{"id":13356,"date":"2022-12-22T11:39:18","date_gmt":"2022-12-22T11:39:18","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=13356"},"modified":"2026-02-05T08:47:26","modified_gmt":"2026-02-05T08:47:26","slug":"plain-x-rays","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/radiology\/plain-x-rays\/","title":{"rendered":"Plain X-Ray &amp; Ultrasound"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\"><strong>Plain X-Rays<\/strong><\/h4>\n\n\n\n<p>Most referrals for Plain x-rays should be made via SCI Gateway using the <strong>Radiology Plain X-ray<\/strong> protocols under the specific location where the x-ray is to take place. In certain practices where there has been appropriate training they are able to use the ICE Ordering system to order <strong>Plain X-rays<\/strong>.<\/p>\n\n\n\n<p>(If ordering electronically is not possible, such as in the event of significant IT failure, please use the appropriate paper X-ray department form. These should be sent via internal mail and when advising patients to phone to arrange the x-ray, allow 48 hours for form to arrive.)<\/p>\n\n\n\n<p><strong>After referral all plain x-ray requests need to be scheduled in by the patient phoning the appropriate department using the guidance above.<\/strong><\/p>\n\n\n\n<p><strong>TELEPHONE BOOKING SYSTEM FOR PRIMARY CARE ELECTRONIC PLAIN FILM REQUESTS<\/strong><\/p>\n\n\n\n<p><strong>All plain x-ray requests need to be scheduled in by the patient phoning the appropriate department.<\/strong><\/p>\n\n\n\n<p>In Radiology, we remain extremely grateful to you for using electronic requesting and the phone booking system. This has significantly improved how we deal with the large number of requests we receive and has improved the efficiency of the X-ray departments.<\/p>\n\n\n\n<p>Please follow the following guidance for requesting Plain X-rays:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>The electronic referral MUST be made before a patient phones for an appointment<\/strong><\/li>\n\n\n\n<li><strong>The referrer must select the correct priority (Routine or Urgent) on the electronic referral before it can be sent. <\/strong>The majority of referrals will be Routine, however in certain circumstances (see below) the Referral should be requested as Urgent.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a><strong>In the few cases where the request for an x-ray is urgent (e.g. the suspicion of lung cancer in a CXR request) then please indicate that the priority is urgent on the SCI Gateway request. Radiology will always try to prioritise these requests and ensure that the patient is offered an appointment as soon as possible.<\/strong><\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Please ask the patient\/carer to wait ONE WORKING DAY after submission of a referral before phoning for an appointment<\/strong>. This is because all x-ray requests must be vetted in accordance with <a href=\"https:\/\/www.hse.gov.uk\/pubns\/books\/l121.htm\" target=\"_blank\" rel=\"noreferrer noopener\">IRMER rules<\/a><\/li>\n\n\n\n<li><strong>Patients MUST phone the department to arrange an appointment, they should NOT PRESENT themselves to x-ray departments as they used to be able to.<\/strong><a><strong> <\/strong><\/a>This may need to be explained clearly to patients who previously last attended for x-rays when walk-in was the system.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients may have to wait several days for an appointment or be asked to attend another site for an alternative appointment.<\/li>\n\n\n\n<li>Please remember that <strong>Children under 16<\/strong> should attend either the Royal Hospital for Children and Young People or St John\u2019s Hospital for Plain x-rays.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients MUST phone within 30 days of the referral being made (unless a follow up film has been recommended beyond the standard 4 weeks. Please see the <strong>Specific Referral Guidance<\/strong> section below on <strong>Follow up CXRs in primary care <\/strong>for more information regarding the arrangements in such cases).<\/li>\n<\/ul>\n\n\n\n<p><strong><br>How to discuss with patients arranging a plain x-ray<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"951\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-951x1024.png\" alt=\"plain xray GP script\" class=\"wp-image-23404\" style=\"aspect-ratio:0.9287240211188086;width:691px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-951x1024.png 951w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-279x300.png 279w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-768x827.