Post on 27-Apr-2020
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 1 of 25
MIDLAND REGION
CLINICAL ACCESS CRITERIA
FOR
COMMUNITY REFERRED RADIOLOGY
FINAL VERSION
Dated 15 July 2014
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 2 of 25
Contents Introduction ........................................................................... 3 General X-ray
Abdomen ......................................................................................... 4 Ankle ............................................................................................... 4 Chest ............................................................................................... 5 Paediatric Chest .............................................................................. 5 Elbow ............................................................................................... 5 Hand/Wrist ....................................................................................... 6 Hip ................................................................................................... 6 Paediatric Hip .................................................................................. 7 Knee ................................................................................................ 7 Shoulder .......................................................................................... 8 Skull ................................................................................................. 8 Spine ............................................................................................... 8 TMJ ................................................................................................. 8
Ultrasound (US)
Abdomen ......................................................................................... 9 Carotid Doppler ............................................................................... 9 Paediatric Hips ................................................................................ 9 Paediatric Renal .............................................................................. 9 Renal ........................................................................................ 10-11 Pelvic ............................................................................................. 12 Scrotal ........................................................................................... 13 Neonatal Spine .............................................................................. 13 Thyroid........................................................................................... 13 Vascular......................................................................................... 14
Computed Tomography (CT)
CT Head ........................................................................................ 15 CT Chest ....................................................................................... 16 CT Abdomen ................................................................................. 16 CT KUB ......................................................................................... 17 CT Colonography .......................................................................... 17 CT Sinus ........................................................................................ 17
Mammography and Breast Ultrasound
Mammography ............................................................................... 18 Ultrasound Breast .......................................................................... 19
Prioritisation Methodology ....................................................20 Appendix 1 - Current Access by DHB ............................................. 21-22 Appendix 2 - Planned Access by DHB ............................................ 23-24 Appendix 3 – Midland Regional Advisory Group Members .................. 25
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 3 of 25
Introduction The following regional access criteria for primary referred radiology referrals have been developed from a number of sources, including the draft National Community Radiology Access Criteria (Nov 2013). These criteria have been developed to improve equity of access across the Midland Region. They are a minimum that should be provided and should be read in conjunction with the Prioritisation Methodology detailed in Appendix 2 (when we have redefined this in line with National guidelines). DHB’s will advise local GP’s where copies of these access criteria are available. We are unable to accept any patient referral for investigation without the required actions being completed and the results supplied with the referral. If your patient does not meet the criteria but you think that an investigation is warranted, please phone a DHB Radiologist for advice. If they advise an investigation please document their name as well as all clinical information on the referral form. Primary Care Nurse Practitioner Referrals
The RANZCR considers that appropriately qualified Nurse Practitioners should be able to refer for diagnostic imaging testing within their particular clinical context as approved by the local radiation licensee.
NPs are expected to apply the practice expectations for public protection set out in the Nurse Practitioner practice standard “Competencies for the nurse practitioner scope of practice 2008”.
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 4 of 25
GENERAL X-RAY
Abdomen Standard indications for x-ray referral
• Diagnosis of constipation where patient history is unobtainable e.g. autism, special needs
• Follow up of diagnosed renal stones with a KUB x-ray • Suspected renal tract stone use local pathway
Referral for x-ray not typically indicated
• Acute abdomen: Discuss with acute surgical services or emergency services access points
• Vague central abdominal pain • Suspected colorectal neoplasm (refer to colorectal cancer guidelines) • Suspected constipation (other than in specific patient groups as above). • Suspected abdominal masses refer to ultrasound
Ankle
Standard indications for x-ray referral Two of the below needed to qualify.
• The pain has been present for >4 weeks. • The pain was sudden in onset and is severe and <4 weeks duration. • There is swelling near the joint. • There is a palpable mass or deformity. • There is limited ROM (range of movement). • There is evidence of inflammatory arthritis.
Referral for x-ray not typically indicated
• Suspected septic arthritis: refer for acute review • Acute gout.
Ankle – Trauma Use Ottawa Ankle Rules
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 5 of 25
Chest Standard indications for x-ray referral
The x-ray result will influence patient management.
