midland region clinical access criteria for …...midland region clinical access criteria for...

Midland Region Community Radiology Access Criteria 28 May, 2014

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MIDLAND REGION

CLINICAL ACCESS CRITERIA

FOR

COMMUNITY REFERRED RADIOLOGY

FINAL VERSION

Dated 15 July 2014


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Contents Introduction ........................................................................... 3 General X-ray

Abdomen ......................................................................................... 4 Ankle ............................................................................................... 4 Chest ............................................................................................... 5 Paediatric Chest .............................................................................. 5 Elbow ............................................................................................... 5 Hand/Wrist ....................................................................................... 6 Hip ................................................................................................... 6 Paediatric Hip .................................................................................. 7 Knee ................................................................................................ 7 Shoulder .......................................................................................... 8 Skull ................................................................................................. 8 Spine ............................................................................................... 8 TMJ ................................................................................................. 8

Ultrasound (US)

Abdomen ......................................................................................... 9 Carotid Doppler ............................................................................... 9 Paediatric Hips ................................................................................ 9 Paediatric Renal .............................................................................. 9 Renal ........................................................................................ 10-11 Pelvic ............................................................................................. 12 Scrotal ........................................................................................... 13 Neonatal Spine .............................................................................. 13 Thyroid........................................................................................... 13 Vascular......................................................................................... 14

Computed Tomography (CT)

CT Head ........................................................................................ 15 CT Chest ....................................................................................... 16 CT Abdomen ................................................................................. 16 CT KUB ......................................................................................... 17 CT Colonography .......................................................................... 17 CT Sinus ........................................................................................ 17

Mammography and Breast Ultrasound

Mammography ............................................................................... 18 Ultrasound Breast .......................................................................... 19

Prioritisation Methodology ....................................................20 Appendix 1 - Current Access by DHB ............................................. 21-22 Appendix 2 - Planned Access by DHB ............................................ 23-24 Appendix 3 – Midland Regional Advisory Group Members .................. 25


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Introduction The following regional access criteria for primary referred radiology referrals have been developed from a number of sources, including the draft National Community Radiology Access Criteria (Nov 2013). These criteria have been developed to improve equity of access across the Midland Region. They are a minimum that should be provided and should be read in conjunction with the Prioritisation Methodology detailed in Appendix 2 (when we have redefined this in line with National guidelines). DHB’s will advise local GP’s where copies of these access criteria are available. We are unable to accept any patient referral for investigation without the required actions being completed and the results supplied with the referral. If your patient does not meet the criteria but you think that an investigation is warranted, please phone a DHB Radiologist for advice. If they advise an investigation please document their name as well as all clinical information on the referral form. Primary Care Nurse Practitioner Referrals

The RANZCR considers that appropriately qualified Nurse Practitioners should be able to refer for diagnostic imaging testing within their particular clinical context as approved by the local radiation licensee.

NPs are expected to apply the practice expectations for public protection set out in the Nurse Practitioner practice standard “Competencies for the nurse practitioner scope of practice 2008”.

http://www.cno.org/Global/docs/prac/41038_StrdRnec.pdf


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GENERAL X-RAY

Abdomen Standard indications for x-ray referral

• Diagnosis of constipation where patient history is unobtainable e.g. autism, special needs

• Follow up of diagnosed renal stones with a KUB x-ray • Suspected renal tract stone use local pathway

Referral for x-ray not typically indicated

• Acute abdomen: Discuss with acute surgical services or emergency services access points

• Vague central abdominal pain • Suspected colorectal neoplasm (refer to colorectal cancer guidelines) • Suspected constipation (other than in specific patient groups as above). • Suspected abdominal masses refer to ultrasound

Ankle

Standard indications for x-ray referral Two of the below needed to qualify.

• The pain has been present for >4 weeks. • The pain was sudden in onset and is severe and <4 weeks duration. • There is swelling near the joint. • There is a palpable mass or deformity. • There is limited ROM (range of movement). • There is evidence of inflammatory arthritis.