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-1426x1536.png 1426w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-1901x2048.png 1901w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/plain-xray-GP-script-1058x1140.png 1058w\" sizes=\"auto, (max-width: 951px) 100vw, 951px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p>Where it is appropriate, the following forms may be helpful to GPs. They can be handed directly to the patient and lay out the current arrangements for x-rays in NHS Lothian. &nbsp;There are two versions of the form \u2013 the first one can be used with labels stuck on to provide patient details, the second version can be used by practices which use Vision as a Vision template.<\/p>\n\n\n\n<p><strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/XRay-patient-information-sheet-May-24-Label-version-7.docx\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/XRay-patient-information-sheet-May-24-Label-version-7.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Information Sheet for X-rays &#8211; Label Form<\/a><\/strong><\/p>\n\n\n\n<p><strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/XRay-patient-information-sheet-May-24-Vision-template-version-4.docx\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/XRay-patient-information-sheet-May-24-Vision-template-version-4.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Information Sheet for X-rays &#8211; Vision Template<\/a><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td colspan=\"2\"><strong>Radiology Departments Contact Information for Patients to call Monday to Friday Only<\/strong><\/td><\/tr><tr><td>Leith Community Treatment Centre (8.30am-4.00pm)<\/td><td>0131 536 6400<strong><\/strong><\/td><\/tr><tr><td>East Lothian Community Hospital (8.30am-4.00pm)<\/td><td>01620 642 732<strong><\/strong><\/td><\/tr><tr><td>Midlothian Community Hospital (9.15am-4pm)<\/td><td>0131 454 1045<strong><\/strong><\/td><\/tr><tr><td>Lauriston Building (8.30am-4.00pm)<\/td><td>0131 536 2942<strong><\/strong><\/td><\/tr><tr><td>RHCYP (U16s only) (8.30am-4.00pm)<\/td><td>0131 312 0880<strong><\/strong><\/td><\/tr><tr><td>RIE (09.00am-5.00pm)<\/td><td>0131 242 3700<strong><\/strong><\/td><\/tr><tr><td>SJH (8.30am-5.00pm)<\/td><td>01506 524 339 or 01506 524 350<strong><\/strong><\/td><\/tr><tr><td>WGH (8.30am-5.00pm)<\/td><td>0131 537 2054<strong><\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Specific Referral Guidance<\/strong><\/h4>\n\n\n\n<p>Please see the links at the top of this page for radiological guidance related to anatomical area, however the Radiology Department would like to highlight the specific pathways below. These are usually highlighted because they of either being high use pathways or because they have been recently amended:<\/p>\n\n\n\n<p><strong>Follow Up CXRs in Primary Care: <\/strong>In cases where a follow up film has been recommended beyond the standard 4 weeks this will be done and the patient will not be turned away. Please see below the diagram below for further information regarding the arrangements as well as the specific guidance outlined in the <strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Edinburgh-Adult-Pneumonia-CXR-FOLLOW-UP-ADVICE-DEC-24.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Edinburgh-Adult-Pneumonia-CXR-FOLLOW-UP-ADVICE-DEC-24.pdf<\/a><\/strong><\/p>\n\n\n\n<p><strong>GP REQUEST FOR ? NOF#:<\/strong> If referring for assessment to rule out fractured NOF in patients who have had had a fall with hip pain and where A&amp;E referral is not considered appropriate, please see the Radiology Flow Chart <strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/GP-REQUEST-FOR-NOF-FRACTURE-XRAY-MARCH-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Radiology Guidance re GP REQUEST FOR NOF FRACTURE XRAY MARCH 2025<\/a><\/strong> as to where the patient should be seen for x-ray. This is to avoid patients becoming stranded in community radiology clinics if they are found to need acute review.<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"491\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Specific-Referral-Guidance-Image-1024x491.png\" alt=\"Specific Referral Guidance Image\" class=\"wp-image-26030\" style=\"aspect-ratio:2.085611365472664;width:801px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Specific-Referral-Guidance-Image-1024x491.png 1024w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Specific-Referral-Guidance-Image-300x144.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Specific-Referral-Guidance-Image-768x368.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Specific-Referral-Guidance-Image.png 1047w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<h4 class=\"wp-block-heading\">Ultrasound<\/h4>\n\n\n\n<p>All referrals for Ultrasound should be made via SCI Gateway using the <strong>Radiology \u2013 Ultrasound<\/strong> referral form. For general ultrasound requests this referral pathway is available at:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Leith Community Treatment Centre, East Lothian Community Hospital, Lauriston Building, Royal Infirmary Edinburgh, Western General Hospital, St John\u2019s&nbsp;Hospital and Royal Hospital for Sick Children&nbsp;<strong>(only for children aged 0 to 16 NOT adults)<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Patients will be sent appointments directly from Radiology, by letter or increasingly they may be sent their patient letters electronically. Patients may receive a text notification prompting them to log into a secure portal to view these letters.