Doctors have it hard.
In fact, doctors have it very hard. (But that’s a topic for another article.)
In the eyes of patients, doctors are often expected to know everything—orthopaedics, nutrition, cardiology, minor surgery, pharmacology, haematology, radiology, and more.
In reality, doctors are a product of their training: medical school education combined with experience gained during clinical rotations and early years of practice. Even then, it is impossible for any one doctor to encounter or master every medical condition.
There is a well-known saying in medicine: “Common things happen commonly, and uncommon things happen uncommonly.” This principle serves as a guiding framework for clinical decision-making and is often the saving grace for young doctors navigating complex cases.
Radiology and the Referral Challenge
As part of their training, doctors are exposed to radiology—primarily image interpretation basics. They learn how images are presented, how common diseases may appear on X-rays, and the standard protocol views for various body parts. This is where challenges often arise, and where the purpose of this article becomes clear.
Before proceeding, it is helpful to explain what is meant by views and protocol views.
In radiography, most body parts are imaged using at least two views taken at approximately ninety degrees to each other. Views are named according to the direction of the X-ray beam as it passes through the patient. For example:
- Anterior–Posterior (AP): the X-ray beam enters the front of the body and exits the back.
- Posterior–Anterior (PA): the beam enters the back and exits the front.
- Lateral: the beam enters one side of the body and exits the other. The view is named according to the side closest to the image receptor (e.g. left lateral).
Protocol views refer to the minimum required views for a specific body part, as determined by departmental or hospital policy and patient management strategies.
The Responsibility of Ordering Imaging
When a doctor requests imaging that uses ionising radiation—such as X-rays or CT scans—a cost–benefit analysis should be considered. One critical question must be answered:
Does the potential diagnostic benefit outweigh the risk of radiation exposure?
If the answer is no, alternative diagnostic methods should be explored. If yes, the imaging study is ordered via a written referral or, in urgent situations, a verbal request.
It is essential to understand that a referral is not a casual request—it is a legal document, comparable in importance to a medication prescription or laboratory request. In many jurisdictions, imaging technologists are legally prohibited from performing examinations involving ionising radiation without a valid request.
What Makes a Good Imaging Referral?
A well-constructed referral contains specific, essential information:
1. Patient Demographics
This includes the patient’s full name, date of birth, age, gender, and a unique identifier such as a hospital or registration number. Additional identifiers—address, national ID number, or phone contact—help reduce the risk of imaging the wrong patient. A minimum of three identifiers is standard practice.
2. Relevant Clinical History
This is one of the most valuable components of the referral.
- Trauma: The mechanism of injury should be briefly described. This information guides patient handling, positioning, and view selection (e.g. trauma shoulder views versus routine shoulder views).
- Non-traumatic conditions: A concise description of symptoms assists the radiographer in selecting appropriate views and exposure factors to optimise diagnostic quality.
Clinical context directly influences how the examination is performed.
3. Body Part to Be Imaged
Based on history, examination, and differential diagnosis, the doctor identifies the most appropriate body part. This may not always match the patient’s perceived source of pain. For example, numbness in the hand may warrant cervical spine imaging rather than a hand X-ray.
4. Suggested Views
This is a common area of friction. Radiology is not a doctor’s specialty, and exposure during training is limited. As a result, incorrect or non-optimal views are sometimes requested. Examples include:
- Requesting an AP chest when a PA chest is the gold standard whenever feasible.
- Requesting AP and lateral views when the protocol calls for PA and oblique views, such as for hands or feet.
Open communication between doctor and radiographer can easily resolve these issues.
5. Additional Relevant Information
Helpful details include:
- Mobility limitations or inability to stand
- Communication barriers (e.g. hearing impairment, language differences)
- Cognitive status (e.g. dementia, altered mental state)
- Medical conditions that may affect positioning (e.g. Parkinson’s disease, seizure disorders)
This information allows the imaging technologist to properly prepare for the examination.
A Team-Based Approach to Patient Care
It is the imaging technologist’s responsibility to assess the referral for accuracy—correct patient, correct body part, correct side, and appropriate views. This includes interviewing the patient and establishing rapport, which is essential for patient safety and cooperation.
Healthcare should never be viewed as a competition between professions. It is a team effort, united by a shared goal: improving patient outcomes.
- To doctors: humility and communication go a long way. If you share what you are clinically looking for, radiographers can advise on the most diagnostically useful images.
- To imaging technologists: professionalism and respect are key. If a referral is unclear or questionable, a timely and collegial discussion with the referring doctor benefits everyone—especially the patient.
In Summary
A good imaging referral is:
- A legal document
- Clearly dated
- Contains accurate patient identifiers
- Includes a concise clinical history
- Specifies the body part and suggested views
- Provides any additional relevant patient information
When done properly, referrals enable imaging technologists to deliver safe, efficient, and diagnostically valuable examinations.
Medical Disclaimer The author is not a medical doctor but has over twenty years’ experience in medical imaging. All scenarios described are simplified for educational purposes only and should not be considered medical advice. If you or a loved one are experiencing symptoms, please consult your trusted medical professional.
If you would like a free PDF copy of this article or have questions, feel free to contact the author:
📲 Call/WhatsApp: 868-382-2030 📧 Email: [email protected]