• Suspected septic arthritis: refer for acute review • Acute gout.

Ankle – Trauma Use Ottawa Ankle Rules


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Chest Standard indications for x-ray referral

The x-ray result will influence patient management.


• Pneumonia doesn’t require routine CXR follow up unless there are risk factors or red flags including age>50 years or age >40 years if smoker, suspicious radiologic findings on initial CXR or incomplete clinical resolution at 6 weeks (this is a guideline only and there may be local pathways which apply)

• Routine assessment of hypertension • Routine monitoring of known pulmonary sarcoidosis • Routine x-ray for asbestos exposure surveillance • Follow-up of nodules detected on chest x-ray or CT other than where

recommended by reporting or reviewing specialist (consider referral for respiratory specialist review)

• Initial investigation of heart murmur, unless signs of complications such as heart failure

• Routine follow-up of asymptomatic patients on amiodarone. Paediatric Chest Standard indications for x-ray referral

• Acute chest infection/sepsis consider acute referral to specialist as per local pathway

• Recurrent productive cough – if resistant to treatment or additional clinical features i.e. pyrexia

• Wheeze with additional features such as fevers and localised crackles, chronic heart or respiratory disease and immunocompromised patients

• Suspected/inhalation foreign body. Referral for x-ray not typically indicated

• Incidental finding of a murmur • Uncomplicated (afebrile) presentation of asthma/bronchiolitis.

Elbow Standard indications for x-ray referral

• Pain has been present for >4 weeks and no response to treatment and/or not reproduced on examination.

• Unrelenting severe pain <4 weeks. • Significant restriction in ROM (range of movement) after 4 weeks. • Unexplained deformity/palpable enlarging mass or swelling. • There is evidence of inflammatory arthritis.


• Suspected septic joint: refer for acute review • Acute gout


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Hand/wrist Standard indications for x-ray referral

• Swelling confirmed on examination • Deformity • Strong history of Inflammatory symptoms >12 weeks with increased

inflammatory markers +/- swelling +/- deformity • Long (>1year) history of Inflammatory symptoms (without increased

inflammatory markers or swelling or deformity) • Pain with red flags

Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause.


• Acute gout • Suspected inflammatory arthritis <12 weeks with no significant inflammatory

markers or swelling or deformity

Guidance • Dedicated wrist views do not typically provide additional information to single

PA hand view. Where inflammatory arthritis is suspected consider requesting an AP feet x-ray as well.

Hip Standard indications for imaging referral

• Undiagnosed hip pain present for more than 4 weeks where the x-ray is expected to change management

• Hip pain with red flags and / or history of recent injury • Known osteoarthritis where symptoms meet local criteria for surgical

consideration (not required if previously x-rayed within 6 months) • Pain in previous arthroplasty.

Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause.


• Suspected septic arthritis: refer for acute review at Emergency Department /Orthopaedic Department

• Mild symptoms and normal examination findings • Follow up of known or suspected osteoarthritis unless development of red

flags or meets local criteria for surgery


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Paediatric Pelvis/hips Standard indications for x-ray referral

• Pain • Limp • Risk factors/ soft signs or suspected development dysplasia of the hip (DDH)

after 5-6 months of age.

Guidance • Capital femoral epiphyses ossify on average at 5-6 months of age; DDH can

usually be reliably excluded from this age onwards on x-ray. • Slipped upper femoral epiphysis require urgent orthopaedic referral. • < 5-6 months of age if clinical suspicion of DDH ultrasound is the investigation

of choice – refer local pathway Paediatric Lower and Upper limb Standard indications for x-ray referral

• Focal bone pain Referral for x-ray not typically indicated

• Osgood-Schlatters, Severs and other apophysitides- x-rays not generally required for diagnosis or management

Knee Standard indications for x-ray referral

• Undiagnosed knee pain present > 4 weeks where the x-ray is expected to change management

• Knee pain with red flags • Known osteoarthritis with symptoms meeting local criteria for surgical

consideration (not required if previously x-rayed within 6 months) • Pain in previous arthroplasty • Swelling or deformity

