoidable eg. cannula, patient-refusal or the patient is repeatedly not fit to attend, then the request will be cancelled by Radiology and a new request will have to be made when the patient is in a position to attend. The ward will be notified of any cancellations and all attempts will be made to undertake the CT scan during the 3 days that the request is held.

Questions and queries

For any questions and escalation requirements, please call the duty radiology registrar (09:00 - 17:00 Monday- Friday) or bleep out of hours (17:00- 09:00 and on weekends and bank holidays).

Radiologists:
0113 20(68948) SJUH or 0113 39(25207) General LGI, or Ext 23780 Neuro LGI

Bleep 80-5138 SJUH, 80-2342 LGI

Scan Rooms:
0113 20(68612) SJUH or 0113 39(23617)

Any logistical or scanning requirement queries, please call the CT department.

Appendix 1: Cannula Requirements

CT use automated pressure injector pumps to deliver the iodinated contrast injection. These pumps have an inbuilt pressure limit which dictates the type of lines which can be used. Due to the risk of radiation and the requirement for contrast to be delivered as a bolus within a timeframe which is in-keeping with the scan time; a minimum of 2ml/s is usually required, which cannot be given by hand.

Some scans require a quicker contrast injection to ensure that the scan is diagnostic and can answer the clinical question being asked.

Below is a rough guide of requirements.

Clinical Concern/History

Iodinated Contrast Media Required

Cannula Colour Required

Any: where concern of renal failure, CKI or a contrast allergy/contra-indication

N

None

Cancer Staging/ Follow-up

Y

Pink/Blue

Leak (oesophageal, GI, pelvic Anastomosis or renal tract)

Y

Pink/Blue

Acute GI Bleed/ Intra-abdominal Haemorrhage or Ischemia

Y

Green/Pink

Trauma Head & Neck

N

None

Trauma Bastion

Y

Green/Pink

Liver Assessment (cirrhosis, pancreatic Ca/lesion/pancreatitis, HCC, transplant and suspected vascular complications)

Y

Green (pink on discussion)

Renal calculi

N

None

Haematuria

Y

Pink/Blue

Aorta (AAA, cardiac vessel assessment, and follow-up stents)

Y

Green (pink on discussion)

Aorta (dissection

Y

Green in right-arm

TAVI

Y

Green in right-arm

Cardiac (calcium scoring)

N

None

Cardiac (coronary heart disease, post-op valve implantation)

Y

Green

Angiograms (peripheral, upper limb, epigastric arteries, prostate for embolization, intercranial)

Y

Green/Pink

CTPA (pulmonary embolism)

Y

Green/Pink

Lung nodule/ Chest completion staging/ CF or mesothelioma

N

None

Head/ Face (dementia, trauma, sinus, confusion/sepsis screen)

N

None

Head Metastasis/ Pituitary or Orbital tumour

Y

Blue/Pink

ENT

Y

Blue/Pink

MSK

N

None

For patients with difficult access, please speak to a radiologist about the appropriate use of a central line or CT compatible PICC line.

(Midlines, PortaCaths, Hickmann Lines and non-CT compatible PICC lines cannot be accepted).