One of the questions that patients sometimes ask us is why radiologists are so strict about referrals from other medical professionals. If you’re wondering about this too, this explainer could help you understand the reasons behind the radiology referral system.

Medical necessity

Referrals ensure that imaging requests are clinically justified. This process allows radiologists to prioritise imaging procedures according to information in the referring doctor’s request. The request is based on the patient’s medical history and symptoms and could help ensure they receive appropriate care.

Appropriate imaging

A referral provides essential clinical context, allowing radiologists to select the most suitable imaging technique or modality. Some injuries or illnesses will be more visible on an X-ray image, while others may require an MRI or an ultrasound. Knowing precisely what pathology the referring doctor suspects will help radiology staff to select the best imaging technique and, ultimately, to diagnose conditions more accurately.

Patient safety

Your referring doctor is trained to know when imaging is essential. Requiring referrals can therefore minimise unnecessary radiation exposure. This is particularly important for patient safety in radiology practices.

The guiding principle of radiation safety is ALARA, which stands for “as low as reasonably achievable”. As part of this responsibility, not to expose the general public to unnecessary radiation, X-ray-based imaging may only be done when it’s indicated and when the benefits outweigh exposure risk.

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Cost efficiency

Referrals help reduce unnecessary costs for patients and medical schemes. Appropriate imaging, based on a referral, can prevent patients from undergoing redundant tests, ultimately saving resources for everyone involved.

Appropriate care

Importantly, your referring doctor is trained to know what to do with the result of an X-ray or scan. With detailed clinical information accompanying referrals, radiologists can provide targeted recommendations to the referring doctor, who can then decide on the appropriate next steps and follow-up care, improving patient outcomes.

Exceptions for referrals

Some screening examinations in asymptomatic patients, such as mammograms or DEXA scans (to measure bone mineral density), may be performed at the patient’s request without a referral letter, provided they meet the screening criteria for that particular examination. We suggest talking to your doctor about screening criteria.

In emergency situations, verbal referrals may be accepted, but these should be followed up with a written or electronic referral note to ensure proper documentation and continuity of care.

A final note

As fully qualified medical doctors with an additional specialist’s qualification in medical imaging, radiologists are ideally positioned to recommend appropriate and safe imaging for patients. Receiving a referral does not always obligate the radiologist to perform the examination exactly as requested. Sometimes they will recommend or perform alternative examinations if these are indicated by clinical factors or patient safety, as long as the patient’s best interest and appropriate care always remain the top priority.

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• This article is intended to create awareness and none of the information it contains should replace the need for seeking personal advice from a qualified medical practitioner.
• Apart from selected screening examinations, all radiology procedures are performed upon referral from a qualified medical professional.