Red flags include: Persistent deep nagging pain unrelated to activity Night pain in the absence of an obvious cause


• Suspected septic arthritis: refer for acute review • Mild symptoms and normal examination finding • Follow up of suspected or known osteoarthritis unless red flags develop or

clinically now meets criteria for surgical consideration • Suspected meniscal and ligament injury


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Shoulder Standard indications for x-ray referral

• Suspected bone/joint pathology (>4 weeks) with red flags present

Red flags include: Any unexplained deformity, mass, or swelling Persistent deep nagging pain unrelated to activity Night pain in the absence of an obvious cause


• Recent onset pain in the absence of red flags • Frozen shoulder (unless the condition does not follow its expected natural

history) • Pre-requisite for a trial of steroid injection (when a reasonable clinical

diagnosis has been made and red flags are excluded) • Suspected septic arthritis: refer for acute review at Emergency Department

/Orthopaedic Department. Skull Routine x-ray not indicated Spine Standard indications for x-ray referral

• Unrelenting spine pain > 8 weeks • Spine pain with red flags • Spine pain and osteoporosis or prolonged use of corticosteroids • Significant spinal deformity

Red flags include: Persistent deep pain unrelated to activity Night pain in the absence of obvious cause History of cancer Immunosuppression Signs of infection : refer for acute review


• Coccyx pain • Acute and chronic uncomplicated spine pain without red flags

Guidance

• For high clinical suspicion of infection or cancer consider referral for acute review

TMJ Xray is not indicator for TMJ pain


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ULTRASOUND

Abdomen

Standard indications for ultrasound referral

• Asymptomatic with abnormal Liver Function Test (LFTS) -more than 3 times normal range persisting for at least 3 months

• Suspected biliary tract obstruction or malignancy (infective causes and medications excluded)

• Abdominal mass or other palpable abdominal abnormality

• Painless jaundice without obvious cause

• Clinical biliary colic/gallstones (not already imaged) or use established

pathway

• Suspected asymptomatic aortic aneurysm (AAA) Radiological report indicates the following maximum measurement of aorta:

Normal < 3 cms No further routine radiology FU AAA 3 – 3.9 cms Repeat scan 2 years AAA 4 – 4.5 cms 1 year scan AAA 4.6 – 5.0 cms 6 month scan AAA 5.1 – Over URGENT vascular referral If expansion URGENT vascular referral

> 7mm in 6 months > 1 cms in 12 months

Required Actions Please supply appropriate biochemistry and dates with abdominal ultrasound referral

Carotid Doppler

Use local pathways

Paediatric Hips

No direct access; refer local pathway Paediatric Renal Refer local pathway


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Renal


• Loin pain suggesting renal tract obstruction

• Haematuria

persistent isolated microscopic haematuria > 25 year old (defined as 2 or more episodes of positive urine dipstick of 1+ or more i.e. not trace) and infection excluded and renal impairment (as defined below)

macroscopic haematuria with UTI excluded

persistent isolated microscopic haematuria >25yo (on two or more on

MSU; not dipstix) and infection excluded and normal renal function

• Chronic urinary retention with palpable enlarged bladder

• Renal Impairment No prior relevant renal imaging and recheck with good hydration.

Acute kidney injury (increase in serum creatinine of more than 50% from baseline and/or decrease in eGFR of more than 50% from baseline) AND Consider direct referral to renal service.

Progressive chronic kidney disease (> 5 ml/min/year eGFR loss or >

10 mls/min over 3 years)

Guidance • Proteinuria >1.0g/24hours or protein/creatinine ratio >100 mg/mmol or

albuminuria (albumin/creatinine ratio>65 mg/mmol) - consider referral to renal physician

• If long term stable elevated creatinine/low eGFR then potential for any

reversibility low therefore US findings unlikely to change management. • In diabetic with known diabetic complications, ultrasound may not be indicated.


