midland region clinical access criteria for … · < 5-6 months of age if clinical suspicion of...

Midland Region Community Radiology Access Criteria 26th July, 2016

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MIDLAND REGION

CLINICAL ACCESS CRITERIA

FOR

COMMUNITY REFERRED

RADIOLOGY

2013-2014 Review V8 July 2016


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Contents Introduction ........................................................................... 3

General X-ray Abdomen ......................................................................................... 4 Ankle ............................................................................................... 4 Chest ............................................................................................... 5 Paediatric Chest .............................................................................. 5 Elbow ............................................................................................... 5 Hand/Wrist ....................................................................................... 6 Hip ................................................................................................... 6 Paediatric Hip .................................................................................. 7 Knee ................................................................................................ 7 Shoulder .......................................................................................... 8 Skull ................................................................................................. 8 Spine ............................................................................................... 8 TMJ ................................................................................................. 8

Ultrasound (US) Abdomen ......................................................................................... 9 Carotid Doppler ............................................................................... 9 Paediatric Hips ................................................................................ 9 Paediatric Renal .............................................................................. 9 Renal ........................................................................................ 10-11 Pelvic ............................................................................................. 12 Scrotal ........................................................................................... 13 Neonatal Spine .............................................................................. 13 Thyroid........................................................................................... 13 Vascular......................................................................................... 14

Computed Tomography (CT) CT Head ........................................................................................ 15 CT Chest ....................................................................................... 16 CT Abdomen ................................................................................. 16 CT KUB ......................................................................................... 17 CT Colonography .......................................................................... 17 CT Sinus ........................................................................................ 17

Mammography and Breast Ultrasound Mammography ............................................................................... 18 Ultrasound Breast .......................................................................... 19

Prioritisation Methodology ....................................................20 Appendix 1 - Current Access by DHB ............................................. 21-22 Appendix 2 - Planned Access by DHB ............................................ 23-24 Appendix 3 – Midland Regional Advisory Group Members .................. 25


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Introduction The following regional access criteria for primary referred radiology referrals have been developed from a number of sources, including the draft National Community Radiology Access Criteria (Nov 2013). These criteria have been developed to improve equity of access across the Midland Region. They are a minimum that should be provided and should be read in conjunction with the Prioritisation Methodology detailed in Appendix 2 (when we have redefined this in line with National guidelines). DHB’s will advise local GP’s where copies of these access criteria are available. We are unable to accept any patient referral for investigation without the required actions being completed and the results supplied with the referral. If your patient does not meet the criteria but you think that an investigation is warranted, please phone a DHB Radiologist for advice. If they advise an investigation please document their name as well as all clinical information on the referral form. Primary Care Nurse Practitioner Referrals

The RANZCR considers that appropriately qualified Nurse Practitioners should be

able to refer for diagnostic imaging testing within their particular clinical context

as approved by the local radiation licensee.

NPs are expected to apply the practice expectations for public protection set out in the Nurse Practitioner practice standard “Competencies for the nurse practitioner scope of practice 2008”.

http://www.cno.org/Global/docs/prac/41038_StrdRnec.pdf


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GENERAL X-RAY

Abdomen Standard indications for x-ray referral

Diagnosis of constipation where patient history is unobtainable e.g. autism, special needs

Follow up of diagnosed renal stones with a KUB x-ray

Suspected renal tract stone use local pathway

Referral for x-ray not typically indicated

Acute abdomen: Discuss with acute surgical services or emergency services access points

Vague central abdominal pain

Suspected colorectal neoplasm (refer to colorectal cancer guidelines)

Suspected constipation (other than in specific patient groups as above).

Suspected abdominal masses refer to ultrasound

Ankle

Standard indications for x-ray referral Two of the below needed to qualify.

The pain has been present for >4 weeks.

The pain was sudden in onset and is severe and <4 weeks duration.

There is pain or swelling where previous arthroplasty

There is a palpable mass or deformity.

There is limited ROM (range of movement).

There is evidence of inflammatory arthritis.

