Radiology department guidelines - 2012 to now

Summary

The requester asked for specific written guidelines governing MRI referrals and refusals at the Nobles Radiology department from 2012 to present. The Department of Health and Social Care explained the current vetting process and referral criteria but refused to provide historical written guidelines, stating they do not hold them as practice follows general medical standards.

Key Facts

• MRI requests are vetted individually by a Consultant Radiologist based on best medical practice.
• Referrals to the UK occur only if the examination is a sub-speciality, requires unavailable procedures like paediatric sedation, or needs equipment not on-island.
• The Department does not hold specific written guidelines for the Radiology department dating back to 2012.
• Radiology practices align with General Medical Council (GMC) Good Medical Practice guidelines.
• Examination appropriateness follows Royal College of Radiology (RCR) guidelines.

Data Disclosed

• 2012
• 2020-07-28
• 2020-08-24
• 1391261
• section 11(3)a

Exemptions Cited

• Section 11(3)a of the Act (Practical refusal: information not held or cannot be found after reasonable steps)

Original Request

Question 1: What are the guidelines applicable to the Nobles Radiology department that would determine how the standard response to an Magnetic Resonance Imaging (MRI) request from a Nobles clinician was decided - specifically, what would lead the radiology department to refuse to investigate a patient presented by a doctor employed by Nobles, or to refer that patient to the UK to receive an MRI facility not provided on-Island.? Question 2: I would like the guidelines in place in 2012, and any subsequent changes to those guidelines, along with the date applicable.

Data Tables (1)

Full Response Text

Interim Chief Executive: Kathryn Magson Freedom of Information Team Crookall House Demesne Road Douglas Isle of Man IM1 3QA

Tel: (01624) 642621 Email: dhsc@foi.gov.im Website: www.gov.im/dhsc Our ref: 1391261 20th August 2020

Dear ###

We write further to your request which was received on the 28th July 2020 and states:

"Question 1: What are the guidelines applicable to the Nobles Radiology department that would determine how the standard response to an Magnetic Resonance Imaging (MRI) request from a Nobles clinician was decided - specifically, what would lead the radiology department to refuse to investigate a patient presented by a doctor employed by Nobles, or to refer that patient to the UK to receive an MRI facility not provided on-Island? Question 2: I would like the guidelines in place in 2012, and any subsequent changes to those guidelines, along with the date applicable." Our response: Question 1: What are the guidelines applicable to the Nobles Radiology department that would determine how the standard response to an Magnetic Resonance Imaging (MRI) request from a Nobles clinician was decided - specifically, what would lead the radiology department to refuse to investigate a patient presented by a doctor employed by Nobles, or to refer that patient to the UK to receive an MRI facility not provided on-Island?

All the cross sectional examination requests are vetted by a Consultant Radiologist on an individual basis. When vetting the Radiology Department follows best medical practice guidelines, the Radiology Department assesses the request and do one of the following: 1. Accept the request as it is, because the clinical information is sufficient, clear and justifies exactly the examination requested. 2. Request more information before the Radiology Department decides what the best examination for the patient is. This happens when the clinical information given to the

Radiology Department in the request form is inadequate, or does not justify the scan requested, in this case more information is asked for to clarify what is the best examination for the patient. 3. The Radiology Department suggests a change of examination. If the clinical information is sufficient, however the examination requested is not the right one, the Radiology Department will suggest changing it to the correct one. 4. The Radiology Department refuses the examination because the clinical information does not justify the examination requested, and an option is given to discuss this. In all the above cases, and in case the clinician (from Noble’s Hospital or from Primary Care) needs advice or needs to discuss a case, the Radiology Department always has someone available to take calls or to discuss in person in the Department. The Radiology Department would advise for the patient to have an MRI in the UK only if the Department is unable to offer the examination on Island. The main reasons would be: 1. If the examination is a sub-speciality scan which needs a specific expertise both performing and reporting, such as cardiac MRI. 2. In cases where the patient needs a particular procedure which is not offered by the Department, such as paediatric sedation. 3. If the Radiology Department don’t have the equipment, for example in cases of PET (positron emission tomography) scans. Question 2: I would like the guidelines in place in 2012, and any subsequent changes to those guidelines, along with the date applicable While our aim is to provide information whenever possible, in this instance Department of Health and Social Care (“the Department”) is unable to provide the information you have requested. This is in line with section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. The Radiology Department does not have specific written guidelines, as the approach falls into the general GMC (General Medical Council) Good Medical Practice guidelines.
The Radiology Department also has a questionnaire whereby a scan would be refused if the patient did not meet the safety requirements covered in the questionnaire e.g. they had a non MRI compatible implant. The Radiology Department for examination appropriateness follows the RCR (Royal College of Radiology) guidelines. To provide help and assistance you can find those guidelines on the RCR webpage by using this link https://www.rcr.ac.uk/guidelines

Please quote the reference number 1391261 in any future communications.

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I will now close your request as of this date.

Yours sincerely