Referral for x-ray not typically indicated
• Pneumonia doesn’t require routine CXR follow up unless there are risk factors or red flags including age>50 years or age >40 years if smoker, suspicious radiologic findings on initial CXR or incomplete clinical resolution at 6 weeks (this is a guideline only and there may be local pathways which apply)
• Routine assessment of hypertension • Routine monitoring of known pulmonary sarcoidosis • Routine x-ray for asbestos exposure surveillance • Follow-up of nodules detected on chest x-ray or CT other than where
recommended by reporting or reviewing specialist (consider referral for respiratory specialist review)
• Initial investigation of heart murmur, unless signs of complications such as heart failure
• Routine follow-up of asymptomatic patients on amiodarone. Paediatric Chest Standard indications for x-ray referral
• Acute chest infection/sepsis consider acute referral to specialist as per local pathway
• Recurrent productive cough – if resistant to treatment or additional clinical features i.e. pyrexia
• Wheeze with additional features such as fevers and localised crackles, chronic heart or respiratory disease and immunocompromised patients
• Suspected/inhalation foreign body. Referral for x-ray not typically indicated
• Incidental finding of a murmur • Uncomplicated (afebrile) presentation of asthma/bronchiolitis.
Elbow Standard indications for x-ray referral
• Pain has been present for >4 weeks and no response to treatment and/or not reproduced on examination.
• Unrelenting severe pain <4 weeks. • Significant restriction in ROM (range of movement) after 4 weeks. • Unexplained deformity/palpable enlarging mass or swelling. • There is evidence of inflammatory arthritis.
Referral for x-ray not typically indicated
• Suspected septic joint: refer for acute review • Acute gout
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 6 of 25
Hand/wrist Standard indications for x-ray referral
• Swelling confirmed on examination • Deformity • Strong history of Inflammatory symptoms >12 weeks with increased
inflammatory markers +/- swelling +/- deformity • Long (>1year) history of Inflammatory symptoms (without increased
inflammatory markers or swelling or deformity) • Pain with red flags
Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause.
Referral for x-ray not typically indicated
• Acute gout • Suspected inflammatory arthritis <12 weeks with no significant inflammatory
markers or swelling or deformity
Guidance • Dedicated wrist views do not typically provide additional information to single
PA hand view. Where inflammatory arthritis is suspected consider requesting an AP feet x-ray as well.
Hip Standard indications for imaging referral
• Undiagnosed hip pain present for more than 4 weeks where the x-ray is expected to change management
• Hip pain with red flags and / or history of recent injury • Known osteoarthritis where symptoms meet local criteria for surgical
consideration (not required if previously x-rayed within 6 months) • Pain in previous arthroplasty.
Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause.
Referral for x-ray not typically indicated
• Suspected septic arthritis: refer for acute review at Emergency Department /Orthopaedic Department
• Mild symptoms and normal examination findings • Follow up of known or suspected osteoarthritis unless development of red
flags or meets local criteria for surgery
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 7 of 25
Paediatric Pelvis/hips Standard indications for x-ray referral
• Pain • Limp • Risk factors/ soft signs or suspected development dysplasia of the hip (DDH)
after 5-6 months of age.