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Contacting Radiology<\/strong><\/h4>\n\n\n\n<p><strong>By Phone<\/strong><\/p>\n\n\n\n<p><strong>PLEASE NOTE THESE NUMBERS ARE FOR PROFESSIONAL USE ONLY, THEY ARE NOT FOR PATIENTS<\/strong><\/p>\n\n\n\n<p>If GPs have any specific queries they can contact the Duty Radiologist for advice on the numbers below. (Patient department contact numbers can be found further up the page).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>WGH: GP contact number for Duty Radiologist 0131 537 2315<\/li>\n\n\n\n<li>SJH: GP contact number for Duty Radiologist 01506 524 352<\/li>\n\n\n\n<li>RIE: GP contact number for Duty Radiologist 0131 242 3572<\/li>\n\n\n\n<li>RHCYP: GP contact number for Duty Radiologist 0131 312 0120<\/li>\n<\/ul>\n\n\n\n<p><strong>By Email<\/strong><\/p>\n\n\n\n<p>The email addresses below can be used for administrative enquiries\/ expediting reports\/ changing appointments etc, but not for specific individual purely clinical questions. <strong>PLEASE NOTE THESE EMAIL CONTACTS ARE FOR PROFESSIONAL USE ONLY, THEY ARE NOT FOR PATIENTS<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>WGH: <a href=\"mailto:wgh.radiology@nhs.scot\" data-type=\"mailto\" data-id=\"mailto:wgh.radiology@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">wgh.radiology@nhs.scot<\/a><\/li>\n\n\n\n<li>WGH Mammography: <a href=\"mailto:wgh.mammography@nhs.scot\" data-type=\"mailto\" data-id=\"mailto:wgh.mammography@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">wgh.mammography@nhs.scot<\/a><\/li>\n\n\n\n<li>RIE: <a href=\"mailto:radiology.rie@nhs.scot\" data-type=\"mailto\" data-id=\"mailto:radiology.rie@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">radiology.rie@nhs.scot<\/a><\/li>\n\n\n\n<li>SJH: <a href=\"mailto:sjh.radiology@nhs.scot\" data-type=\"mailto\" data-id=\"mailto:sjh.radiology@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">sjh.radiology@nhs.scot<\/a><\/li>\n<\/ul>\n\n\n\n<p>If GPs have a query about a specific radiological report they can also email the reporting Radiologist directly.<\/p>\n\n\n\n<p><strong>UPDATED SG AND JB DEC 2025<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Please see individual pathways and the <strong>Primary Care Management section<\/strong> on Who to Refer<\/p>\n\n\n\n<p>Referral for x-rays are governed by&nbsp;<a href=\"http:\/\/www.hse.gov.uk\/pubns\/books\/l121.htm\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Ionising Radiation (Medical Exposure) Regulations 2018<\/strong><\/a>&nbsp;<strong>and these are the responsibility of the Referrer.<\/strong><\/p>\n\n\n\n<p><strong>For all Radiology requests: Referrers accept responsibility for dealing with the result(s) and informing the patient as necessary.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p><strong>Plain x-rays: <\/strong>The majority of referrals for Plain x-rays should be made via SCI Gateway using the <strong>Radiology Plain X-ray<\/strong> protocols under the specific location where the x-ray is to take place. In certain practices where there has been appropriate training they are able to use the ICE Ordering system to order <strong>Plain X-rays<\/strong><\/p>\n\n\n\n<p>(If this is not possible, such as in the event of significant IT failure, please use the appropriate paper X-ray department form. These should be sent via internal mail and when advising patients to phone to arrange the x-ray, allow 48 hours for form to arrive.)<\/p>\n\n\n\n<p><strong>After referral all plain x-ray requests need to be scheduled in by the patient phoning the appropriate department using the guidance above. <\/strong><strong><\/strong><\/p>\n\n\n\n<p><strong>Ultrasound: <\/strong>All referrals for Ultrasound should be made via SCI Gateway using the <strong>Radiology \u2013 Ultrasound<\/strong> referral form.