Requests for diagnostic procedures
Under the Radiation Safety Act 1999, only an authorised person may request a diagnostic procedure for another person.
- Requests for diagnostic procedures may only be made by authorised persons (a person described in section 64 or listed in schedule 6 of the Radiation Safety Regulation 2010).
- Use licensees may only carry out a diagnostic procedure if they reasonably believe the diagnostic procedure has been requested by an authorised person.
- The Radiation Safety Act 1999 does not place any restrictions on who may refer patients for a diagnostic procedure.
- In-house protocols may be developed to permit the general authorisation of certain types of diagnostic procedures following referrals by specified clinicians without a patient-specific prior authorisation being made.
- 'Blank' request forms pre-signed by authorised persons are not acceptable under any circumstances.
For a diagnostic procedure, an 'authorised person' is a person listed in Schedule 6 of the Radiation Safety Regulation 2010.
Although the terms 'refer' and 'request' tend to be used interchangeably, that the word 'request' has a special meaning under the Act.
A referral for a diagnostic procedure may be made by anyone, but a 'request' can only be made by an authorised person.
A request must be made in written or electronic form and must state:
- particulars of the radiation source to be used (might be suggested by the referrer)
- particulars of the diagnostic information sought from the procedure (should be provided by the referrer.)
Why an 'Authorised Person' is necessary
This requirement is to ensure that the diagnostic procedure to be performed uses the most appropriate modality and that it is justified on clinical grounds. Additionally, once the requested diagnostic procedure has been performed, the exposure would not be justified if the radiology (e.g. clinical assessment) was not performed by a person sufficiently skilled and experienced to make the clinical assessment (an authorised person) and provide the advice to the referrer.
The person making the request (authorised person) will decide on the best modality to be used, whether the request is justified on clinical and radiological grounds, and the extent of the procedure required. This decision should therefore implicitly take the risk/benefit considerations into account. The authorised person should consider whether a comparable diagnostic outcome is able to be achieved using a non-radiation related procedure.
Schedule 6 of the Radiation Safety Regulation 2010 recognises that additional specialist medical qualifications and skills are required to request complex diagnostic procedures, such as CT scans, fluoroscopy etc. This helps to ensure that the required medical practitioner or specialist involvement does occur for these procedures.
Responsibilities of the Use Licensee
A use licensee must:
- not carry out a diagnostic procedure unless they reasonably believe the procedure has been requested by an authorised person
- ensure the treated person does not receive a radiation dose from the carrying out of the diagnostic procedure in an amount, or a way, that does not comply with the request for the procedure.
Ensuring the procedure is authorised?
Use licensees need to check that each diagnostic procedure is authorised by an authorised person, by checking that the:
- request for the procedure has been made by an authorised person prior to the procedure being conducted; or
- if the radiology practice has a written internal protocol describing the actions to be taken on receipt of categories of referrals from other persons, the referral may be accepted without use licensees gaining specific prior approval from an authorised person.
If use licensees are unclear about a referral, they should seek the advice of an authorised person at the radiology practice.
Blank request forms pre-signed by authorised persons are not acceptable under any circumstances.
Pre-signing request forms indicates poor clinical practice and should be referred to the relevant health practitioner registration board for investigation.
The authorised persons at a radiology practice determine what referrals are accepted without prior authorisation by an authorised person.
These internal protocols should:
- be developed in consultation with the relevant stakeholders within the practice
- contain details such as:
- who the referrals are to be accepted from
- the particulars of the radiation sources to be used for particular diagnostic procedures
- the particulars of the diagnostic information to be sought from the procedures
- details of the extent of the radiography required for the particular types of procedures
- be referenced in the licensee’s radiation safety and protection plan.
Information to include on a referral
The RANZCR Imaging Guidelines recommends these details should be contained on a referral for medical imaging:
- Patient details (name, address, date of birth, and hospital ID number (if relevant))
- Examination requested (area to be examined and type of examination)
- Clinical Information (such as relevant history and allergies/contraindications)
- Main objective of the examination (clinical questions to be answered by performing the procedure)
- Identifying mark of referrer (signed, dated and legible identification)