Guidance • Capital femoral epiphyses ossify on average at 5-6 months of age; DDH can
usually be reliably excluded from this age onwards on x-ray. • Slipped upper femoral epiphysis require urgent orthopaedic referral. • < 5-6 months of age if clinical suspicion of DDH ultrasound is the investigation
of choice – refer local pathway Paediatric Lower and Upper limb Standard indications for x-ray referral
• Focal bone pain Referral for x-ray not typically indicated
• Osgood-Schlatters, Severs and other apophysitides- x-rays not generally required for diagnosis or management
Knee Standard indications for x-ray referral
• Undiagnosed knee pain present > 4 weeks where the x-ray is expected to change management
• Knee pain with red flags • Known osteoarthritis with symptoms meeting local criteria for surgical
consideration (not required if previously x-rayed within 6 months) • Pain in previous arthroplasty • Swelling or deformity
Red flags include: Persistent deep nagging pain unrelated to activity Night pain in the absence of an obvious cause
Referral for x-ray not typically indicated
• Suspected septic arthritis: refer for acute review • Mild symptoms and normal examination finding • Follow up of suspected or known osteoarthritis unless red flags develop or
clinically now meets criteria for surgical consideration • Suspected meniscal and ligament injury
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 8 of 25
Shoulder Standard indications for x-ray referral
• Suspected bone/joint pathology (>4 weeks) with red flags present
Red flags include: Any unexplained deformity, mass, or swelling Persistent deep nagging pain unrelated to activity Night pain in the absence of an obvious cause
Referral for x-ray not typically indicated
• Recent onset pain in the absence of red flags • Frozen shoulder (unless the condition does not follow its expected natural
history) • Pre-requisite for a trial of steroid injection (when a reasonable clinical
diagnosis has been made and red flags are excluded) • Suspected septic arthritis: refer for acute review at Emergency Department
/Orthopaedic Department. Skull Routine x-ray not indicated Spine Standard indications for x-ray referral
• Unrelenting spine pain > 8 weeks • Spine pain with red flags • Spine pain and osteoporosis or prolonged use of corticosteroids • Significant spinal deformity
Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause History of cancer Immunosuppression Signs of infection : refer for acute review
Referral for x-ray not typically indicated
• Coccyx pain • Acute and chronic uncomplicated spine pain without red flags
Guidance
• For high clinical suspicion of infection or cancer consider referral for acute review
TMJ Xray is not indicator for TMJ pain
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 9 of 25
ULTRASOUND
Abdomen
Standard indications for ultrasound referral
• Asymptomatic with abnormal Liver Function Test (LFTS) -more than 3 times normal range persisting for at least 3 months
• Suspected biliary tract obstruction or malignancy (infective causes and medications excluded)
• Abdominal mass or other palpable abdominal abnormality
• Painless jaundice without obvious cause
• Clinical biliary colic/gallstones (not already imaged) or use established
pathway
• Suspected asymptomatic aortic aneurysm (AAA) Radiological report indicates the following maximum measurement of aorta:
Normal < 3 cms No further routine radiology FU AAA 3 – 3.9 cms Repeat scan 2 years AAA 4 – 4.5 cms 1 year scan AAA 4.6 – 5.0 cms 6 month scan AAA 5.1 – Over URGENT vascular referral If expansion URGENT vascular referral
> 7mm in 6 months > 1 cms in 12 months
Required Actions Please supply appropriate biochemistry and dates with abdominal ultrasound referral
Carotid Doppler
Use local pathways
Paediatric Hips
No direct access; refer local pathway Paediatric Renal Refer local pathway
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 10 of 25
Renal
Standard indications for ultrasound referral
• Loin pain suggesting renal tract obstruction
• Haematuria
persistent isolated microscopic haematuria > 25 year old (defined as 2 or more episodes of positive urine dipstick of 1+ or more i.e. not trace) and infection excluded and renal impairment (as defined below)
macroscopic haematuria with UTI excluded
persistent isolated microscopic haematuria >25yo (on two or more on
MSU; not dipstix) and infection excluded and normal renal function
• Chronic urinary retention with palpable enlarged bladder
• Renal Impairment No prior relevant renal imaging and recheck with good hydration.
Acute kidney injury (increase in serum creatinine of more than 50% from baseline and/or decrease in eGFR of more than 50% from baseline) AND Consider direct referral to renal service.
Progressive chronic kidney disease (> 5 ml/min/year eGFR loss or >
10 mls/min over 3 years)
Guidance • Proteinuria >1.0g/24hours or protein/creatinine ratio >100 mg/mmol or
albuminuria (albumin/creatinine ratio>65 mg/mmol) - consider referral to renal physician
• If long term stable elevated creatinine/low eGFR then potential for any
reversibility low therefore US findings unlikely to change management. • In diabetic with known diabetic complications, ultrasound may not be indicated.