Known arthritis with symptoms meeting local criteria for surgical consideration (if has not been xrayed in the past 6 months)


Suspected septic arthritis: refer for acute review

Acute gout. Ankle – Trauma Use Ottawa Ankle Rules


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Chest Standard indications for x-ray referral

The x-ray result will influence patient management. Follow up xray where abnormal x-ray related to infection or failure following treatment *take out


Pneumonia doesn’t require routine CXR follow up unless there are risk factors or red flags including age>50 years or age >40 years if smoker, suspicious radiologic findings on initial CXR or incomplete clinical resolution at 6 weeks (this is a guideline only and there may be local pathways which apply)

Routine assessment of hypertension

Routine monitoring of known pulmonary sarcoidosis

Routine x-ray for asbestos exposure surveillance

Follow-up of nodules detected on chest x-ray or CT other than where recommended by reporting or reviewing specialist (consider referral for respiratory specialist review)

Initial investigation of heart murmur, unless signs of complications such as heart failure

Routine follow-up of asymptomatic patients on amiodarone. Paediatric Chest Standard indications for x-ray referral

Acute chest infection/sepsis consider acute referral to specialist as per local pathway

Recurrent productive cough – if resistant to treatment or additional clinical features i.e. pyrexia

Wheeze with additional features such as fevers and localised crackles, chronic heart or respiratory disease and immunocompromised patients

Suspected/inhalation foreign body. Referral for x-ray not typically indicated

Incidental finding of a murmur

Uncomplicated (afebrile) presentation of asthma/bronchiolitis. Elbow Standard indications for x-ray referral

Pain has been present for >4 weeks and no response to treatment and/or not reproduced on examination.

Unrelenting severe pain <4 weeks.

Significant restriction in ROM (range of movement) after 4 weeks.

Unexplained deformity/palpable enlarging mass or swelling.

There is evidence of inflammatory arthritis. Referral for x-ray not typically indicated


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Suspected septic joint: refer for acute review

Acute gout Hand/wrist Standard indications for x-ray referral

Swelling confirmed on examination

Deformity

Strong history of Inflammatory symptoms >12 weeks with increased inflammatory markers +/- swelling +/- deformity

Long (>1year) history of Inflammatory symptoms (without increased inflammatory markers or swelling or deformity)

Pain with red flags Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause.


Acute gout

Suspected inflammatory arthritis <12 weeks with no significant inflammatory markers or swelling or deformity

Guidance

Dedicated wrist views do not typically provide additional information to single PA hand view. Where inflammatory arthritis is suspected consider requesting an AP feet x-ray as well.

Hip Standard indications for imaging referral

Undiagnosed hip pain present for more than 4 weeks where the x-ray is expected to change management

Hip pain with red flags and / or history of recent injury

Known osteoarthritis where symptoms meet local criteria for surgical consideration (not required if previously x-rayed within 6 months)

Pain in previous arthroplasty.

Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause.


Suspected septic arthritis: refer for acute review at Emergency Department /Orthopaedic Department

Mild symptoms and normal examination findings

Follow up of known or suspected osteoarthritis unless development of red flags or meets local criteria for surgery


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Paediatric Pelvis/hips Standard indications for x-ray referral

Pain

Limp

Risk factors/ soft signs or suspected development dysplasia of the hip (DDH) after 5-6 months of age.

Guidance

Capital femoral epiphyses ossify on average at 5-6 months of age; DDH can usually be reliably excluded from this age onwards on x-ray.

Slipped upper femoral epiphysis require urgent orthopaedic referral.

< 5-6 months of age if clinical suspicion of DDH ultrasound is the investigation of choice – refer local pathway

Paediatric Lower and Upper limb Standard indications for x-ray referral

Focal bone pain Referral for x-ray not typically indicated

Osgood-Schlatters, Severs and other apophysitides- x-rays not generally required for diagnosis or management

Knee Standard indications for x-ray referral, typically performed erect *take out

Undiagnosed knee pain present > 4 weeks where the x-ray is expected to change management

Knee pain with red flags

Known osteoarthritis with symptoms meeting local criteria for surgical consideration (not required if previously x-rayed within 6 months)

Pain in previous arthroplasty

Swelling or deformity Red flags include: Persistent deep nagging pain unrelated to activity Night pain in the absence of an obvious cause


Suspected septic arthritis: refer for acute review

Mild symptoms and normal examination finding

Follow up of suspected or known osteoarthritis unless red flags develop or clinically now meets criteria for surgical consideration

