Clinical Referral Guidelines


How to use this book


These evidence-based guidelines are developed to assist clinical decision making in the appropriate utilization of radiology diagnostic and interventional procedures, and to enhance the standard of patient care. Since the first edition there have been further advances in various radiology diagnostic and interventional procedures and this has been reflected in the guidelines.


This latest version of the guidelines has evolved from the first edition and includes a total of 64 chapters arranged in 11 organ systems. These chapters have been judiciously edited and integrated into a unifying structure with most chapters composing of an algorithm followed by remarks and a list of references. The algorithm and remarks are complementary to each other and should not be used separately. With the exception of the paediatric guidelines, the guidelines in all other chapters apply to adult cases only.


The recommendations in the guidelines are best utilized if used while taken into consideration the specified clinical context of each individual patient and the availability of accessible resources. These guidelines should not be deemed inclusive of all proper methods of utilization of radiology diagnostic and interventional procedures or exclusive of other methods of application of radiology procedures that are reasonably directed towards similar standard of patient care. These guidelines are not intended to replace the consultation with the radiologist or nuclear medicine physician. Majority of these guidelines provide recommendations in the stage of diagnosis and readers should refer to other guidelines for further treatment of patients.


These guidelines were prepared with the most current information available to the Hong Kong College of Radiologists at the time of publication. It is the responsibility of the user to evaluate and determine the suitability of the information described herein based on their own assessment of the most current information available at the time of application of these guidelines.



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List of Abbreviations





Neuroradiology Guidelines

NR 1 Acute head injury

NR 2 Blunt cervical spine trauma

NR 3 Thoracolumbar spine trauma

NR 4 Acute non-traumatic spinal cord compression

NR 5 Acute seizure in adult

NR 6 Acute headache

NR 7 Neck pain

NR 8 Low back pain


Thyroid Imaging Guidelines

TI 1 Thyrotoxicosis

TI 2 Euthyroid nodule


Chest Radiology Guidelines

CH 1 Blunt chest trauma with suspected pulmonary injury

CH 2 Dyspnoea

CH 3 Acute chest pain with suspected pneumothorax

CH 4 Haemoptysis

CH 5 Solitary pulmonary nodule

CH 6 Mediastinal mass

CH 7 Lung cancer


Cardiovascular Radiology Guidelines

CV 1 Blunt chest trauma with suspected thoracic cardiovascular

CV 2 Acute aortic dissection

CV 3 Abdominal aortic aneurysm

CV 4 Intermittent claudication

CV 5 Acute pulmonary embolism

CV 6 Deep vein thrombosis

CV 7 Chest pain


Gastrointestinal Radiology Guidelines

GI 1 Blunt abdominal trauma in adult

GI 2 Blunt pelvic trauma

GI 3 Suspected pneumoperitoneum

GI 4 Dysphagia

GI 5 Acute gastrointestinal bleeding

GI 6 Chronic recurrent gastrointestinal bleeding

GI 7 Small bowel obstruction

GI 8 Large bowel obstruction

GI 9 Palpable abdominal mass

GI 10 Suspected liver mass in cirrhotic patients

GI 11 Jaundice in adult

GI 12 Suspected biliary disease in adult


Uroradiology Guidelines

UR 1 Renal trauma

UR 2 Lower urinary tract injury

UR 3 Acute renal failure

UR 4 Acute flank pain

UR 5 Haematuria

UR 6 Renal mass

UR 7 Prostatism

UR 8 Acute scrotal pain

UR 9 Imaging in prostate cancer


Musculoskeletal Radiology Guidelines

MS 1 Acute osteomyelitis

MS 2 Non-traumatic shoulder pain

MS 3 Avascular necrosis of hip

MS 4 Primary bone tumour

MS 5 Soft tissue tumour

MS 6 Screening for bone metastasis with known primary


Breast Radiology Guidelines

BR 1 Palpable breast lump

BR 2 Mammography for self-referral asymptomatic woman


Obstetric and Gynaecological Radiology Guidelines

OG 1 Pelvic pain

OG 1 Pelvic mass

OG 3 Suspected ectopic pregnancy


Paediatric Radiology Guidelines

PD 1 Suspected non-accidental injury

PD 2 Paediatric seizures

PD 3 Vomiting in infants

PD 4 Non-traumatic abdominal pain

PD 5 Abdominal mass

PD 6 Urinary tract infection


Miscellaneous Guidelines

MC 1 Pyrexia of unknown origin

MC 2 Metastases from unknown primary