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• Adult UTI

Females: > 3 documented UTI's in 6 months, or 6 in a year despite adequate

courses of culture specific antibiotics. This pattern implies bacterial persistence rather than recurrence. (Ensure that patient has not previously been investigated with imaging)

Recurrent pyelonephritis with no previous imaging. Males: Recurrent or persistent infections (if not previously investigated with

imaging)

• Paediatric UTI (please see local guidelines)

Required Actions Please supply appropriate biochemistry and dates with renal ultrasound referral


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Pelvic


• Post menopausal bleeding (bleeding after 1 year of amenorrhoea)

• Pelvic Mass or uterine size >12 weeks

• Primary amenorrhoea (delay menarche after age of 18years with appropriate

endocrine assay)

• IUCD not visible

• Polycystic Ovary Syndrome (PCOS) only if appropriate biochemical signs of

hyperandrogensism or oligo- or amenorrhoea. If both present US not

required.

• Chronic Pelvic pain/ suspected endometriosis – persisting symptoms over at

least 3 month with PID excluded

• Heavy menstrual bleeding (heavy cyclical menstrual bleeding over several

cycles) and Age > 45years or Age >35years with at least one of the following:

Weight >90kg

Risk factors for endometrial hyperplasia (nulliparity, infertility,

FH endometrial/colon cancer, use of either Tamoxifen or

unopposed oestrogens, P.C.O.S)

First degree relative less than 60 years old with a diagnosis of

endometrial or bowel cancer

Required Actions All referrers should have completed ALL of the following:

I have removed a copper IUCD and observed for 3 months, or there is no

IUCD present

I have carried out a pelvic examination, visualized the cervix and taken a

smear and STI check if appropriate

Those patients without risk factors have had no improvement with a three

month trial of medical management (hormonal/tranexamic acid/mirena)

Appropriate biochemical profiles to be supplied for PCOS Ultrasound referrals

Local pathways should be followed


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Scrotal


• Scrotal masses with concerning features i.e. testicular, painless, nontransilluminating, rapidly growing –(urgent urology referral recommended)

• Scrotal masses where it is unclear if the swelling is testicular or extra-testicular

• New hydrocele in adults (may be secondary to testicular cancer).

Referral for imaging not typically indicated

• Non-solid (transilluminating) scrotal masses • Hydrocoele in children • Long-standing hydrocoele in adults • Acute inflammatory conditions and only refer for ultrasound if symptoms and

/or swelling fail to resolve with antibiotics • Chronic orchalgia in the absence of abnormality on examination

Guidance

• Urgent referral to Urology or General Surgery should not be delayed by a wait for ultrasound scan if there are red flags for:

testicular torsion

testicular cancer

strangulated inguinal hernia

acute testicular trauma

• Scrotal masses can often be diagnosed clinically. If unsure, seek a second opinion from a general practitioner colleague or specialist.

Neonatal Spine No direct access Thyroid Standard indications for ultrasound referral Rapidly enlarging mass. If you have any concerns discuss or refer to an Endocrinologist or a Hospital Specialist


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Vascular


• Pulsatile mass for investigation

• Suspected deep venous thrombosis (DVT) – use local pathway


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CT SCANNING

CT Head Standard indications for CT referral

• New/Progressive Headache with background of systemic illness with cerebral complications or involvement especially malignancy ( breast, lung, melanoma)

• Chronic Headache (lasting more than 3 months for more than 15 days per

calendar month) with one or more of the following:

new onset >50 yrs change in pattern of headaches with increase in frequency or severity aggravated by exertion or Valsalva associated with nausea and vomiting

• Cognitive Decline

The main reason for imaging is to identify and rule out pathologies other than Dementia of the Alzheimer’s type and Vascular Dementia.