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 11 of 25
• Adult UTI
Females: > 3 documented UTI's in 6 months, or 6 in a year despite adequate
courses of culture specific antibiotics. This pattern implies bacterial persistence rather than recurrence. (Ensure that patient has not previously been investigated with imaging)
Recurrent pyelonephritis with no previous imaging. Males: Recurrent or persistent infections (if not previously investigated with
imaging)
• Paediatric UTI (please see local guidelines)
Required Actions Please supply appropriate biochemistry and dates with renal ultrasound referral
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 12 of 25
Pelvic
Standard indications for ultrasound referral
• Post menopausal bleeding (bleeding after 1 year of amenorrhoea)
• Pelvic Mass or uterine size >12 weeks
• Primary amenorrhoea (delay menarche after age of 18years with appropriate
endocrine assay)
• IUCD not visible
• Polycystic Ovary Syndrome (PCOS) only if appropriate biochemical signs of
hyperandrogensism or oligo- or amenorrhoea. If both present US not
required.
• Chronic Pelvic pain/ suspected endometriosis – persisting symptoms over at
least 3 month with PID excluded
• Heavy menstrual bleeding (heavy cyclical menstrual bleeding over several
cycles) and Age > 45years or Age >35years with at least one of the following:
Weight >90kg
Risk factors for endometrial hyperplasia (nulliparity, infertility,
FH endometrial/colon cancer, use of either Tamoxifen or
unopposed oestrogens, P.C.O.S)
First degree relative less than 60 years old with a diagnosis of
endometrial or bowel cancer
Required Actions All referrers should have completed ALL of the following:
I have removed a copper IUCD and observed for 3 months, or there is no
IUCD present
I have carried out a pelvic examination, visualized the cervix and taken a
smear and STI check if appropriate
Those patients without risk factors have had no improvement with a three
month trial of medical management (hormonal/tranexamic acid/mirena)
Appropriate biochemical profiles to be supplied for PCOS Ultrasound referrals
Local pathways should be followed
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 13 of 25
Scrotal
Standard indications for ultrasound referral
• Scrotal masses with concerning features i.e. testicular, painless, nontransilluminating, rapidly growing –(urgent urology referral recommended)
• Scrotal masses where it is unclear if the swelling is testicular or extra-testicular
• New hydrocele in adults (may be secondary to testicular cancer).
Referral for imaging not typically indicated
• Non-solid (transilluminating) scrotal masses • Hydrocoele in children • Long-standing hydrocoele in adults • Acute inflammatory conditions and only refer for ultrasound if symptoms and
/or swelling fail to resolve with antibiotics • Chronic orchalgia in the absence of abnormality on examination
Guidance
• Urgent referral to Urology or General Surgery should not be delayed by a wait for ultrasound scan if there are red flags for:
testicular torsion
testicular cancer
strangulated inguinal hernia
acute testicular trauma
• Scrotal masses can often be diagnosed clinically. If unsure, seek a second opinion from a general practitioner colleague or specialist.
Neonatal Spine No direct access Thyroid Standard indications for ultrasound referral Rapidly enlarging mass. If you have any concerns discuss or refer to an Endocrinologist or a Hospital Specialist
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 14 of 25
Vascular
Standard indications for ultrasound referral
• Pulsatile mass for investigation
• Suspected deep venous thrombosis (DVT) – use local pathway
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 15 of 25
CT SCANNING
CT Head Standard indications for CT referral
• New/Progressive Headache with background of systemic illness with cerebral complications or involvement especially malignancy ( breast, lung, melanoma)
• Chronic Headache (lasting more than 3 months for more than 15 days per
calendar month) with one or more of the following:
new onset >50 yrs change in pattern of headaches with increase in frequency or severity aggravated by exertion or Valsalva associated with nausea and vomiting
• Cognitive Decline
The main reason for imaging is to identify and rule out pathologies other than Dementia of the Alzheimer’s type and Vascular Dementia.
A careful neurological screening examination is to be carried out including a brain CT scan, if there are one or more of the following in addition to cognitive decline (for example a MoCA Score of less than 26 or similar decline using validated assessment tools – see initial cognitive assessment node):
age less than 65 unexpectedly rapid decline in cognition or function onset significant headache any localising or unexplained neurological signs recent head trauma history of cancer with high risk of intracranial metastases (particularly
lung, breast, colon/pancreatic, genitourinary, melanoma, head and neck cancers and lymphoma).
use of anticoagulants history of bleeding in conjunction with other factors listed
history of the combination of urinary incontinence, balance and gait disorder suggesting possible Normal Pressure Hydrocephalus (NPH)
gait disturbance, not otherwise explained intellectual disability
If a CT is indicated, clinician (GP or hospital doctor) to request via radiology as per local pathway agreements.