Suspected meniscal and ligament injury


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Shoulder Standard indications for x-ray referral

Suspected bone/joint pathology (>4 weeks) with red flags present

Pain in previous arthroplasty *take out put in ankle known OA…

Red flags include: Any unexplained deformity, mass, or swelling Persistent deep nagging pain unrelated to activity Night pain in the absence of an obvious cause


Recent onset pain in the absence of red flags

Frozen shoulder (unless the condition does not follow its expected natural history)

Pre-requisite for a trial of steroid injection (when a reasonable clinical diagnosis has been made and red flags are excluded)

Suspected septic arthritis: refer for acute review at Emergency Department /Orthopaedic Department.

Skull Routine x-ray not indicated. Please discuss with radiologist if concerns. *out Spine Standard indications for x-ray referral

Unrelenting spine pain > 8 weeks

Spine pain with red flags

Spine pain and osteoporosis or prolonged use of corticosteroids

Significant spinal deformity Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause History of cancer Immunosuppression Signs of infection : refer for acute review


Coccyx pain

Acute uncomplicated spine pain without red flags

Guidance

For high clinical suspicion of infection or cancer consider referral for acute review


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TMJ Xray is not indicator for TMJ pain Sinuses Plain Xrays are not indicated


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ULTRASOUND

Abdomen

Standard indications for ultrasound referral

Asymptomatic with abnormal Liver Function Test (LFTS) - more than 1.5 times normal range persisting for at least 3 months

Suspected biliary tract obstruction or malignancy (infective causes and medications excluded) e.g. persistently raised ALP/?GAT +/- bilirubin

Abdominal mass or other palpable abdominal abnormality

Painless jaundice without obvious cause

Clinical biliary colic/gallstones (not already imaged) or use established pathway

Suspected asymptomatic aortic aneurysm (AAA)- Refer to local vascular guidelines -

Required Actions

Please supply appropriate biochemistry and dates with abdominal ultrasound referral

Carotid Doppler

Use local pathways

Not typically indicated for asymptomatic carotid bruits

Paediatric Hips

No direct access; refer local pathway

Paediatric Renal Refer local pathway


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Renal


Loin pain suggesting renal tract obstruction

Haematuria

persistent isolated microscopic haematuria > 25 year old (defined as 2 or more episodes of positive urine dipstick of 1+ or more i.e. not trace) and infection excluded and renal impairment (as defined below)

macroscopic haematuria with UTI excluded

persistent isolated microscopic haematuria >25yo (on two or more on

MSU; not dipstix) and infection excluded and normal renal function

Chronic urinary retention with palpable enlarged bladder

Renal Impairment No prior relevant renal imaging and recheck with good hydration.

Acute kidney injury (increase in serum creatinine of more than 50% from baseline and/or decrease in eGFR of more than 50% from baseline) AND Consider direct referral to renal service.

Progressive chronic kidney disease (> 5 ml/min/year eGFR loss or >

10 mls/min over 3 years)

Polycystic kidney screening >20 years where family history

Guidance

Proteinuria >1.0g/24hours or protein/creatinine ratio >100 mg/mmol or albuminuria (albumin/creatinine ratio>65 mg/mmol) - consider referral to renal physician

If long term stable elevated creatinine/low eGFR then potential for any reversibility low therefore US findings unlikely to change management.

In diabetic with known diabetic complications, ultrasound may not be indicated.

Groin


Non reducible groin mass present for >3 weeks. If mass is suspicious for cancer please refer to specialist


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Guidance

Most hernias can be diagnosed clinically and ultrasound is rarely required

Some local pathwayts may exist for hernia


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Adult UTI – urea splitting organisms, history of malignancy, calculi, previous surgery, obstruction symptoms

Or in: Females:

> 3 documented UTI's in 6 months, or 6 in a year despite adequate courses of culture specific antibiotics. This pattern implies bacterial persistence rather than recurrence. (Ensure that patient has not previously been investigated with imaging)

Recurrent pyelonephritis with no previous imaging. Males:

Recurrent or persistent infections (if not previously investigated with imaging)

Paediatric Renal US (please see local guidelines)