A careful neurological screening examination is to be carried out including a brain CT scan, if there are one or more of the following in addition to cognitive decline (for example a MoCA Score of less than 26 or similar decline using validated assessment tools – see initial cognitive assessment node):

age less than 65 unexpectedly rapid decline in cognition or function onset significant headache any localising or unexplained neurological signs recent head trauma history of cancer with high risk of intracranial metastases (particularly

lung, breast, colon/pancreatic, genitourinary, melanoma, head and neck cancers and lymphoma).

use of anticoagulants history of bleeding in conjunction with other factors listed

history of the combination of urinary incontinence, balance and gait disorder suggesting possible Normal Pressure Hydrocephalus (NPH)

gait disturbance, not otherwise explained intellectual disability

If a CT is indicated, clinician (GP or hospital doctor) to request via radiology as per local pathway agreements.

• Headache in Children

As per local pathway


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Guidance While CT may be appropriate as part of the workup, initial discussion with a local

relevant specialist is recommended for patients with:

Focal neurological signs

Notes Clinical circumstances determines urgency

If patient is pregnant consider specialist opinion

Additional Notes – Cognitive Decline If you are unsure or there are unusual/atypical symptoms, or there is clinically

significant immunosuppression, then seek advice through the advice line in your local

information node

CT Chest

On recommendation by Radiologists from an Abnormal Chest Xray with suspected cancer reported.

Required Actions Please enclose a copy of the report recommending further investigation with your referral Specialist referral should not be delayed whilst waiting for an investigation where there are red flag symptoms

CT Abdomen

On recommendation by Radiologists from an Abnormal Ultrasound or CT Colonography with suspected cancer reported.

Required Actions Please enclose a copy of the report recommending further investigation with your referral Specialist referral should not be delayed whilst waiting for an investigation where there are red flag symptoms


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CT KUB

Referral for CT KUB is the preferred imaging investigation for:

• Non pregnant patients with renal colic

Guidance

• Referral should be guided by your local pathway which may include

Primary Options

CT Colonography

Use local pathway

CT Sinus

Referral for CT sinus not indicated unless there is local pathway which supports this.


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MAMMOGRAPHY AND BREAST ULTRASOUND

Mammography

Asymptomatic Women

a mother or sister or daughter with pre-menopausal breast cancer or

bi-lateral breast cancer, or a breast histology demonstrating an at risk

lesion. Imaging to start 10 years before diagnosis of the youngest first

degree relative, but not before 30 years. Alternating with BSA from 45

years.

NOTE: MRI is advised if less than 30 years – refer to specialist.

a breast histology demonstrating an at risk lesion (for example, a

typical hyperplasia

If previous breast cancer – annually. NB After 5 years can re-enter

BSA

Symptomatic Women If new breast symptom, not lactating or pregnant and any of the following:

Palpable lump and no normal mammogram in the last year

Bloody or serous nipple discharge

35 years and over (If under 35 – refer for Ultrasound)

New inversion of Nipple)

Referral for Mammogram not typically indicated for:

• Breast pain without associated lumps or other symptoms

Guidance

• If you are unsure please discuss with a radiologist


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Ultrasound Breast

• Women <35 years with symptoms as follows:

Palpable lump and no normal mammogram in the last year

Bloody or serous nipple discharge

New inversion of Nipple)

• Men with unexplained or suspicious unilateral breast enlargement • Axillary lymph node enlargement or suspected lymph node enlargement in

the absence of obvious infectious cause.

Referral for ultrasound not typically indicated

• Breast pain alone • Bilateral male breast enlargement.

Guidance

• Referral to local breast service for advice / assessment and multidisciplinary work up is preferable and where this is available locally would supersede these recommendations

• In the absence of access to breast clinic services patients over the age of 35 and all patients presenting with suspicious masses should be referred for mammography along with ultrasound as part of the initial work up.

• Pagets disease is not excluded with normal imaging. If clinical concern seek Surgical assessment.


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Prioritisation Methodology The following methodology will be used by Midland DHB Radiology Departments. It is subject to the interpretation of clinical information in the referral and service capacity. Note that any procedure should only be requested where the results (either positive or negative) will alter the management of the patient’s condition/will either confirm or eliminate significant disease from the differential diagnosis.