• Headache in Children
As per local pathway
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 16 of 25
Guidance While CT may be appropriate as part of the workup, initial discussion with a local
relevant specialist is recommended for patients with:
Focal neurological signs
Notes Clinical circumstances determines urgency
If patient is pregnant consider specialist opinion
Additional Notes – Cognitive Decline If you are unsure or there are unusual/atypical symptoms, or there is clinically
significant immunosuppression, then seek advice through the advice line in your local
information node
CT Chest
On recommendation by Radiologists from an Abnormal Chest Xray with suspected cancer reported.
Required Actions Please enclose a copy of the report recommending further investigation with your referral Specialist referral should not be delayed whilst waiting for an investigation where there are red flag symptoms
CT Abdomen
On recommendation by Radiologists from an Abnormal Ultrasound or CT Colonography with suspected cancer reported.
Required Actions Please enclose a copy of the report recommending further investigation with your referral Specialist referral should not be delayed whilst waiting for an investigation where there are red flag symptoms
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 17 of 25
CT KUB
Referral for CT KUB is the preferred imaging investigation for:
• Non pregnant patients with renal colic
Guidance
• Referral should be guided by your local pathway which may include
Primary Options
CT Colonography
Use local pathway
CT Sinus
Referral for CT sinus not indicated unless there is local pathway which supports this.
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 18 of 25
MAMMOGRAPHY AND BREAST ULTRASOUND
Mammography
Asymptomatic Women
a mother or sister or daughter with pre-menopausal breast cancer or
bi-lateral breast cancer, or a breast histology demonstrating an at risk
lesion. Imaging to start 10 years before diagnosis of the youngest first
degree relative, but not before 30 years. Alternating with BSA from 45
years.
NOTE: MRI is advised if less than 30 years – refer to specialist.
a breast histology demonstrating an at risk lesion (for example, a
typical hyperplasia
If previous breast cancer – annually. NB After 5 years can re-enter
BSA
Symptomatic Women If new breast symptom, not lactating or pregnant and any of the following:
Palpable lump and no normal mammogram in the last year
Bloody or serous nipple discharge
35 years and over (If under 35 – refer for Ultrasound)
New inversion of Nipple)
Referral for Mammogram not typically indicated for:
• Breast pain without associated lumps or other symptoms
Guidance
• If you are unsure please discuss with a radiologist
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 19 of 25
Ultrasound Breast
• Women <35 years with symptoms as follows:
Palpable lump and no normal mammogram in the last year
Bloody or serous nipple discharge
New inversion of Nipple)
• Men with unexplained or suspicious unilateral breast enlargement • Axillary lymph node enlargement or suspected lymph node enlargement in
the absence of obvious infectious cause.
Referral for ultrasound not typically indicated
• Breast pain alone • Bilateral male breast enlargement.
Guidance
• Referral to local breast service for advice / assessment and multidisciplinary work up is preferable and where this is available locally would supersede these recommendations
• In the absence of access to breast clinic services patients over the age of 35 and all patients presenting with suspicious masses should be referred for mammography along with ultrasound as part of the initial work up.
• Pagets disease is not excluded with normal imaging. If clinical concern seek Surgical assessment.
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 20 of 25
Prioritisation Methodology The following methodology will be used by Midland DHB Radiology Departments. It is subject to the interpretation of clinical information in the referral and service capacity. Note that any procedure should only be requested where the results (either positive or negative) will alter the management of the patient’s condition/will either confirm or eliminate significant disease from the differential diagnosis.
Priority description Timeframe URGENT: Where immediate treatment and management of acute condition is dependent on diagnosis:
High clinical probability of malignancy or serious inflammatory/infective condition.
High clinical probability of fracture. Major functional impairment including
uncontrolled pain. Risk of significant permanent damage
to tissues or systems if diagnosis is delayed.
Imaging takes place within 7 working days.
SEMI-URGENT: Conditions where there is possibility of malignancy, serious inflammatory / infective condition, and complications or where imaging may affect short term management.
Imaging takes place within 4 weeks.