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Guidance re Specific Plain x-ray and Ultrasound Investigations<\/strong><\/p>\n\n\n\n<p><strong><u>Head and Neck &#8211; Skull<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>X-ray for palpable vault abnormality which feels bony<\/p>\n\n\n\n<p><strong>Who not to routinely refer for x-ray:<\/strong><\/p>\n\n\n\n<p>Headache \u2013 see guidance re <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/ct-head-for-chronic-headache-or-memory-issues\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/ct-head-for-chronic-headache-or-memory-issues\/\" target=\"_blank\" rel=\"noreferrer noopener\">CT Head<\/a>, see also <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/Neurology\/Headache\" target=\"_blank\" rel=\"noreferrer noopener\">Neurology &#8211; Headache<\/a> guidance<\/p>\n\n\n\n<p>Headache suspicious of cancer \u2013 see guidance re <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/brain-and-central-nervous-system-tumours-incl-cancers-including-headache-plus-pathway\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/brain-and-central-nervous-system-tumours-incl-cancers-including-headache-plus-pathway\/\" target=\"_blank\" rel=\"noreferrer noopener\">Brain and Central Nervous System Cancers<\/a><\/p>\n\n\n\n<p>Head Injury &#8211; if any concerns re intracranial injury, i.e. loss of consciousness, neurological defect, significant laceration, or haematoma &#8211; patient should be referred as an emergency to A&amp;E<\/p>\n\n\n\n<p><strong>Note<\/strong>: Imaging departments may undertake skull X-ray as part of their imaging protocol for specific clinical problems e.g. skeletal survey for myeloma, but referral should specify the clinical indication for imaging.<\/p>\n\n\n\n<p><strong><u>Head and Neck \u2013 Face<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>X-ray for trauma to facial skeleton or mandible, not requiring attendance at A&amp;E<\/p>\n\n\n\n<p>X-ray for trauma to orbits including ?metallic foreign body, not requiring attendance at A&amp;E<\/p>\n\n\n\n<p><strong>Who not to routinely refer for x-ray:<\/strong><\/p>\n\n\n\n<p>Middle or inner ear symptoms<\/p>\n\n\n\n<p>Nasal trauma<\/p>\n\n\n\n<p>Sinus disease<\/p>\n\n\n\n<p>Temporal Mandibular Joint (TMJ) Dysfunction<\/p>\n\n\n\n<p><strong><u>Head and Neck \u2013 Neck soft tissues<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Suspected thyroid mass\/goitre \u2013 refer directly to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/endocrinology\/thyroid\/\" target=\"_blank\" rel=\"noreferrer noopener\">Endocrinology<\/a> for all suspected thyroid disease. GPs should <strong>NOT<\/strong> refer for prior imaging.<\/p>\n\n\n\n<p>Vascular\/Carotid problems \u2013 refer to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/transientischaemicattacktiaandstroke\/\" target=\"_blank\" rel=\"noreferrer noopener\">Stroke<\/a> service for specialist assessment<\/p>\n\n\n\n<p>Ultrasound for Salivary Glands<\/p>\n\n\n\n<p><strong><u>Chest<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p><strong>CXR Urgent Suspicion of Cancer (Remember to choose USC priority on the SCI GW Referral) as per <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/lung-and-pleural-cancers\/\" target=\"_blank\" rel=\"noreferrer noopener\">SRGC<\/a> and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/lungcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Lung Cancer guidance<\/a><\/strong><\/p>\n\n\n\n<p>Any unexplained haemoptysis<\/p>\n\n\n\n<p>Unexplained and persistent (more than 3 weeks): change in cough or new cough, breathlessness, chest\/shoulder pain, loss of appetite, weight loss, chest signs, hoarseness, fatigue<\/p>\n\n\n\n<p>Examination findings: focal chest signs, supraclavicular lymphadenopathy, New or not previously documented finger clubbing<\/p>\n\n\n\n<p>Persistent or recurrent chest infection<\/p>\n\n\n\n<p>Cervical and\/or persistent supraclavicular lymphadenopathy<\/p>\n\n\n\n<p>Thrombocytosis where symptoms and signs do not suggest other specific cancer<\/p>\n\n\n\n<p><strong>CXR Other indications:<\/strong><\/p>\n\n\n\n<p>Night sweats, fevers<\/p>\n\n\n\n<p>Chronic respiratory conditions with unexplained change in symptoms<\/p>\n\n\n\n<p>Unexplained increased CRP<\/p>\n\n\n\n<p>Unexplained erythema nodosum<\/p>\n\n\n\n<p>Strong suspicion of suspected underlying malignancy without obvious clinical primary (see additional RefHelp guidance here)<\/p>\n\n\n\n<p>Post pneumonia follow up as advised by Radiology (Please see here for the <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Edinburgh-Adult-Pneumonia-CXR-FOLLOW-UP-ADVICE-DEC-24.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Radiology Pneumonia Follow up protocol<\/a>)<\/p>\n\n\n\n<p>TB screening for new entrants to the UK from countries with a high prevalence of TB<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Chest trauma e.g. suspicion of rib fracture<\/p>\n\n\n\n<p>COPD&nbsp; \/ Asthma follow up<\/p>\n\n\n\n<p>Heart failure \/ hypertension without clinical change (Please see guidance on diagnosis of Heart failure where prior to referral a CXR is considered \u2018Helpful but not essential\u2019)<\/p>\n\n\n\n<p>Infection \/ cough \/ wheeze in children<\/p>\n\n\n\n<p>Pre-operative assessment<\/p>\n\n\n\n<p>Routine follow-up in the absence of clinical deterioration (unless advised by