Radiology Referrals

Information for Imaging Referrers – Ramsay Hospitals


Referring for an imaging examination is comparable to writing a prescription, as it must comply with legal requirements. The Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2024) detail specific obligations imposed by statutes for the protection of patients from unnecessary or excessive exposure to medical X-rays (Ionising radiation). These regulations provide specific guidance for Employers, Referrers, Practitioners and Operators, outlining their responsibilities as IR(ME)R Duty Holders.

Understanding the legal framework

It is crucial to understand the reasons behind these legal requirements. A quick overview of the legislation is described in this section.

The regulations identify distinct categories of Duty Holders, each responsible for ensuring the safety of patients undergoing medical exposures using ionising radiation. The Duty Holders identified in the IR(ME)R legislation are:

Entitlement

All new Non-Medical Referrers (NMRs) will be required to complete an application enabling their entitlement to refer patients for imaging. Referral scope of practice must be agreed in advance between the Radiology Department and the NMR. The application form must be completed and the Radiology Department contacted for approval before sending a referral form to the hospital.

Requests for examinations involving ionising radiation will require evidence of IR(ME)R training. Requests for MRI examinations will require evidence of MR Safety training to ensure an awareness of the hazards associated with MRI. Additionally, evidence of revalidation of this training is required to be provided every three years.

Please see the Training section on this page.

Know how to refer for an imaging examination involving ionising radiation

There is a useful Referrer checklist available to assist you when referring a patient for a diagnostic imaging examination. View the checklist here.

Know how to refer for a Magnetic Resonance Imaging Examination

Although there are no statutory regulations covering referrals for MRI, it is considered best practice to follow the principles set out under IR(ME)R legislation.

Know how to refer for an Ultrasound Examination

Although there are no statutory regulations covering referrals for Ultrasound, it is considered best practice to follow the principles set out under IR(ME)R legislation.

Training

Referrer training should cover the following topics:

⦁    Principles of radiation protection.
⦁    Benefits and risks of x-ray examinations, including radiation dose levels and the use of appropriate low dose, or non-ionising alternative examinations.
⦁    Ionising Radiation Regulations (IRR) 2017 and the Ionising Radiation (Medical Exposures) Regulations (IR(ME)R 2024 regulations.
⦁    Responsibilities of Non-Medical Referrers in relation to patient safety and clinical governance.
⦁    Professional and legislative responsibilities.
⦁    MRI safety / contraindication training (if referring for MRI examinations).

British Institute of Radiology - Referring your patient for imaging: For GPs and medical doctors

https://www.bir.org.uk/education-and-events/bir-video-courses/referring-your-patient-for-imaging-for-gps-and-medical-doctors.aspx

British Institute of Radiology - Requesting imaging safely: For Nurses and Allied Health Professionals

https://www.bir.org.uk/education-and-events/bir-video-courses/requesting-imaging-safely-for-nurses-and-allied-health-professionals.aspx

If you refer patients for MRI, you will need to demonstrate that you are up to date with ‘MRI Safety Training for Referrers,’

This training is available on the e-LfH platform: https://www.e-lfh.org.uk/programmes/mri-safety/

Or if you cannot access e-LFH:
MRI Safety (only the referrer module is required) https://www.eintegrity.org/healthcare-course/mri-safety/

Relevant Regulations, Policies and Procedures

Ramsay Employers Procedures:

Employers Procedure 1 - Correctly identify individuals exposed to Ionising Radiation - view here

Employers Procedure 2 - Referral Criteria - view here

Employers Procedure 2b - Making, amending and cancellation of referrals for exposure - view here

Employers Procedure 3a - Identification, Responsibilities and Training of IR(ME)R Referrers - view here

Employers Procedure 3d - Justification and Authorisation of a medical exposure - view here

Employers Procedure 4 - Enquiries of individuals of child-bearing potential, pregnancy and breast feeding - view here

Employers Procedure 4 Appendix - Pregnancy Flowchart - view here

Employers Procedure 10 - Provision of information on Radiation Benefits & Risks to patients - view here

Employers Procedure 14 - Non-Medical Imaging - view here

Employers Procedure 15 - Co-operation of Employers - view here

 

Relevant Regulations:

Ionising (Medical Exposures) Regulations 2017 Statutory Instruments 2017 No 1322 - view here

The Ionising Radiation (Medical Exposure) (Amendment) Regulations 2024 - view here

MHRA - Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use - view here

Important Information

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