ROUTINE: Conditions with minor functional impairment and where imaging is unlikely to affect short term management, but likely to affect long term management.
Imaging takes place within 6 weeks (key performance indicator measure)
DECLINED:
• Referrals that meet the criteria but are unable to be offered within 4 months
• Referrals that do not meet the criteria
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 21 of 25
Appendix 1 – Current Access by DHB
Table by DHB showing CURRENT referral access pathway by procedure type Procedure BOP DHB Lakes DHB Tairawhiti
DHB Taranaki DHB
Waikato DHB
General X-ray On Hold Abdomen Direct Access Direct Access Direct
Access Direct Access
Ankle Direct Access Direct Access Direct Access
Direct Access
Chest Direct Access Direct Access Direct Access
Direct Access
Paediatric Chest
Direct Access Direct Access Direct Access
Direct Access
Elbow Direct Access Direct Access Direct Access
Direct Access
Hand/Wrist Direct Access Direct Access Direct Access
Direct Access
Hip Direct Access Direct Access Direct Access
Direct Access
Paediatric Pelvis/hips
Direct Access Direct Access Direct Access
Direct Access
Paediatric Lower/Upper Limb
Direct Access Direct Access Direct Access
Direct Access
Knee Direct Access Direct Access Direct Access
Direct Access
Shoulder Direct Access Direct Access Direct Access
Direct Access
Spine Direct Access Direct Access Direct Access
Direct Access
Ultrasound On Hold Abdomen Direct
Access, Local Gallbladder Pathway
Direct Access Direct Access
Direct Access
Carotid Doppler Local Pathway
Local Pathway Local Pathway
Vascular Lab
Paediatric Hips No Direct Access, Local Pathway
Local Pathway Direct Access
No direct Access, Paediatric Orthopaedic Clinic
Renal Direct Access Direct Access Direct Access
Direct Access
Paediatric Renal
Local Pathway
Local Pathway Direct Access
Direct Access
Pelvic Direct Access, Local HMB Pathway
Direct Access Direct Access
Direct Access
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 22 of 25
Scrotal Direct Access Direct Access Direct Access
Direct Access
Thyroid Direct Access Direct Access Direct Access
Direct Access
Vascular Direct Access for AAA, DVT Pathway
Direct Access Direct Access for AAA, DVT Pathway
Direct Access for AAA, DVT GP Pathway
CT Scanning CT Head –Headache
No Access without discussion
Direct Access Direct Access
Limited Access
CT Head – Cognitive Decline
No Direct Access, Local Pathway
Local Pathway with Consultant Referral
Direct Access
Local Pathway with Specialist Referral
CT Head – Headache in Children
No Direct Access, Local Pathway
Local Pathway with Consultant Referral
Local Pathway with Consultant Referral
Local Pathway with Specialist Referral
CT Chest Radiologist recommendation only
Access via Chest Physician
Direct Access
Limited Access
CT Abdomen Radiologist recommendation only
No Access Direct Access
Limited Access
CT KUB Local CPO Pathway in development
Radiologist request only
Direct Access
Limited Access via Map of Medicine Renal Colic Pathway
CT Colonography
Local Pathway
Local Pathway Local Pathway
No Access
CT Sinus No Access Direct Access Direct Access
Limited Access
Mammography and US Breast
Mammography Direct Access Direct Access to Private
Direct Access
Direct Access
US Breast Direct Access Direct Access to Private
Direct Access
Direct Access
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 23 of 25
Appendix 2 – Planned Access by DHB Table by DHB showing PLANNED referral access or pathway by procedure type once new
criteria have been published Procedure BOP DHB Lakes DHB Tairawhiti
DHB Taranaki DHB
Waikato DHB
General X-ray On Hold Abdomen Direct Access Direct Access Direct
Access Direct Access
Ankle Direct Access Direct Access Direct Access
Direct Access
Chest Direct Access Direct Access Direct Access
Direct Access
Paediatric Chest Direct Access Direct Access Direct Access
Direct Access
Elbow Direct Access Direct Access Direct Access