radiologist)<\/p>\n\n\n\n<p>Medical screening \u2013 unless employment related risk<\/p>\n\n\n\n<p>Upper respiratory tract infection<\/p>\n\n\n\n<p>Suspected costochondritis<\/p>\n\n\n\n<p><strong>CXR for patients requiring admission &#8211; <em>Included here for info, these conditions require admission, and investigations will be arranged by Secondary Care<\/em><\/strong><\/p>\n\n\n\n<p>Acute respiratory distress<\/p>\n\n\n\n<p>Suspected pulmonary embolus (rule out other pathology prior to CTPA)<\/p>\n\n\n\n<p>Chest trauma \u2013 severe \/ penetrating injury<\/p>\n\n\n\n<p>Acute severe chest pain<\/p>\n\n\n\n<p>Suspected acute decompensated heart failure<\/p>\n\n\n\n<p>Suspected pneumothorax<\/p>\n\n\n\n<p>Suspected chest sepsis<\/p>\n\n\n\n<p>Sepsis of unknown origin<\/p>\n\n\n\n<p><strong><u>Testes<\/u><\/strong><\/p>\n\n\n\n<p>Please see guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/urology\/scrotolconditions\/\" target=\"_blank\" rel=\"noreferrer noopener\"> Scrotal Conditions<\/a> page for advice on when to refer for testicular ultrasound<\/p>\n\n\n\n<p><strong><u>Abdomen<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (ultrasound):<\/strong><\/p>\n\n\n\n<p>Palpable abdominal mass (indicate if mass is lower or upper abdomen as patient preparation may be different)<\/p>\n\n\n\n<p>Jaundice<\/p>\n\n\n\n<p>Suspected gallbladder disease<\/p>\n\n\n\n<p>Suspected pancreatic disease<\/p>\n\n\n\n<p>? Abdominal aortic aneurysm<\/p>\n\n\n\n<p>Post cholecystectomy pain<\/p>\n\n\n\n<p>? Hepatic metastases<\/p>\n\n\n\n<p>Persistent unexplained abnormal LFTS \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/radiology\/asymptomatic-abnormal-lfts\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp guidance<\/a> on when to refer<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Constipation \u2013 (although AXR may be useful in frail elderly, psychiatric and patients with intellectual impairment)<\/p>\n\n\n\n<p>Non-specific abdominal pain<\/p>\n\n\n\n<p>Abdominal bloating<\/p>\n\n\n\n<p>Dysphagia \u2013 See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/dysphagia\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Dysphagia guidance<\/a><\/p>\n\n\n\n<p>Heartburn \/ hiatus hernia \/ dyspepsia \u2013- See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/dyspepsia\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Dyspepsia guidance<\/a><\/p>\n\n\n\n<p>Intestinal blood loss \u2013 See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp GI guidance<\/a><\/p>\n\n\n\n<p>Suspected small bowel disease \u2013 See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp GI guidance<\/a><\/p>\n\n\n\n<p>Suspected colonic pathology \u2013 See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp GI guidance<\/a><\/p>\n\n\n\n<p>For abdominal wall masses see section on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/suspectedsofttissuetumour\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Radiology-Lumps-bumps--Soft-Tissue-Hernia.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">soft tissue\/MSK Lumps and bumps<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/hernia\/\" target=\"_blank\" rel=\"noreferrer noopener\">Suspected hernia<\/a> should be referred to the Surgical Service without prior imaging<\/p>\n\n\n\n<p><strong><u>Renal Tract<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (ultrasound):<\/strong><\/p>\n\n\n\n<p>CKD<\/p>\n\n\n\n<p>? Hydronephrosis<\/p>\n\n\n\n<p>? Urinary retention not requiring admission<\/p>\n\n\n\n<p>? Renovascular hypertension<\/p>\n\n\n\n<p>? Renal mass<\/p>\n\n\n\n<p>Recurrent UTI as per <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/urology\/recurrentutis\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Urology Recurrent UTIs<\/a> guidance<\/p>\n\n\n\n<p>Nonvisible haematuria as per <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/urology\/haematuria-nonvisible\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Urology NVH<\/a> guidance<\/p>\n\n\n\n<p>Trauma and haematuria not requiring admission<\/p>\n\n\n\n<p>Loin pain where renal calculi not suspected<\/p>\n\n\n\n<p>Loin pain in women &lt;40 years<\/p>\n\n\n\n<p><strong>Who to refer (CT KUB):<\/strong><\/p>\n\n\n\n<p>Acute renal colic not requiring admission<\/p>\n\n\n\n<p><strong>Who not to refer:<\/strong><\/p>\n\n\n\n<p>Visible haematuria \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/urology\/haematuria-visible\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Urology Visible Haematuria<\/a> guidance<\/p>\n\n\n\n<p>Plain film KUB \u2013 except for long term follow up of at-risk patients \u2013 spinal injury\/previous lithotripsy<\/p>\n\n\n\n<p>?Prostatic malignancy \u2013 for specialist referral<\/p>\n\n\n\n<p><strong><u>Gynaecology<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (ultrasound):<\/strong><\/p>\n\n\n\n<p>Palpable pelvic