Referring for an x-ray is similar to writing a prescription and there are legal requirements that you must comply with when referring for an x-ray. You can only work as a referrer if you are entitled to do so by the employer. If you fail to undertake your responsibilities as a referrer you may have your referral privileges removed.
Understand the legal framework
It is really important that you understand why you are being asked to do things. A background understanding of the legislation will help you with this. Below is a short introduction, if you want more information there is a detailed IR(ME)R package on the E-Learning for Healthcare website here.
More information can be found here:
Work within your agreed scope of practice
Working outside your scope of practice could put your professional registration at risk.
Your scope of practice will depend on whether you are a medically qualified referrer (medic or dentist) or a non-medically qualified referrer. See below for more details:
Medically qualified referrers
All medically qualified doctors and dentists are able to refer for medical imaging using radiation if permitted by the site that carries out the imaging.
Non-medically qualified referrers
You may also be a non-medically qualified referrer as long as you:
are a registered healthcare profession,
have had adequate training
have been entitled by the employer of the individual exposing the patient to radiation to act in this role.
It is important to note that just because you can act as a non-medical referrer for one hospital (for example) it does not mean that you can automatically act as a non-medical referrer for another hospital. You have to be entitled under each employer's procedures. Some comprehensive guidance on non-medical referrers can be found here.
Know how to refer for an x-ray
Make sure that you are aware of the referral criteria where you are. Most places base their referral criteria on iRefer.
This short educational cartoon designed by firstname.lastname@example.org, and funded by the Health Foundation, talks you through the thought process of a doctor requesting X-rays.
Inform the patient of risks and benefits
Informing the patient of the risks and benefits of medical imaging using ionising radiation is a legal requirement. It is important ethically that we involve patients in the decision making process. The video below gives you practical information about how to do this.
For more information to support you to have these conversations including example conversations, individual exam risk values and other useful resources press the button below:
Know which individuals are more radiosensitive
Individual radiosensitivity varies depending on age, genetics and environmental factors.
Children are more sensitive to radiation. Because of the unique challenges around radiation exposure in children the World Health Organization has produced leaflets and posters which can be found here.
If an individual is pregnant the risks of exposing the unborn baby must also be considered when justifying an exposure to medical radiation. If you are referring for Nuclear Medicine procedures you referral must include information about breastfeeding status. Further information can be found on the following page:
There are rare genetic conditions that are believed to increase radiosensitivity such as Ataxia Telangiectasia and Nijmegen Breakage Syndrome. A detailed report by UKHSA (previously HPA) can be found here.
Understanding and being able to discuss the risks with your patients allows you to make more efficient use of precious health resources. We have provided further resources here:
If you have any queries please seek the advice of your local Medical Physics Expert.