RD4.1 | Imaging Requisitions, Urgency Communication and Specialist Clarification — Summary & Reflection

KEY TAKEAWAYS

Imaging Requisitions, Urgency and Specialist Clarification — Key Points

• The requisition is a clinical communication act, not a clerical form: everything the radiologist decides (modality, protocol, contrast, priority, interpretation) flows from what you write.
• A high-quality requisition contains a focused history, a specific clinical question, a provisional diagnosis, the urgency, and the safety flags (eGFR for contrast; contrast-allergy history; pregnancy/LMP; implants/devices for MRI; anticoagulation for procedures) plus identifiers and your contact.
• Build it with a repeatable SBAR-style method and never leave a safety field blank — record present/absent so the radiologist knows you checked.
• Convey urgency in tiers — routine (days-weeks), urgent (same-day/24 h), emergent (immediate; telephone the radiologist directly). Examples of emergent: aortic dissection, acute stroke in the thrombolysis window, testicular torsion, major trauma.
• Clarify appropriateness when in doubt by phoning the radiologist before ordering; use ACR Appropriateness Criteria / AERB referral guidance; every ionising study must be justified, a duty shared by the requesting clinician (AERB is India's regulator).
• Close the loop: read the full report, act on critical findings, avoid duplicate imaging, and re-clarify if the report does not answer your question.

REFLECT

Think about the last imaging request you saw written on a ward or in clinic. Ask yourself: (1) Did it contain a specific clinical question, or just a body part and a symptom — and could a radiologist who had never met the patient have chosen the protocol from it alone? (2) Were the safety flags (renal function, pregnancy, implants, allergy) filled in as present/absent, or left blank? (3) Was the urgency communicated in a way that matched the clinical reality, and if it was an emergency, was the radiologist actually telephoned? Resolving to write the next requisition you are responsible for as a genuine clinical consultation — with a clear question, complete safety flags, honest urgency, and your contact details — is how this competency becomes a habit rather than a piece of theory.