Referral Criteria

These referral criteria are aligned with Royal College of Radiologists iRefer guidance and IR(ME)R 2017. CT examinations should only be requested where the result is expected to influence diagnosis or patient management.

General Requirements

• Requests must contain adequate clinical history and a specific clinical question.
• Alternative non-ionising imaging modalities (ultrasound or MRI) should be considered where appropriate.
• Intravenous contrast studies require appropriate renal function assessment and relevant allergy history.
• All exposures must be justified by an entitled IR(ME)R Practitioner.

CT Head

• Persistent headache with red flag features
• Suspected intracranial mass lesion
• Hydrocephalus assessment
• Follow-up of known intracranial abnormality
• Chronic neurological symptoms where MRI is contraindicated or unsuitable

CT Sinuses

• Chronic rhinosinusitis prior to surgery
• Suspected sinonasal mass
• Assessment of anatomical obstruction
• Complicated sinus disease

CT Neck

• Persistent neck mass
• Staging or follow-up of head and neck malignancy
• Salivary gland pathology where CT is appropriate
• Assessment of deep neck pathology

HRCT Thorax

• Suspected interstitial lung disease
• Pulmonary fibrosis assessment and follow-up
• Suspected bronchiectasis
• Diffuse parenchymal lung disease
• Occupational lung disease
• Emphysema assessment
• Small airways disease

Contrast CT Thorax

• Thoracic malignancy staging or follow-up
• Pulmonary nodule assessment
• Mediastinal or hilar lymphadenopathy
• Pleural disease
• Chest wall mass assessment
• Complicated intrathoracic infection

CT Abdomen and Pelvis

• Suspected abdominal or pelvic malignancy
• Cancer staging or surveillance
• Unexplained weight loss
• Complications of inflammatory bowel disease
• Complicated diverticular disease
• Intra-abdominal collection or abscess
• Assessment of abdominal or pelvic mass

CT KUB

• Suspected urinary tract calculi
• Acute or recurrent flank pain suggestive of urolithiasis

CT Liver

• Characterisation of focal liver lesions
• Liver malignancy staging
• Follow-up of known liver lesions
• Assessment of chronic liver disease complications

CT Pancreas

• Suspected pancreatic malignancy
• Pancreatic cystic lesion assessment
• Complications of pancreatitis

CT Urogram

• Visible or non-visible haematuria investigation
• Suspected urothelial malignancy
• Urinary tract obstruction
• Complex urinary tract anatomy

CT Spine

• Assessment of fracture
• Post-operative spinal assessment
• Suspected destructive bony lesion
• Complex degenerative bony anatomy where MRI unsuitable

CT Musculoskeletal / Orthopaedic

• Complex fracture assessment
• Orthopaedic pre-operative planning
• Assessment of prosthesis complications
• Suspected bone tumour or destructive lesion

CT Oncology

• Initial cancer staging
• Treatment response assessment
• Surveillance imaging where guideline-supported

Key IR(ME)R Justification Statement

CT should only be performed where the expected diagnostic benefit outweighs the radiation risk and where the examination is the most appropriate modality to answer the clinical question and influence patient management.

Referral Criteria for Nuclear Medicine Examinations – Trinity Medical Imaging

Bone Scan (99mTc-HDP)

• Evaluation of suspected osteomyelitis or septic arthritis
• Assessment of prosthetic joint infection
• Bone infarction and avascular necrosis (AVN)
• Staging/restaging of bone metastases
• Evaluation of primary bone tumours
• Treatment response assessment
• Detection of stress or occult fractures
• Differentiation of benign vs malignant vertebral collapse
• Assessment of bone biopsy sites and post-operative healing
• Equivocal X-rays where bone pathology remains suspected
• Arthritis evaluation
• Metabolic bone disease (Paget’s, renal osteodystrophy, hyperparathyroidism)

DaTscan (123I Ioflupane SPECT)

• Differentiation of essential tremor from parkinsonian syndromes
• Support diagnosis of idiopathic Parkinson’s disease
• Evaluation of atypical parkinsonism

HMPAO / ECD Brain Perfusion SPECT

• Assessment of dementia
• Localisation of seizure focus
• TIA or stroke evaluation
• Pre-surgical carotid occlusion assessment
• Confirmation of brain death
• Traumatic brain injury evaluation

MUGA (Radionuclide Ventriculography)

• Measurement of ventricular ejection fraction
• Monitoring during cardiotoxic chemotherapy
• Assessment of wall motion abnormalities
• Differentiation of cardiac vs pulmonary dyspnoea

Parathyroid MIBI SPECT-CT

• Localisation of parathyroid adenoma
• Evaluation of recurrent hyperparathyroidism
• Suspected parathyroid hyperplasia or carcinoma

Thyroid Scan (Tc-99m Pertechnetate)

• Investigation of thyroid nodules
• Assessment of hyperthyroidism
• Evaluation of thyroiditis
• Detection of ectopic thyroid tissue
• Goitre characterisation

Colonic Transit Study

• Evaluation of chronic constipation
• Pre-surgical colonic motility assessment

GI Bleed Study (99mTc-labelled RBCs)

• Localisation of active GI haemorrhage
• Differentiation of upper vs lower GI source