mass<\/p>\n\n\n\n<p>Post Menopausal Bleeding in those not taking HRT: Please see RefHelp guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/postmenopausalbleeding\/\" target=\"_blank\" rel=\"noreferrer noopener\">Post Menopausal Bleeding (No HRT) page<\/a> and make sure when referring for ultrasound to <strong>use the appropriate referral protocol on SCI Gateway<\/strong> <\/p>\n\n\n\n<p>Unscheduled Bleeding in those taking HRT: Please see RefHelp guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\">Unscheduled Bleeding on HRT \u2013 RefHelp<\/a> and make sure when referring for ultrasound to <strong>use the appropriate referral protocol on SCI Gateway<\/strong><\/p>\n\n\n\n<p>Irregular menstrual bleeding\/ inter-menstrual bleeding (not mid-cycle ovulatory bleeding)<\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/abnormaluterinebleeding\/heavymenstrualbleeding\/\" target=\"_blank\" rel=\"noreferrer noopener\">Menorrhagia<\/a> as indicated by Gynae Flowchart<\/p>\n\n\n\n<p>Cyclical pelvic pain<\/p>\n\n\n\n<p>Lost IUCD<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>? PCOS (not routinely required -see guidance on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/fertilityreproductive-endocrinology\/polycysticovarysyndrome\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp PCOS page<\/a> re diagnosis of PCOS)<\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/abnormaluterinebleeding\/heavymenstrualbleeding\/\" target=\"_blank\" rel=\"noreferrer noopener\">Menorrhagia<\/a> without additional features suggesting ultrasound is required, as per Gynae Flowchart<\/p>\n\n\n\n<p>Incidental finding of endometrial thickening in absence of PMB<\/p>\n\n\n\n<p>Simple ovarian cysts where follow up not advised by <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/ovarianpathology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Gynae \/ Radiology flow chart<\/a><\/p>\n\n\n\n<p><strong><u>MSK: Overall<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray)<\/strong><\/p>\n\n\n\n<p>Bone pain \u2013 symptomatic area only<\/p>\n\n\n\n<p>? Myeloma \u2013 skeletal survey<\/p>\n\n\n\n<p>? New arthropathy \u2013 x-ray affected joint only + hands\/feet (single view) if RA suspected. For suspected OA (diagnosis confirmation) ensure symptoms &gt;6 weeks; no previous x-ray.<\/p>\n\n\n\n<p>? Osteomalacia \u2013 for local pain<\/p>\n\n\n\n<p>? Osteomyelitis + Nuclear medicine \u2013 particularly in early disease when X-ray may be negative<\/p>\n\n\n\n<p>Painful prosthesis \u2013 X-ray will not exclude all causes, if concerns with or without x-ray changes then refer to Orthopaedics urgently<\/p>\n\n\n\n<p>Palpable bony mass \u2013 particularly if new\/enlarging\/painful and\/or concerns re Primary bone tumour \u2013 this should be requested urgently and guidance in <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma pathway<\/a>\u00a0followed<strong>, <\/strong>specifically the pathway for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/suspectedbonetumour\/\" target=\"_blank\" rel=\"noreferrer noopener\">Suspected Bone Tumours<\/a><\/p>\n\n\n\n<p>? Stress fracture<\/p>\n\n\n\n<p>Trauma ?fracture not requiring attendance at A&amp;E<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Routine Arthropathy follow up<\/p>\n\n\n\n<p>Nonspecific musculoskeletal pain<\/p>\n\n\n\n<p>Metabolic bone disease \u2013 biochemical tests usually suffice<\/p>\n\n\n\n<p>Soft tissue mass \u2013 imaging prior to referral not usually advised &#8211; see guidance in <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma pathway<\/a>\u00a0<\/strong>followed<strong>, <\/strong>specifically the pathway for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/suspectedsofttissuetumour\/\" target=\"_blank\" rel=\"noreferrer noopener\">Suspected Soft Tissue Tumours<\/a><\/p>\n\n\n\n<p><strong><u>MSK: Spine \u2013 Cervical spine<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>X-ray for ?Atlanto-axial subluxation (e.g. Down&#8217;s Syndrome, rheumatoid arthritis)<\/p>\n\n\n\n<p>X-ray for ?Cervical Spondylosis with nerve root signs (MR preferred but not currently available as direct access)<\/p>\n\n\n\n<p>X-ray for Injury with <strong>pain<\/strong> if not requiring admission<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Acute torticollis<\/p>\n\n\n\n<p>? Cervical Spondylosis in absence of nerve root signs<\/p>\n\n\n\n<p>Degenerative change<\/p>\n\n\n\n<p>Dizziness \/ headaches<\/p>\n\n\n\n<p>Whiplash injury without clinical findings<\/p>\n\n\n\n<p>X-ray for injury with neurological deficit \u2013 these patients need A&amp;E referral<\/p>\n\n\n\n<p><strong><u>MSK: Spine \u2013 Dorsal Spine<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>Injury <strong>with<\/strong> pain if not requiring admission<\/p>\n\n\n\n<p>? infection<\/p>\n\n\n\n<p>? Myeloma &#8211; ask for skeletal