Radiology is central to the clinical practice of medicine. Information gained from different imaging modalities can be used for diagnosis, monitoring treatment, assessing progression and detecting relapses of a wide variety of medical conditions in a minimally invasive and anatomically precise manner. As a junior doctor, you will spend much of your time requesting radiological investigations and explaining the results to patients. Many of the following guidelines come from the Royal College of Radiologists. Your hospital may also have its own which you should follow.

Requesting investigations

Radiology registrars are notorious for grilling you on exactly why a scan is required and how it is going to change your management plan. Radiologists have a duty not to expose a patient to unnecessary radiation. Scanners and radiographers are often overstretched resulting in some reluctance on the part of radiology staff to perform unjustified investigations. Take this as a learning exercise and a challenging opportunity to practice your communication skills. The ability to convince a reluctant radiologist to agree to a scan is a rite of passage! It saves a lot of time if you can supply logical and clinically coherent answers, so don’t be shy to ask your seniors why the investigation is needed and what you expect to find. If it isn’t clear to you then it probably won’t be clear to radiology either. By asking your seniors, you will also reinforce your understanding of the indications for certain investigations.

1. Always book procedures as early as possible. Most radiological departments are overbooked. This is particularly true for contrast studies, CTs and particularly magnetic resonance imagings (MRIs). For urgent studies needed on the same day, it is usually best to go down to the department and speak to a radiologist face-to-face early on in the day. In some hospitals, approvals for specialized scans such as MRIs can only come from a registrar or even a consultant. It is best to prepare yourself beforehand with the patient’s details, brief history, results of investigations so far, differential diagnoses and why you think the scan will help to either make the diagnosis or change the management plan.
   
2. The following information must be included on the radiology request form.
   
   
   
   • Patient ID.
     
   • Whether pregnant or not. Any reactions to contrast media.
     
   • Whether the patient has any infective issues, for example, Clostridium difficile or methicillin-resistant Staphylococcus aureus (MRSA) positive.
     
   • A specific question to be answered. Imagine being the radiologist reporting these scans without the benefit of patient history, examination or indeed notes. This is why writing a misleading request card to get a scan done more urgently is dangerous and completely unacceptable.
     
   • Clinical features (not just suspected diagnosis).
     
   • How the results will affect the management plan.
     
   • Any factors which may complicate the procedure (e.g. diabetes, epilepsy).
   
   
3. Ask the radiographers about how to prepare patients for investigations if you are unsure, such as barium enemas. Often, the radiographer will liaise directly with the ward nurse, in which case you don’t have to do anything except prescribe preparations, such as enemas.