Child < 12 months with first UTI Any child with recurrent UTI or complicated UTI Follow up of antenatal hydronephrosis or as recommended by

specialist

Required Actions

Please supply appropriate biochemistry and dates with renal ultrasound referral

Neck US


Salivary gland mass persisting for > 3 weeks

Suspected lymph node or undifferentiated neck mass - >3 weeks, > 1.5cm and no obvious infection or medical cause

Guidance

If cancer is suspected, refer local specialist


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Pelvic


Post menopausal bleeding (bleeding after 1 year of amenorrhoea)

Pelvic Mass or uterine size >12 weeks. Request Ca125 also

Primary amenorrhoea (delay menarche after age of 18years with appropriate

endocrine assay)

IUCD not visible

Polycystic Ovary Syndrome (PCOS) only if appropriate biochemical signs of

hyperandrogensism or oligo- or amenorrhoea. If both present US not

required.

Chronic Pelvic pain/ suspected endometriosis – persisting symptoms over at

least 3 month with PID excluded

Heavy menstrual bleeding (heavy cyclical menstrual bleeding over several

cycles) and Age > 45years or Age >35years with at least one of the following:

Weight >90kg

Risk factors for endometrial hyperplasia (nulliparity, infertility,

FH endometrial/colon cancer, use of either Tamoxifen or

unopposed oestrogens, P.C.O.S)

First degree relative less than 60 years old with a diagnosis of

endometrial or bowel cancer

Suspected ovarian cyst (tenderness and pain for > 4 weeks)

Required Actions

All referrers should have completed ALL of the following:

I have removed a copper IUCD and observed for 3 months, or there is no

IUCD present

I have carried out a pelvic examination, visualized the cervix and taken a

smear and STI check if appropriate

Those patients without risk factors have had no improvement with a three

month trial of medical management (hormonal/tranexamic acid/mirena)

Appropriate biochemical profiles to be supplied for PCOS Ultrasound referrals

Local pathways should be followed

Not typically indicated for


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Fibroud followup, simple ovarioan cyst <5cm in pre-menopausal/ low risk

woman

Primary dysmenorrhea


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Scrotal


Scrotal masses with concerning features i.e. testicular, painless, nontransilluminating, rapidly growing –(urgent urology referral recommended)

Scrotal masses where it is unclear if the swelling is testicular or extra-testicular

New hydrocele in adults (may be secondary to testicular cancer).

Referral for imaging not typically indicated

Non-solid (transilluminating) scrotal masses

Hydrocoele in children

Long-standing hydrocoele in adults

Acute inflammatory conditions and only refer for ultrasound if symptoms and /or swelling fail to resolve with antibiotics

Chronic orchalgia in the absence of abnormality on examination

Guidance

Urgent referral to Urology or General Surgery should not be delayed by a wait for ultrasound scan if there are red flags for:

testicular torsion

testicular cancer

strangulated inguinal hernia

acute testicular trauma

Scrotal masses can often be diagnosed clinically. If unsure, seek a second opinion from a general practitioner colleague or specialist.

Neonatal Spine No direct access Thyroid


Rapidly enlarging mass. (If you have any concerns discuss or refer to an Endocrinologist or a Hospital Specialist – red flags for malignancy <20 years and >60 years history of neck cancer rapid growth of nodule hard, ill-defined


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or fixed nodule, hoarseness, dysphagia or dysphoria, cervical lymphadenopathy)

Euthyroid goitre

Palpable nodules


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Vascular


Pulsatile mass for investigation

Suspected deep venous thrombosis (DVT) – use local pathway


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CT SCANNING

CT Head

Standard indications for CT referral

Undiagnosed cognitive impairment with one or more high risk featuresage less than 60

rapid (i.e 1 or 2 months) unexplained decline in cognition or function recent and significant head trauma unexplained neurological symptoms (eg new onset of severe

headache or seizures) History of cancer with high risk of intracranial metastases (particularly

lung, breast, colon/pancreatic, genitourinary, melanoma, head and neck cancers and lymphoma).