survey<\/p>\n\n\n\n<p>? Osteoporotic vertebral collapse<\/p>\n\n\n\n<p>? Primary malignancy &#8211; localised bone pain (Nuclear medicine may also be required)<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Acute back pain with no history of trauma (unless vertebral collapse suspected)<\/p>\n\n\n\n<p>Degenerative change<\/p>\n\n\n\n<p>? Metastatic bone disease (Nuclear medicine more sensitive)<\/p>\n\n\n\n<p>Osteoporosis (unless vertebral collapse suspected)<\/p>\n\n\n\n<p>Injury with neurological defect\u2013 these patients need A&amp;E referral&nbsp;<\/p>\n\n\n\n<p><strong><u>MSK: Spine \u2013 Lumbar Spine<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>? Ankylosing spondylitis<\/p>\n\n\n\n<p>? Spondylolisthesis<\/p>\n\n\n\n<p>First onset back pain in older patients (&gt;55 years) and younger patients (&lt;20)<\/p>\n\n\n\n<p>Injury with <strong>pain<\/strong> if not requiring admission<\/p>\n\n\n\n<p>? Myeloma \u2013 ask for skeletal survey<\/p>\n\n\n\n<p>? Osteoporotic vertebral collapse<\/p>\n\n\n\n<p>? Primary malignancy \u2013 <strong>localised<\/strong> bone pain (Nuclear medicine may also be required)<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Acute back pain in adults \u2013 symptoms may settle, six-week rule \u2013 thereafter referral to the NHS Lothian integrated back pain service is advised <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/lumbarspine\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Back Pain Pathway<\/a><\/p>\n\n\n\n<p>Chronic back pain in adults with no pointers to infection or neoplasm<\/p>\n\n\n\n<p>? Osteoporosis (vertebral collapse<\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/lumbarspine\/serious-lumbar-spine-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">Back pain with red flag signs<\/a> \u2013 Plain films can be misleadingly normal and arranging them can therefore delay appropriate investigation with CT \/ MRI. Secondary care referral as per the linked guidance should be arranged.<\/p>\n\n\n\n<p>Injury with neurological defect\u2013 these patients need A&amp;E referral&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong><u>MSK: Spine \u2013 Whole Spine<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>Curvature of spine ?scoliosis or ?kyphosis (age 16-40)<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>See reasons listed under individual guidance for cervical, dorsal, and lumbar spine<\/p>\n\n\n\n<p>Patients younger than 16 and older than 40<\/p>\n\n\n\n<p><strong><u>MSK: Shoulder<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>? Rotator cuff calcification<\/p>\n\n\n\n<p>Shoulder pain &gt; 3 months<\/p>\n\n\n\n<p>Trauma \/ dislocation &#8211; not requiring attendance at A&amp;E<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>? Impingement &#8211; specialist request<\/p>\n\n\n\n<p>? Instability\u2013 referral to the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder Physiotherapy Service<\/a> is advised<\/p>\n\n\n\n<p>? Rotator cuff injury \u2013 x-ray unhelpful for most rotator cuff problems \u2013 referral to the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder Physiotherapy Service<\/a> may be indicated<\/p>\n\n\n\n<p>Shoulder pain &#8211; referral to the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder Physiotherapy Service<\/a> may be indicated<\/p>\n\n\n\n<p>Shoulder ultrasound can\u2019t be ordered directly by GPs in NHS Lothian, but may be requested by the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder Physiotherapy Service<\/a> if indicated<\/p>\n\n\n\n<p><strong><u>MSK: Pelvis and Hips<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>SI Joint problems<\/p>\n\n\n\n<p>Trauma with inability to weight bear or persisting pain &#8211; not requiring attendance at A&amp;E \u2013 if any <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/GP-REQUEST-FOR-NOF-FRACTURE-XRAY-MARCH-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">risk of missed #NOF, please follow Radiology guidance re location of x-ray request<\/a><\/p>\n\n\n\n<p>Suspected malignancy and hip pain<\/p>\n\n\n\n<p>Clinical diagnosis of OA and no previous X-Ray<\/p>\n\n\n\n<p>Unexplained undiagnosed hip pain &gt;6 weeks and no previous X-Ray<\/p>\n\n\n\n<p>? Avascular necrosis of the femoral head \u2013 if suspected then should refer for urgent Pelvic x-ray AND to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Orthopaedics<\/a> urgently as per guidance<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Hip pain &#8211; unless symptoms persist &gt;6 weeks, risk of avascular necrosis or surgery considered<\/p>\n\n\n\n<p>Trauma to coccyx<\/p>\n\n\n\n<p><strong><u>MSK: Knee<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>Knee pain with locking, restricted movement, or effusion<\/p>\n\n\n\n<p>Knee pain when surgery considered<\/p>\n\n\n\n<p>Trauma with physical signs &#8211; not requiring attendance at A&amp;E<\/p>\n\n\n\n<p>Suspected malignancy in patient with knee pain<\/p>\n\n\n\n<p>Clinical diagnosis of OA and no previous X-Ray (symptoms &gt;6 weeks and patient willing to undergo surgery)<\/p>\n\n\n\n<p><strong><u>Who not to routinely refer:<\/u><\/strong><\/p>\n\n\n\n<p>Knee pain without locking or restricted movement<\/p>\n\n\n\n<p>? Osgood Schlatter&#8217;s disease<\/p>\n\n\n\n<p>Trauma when physical signs are minimal<\/p>\n\n\n\n<p>? Baker&#8217;s cyst &#8211; neither is ultrasound referral indicated to confirm the diagnosis<\/p>\n\n\n\n<p><strong><u>MSK: Ankle and Foot<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who to refer (x-ray):<\/strong><\/p>\n\n\n\n<p>Most general indications for bone and joint imaging apply (see Overall section above)<\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Hallux valgus &#8211; except for pre-operative assessment<\/p>\n\n\n\n<p>X-Ray for ? plantar fasciitis ? calcaneal spur<\/p>\n\n\n\n<p>Trauma without: localised bony tenderness\/ inability to weight bear\/ significant soft tissue swelling<\/p>\n\n\n\n<p>? Morton&#8217;s neuroma &#8211; refer to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot\/Ankle Service<\/a> in the first instance<\/p>\n\n\n\n<p>? Plantar fasciitis &#8211; refer to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot\/Ankle Service<\/a> in the first instance<\/p>\n\n\n\n<p>Discrete palpable mass ? ganglion\/fibromatosis &#8211; refer to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot\/Ankle Service<\/a> in the first instance<\/p>\n\n\n\n<p>*Foot \/ Ankle ultrasound can\u2019t be ordered directly by GPs in NHS Lothian, but may be requested by the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot\/Ankle Service<\/a> if indicated*<\/p>\n\n\n\n<p><strong><u>Lumps and Bumps<\/u><\/strong><\/p>\n\n\n\n<p><strong>Who not to routinely refer:<\/strong><\/p>\n\n\n\n<p>Lumps &amp; Bumps should, in general, be referred to GP led <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/minorsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Minor surgery<\/a> or to General Surgery.<\/p>\n\n\n\n<p>Suspected soft tissue cancer should be directed to the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Orthopaedic Sarcoma<\/a> clinic at RIE<\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/hernia\/\" target=\"_blank\" rel=\"noreferrer noopener\">Suspected hernia<\/a> can be referred to the Surgical Service<\/p>\n\n\n\n<p>Diffuse soft tissue swelling not suspicious of soft tissue cancer<\/p>\n\n\n\n<p>Obviously, benign pathologies<\/p>\n\n\n\n<p>Skin lumps and lesions<\/p>\n\n\n\n<p>Clinical subcutaneous lipoma<\/p>\n\n\n\n<p>Clinical sebaceous cyst<\/p>\n\n\n\n<p>Mass &lt;5cm diameter unless rapidly enlarging<\/p>\n\n\n\n<p>Baker\u2019s cysts: this is a clinical diagnosis. Referral is not indicated unless atypical and an alternative diagnosis is suspected<\/p>\n\n\n\n<p>Breast lumps: All patients with suspected breast lumps, whether male or female, should be referred to the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/BreastDisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Unit<\/a> for assessment<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Plain X-Rays Most referrals for Plain x-rays should be made via SCI Gateway using the Radiology Plain X-ray protocols under the specific location where the x-ray is to take place. In certain practices where there has been appropriate training they are able to use the ICE Ordering system to order Plain X-rays. (If ordering electronically<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4356,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[871],"class_list":["post-13356","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-plain-x-rays"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/radiology\/https-apps-nhslothian-scot-refhelp-plain-x-rays\/\" rel=\"tag\">Plain X-Rays<\/a>","rttpg_excerpt":"Plain X-Rays Most referrals for Plain x-rays should be made via SCI Gateway using the Radiology Plain X-ray protocols under the specific location where the x-ray is to take place. In certain practices where there has been appropriate training they are able to use the ICE Ordering system to order Plain X-rays. (If ordering electronically","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/13356","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=13356"}],"version-history":[{"count":34,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/13356\/revisions"}],"predecessor-version":[{"id":26661,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/13356\/revisions\/26661"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4356"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=13356"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=13356"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}