imaging-referral

# 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 ```markdown # 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 ```markdown # 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 ```python 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 ```python 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 ```python 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 ``` ```markdown **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, (555) 123-4567 ``` ### Example 2: STAT PE Workup ``` Create an urgent referral for suspected pulmonary embolism ``` ```markdown **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, (555) 987-6543 Direct line for results: (555) 987-6544 ```