These guidelines are intended to support referrers to Ultrasound (US) and ultrasound providers in the appropriate selection of patients for whom ultrasound would be beneficial in terms of diagnosis and or disease management. They have been written to aid ultrasound providers in justifying that an ultrasound examination is the best test to answer the clinical question posed by the referral.
Our local guidelines are underpinned by the BMUS Recommended Good Practice Guidelines: Justification of Ultrasound Requests (2017) (see resources) which is compiled by a panel of ultrasound experts to support good practice in vetting and justifying referrals for US examinations.
Reference is made to the evidence based iRefer publication (see resources) and should be used in conjunction with this. The NICE guidance, NG12, Suspected Cancer: Recognition and Referral published in June 2015 (see resources) has also been considered in the production of this updated publication.
These guidelines have been produced with the aim of providing practical advice as to best practice in the acceptance and justification of US referrals.
This document is based on several non-controversial principles:
Imaging requests should include a specific clinical question(s) to answer, and
Contain sufficient information from the clinical history, physical examination and relevant laboratory investigations to support the suspected diagnosis(es)
The majority of US examinations are now performed by sonographers not doctors. Suspected diagnoses must be clearly stated, not implied by vague, nonspecific terms such as “Pain query cause” or “pathology” etc.
Although US is an excellent imaging modality for a wide range of abdominal diseases, there are many for which US is not an appropriate first line test (e.g. suspected occult malignancy)
This general guidance is based on clinical experience supported by peer reviewed publications and established clinical guidelines and pathways.