imaging-referral

name	imaging-referral
description	Create, optimize, and manage imaging referrals between providers. Also use when the user needs to improve referral quality, add relevant clinical information, or track referral status. For clinical decision support, see guideline-integration.

Imaging Referral

You are an expert in imaging referral management. Your role is to help create complete, appropriate referrals and track their status.

Referral Components

Required Information

Component	Description
Patient demographics	Name, DOB, MRN
Clinical indication	Why imaging is needed
Relevant history	Current symptoms, priors
Modality	Appropriate imaging choice
Urgency	STAT, urgent, routine
Ordering provider	Name, contact
Destination	Facility/location

Clinical Indication Quality

Poor: "Abnormal chest X-ray"

Better: "Abnormal chest X-ray showing right upper lobe mass. Patient is a 58-year-old male smoker with 30 pack-year history.rule out lung malignancy"

Referral Templates

Standard Outpatient Referral

# IMAGING REFERRAL

**Patient Information:**
- Name: [Full Name]
- DOB: [Date of Birth]
- MRN: [Medical Record Number]

**Referring Provider:**
- Name: [MD/DO/NP/PA]
- NPI: [National Provider Identifier]
- Phone: [Contact number]
- Fax: [Fax number]
- Email: [Email]

**Clinical Information:**
- Chief Complaint: [Primary reason for visit]
- Relevant History: [Past medical history, surgeries, hospitalizations]
- Current Symptoms: [Detailed symptoms and duration]
- Lab Results: [Relevant labs if available]

**Imaging Request:**
- Study: [Modality and body part]
- Specific Protocol: [If known]
- Laterality: [Right/Left/Bilateral] (if applicable)

**Clinical Question:**
[Specific question to be answered by imaging]

**Urgency:**
- [ ] STAT (within 24 hours)
- [ ] Urgent (within 48-72 hours)
- [ ] Routine (within 2-4 weeks)

**Prior Imaging:**
- [ ] Yes - See comparison notes below
- [ ] No priors
[Prior studies with dates and findings]

**Allergies:**
- [ ] NKDA
- [ ] Known allergies: [List]

**Special Considerations:**
- [ ] Pregnancy/Pregnancy test required
- [ ] Claustrophobia
- [ ] Weight > [limit] kg
- [ ] Implanted devices
- [ ] Other: [Notes]

STAT/Emergent Referral

# URGENT IMAGING REFERRAL

**THIS IS AN URGENT REQUEST**

**Patient:** [Name] | **DOB:** [Date] | **MRN:** [Number]

**Clinical Emergency:**
Patient presenting with [symptoms] concerning for [condition].
[Duration] of symptoms. Vital signs: [if available].

**Requested Study:**
[Modality] [Body Part] [Protocol if known]

**Clinical Suspicion:**
[High suspicion for...]

**Requested Timeframe:**
By [specific time/date]

**STAT Protocol Required:**
[ ] Yes - Alert radiology
[ ] No

**Physician Contact:**
Direct line: [Phone]
Available: [Time range]

**Condition-Specific Indicators:**

Pulmonary Embolism:
- [ ] Wells Score: [Score]
- [ ] D-dimer: [Result/pending]
- [ ] Symptoms: dyspnea, pleuritic chest pain, tachycardia

Acute Stroke:
- [ ] Last known well: [Time]
- [ ] NIHSS: [Score]
- [ ] CT head non-contrast first, then CTA head/neck

Aortic Dissection:
- [ ] Blood pressure differential
- [ ] Tearing chest pain
- [ ] Medical history

Appendicitis:
- [ ] Right lower quadrant pain
- [ ] Elevated WBC
- [ ] Positive imaging elsewhere

Modality Selection

By Clinical Indication

Clinical Question	First-Line	Alternative
Acute stroke	CT Head, then CTA	MRI DWI
Pulmonary embolism	CTPA	V/Q scan (if contrast contraindicated)
Appendicitis	CT Abdomen/Pelvis	Ultrasound (especially in children)
Kidney stones	CT KUB (non-contrast)	Ultrasound
Lung cancer staging	CT Chest/Abdomen/Pelvis	PET/CT
Spinal cord compression	MRI Spine	CT
Pulmonary nodule	CT Chest	Chest X-ray first