Gastric Emptying Study

• Diagnosis of gastroparesis
• Evaluation of rapid gastric emptying
• Serial therapy response assessment

Oesophageal Transit Study

• Investigation of dysphagia
• Quantitative oesophageal clearance evaluation

Hepatobiliary (HIDA / IDA)

• Acute cholecystitis diagnosis
• Gallbladder ejection fraction measurement
• Detection of bile leak
• Evaluation of obstructive jaundice
• Assessment of biliary atresia
• Sphincter of Oddi dysfunction

Meckel’s Diverticulum Scan

• Investigation of painless GI bleeding in children/young adults

SeHCAT Retention

• Investigation of chronic diarrhoea
• Post-ileal resection or Crohn’s disease
• Post-cholecystectomy diarrhoea

Small Bowel Transit

• Evaluation of small-bowel dysmotility
• Assessment of suspected obstruction or pseudo-obstruction

111In White Cell Labelled Scan

• Localisation of occult infection
• Osteomyelitis evaluation
• Assessment of inflammatory bowel disease activity

Infection Imaging with Leukoscan (Tc-99m Sulesomab)

• Investigation of prosthetic joint infection
• Evaluation of osteomyelitis
• Suspected septic arthritis

V/Q Lung Scan

• Diagnosis of pulmonary embolism
• Pre-operative lung function assessment
• Assessment of CTEPH

123I MIBG Scan (Oncologic)

• Localisation/staging of phaeochromocytoma
• Staging of neuroblastoma
• Localisation of carcinoid and medullary thyroid carcinoma
• Selection for MIBG therapy

111In Octreotide (Pentetreotide)

• Detection and staging of neuroendocrine tumours
• Assessment for PRRT
• Monitoring disease progression

Static Renal DMSA

• Detection of renal cortical scarring
• Differential renal function
• Assessment of renal size and shape
• Post-trauma renal viability

Dynamic Renal MAG3 Renogram

• Assessment of renal perfusion and drainage
• Investigation of hydronephrosis
• Evaluation of non-functioning kidney
• Renovascular hypertension assessment
• Post-renal transplant evaluation

Lymphoscintigraphy

• Differentiation of primary lymphoedema vs venous oedema
• Assessment of lymphatic transport function

Liver & Spleen Imaging

• Evaluation of reticuloendothelial function
• Detection of hepatosplenomegaly
• Identification of accessory spleen

Cardiac MIBG Imaging

• Differentiation of Parkinson’s disease from MSA
• Evaluation of heart failure/cardiomyopathy

Referral Criteria for Ultrasound Examinations – Trinity Medical Imaging

Abdominal Ultrasound

• Right upper quadrant pain
• Suspected gallstones or cholecystitis
• Abnormal liver function tests
• Biliary obstruction assessment
• Liver parenchymal disease
• Fatty liver assessment
• Focal liver lesion characterisation
• Jaundice evaluation
• Suspected renal pathology
• Hydronephrosis or obstruction
• Abdominal mass
• Ascites detection

Kidneys & Bladder Ultrasound

• Acute kidney injury
• Chronic kidney disease
• Suspected hydronephrosis
• Recurrent UTIs
• Haematuria
• Bladder dysfunction

Pelvic Ultrasound (Female)

• Pelvic pain
• Abnormal uterine bleeding
• Postmenopausal bleeding
• Suspected ovarian cyst or mass
• Fibroids

Scrotal Ultrasound

• Acute scrotal pain
• Testicular lump
• Scrotal swelling
• Infertility assessment

Thyroid Ultrasound

• Palpable thyroid nodule
• Incidental thyroid nodule
• Goitre assessment
• Risk stratification before FNA

Neck / Lymph Node Ultrasound

• Neck lump
• Cervical lymphadenopathy
• Salivary gland pathology

Musculoskeletal Ultrasound

• Suspected tendon tear
• Soft tissue masses
• Bursitis or joint effusions
• Dynamic tendon assessment
• Image-guided procedures

Vascular Ultrasound (Doppler)

• Suspected deep vein thrombosis
• Carotid artery stenosis (TIA or stroke workup)
• Peripheral arterial disease
• Venous insufficiency (varicose veins)

Soft Tissue / Superficial Ultrasound

• Palpable superficial lump (lipoma, cyst, suspicious lesion)
• Suspected abscess
• Foreign body localisation
• Hernia (dynamic assessment)

Referral Criteria for DEXA Examinations – Trinity Medical Imaging

Standard DEXA (Bone Mineral Density)

• Assessment of osteoporosis in patients with:
  • Fragility fracture
  • Long-term corticosteroid use
  • Premature menopause
  • Secondary causes (e.g., hyperparathyroidism)
• Risk stratification using FRAX/NOGG thresholds

Whole-Body DEXA (Body Composition)

• Monitoring:
  • Obesity and metabolic syndrome
  • Sarcopenia
  • Weight-loss therapy (e.g., GLP-1 therapy)
• Clinical scenarios requiring:
  • Fat distribution analysis (VAT vs SAT)
  • Lean mass monitoring

We also accept NHS patient referrals by fax or email. Please download a request form below if you wish to use fax or email to send a request:

Online form Pdf form word download

Fax: 020 3137 2156

booking@trinitymedicalimaging.co.uk