Priority description Timeframe URGENT: Where immediate treatment and management of acute condition is dependent on diagnosis:

High clinical probability of malignancy or serious inflammatory/infective condition.

High clinical probability of fracture. Major functional impairment including

uncontrolled pain. Risk of significant permanent damage

to tissues or systems if diagnosis is delayed.

Imaging takes place within 7 working days.

SEMI-URGENT: Conditions where there is possibility of malignancy, serious inflammatory / infective condition, and complications or where imaging may affect short term management.

Imaging takes place within 4 weeks.

ROUTINE: Conditions with minor functional impairment and where imaging is unlikely to affect short term management, but likely to affect long term management.

Imaging takes place within 6 weeks (key performance indicator measure)

DECLINED:

• Referrals that meet the criteria but are unable to be offered within 4 months

• Referrals that do not meet the criteria


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Appendix 1 – Current Access by DHB

Table by DHB showing CURRENT referral access pathway by procedure type Procedure BOP DHB Lakes DHB Tairawhiti

DHB Taranaki DHB

Waikato DHB

General X-ray On Hold Abdomen Direct Access Direct Access Direct

Access Direct Access

Ankle Direct Access Direct Access Direct Access

Direct Access

Chest Direct Access Direct Access Direct Access

Direct Access

Paediatric Chest

Direct Access Direct Access Direct Access

Direct Access

Elbow Direct Access Direct Access Direct Access

Direct Access

Hand/Wrist Direct Access Direct Access Direct Access

Direct Access

Hip Direct Access Direct Access Direct Access

Direct Access

Paediatric Pelvis/hips


Direct Access

Paediatric Lower/Upper Limb


Direct Access

Knee Direct Access Direct Access Direct Access

Direct Access

Shoulder Direct Access Direct Access Direct Access

Direct Access

Spine Direct Access Direct Access Direct Access

Direct Access

Ultrasound On Hold Abdomen Direct

Access, Local Gallbladder Pathway

Direct Access Direct Access

Direct Access

Carotid Doppler Local Pathway

Local Pathway Local Pathway

Vascular Lab

Paediatric Hips No Direct Access, Local Pathway

Local Pathway Direct Access

No direct Access, Paediatric Orthopaedic Clinic

Renal Direct Access Direct Access Direct Access

Direct Access

Paediatric Renal

Local Pathway


Direct Access

Pelvic Direct Access, Local HMB Pathway


Direct Access


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Scrotal Direct Access Direct Access Direct Access

Direct Access

Thyroid Direct Access Direct Access Direct Access

Direct Access

Vascular Direct Access for AAA, DVT Pathway

Direct Access Direct Access for AAA, DVT Pathway

Direct Access for AAA, DVT GP Pathway

CT Scanning CT Head –Headache

No Access without discussion


Limited Access

CT Head – Cognitive Decline

No Direct Access, Local Pathway

Local Pathway with Consultant Referral

Direct Access

Local Pathway with Specialist Referral

CT Head – Headache in Children




Local Pathway with Specialist Referral

CT Chest Radiologist recommendation only

Access via Chest Physician

Direct Access

Limited Access

CT Abdomen Radiologist recommendation only

No Access Direct Access

Limited Access

CT KUB Local CPO Pathway in development

Radiologist request only

Direct Access

Limited Access via Map of Medicine Renal Colic Pathway

CT Colonography

Local Pathway

Local Pathway Local Pathway

No Access

CT Sinus No Access Direct Access Direct Access

Limited Access

Mammography and US Breast

Mammography Direct Access Direct Access to Private

Direct Access

Direct Access

US Breast Direct Access Direct Access to Private

Direct Access

Direct Access


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Appendix 2 – Planned Access by DHB Table by DHB showing PLANNED referral access or pathway by procedure type once new

