Making the best use of Clinical Radiology Services Referral Guidelines Royal College of Radiologists This is a wonderful booklet

t that briefly explains the importance of justifying medical exposure to ionising radiation and suggests ways in which this can be limited whilst maintaining a good diagnostic result. Alternatives such as US and MRI should be considered. I was unclear as to which modality would be indicated for different investigations and assumed that, for example, CT would always be the first choice for a head examination. I now realise that a number of factors must be taken into consideration in deciding which modality is the most appropriate for the patients condition. Pregnancy; availability of equipment and trained practitioners which will vary between Trusts (MRI equipment is very expensive which limits the units available); waiting period for appointments; the urgency for a diagnosis; the age and size of the patient and the patients symptoms will all indicate which modality should be selected for the investigation. These guidelines give clear advice on the best option for the patient and also indicate how useful the investigation will be to contribute to a clinical diagnosis. It emphasises that all high-dose radiation exposures (for example CT of the abdomen, barium enema) and some Nuclear Medicine exposures, should be discussed with the radiologist who will indicate whether this modality is the most appropriate or suggest suitable alternatives. The booklet gives tables of typical effective doses from diagnostic medical exposure for different investigations and equates them to an equivalent period of background irradiation. This is the sixth edition of this booklet and with ever-improving technologies procedures are bound to continue to evolve and progress providing better clinical diagnosis and further editions will surely follow who knows what we will be able to achieve in ten years time? Below is review of this book from a GP in Windsor that I found on-line:

Making the best use of clinical radiology services

25-Jan-08
Dr Gwen Lewis reviews some helpful guidelines from the Royal College of Radiologists. This is the sixth edition of the Royal College's clinical radiology referral guidelines, which goes to show how successful it has been. With radiology advancing so rapidly there is plenty of new information contained in this edition.

The guidelines are also available online, which is an excellent way of viewing them. It is stated that they are intended as a guide for referring clinicians and are not to be used to restrict practice. Even small doses of radiation are not entirely without risk, so we should decide whether the investigation does actually confer clinical benefit. Radiation risk explained I was interested in a table showing effective doses of radiation from diagnostic medical exposure. I was unaware that CT scan of the abdomen or pelvis gives a 16-fold increase in radiation risk over plain abdominal X-ray, which is the equivalent to over four years of natural background radiation. It is estimated that the additional lifetime risk of fatal cancer attributable to abdominal CT examination in an adult of one in 2,000. After reading this I felt grateful that as GPs we do not have access to CT scanning. There are questions to ask prior to ordering an investigation - has it already been done? Do I need it? Do I need it now? Is this the best investigation? Have I explained the problem? Are all the investigations needed? I found the section giving a brief discussion on actual imaging techniques, and their risks, benefits and short-comings very useful. CT scanning, MRI scanning, interventional radiology including angiography and ultrasound are all discussed but I was particularly interested to read about positronemission tomography co-registered with CT (PET and PET-CT). I have several patients who have had these investigations and I have not fully understood what is involved. A GP resource Actual disease areas are covered in table form with short notes on indications for different investigations and their degree of usefulness in each disease. This would be very useful for junior doctors as a reference. While many of the investigations tabled are not available for us as GPs to order, it is nonetheless interesting. There is a comprehensive section on the usefulness of different investigations in the diagnosis and staging of different forms of cancer. I was also interested in the section on investigation of breast disease. Other disease areas covered include chest and cardiovascular systems and interventional radiology, much of which is less relevant to GPs as many of the investigations are specialised and available only to hospital doctors. This book is packed with useful information. It is not a book to read from cover to cover, but is a great little reference book with excellent advice.

Dr Lewis is a GP in Windsor, Berkshire Book review Making best use of clinical radiology services Royal College of Radiologists ISBN 978-1-905034-24-6