use of anticoagulants or history of bleeding disorder history of the combination of urinary incontinence, balance and gait

disorder early in the coursed of dementia as may be found in Normal Pressure Hydrocephalus (NPH)

any new localising sign (eg hemiparesis or a Babinsky reflex) unusual or atypical cognitive symptoms or presentation (eg

progressive aphasia) gait disturbance

Chronic Headache (lasting more than 3 months for more than 15 days per

calendar month) with one or more of the following:

new onset >50 yrs change in pattern of headaches with increase in frequency or severity aggravated by exertion or Valsalva associated with nausea and vomiting background systemic illness with cerebral complications or

im=nvilvement; especially malignmancy (breats, lung, melanoma)

Cognitive Decline

The main reason for imaging is to identify and rule out pathologies other than Dementia of the Alzheimer’s type and Vascular Dementia.

A careful neurological screening examination is to be carried out including a brain CT scan, if there are one or more of the following in addition to cognitive decline (for example a MoCA Score of less than 26 or similar decline using validated assessment tools – see initial cognitive assessment node):

If a CT is indicated, clinician (GP or hospital doctor) to request via radiology as per local pathway agreements.

Headache in Children


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As per local pathway


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Guidance

While CT may be appropriate as part of the workup, initial discussion with a local

relevant specialist is recommended for patients with:

Focal neurological signs

Notes

Clinical circumstances determines urgency

If patient is pregnant consider specialist opinion

Additional Notes – Cognitive Decline

If you are unsure or there are unusual/atypical symptoms, or there is clinically

significant immunosuppression, then seek advice through the advice line in your local

information node

CT Chest

On recommendation by Radiologists from an Abnormal Chest Xray with suspected cancer reported.

Required Actions

Please enclose a copy of the report recommending further investigation with your referral Specialist referral should not be delayed whilst waiting for an investigation where there are red flag symptoms

CT Abdomen

On recommendation by Radiologists from an Abnormal Ultrasound or CT Colonography with suspected cancer reported.

Required Actions

Please enclose a copy of the report recommending further investigation with your referral Specialist referral should not be delayed whilst waiting for an investigation where there are red flag symptoms


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CT KUB

Referral for CT KUB is the preferred imaging investigation for:

Non pregnant patients with renal colic

Guidance

Referral should be guided by your local pathway which may include

Primary Options

Consider renal ultrasound in younger or pregnant patients

CT Colonography

Use local pathway

CT Sinus

Referral for CT sinus not indicated unless there is local pathway which supports this, where there is failed medical management


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MAMMOGRAPHY AND BREAST ULTRASOUND

Mammography

Please refer to local pathways which would supercede these guidelines

Asymptomatic Women

a mother or sister or daughter with pre-menopausal breast cancer or

bi-lateral breast cancer, or a breast histology demonstrating an at risk

lesion. Imaging to start 10 years before diagnosis of the youngest first

degree relative, but not before 30 years. Alternating with BSA from 45

years.

NOTE: MRI is advised if less than 30 years – refer to specialist.

a breast histology demonstrating an at risk lesion (for example,atypical

hyperplasia

If previous breast cancer – annually. NB After 5 years can re-enter

BSA

Symptomatic Women

If new breast symptom, not lactating or pregnant and any of the following:

Palpable lump and no normal mammogram in the last year

Bloody or serous nipple discharge

35 years and over (If under 35 – refer for Ultrasound)

New inversion of Nipple)

Referral for Mammogram not typically indicated for:

Breast pain without associated lumps or other symptoms

Bilateral male breast enlargement

Guidance

If you are unsure please discuss with a radiologist


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Ultrasound Breast

Women <35 years with symptoms as follows:

Palpable lump and no normal mammogram in the last year

Bloody or serous nipple discharge

New inversion of Nipple)

Men with unexplained or suspicious unilateral breast enlargement

Axillary lymph node enlargement or suspected lymph node enlargement in the absence of obvious infectious cause.

Referral for ultrasound not typically indicated

Breast pain alone

Bilateral male breast enlargement.

Guidance

Referral to local breast service for advice / assessment and multidisciplinary work up is preferable and where this is available locally would supersede these recommendations

In the absence of access to breast clinic services patients over the age of 35 and all patients presenting with suspicious masses should be referred for mammography along with ultrasound as part of the initial work up.

Pagets disease is not excluded with normal imaging. If clinical concern seek Surgical assessment.