criteria have been published Procedure BOP DHB Lakes DHB Tairawhiti

DHB Taranaki DHB

Waikato DHB

General X-ray On Hold Abdomen Direct Access Direct Access Direct

Access Direct Access

Ankle Direct Access Direct Access Direct Access

Direct Access

Chest Direct Access Direct Access Direct Access

Direct Access

Paediatric Chest Direct Access Direct Access Direct Access

Direct Access

Elbow Direct Access Direct Access Direct Access

Direct Access

Hand/Wrist Direct Access Direct Access Direct Access

Direct Access

Hip Direct Access Direct Access Direct Access

Direct Access

Paediatric Pelvis/hips


Direct Access

Paediatric Lower/Upper Limb


Direct Access

Knee Direct Access Direct Access Direct Access

Direct Access

Shoulder Direct Access Direct Access Direct Access

Direct Access

Spine Direct Access Direct Access Direct Access

Direct Access

Ultrasound On Hold Abdomen Direct Access,

Local Gallbladder Pathway


Direct Access

Carotid Doppler Local Pathway Local Pathway Local Pathway

Vascular Lab

Paediatric Hips No Direct Access, Local Pathway


No direct Access, Paediatric Orthopaedic Clinic

Renal Direct Access Direct Access Direct Access

Direct Access

Paediatric Renal Local Pathway Local Pathway Direct Access

Local Pathway

Pelvic Direct Access, Local HMB Pathway


Direct Access

Scrotal Direct Access Direct Access Direct Access

Direct Access


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Thyroid Direct Access Direct Access Direct Access

Direct Access

Vascular Direct Access for AAA, DVT Pathway

Direct Access Direct Access for AAA, DVT Pathway

Direct Access for AAA, DVT GP Pathway

CT Scanning CT Head –Headache

Identify volumes – Increase CR Contract, identify additional resources



CT Head – Cognitive Decline



Direct Access


CT Head – Headache in Children





CT Chest Radiologist recommendation only

Access via Chest Physician

Direct Access

Radiologist recommendation only

CT Abdomen Radiologist recommendation only

No Access Direct Access

Radiologist recommendation only

CT KUB Local CPO Pathway in development

Radiologist request only

Direct Access

Local pathway via MOM Renal Colic Pathway

CT Colonography

Local Pathway Local Pathway Local Pathway

No Access

CT Sinus No Access Direct Access Direct Access

No Access

Mammography and US Breast

Mammography Direct Access Direct Access to Private

Direct Access

Direct Access

US Breast Direct Access Direct Access to Private

Direct Access

Direct Access


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Appendix 3 Midland Radiology Advisory Group Members Members of the Midland Radiology Advisory Group who have reviewed the Regional Access Criteria for Community Referred Radiology are as follow:

Name Title Organisation

Roger Lysaght Service Manager, Ambulatory Service

Lakes DHB

Andrew Klava HOD Radiology Lakes DHB

Gloria Crossley Clinical Services Manager- Allied Health, Scientific & Technical

Taranaki DHB

Alina Leigh Consultant Radiologist Taranaki DHB

Sue Howard Clinical Imaging Manager Taranaki DHB

Kevin Harris Assistant Group Manager Waikato Hospital

Waikato DHB

Zubayr Zaman Consultant Radiologist Waikato DHB

Rose Newman Consultant Radiologist Waikato DHB

Kim McAnulty Consultant Radiologist Waikato DHB

Sabaratnam Muthukumaraswarmy

HOD Radiology Waikato DHB

Jill Wright Regional Radiology Manager BOP DHB

Roy Buchanan HOD Radiology BOP DHB

Helen Seymour Consultant Radiologist BOP DHB

Gerard Eager Consultant Radiologist BOP DHB

Leigh Potter Radiology Service Manager Tairawhiti DHB

Charles Robinson HOD Radiology Tairawhiti DHB

Lisa Hughes GP Liaison Lakes DHB

Mike Agnew/Stewart Ngatai Portfolio Manager Planning and Funding

BOP DHB

Sue Matthews Primary Options Coordinator WBAY PHO

Joe Bourne GP Liaison BOP DHB

Nick Hanna GP BOP

Rawiri Keenan MHN (GP) Waikato

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