Ultrasound Referral Guidelines

South Tees Hospitals have developed the following referral guidelines to support the delivery of a primary care focused US service.

Referrers are encouraged to clearly state the clinical condition they wish to confirm or exclude. In effect, referrers should always ask themselves the question: “Have I fully explained the clinical problem”. The layout of the request form should allow for this. This would hopefully reduce the need for requests for additional information from the GP which may delay the scan.

Imaging request forms must include all patient demographic and referrer’s information.

Advice is easily and quickly available to referrers via the radiology departments on (01642) 282639 for James Cook or (01609) 763060 for the Friarage. Often a short discussion with a radiologist will clarify the appropriate imaging.

It is essential US reports are accurate, concise, and informative and provide clear advice to the referrer in the form of a “conclusion” Therefore as much relevant clinical history as possible must be provided by the referrer.

The following principles should be adhered to:

  • Will the result of the test affect clinical management?
  • Is the test being requested too quickly?
  • Is the test the correct one?
  • Has the test already been performed elsewhere or in the recent past? If so the need for repetition should be seriously questioned

Pregnancy or suspected pregnancy.

The prime responsibility for identifying patients who are, or might be pregnant lies with the referrer.

Important : Referring clinicians should inform Imaging departments of patient status regarding renal impairment and diabetes mellitus.

Procedures performed: Diagnostic ultrasound including Doppler covering abdomen, renal tract, testicular, thyroid, pediatrics, soft tissue, Musculoskeletal (MSK), MSK +injection.

Exclusions: interventional ultrasound

Gynaecological indications (refer to women and children)

NB: If an interpreter is required this must be stated at the time of referral.

US protocols

Upper abdomen: Includes visualisation of the liver, biliary system, pancreas, spleen, kidneys, abdominal aorta, associated vasculature

Clinical indications include: Upper abdominal pain (not relieved by PPI), upper abdominal pain radiating to back and right shoulder, possible abdominal aortic aneurysm, unexplained weight loss/fever/night sweats, nausea, vomiting, dyspepsia, abnormal LFT’s, raised WCC, organomegaly, increased abdominal girth, jaundice.

Full abdomen: Includes visualisation of all of the above plus urinary bladder (including a post micturition volume), prostate gland, uterus, ovaries, adnexae.

Clinical indications include: UTI, nocturia/poor stream, prostatism, dysuria/frequency/urgency, possible renal calculi, Haematuria, proteinuria, raised serum creatinine, unexplained hypertension, flank pain/colic, FH polycystic kidneys

Thyroid: Involves visualisation of both lobes, isthmus and parathyroid region including associated vasculature.

Clinical indications: Palpable mass, neck swelling, abnormal TFT’s

Testes: Clinical Indications include: Pain/discomfort, swelling/enlargement of scrotum or testis, trauma ( resolving haematoma, suspected lipoma), undescended testis, suspected varicocele, suspected hydrocele

N.B. Non-traumatic sudden onset of acute pain should be referred urgently to urology

Any palpable lump within the testis, particularly in men between 20 – 50, must be referred urgently to Urology under the 2 week rule.

Soft tissue: Any superficial soft tissue lump can be assessed using ultrasound in the first instance

Musculoskeletal ultrasound

Shoulder: Pain, restricted movement, rotator cuff tears, fluid collections, calcific tendonitis, bicep tendon, ganglion cysts, acromio-clavicular joint degeneration or subluxation

Hand/wrist: Pain, soft tissue swelling, tendinopathy, non opaque foreign body, ganglion, Glomus tumour, Schwannoma, lipoma,tenosynovitis

Pelvis/hips: Hip pain, soft tissue swelling/lump, hip effusion, hernia

Knee: Restricted movement/hip pain, joint effusion, ligament/muscle or tendon tear, bursitis

Ankle/foot: Heel or ankle pain, tendinopathy, superficial mass, joint effusion, synovitis, Achilles tendinosis, plantar fascitis, fibromatosis, Morton’s neuroma, bursitis, foreign body, ganglion

Paediatric scans

Upper abdomen and renal tract: As adult

Testes: As adult

Hips: Dislocation/instability, clicking hips, asymmetrical thigh skin crease, asymmetrical leg length.