1. General Imaging Information
Dr Heather Harris
Clinical Director
Imaging Department, CRH

2. Overview Imaging is key to every pathway
Tight TATs for target requests
1 week from request to scan
1 week from scan to report
Reality is often quicker
Recent performance better than benchmark
Some pathways tighter TATs

3. Specific Pathways Lung pathway Prostate Vague sx and jaundice Also
Colorectal, upper GI, unknown primary, other urology, Breast, Gynae, H&N, dermatology etc

4. Imaging Email Advice Service
Part of vague sx pathway
Any enquiry, not just for vague sx
Advice
what test to do, what test to do next, interpretation of report, urgent report needed
If really urgent, please phone
Tel: or

5. Practical Info CRHFT.imaging-secs@nhs.net Mon – Fri 0830 – 1700
Aim to respond within 3 working days
Need patient name and either DOB, hospital number or NHS number
Brief outline of the query
Not for complaints please

6. Advantages You can email when convenient
We can respond when convenient
More considered response
Allows time to look into the issue
Doesn’t interrupt either of our working days
Improved TAT for reporting

7. Outcomes so far Started 15th May 2018 67 enquiries
Average TAT for response = 8 days
45 were 7 days or less
27 were 0 – 3 days
22 were more than 7 days, range 8 – 29 days
BUT
Delay in sending to consultant
0 – 3 days, 1 was 19 days
Weekends have been included
Aimed response is 3 working days from receipt
Reality better but needs improvement
Need to dig deeper into data

8. Big Change to U&Es for CT
New guidance from RCR
Contrast is no longer thought to be a main factor in AKI
Now referred to as Post Contrast AKI instead of contrast induced AKI

9. Out patient/GP Requests
Most OP/GP patients do not need U&Es
Need to identify high risk patients

10. High Risk Out Patients Age >65 years
Known renal disease including transplant kidney, solitary kidney, dialysis, renal cancer and previous kidney surgery
History of hypertension requiring medical treatment
History of diabetes
Metformin or metformin containing drugs (due to risk of lactic acidosis in the presence of AKI, not PC-AKI)

11. High Risk Patients ICE has been changed Questionnaire for referrer
Low risk vs high risk
Low risk patients
No U&Es!!
High risk patients – questionnaire
High risk factors are flagged up on our system
Must have had U&Es within 1 month

12. High Risk Out Patients
eGFR >45 ml/min/1.73m2
give iv contrast

13. High Risk Out Patients eGFR 30-45 ml/min/1.73m2 Give iv contrast
CT staff give the patient a U&Es blood test form and advise them to have a blood test hours after the scan.
CT staff will record the pre-scan renal function, and will then follow-up the post scan blood result.
If there is a significant deterioration in renal function (25%)
CT staff will inform a radiologist and contact the GP with the result
advice to recheck the renal function again at 7 days.

14. High Risk Out Patients eGFR <30 ml/min/1.73m2
Non contrast CT +/- liver ultrasound following advice from a radiologist

15. Benefits Saves time Saves money Reduced checking of U&Es
Less patient trips to CRH or GP
Less patients to follow up
More time to do other tasks
Saves money
Reduced U&Es tests, blood forms, postage costs

16. Any Questions?