RD4.1-3 | Interdisciplinary Imaging Communication — Assignment

CLINICAL SCENARIO

It is 02:30 on the acute medical take. A 74-year-old man, Mr R, presents with sudden-onset severe central abdominal pain radiating to the back, a blood pressure of 92/58 mmHg and a tender, pulsatile epigastric mass. He has known chronic kidney disease (most recent eGFR 38 mL/min/1.73 m²), a documented allergy to iodinated contrast (urticaria and wheeze on a previous study), and an implanted permanent pacemaker. The medical registrar asks you to arrange urgent cross-sectional imaging to exclude a leaking abdominal aortic aneurysm and to organise the patient's safe transfer to the scanner. You must communicate clearly with the radiologist and plan a safe transport for a haemodynamically unstable patient.

1. Draft the imaging requisition (RD4.1)

Write out the actual requisition you would send, structured using an SBAR-style scaffold (Situation, Background, Assessment, Recommendation/Request). State the specific clinical question, the relevant focused history, the requested study and the urgency tier you would assign.

Guidance: Include every safety flag relevant to THIS patient (renal function/eGFR, contrast allergy, implanted pacemaker) and explain how each one changes the radiologist's protocol choice. Make the clinical question precise (what are you asking the radiologist to confirm or exclude?).

2. Clarify appropriateness and resolve the contrast dilemma (RD4.1)

A CT angiogram normally requires iodinated contrast, but this patient has both significant renal impairment and a contrast allergy. Describe the conversation you would have with the radiologist to clarify the appropriate study and how the risks would be balanced against the clinical urgency.

Guidance: Discuss the justification principle — matching modality to the clinical question while respecting risk. Consider what options the radiologist might offer (e.g. risk/benefit in a life-threatening emergency, premedication, alternative protocols) and why clarifying with the specialist, rather than simply cancelling or proceeding blindly, is the correct behaviour.

3. Pre-transport safety checklist (RD4.2)

The patient is hypotensive and may deteriorate. Work through your pre-transport checklist before leaving the resuscitation area, using the Oxygen–Monitoring–Drugs–People framework.

Guidance: Show your oxygen calculation method (cylinder contents ÷ fresh-gas flow = usable minutes; confirm it exceeds round-trip time plus a delay margin). Specify the monitoring you require, the emergency drugs and running infusions, and who must escort this unstable patient. State explicitly why moving him is itself a risk.

4. Anticipate deterioration and complete the loop

Describe what you would do if the patient arrests during transport or in the scanner, and how you would close the communication loop after the study is reported.

Guidance: Address the governing principle that transport must reproduce the controlled environment. Explain how you would hand over to the radiology team and how you would ensure the result is acted upon (closing the loop). Note: this case is CT, not MRI — but briefly state how your plan would change if MRI were required (zones, ferromagnetic equipment, the pacemaker as an MRI contraindication/conditional-device issue).

PEER REVIEW

Exchange your response with a peer. Check: (1) Is the clinical question on their requisition specific enough that a radiologist could choose a protocol from it alone? (2) Did they identify ALL three safety flags (renal, allergy, pacemaker) and explain the impact of each? (3) Did they CALCULATE the oxygen reserve rather than guess it? Give one concrete suggestion to make either the requisition or the transport plan safer.