MRI Ordering Guidelines
Referral and Triage Process
To refer a patient for an MRI study, a standard MRI requisition must be completed and faxed to the hospital of your choice. All requests for MRI services are screened by a local radiologist for appropriateness and triaged according to level of urgency. Please refer to the Canadian Association of Radiologists Diagnostic Imaging Referral Guidelines (2012) for appropriate indications (http://www.car.ca/en/standards-guidelines/guidelines.aspx). Any requisition that lacks a detailed written indication will be returned to the requesting physician. On reviewing the requisition, the radiologist may: return the request as not indicated, return the request for more information, suggest or book an alternate investigation.
MRI wait times vary across the province and can be lengthy for non-urgent or routine cases at some hospitals. Referring physicians are encouraged to consult the Nova Scotia Wait Time Website at http://waittimes.novascotia.ca/ to help guide decisions about referral location for patients who are able to travel. Physicians are asked to send requisitions to only one hospital, as simultaneous requests to multiple hospitals block openings and contribute to longer wait times.
Family Physician and Nurse Practitioner Ordering
Starting in February 2013, all family physicians and Nurse Practitioners in Nova Scotia may order adult MRI services directly without prior approval from a specialist or radiologist. The ability to order MRI services directly is based on a phased approach by body region beginning with investigations for central nervous system (brain), head and neck conditions starting February 28, 2013. The subsequent phases are tentatively scheduled as follows:
- Phase 2: Spine – June 2013
- Phase 3: Musculoskeletal System – September 2013
- Phase 4: Cardiac/Thoracic Systems and Abdomen/Pelvis Conditions – April 2014
Pediatric MRI exams and breast MRI exams are excluded from the new policy and will continue to follow existing ordering protocols.
Some patients cannot safely undergo MRI because they have metallic foreign bodies in the eye or certain implanted medical devices in their bodies. Patients with severe renal failure cannot safely undergo gadolinium enhanced MRI. It is very important to fill out the safety information on the MRI requisition. Many implanted medical devices are MRI safe. Information about specific devices can be obtained at www. mrisafety.com.
Approximately 10% of patients experience significant claustrophobia in the MRIs.