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Prioritisation Methodology

The following methodology will be used by Midland DHB Radiology Departments. It is subject to the interpretation of clinical information in the referral and service capacity. Note that any procedure should only be requested where the results (either positive or negative) will alter the management of the patient’s condition/will either confirm or eliminate significant disease from the differential diagnosis.

Priority description Timeframe

URGENT: Where immediate treatment and management of acute condition is dependent on diagnosis:

High clinical probability of malignancy or serious inflammatory/infective condition.

High clinical probability of fracture. Major functional impairment including

uncontrolled pain. Risk of significant permanent damage

to tissues or systems if diagnosis is delayed.

Imaging takes place within 7 working days.

SEMI-URGENT: Conditions where there is possibility of malignancy, serious inflammatory / infective condition, and complications or where imaging may affect short term management.

Imaging takes place within 4 weeks.

ROUTINE: Conditions with minor functional impairment and where imaging is unlikely to affect short term management, but likely to affect long term management.

Imaging takes place within 6 weeks (key performance indicator measure)

DECLINED:

Referrals that meet the criteria but are unable to be offered within 4 months

Referrals that do not meet the criteria


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Appendix 1 – Current Access by DHB

Table by DHB showing CURRENT referral access pathway by procedure type

Procedure BOP DHB Lakes DHB Tairawhiti DHB

Taranaki DHB

Waikato DHB

General X-ray On Hold

Abdomen Direct Access Direct Access Direct Access

Direct Access

Ankle Direct Access Direct Access Direct Access

Direct Access

Chest Direct Access Direct Access Direct Access

Direct Access

Paediatric Chest

Direct Access Direct Access Direct Access

Direct Access

Elbow Direct Access Direct Access Direct Access

Direct Access

Hand/Wrist Direct Access Direct Access Direct Access

Direct Access

Hip Direct Access Direct Access Direct Access

Direct Access

Paediatric Pelvis/hips


Direct Access

Paediatric Lower/Upper Limb


Direct Access

Knee Direct Access Direct Access Direct Access

Direct Access

Shoulder Direct Access Direct Access Direct Access

Direct Access

Spine Direct Access Direct Access Direct Access

Direct Access

Ultrasound On Hold

Abdomen Direct Access, Local Gallbladder Pathway

Direct Access Direct Access

Direct Access

Carotid Doppler Local Pathway

Local Pathway Local Pathway

Vascular Lab

Paediatric Hips No Direct Access, Local Pathway

Local Pathway Direct Access

No direct Access, Paediatric Orthopaedic Clinic

Renal Direct Access Direct Access Direct Access

Direct Access

Paediatric Renal

Local Pathway


Direct Access

Pelvic Direct Access, Local HMB Pathway


Direct Access


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Scrotal Direct Access Direct Access Direct Access

Direct Access

Thyroid Direct Access Direct Access Direct Access

Direct Access

Vascular Direct Access for AAA, DVT Pathway

Direct Access Direct Access for AAA, DVT Pathway

Direct Access for AAA, DVT GP Pathway

CT Scanning

CT Head –Headache

No Access without discussion


Limited Access

CT Head – Cognitive Decline

No Direct Access, Local Pathway

Local Pathway with Consultant Referral

Direct Access

Local Pathway with Specialist Referral

CT Head – Headache in Children




Local Pathway with Specialist Referral

CT Chest Radiologist recommendation only

Access via Chest Physician

Direct Access

Limited Access

CT Abdomen Radiologist recommendation only

No Access Direct Access

Limited Access

CT KUB Local CPO Pathway in development

Radiologist request only

Direct Access

Limited Access via Map of Medicine Renal Colic Pathway

CT Colonography

Local Pathway

Local Pathway Local Pathway

No Access

CT Sinus No Access Direct Access Direct Access

Limited Access

Mammography and US Breast

Mammography Direct Access Direct Access to Private

Direct Access

Direct Access

US Breast Direct Access Direct Access to Private

Direct Access

Direct Access


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Appendix 2 – Planned Access by DHB

Table by DHB showing PLANNED referral access or pathway by procedure type once new criteria have been published