Direct Access
Hand/Wrist Direct Access Direct Access Direct Access
Direct Access
Hip Direct Access Direct Access Direct Access
Direct Access
Paediatric Pelvis/hips
Direct Access Direct Access Direct Access
Direct Access
Paediatric Lower/Upper Limb
Direct Access Direct Access Direct Access
Direct Access
Knee Direct Access Direct Access Direct Access
Direct Access
Shoulder Direct Access Direct Access Direct Access
Direct Access
Spine Direct Access Direct Access Direct Access
Direct Access
Ultrasound On Hold Abdomen Direct Access,
Local Gallbladder Pathway
Direct Access Direct Access
Direct Access
Carotid Doppler Local Pathway Local Pathway Local Pathway
Vascular Lab
Paediatric Hips No Direct Access, Local Pathway
Local Pathway Direct Access
No direct Access, Paediatric Orthopaedic Clinic
Renal Direct Access Direct Access Direct Access
Direct Access
Paediatric Renal Local Pathway Local Pathway Direct Access
Local Pathway
Pelvic Direct Access, Local HMB Pathway
Direct Access Direct Access
Direct Access
Scrotal Direct Access Direct Access Direct Access
Direct Access
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 24 of 25
Thyroid Direct Access Direct Access Direct Access
Direct Access
Vascular Direct Access for AAA, DVT Pathway
Direct Access Direct Access for AAA, DVT Pathway
Direct Access for AAA, DVT GP Pathway
CT Scanning CT Head –Headache
Identify volumes – Increase CR Contract, identify additional resources
Direct Access Direct Access
Identify volumes – Increase CR Contract, identify additional resources
CT Head – Cognitive Decline
Identify volumes – Increase CR Contract, identify additional resources
Local Pathway with Consultant Referral
Direct Access
Identify volumes – Increase CR Contract, identify additional resources
CT Head – Headache in Children
No Direct Access, Local Pathway
Local Pathway with Consultant Referral
Local Pathway with Consultant Referral
Local Pathway with Consultant Referral
CT Chest Radiologist recommendation only
Access via Chest Physician
Direct Access
Radiologist recommendation only
CT Abdomen Radiologist recommendation only
No Access Direct Access
Radiologist recommendation only
CT KUB Local CPO Pathway in development
Radiologist request only
Direct Access
Local pathway via MOM Renal Colic Pathway
CT Colonography
Local Pathway Local Pathway Local Pathway
No Access
CT Sinus No Access Direct Access Direct Access
No Access
Mammography and US Breast
Mammography Direct Access Direct Access to Private
Direct Access
Direct Access
US Breast Direct Access Direct Access to Private
Direct Access
Direct Access
Midland Region Community Radiology Access Criteria 28 May, 2014
Page 25 of 25
Appendix 3 Midland Radiology Advisory Group Members Members of the Midland Radiology Advisory Group who have reviewed the Regional Access Criteria for Community Referred Radiology are as follow:
Name Title Organisation
Roger Lysaght Service Manager, Ambulatory Service
Lakes DHB
Andrew Klava HOD Radiology Lakes DHB
Gloria Crossley Clinical Services Manager- Allied Health, Scientific & Technical
Taranaki DHB
Alina Leigh Consultant Radiologist Taranaki DHB
Sue Howard Clinical Imaging Manager Taranaki DHB
Kevin Harris Assistant Group Manager Waikato Hospital
Waikato DHB
Zubayr Zaman Consultant Radiologist Waikato DHB
Rose Newman Consultant Radiologist Waikato DHB
Kim McAnulty Consultant Radiologist Waikato DHB
Sabaratnam Muthukumaraswarmy
HOD Radiology Waikato DHB
Jill Wright Regional Radiology Manager BOP DHB
Roy Buchanan HOD Radiology BOP DHB
Helen Seymour Consultant Radiologist BOP DHB
Gerard Eager Consultant Radiologist BOP DHB
Leigh Potter Radiology Service Manager Tairawhiti DHB
Charles Robinson HOD Radiology Tairawhiti DHB
Lisa Hughes GP Liaison Lakes DHB
Mike Agnew/Stewart Ngatai Portfolio Manager Planning and Funding
BOP DHB
Sue Matthews Primary Options Coordinator WBAY PHO
Joe Bourne GP Liaison BOP DHB
Nick Hanna GP BOP
Rawiri Keenan MHN (GP) Waikato