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This
booklet tends to highlight areas of difficulty or controversy.
The pages are composed of five columns: the first sets the
clinical/diagnostic situation for requesting an examination; the next
lists some possible imaging techniques; the third gives the
recommendation [and the grade of available evidence] on whether or not
the investigation is appropriate; the fourth provides explanatory
comment; and the fifth shows the band of radiation exposure involved.
The
recommendations used are:
-
Indicated.
This shows an investigation most likely to
contribute to clinical diagnosis and management. This may
differ from the investigation requested by the clinician: e.g. US
rather than venography for deep vein thrombosis.
-
Specialised
investigation.
These are frequently complex,
time-consuming or resource-intensive investigations which will
usually only be performed after discussion with the radiologist or
in the context of locally agreed protocols.
-
Not
indicated initially.
This includes situations where
experience shows that the clinical problem usually resolves with
time; we therefore suggest deferring the study for three to six
weeks (timescale may be shorter for children) and only performing it
then if symptoms continue.
Shoulder pain is a typical example.
-
Indicated
only in specific circumstances.
These are non-routine studies which
will only be carried out if a clinician provides cogent reasons or
if the radiologist feels the examination represents an appropriate
way of furthering the diagnosis and management of the patient.
An example of such a justification would be plain radiography
in a patient with backache in whom there were clinical findings to
suggest something more than a degenerative disease (e.g.
?osteoporotic vertebral fracture).
-
Not
indicated.
Examinations in this group are those where the supposed
rationale for the investigation is untenable (e.g. skull radiograph
for dementia).
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