Procedure BOP DHB Lakes DHB Tairawhiti DHB

Taranaki DHB

Waikato DHB

General X-ray On Hold

Abdomen Direct Access Direct Access Direct Access

Direct Access

Ankle Direct Access Direct Access Direct Access

Direct Access

Chest Direct Access Direct Access Direct Access

Direct Access

Paediatric Chest Direct Access Direct Access Direct Access

Direct Access

Elbow Direct Access Direct Access Direct Access

Direct Access

Hand/Wrist Direct Access Direct Access Direct Access

Direct Access

Hip Direct Access Direct Access Direct Access

Direct Access

Paediatric Pelvis/hips


Direct Access

Paediatric Lower/Upper Limb


Direct Access

Knee Direct Access Direct Access Direct Access

Direct Access

Shoulder Direct Access Direct Access Direct Access

Direct Access

Spine Direct Access Direct Access Direct Access

Direct Access

Ultrasound On Hold

Abdomen Direct Access, Local Gallbladder Pathway


Direct Access

Carotid Doppler Local Pathway Local Pathway Local Pathway

Vascular Lab

Paediatric Hips No Direct Access, Local Pathway


No direct Access, Paediatric Orthopaedic Clinic

Renal Direct Access Direct Access Direct Access

Direct Access

Paediatric Renal Local Pathway Local Pathway Direct Access

Local Pathway

Pelvic Direct Access, Local HMB Pathway


Direct Access

Scrotal Direct Access Direct Access Direct Access

Direct Access


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Thyroid Direct Access Direct Access Direct Access

Direct Access

Vascular Direct Access for AAA, DVT Pathway

Direct Access Direct Access for AAA, DVT Pathway

Direct Access for AAA, DVT GP Pathway

CT Scanning

CT Head –Headache

Identify volumes – Increase CR Contract, identify additional resources



CT Head – Cognitive Decline



Direct Access


CT Head – Headache in Children





CT Chest Radiologist recommendation only

Access via Chest Physician

Direct Access

Radiologist recommendation only

CT Abdomen Radiologist recommendation only

No Access Direct Access

Radiologist recommendation only

CT KUB Local CPO Pathway in development

Radiologist request only

Direct Access

Local pathway via MOM Renal Colic Pathway

CT Colonography

Local Pathway Local Pathway Local Pathway

No Access

CT Sinus No Access Direct Access Direct Access

No Access

Mammography and US Breast

Mammography Direct Access Direct Access to Private

Direct Access

Direct Access

US Breast Direct Access Direct Access to Private

Direct Access

Direct Access


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Appendix 3 Midland Radiology Advisory Group Members Members of the Midland Radiology Advisory Group who have reviewed the Regional Access Criteria for Community Referred Radiology are as follow:

Name Title Organisation

Roger Lysaght Service Manager, Ambulatory Service

Lakes DHB

Andrew Klava HOD Radiology Lakes DHB

Gloria Crossley Clinical Services Manager- Allied Health, Scientific & Technical

Taranaki DHB

Alina Leigh Consultant Radiologist Taranaki DHB

Sue Howard Clinical Imaging Manager Taranaki DHB

Kevin Harris Assistant Group Manager Waikato Hospital

Waikato DHB

Zubayr Zaman Consultant Radiologist Waikato DHB

Rose Newman Consultant Radiologist Waikato DHB

Kim McAnulty Consultant Radiologist Waikato DHB

Sabaratnam Muthukumaraswarmy

HOD Radiology Waikato DHB

Jill Wright Regional Radiology Manager BOP DHB

Roy Buchanan HOD Radiology BOP DHB

Helen Seymour Consultant Radiologist BOP DHB

Gerard Eager Consultant Radiologist BOP DHB

Leigh Potter Radiology Service Manager Tairawhiti DHB

Charles Robinson HOD Radiology Tairawhiti DHB

Lisa Hughes GP Liaison Lakes DHB

Mike Agnew/Stewart Ngatai Portfolio Manager Planning and Funding

BOP DHB

Sue Matthews Primary Options Coordinator WBAY PHO

Joe Bourne GP Liaison BOP DHB

Nick Hanna GP BOP

Rawiri Keenan MHN (GP) Waikato

midland region clinical access criteria for … · < 5-6 months of age if clinical suspicion of...

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