ACR Appropriateness Criteria

ACR_APPROPRIATENESS = {
    "chest_xray_for_cough": {
        "rating": 8,
        "variant": "Usually appropriate",
        "notes": "First-line for most respiratory symptoms"
    },
    "ct_pulmonary_angiography": {
        "indications": {
            "moderate_pretest_pe": {"rating": 9, "variant": "Usually appropriate"},
            "high_pretest_pe": {"rating": 9, "variant": "Usually appropriate"},
            "low_pretest_pe": {"rating": 5, "variant": "May be appropriate"}
        }
    },
    "mri_lumbar_spine": {
        "indications": {
            "radiculopathy_4weeks": {"rating": 8},
            "red_flags": {"rating": 9}
        }
    }
}

Referral Quality Checklist

• Patient demographics complete
• Clinical indication clearly stated
• Specific clinical question asked
• Appropriate modality selected
• Urgency appropriately classified
• Relevant history included
• Prior imaging mentioned
• Allergies documented
• Special needs noted (claustrophobia, weight, implants)
• Provider contact information included

Tracking Referrals

Referral Status Workflow

REFERRAL_STATUS = {
    "ordered": "Referral placed in system",
    "scheduled": "Appointment scheduled",
    "completed": "Study completed",
    "preliminary": "Preliminary results available",
    "final": "Final report available",
    "cancelled": "Study cancelled",
    "no_show": "Patient did not attend",
    "pending_auth": "Awaiting insurance authorization"
}

Status Check Request

Subject: Referral Status Check
Patient: [Name], DOB [Date]
MRN: [Number]
Accession: [Number if known]
Referring Provider: [Name]
Study Ordered: [Modality + Body Part]
Date Ordered: [Date]

Please confirm:
1. Current status of referral
2. Scheduled appointment date/time (if applicable)
3. Any issues requiring action

Optimization Tips

Improve Incomplete Referrals

Before: "CT scan"

After: "58-year-old male with 30 pack-year smoking history, abnormal chest X-ray showing 2.5cm right upper lobe mass. Rule out lung malignancy. Recommend CT chest with contrast for staging evaluation."

Add Clinical Context

def enhance_referral(basic_referral):
    """Enhance referral with clinical context."""
    
    enhanced = basic_referral.copy()
    
    # Add relevant positives/negatives
    if "cough" in basic_referral["symptoms"]:
        enhanced["relevant_negatives"] = [
            "No hemoptysis",
            "No fever",
            "No recent travel"
        ]
    
    # Add risk factors if relevant
    if basic_referral["modality"] == "CT Chest":
        enhanced["risk_factors"] = {
            "smoking_history": enhanced.get("pack_years"),
            "occupational_exposure": enhanced.get("exposures")
        }
    
    # Add pertinent negatives
    if "abdominal_pain" in basic_referral["symptoms"]:
        enhanced["pertinent_negatives"] = [
            "No nausea/vomiting",
            "No diarrhea",
            "No urinary symptoms"
        ]
    
    return enhanced

Related Skills

• guideline-integration: For appropriate modality selection
• care-gap-closure: For screening referral management
• followup-tracking: For tracking referral completion

Examples

Example 1: Complete CT Referral

Create a referral for CT chest to evaluate a lung nodule

**Patient:** John Smith, DOB 01/15/1968, MRN 123456

**Clinical History:**
58-year-old male with 30 pack-year smoking history (quit 5 years ago).
Presented with abnormal chest X-ray found incidentally on routine physical.

**Clinical Question:**
Characterize 2.5cm right upper lobe mass found on chest X-ray. 
Rule out lung malignancy.

**Imaging Request:**
CT Chest with contrast (thin-section protocol for nodule characterization)

**Prior Imaging:**
Chest X-ray 01/20/2026: 2.5cm right upper lobe mass, no other 
abnormalities

**Urgency:** Urgent (within 48-72 hours)

**Contact:** Dr. Jane Doe, [phone]

Example 2: STAT PE Workup

Create an urgent referral for suspected pulmonary embolism

**URGENT - SUSPECTED PE**

**Patient:** Jane Doe, DOB 06/20/1975, MRN 789012

**Clinical:**
- 50-year-old female
- 3 days of progressive dyspnea and pleuritic chest pain
- No hemoptysis, no calf swelling
- D-dimer: Elevated at 850 ng/mL
- Wells Score: 4.5 (moderate probability)

**Request:**
CT Pulmonary Angiography (CTPA)

**Clinical Question:**
Evaluate for pulmonary embolism

**Urgency:** STAT

**Contact:** Dr. Robert Chen, [phone]
Direct line for results: [phone]