Managing imaging requests
A recent case in Brent highlighted the potential impact of delays in radiology reporting. The case involved a patient with a history of breast cancer, who had been referred for a routine pelvic X-ray to investigate hip pain. The X-ray showed possible metastatic disease, but the report was not returned to the requesting GP for almost two months.
For patients with a current or previous history of cancer, particularly where there is concern about possible bone metastases, early discussion with oncology teams or referral via an urgent suspected cancer pathway may be appropriate, recognising the limited sensitivity of plain X-ray.
Please be mindful of the importance of detailing any history of malignancy in requests for direct access investigation. Clinicians should also consider requesting direct access imaging as urgent or suspected malignancy, rather than routine, where appropriate. This helps radiology services to identify scans for priority reporting and supports shared efforts to minimise delays.
A current or previous history of cancer (particularly breast, prostate, lung and kidney) is a significant red flag for positive findings in musculoskeletal presentations. Where there is suspicion of a bony metastases, clinicians are encouraged to contact oncology or the relevant CNS if the patient is under follow up, or refer to an urgent suspect cancer pathway as X-ray has limited sensitivity and some patients may warrant further imaging. If you highlight that you are requesting this X-ray because the patient has a past history of cancer or that you are concerned that there may be metastases than this should mean that the reporting is fast tracked to the radiologist.
Specifically for LNWH, GPs may contact patient pathway co-ordinators (PPCs) via the telephone number on the clinic letter to request that oncology follow‑up appointments are brought forward for patients who are already under oncology follow‑up. GPs cannot refer directly to oncology. For patients on a CNS‑led stratified follow‑up pathway, GPs may contact the relevant CNS team using the tumour‑site generic email address as in the
table (PDF).
Regarding radiology reporting turn-around arounds, LNWH (across the three sites) has seen an increase in radiology requests, with over 20,000 GP plain films requested per month. The compounding pressure in the system has come from both the A&E (non-elective) and increasing elective pressures in radiology. This has resulted in the reporting of routine or 'low risk' imaging having a prolonged turn around time. North west London trusts adopt the national standard of 28 days from image acquisition to report and recognise in some cases, they have not been reaching this target. Please be reassured that an increase in reporting radiographer capacity as well as focussed effort on the accumulated back log has shown a marked improvement within the service. Our radiology colleagues have highlighted the value of clinically significant information being included in the request as this helps triage and identify those where earlier review and reporting would be beneficial.
From a primary care perspective, we are exploring ways to alert referring clinicians to potential delays in acquiring the results of direct access diagnostics.
