ULTRASOUND REQUEST. CLINICAL RADIOLOGY. UBHT.



BRISTOL PRIMARY CARE TRUST

ULTRASOUND REQUEST. CLINICAL RADIOLOGY. UHB FT.

Name: NHS No. G.P. Name & Address: (Stamp)

[ ]

Address:

Postcode:

DoB: Sex: M / F Practice code: L

PATIENT SECTION

Please telephone Monday – Friday to arrange your appointment at Bristol General Hospital/ BRI

Tel 0117 342 6250 9.00 am – 3.30 pm

Please follow the preparation instructions below, and attend with this request form approx 15mins before your allotted time. (Further details see Patient Information).

AVAILABLE INVESTIGATIONS

|Examination Required |Patient Preparation |Tick |

|Upper Abdomen |Nil By Mouth for 6 hrs prior to appointment | |

|(GB, Biliary Tree, Pancreas, Liver, Spleen, Kidneys | | |

|Aorta |No Preparation | |

|Renal tract (kidneys and bladder) |Please fill your bladder prior to your appointment | |

| |(drink 1 pint of water approx. 1 hour before your | |

| |allotted time) | |

G.P. SECTION – please do not alter the examinations available

Requests for Obstetric and Gynaecological U/S should be sent directly to the U/S Dept at

St. Michael’s Hosp. Problems in the first trimester of pregnancy should be referred to the early pregnancy service at St. Michael’s Hospital. Requests for U/S on Children 16 years and under should be sent to the Bristol Children’s Hospital. Requests for small parts, Testes U/S or if query hernia should be referred to the BRI.

Please note urgent examinations should be referred to BRI

Tel; 0117 342 2635 X-Ray Examinations required

Clinical indications at the same time as scan:

Indications:

Known Inoculation Risk? Yes / No If Yes Please Specify

Previous Radiological Examinations: (What, When and Where)

Drs Name: (Please Print)

Drs Signature: Date:

Issue May ‘11

PLEASE PRESENT WITHIN 1 MONTH

PATIENT INFORMATION

Open Access Ultrasound – Bristol General Hospital

Your GP has requested that you have an ultrasound scan, and given you a request for Open Access Ultrasound.

After seeing your GP

Please telephone the Bristol General Hospital X Ray Department Monday – Friday and we will endeavour to arrange your appointment at a time convenient to you

0117 342 6250 9.00 am – 3.30 pm

You will be asked to give your contact details.

Please attend approximately 15mins before your allocated time slot with your request form so that your details can be checked and request processed.

When you arrive

The waiting room serves not only the Ultrasound rooms but some X-ray rooms as well, so it may appear as though some patients are being called out of turn.

We will endeavour to see to see you at your allotted time, however, please appreciate some examinations are more complex and may take longer than expected; your patience would be appreciated.

What does an ultrasound scan involve?

Ultrasound is the use of sound waves to produce an image. The sound waves cannot be heard but they are sent into the body and their ‘echo’ detected again after they have been reflected by the internal organs. In order to allow these sound waves to pass through the body a jellylike substance is applied to the appropriate area of the skin and then the ultrasound probe is moved over that area on the body. The operator will apply a little pressure to your abdomen to improve image detail. The images are viewed on a screen and you will be asked to breathe in and hold your breath at various intervals during the examination.

X-rays do not generally give adequate information when imaging the soft tissue organs, whereas an ultrasound scan often shows the structure of the internal organs in good detail.

Ultrasound is regarded as a safe procedure, and is the same type of examination preformed on pregnant women during their obstetric care.

What Happens?

The examination will be performed by a Radiographer who specialises in ultrasound examinations.

Each scan takes approximately 20 mins. On occasion an x-ray is also required to complement the ultrasound examination.

When the scan is completed you may leave immediately, and the report will be sent to your GP within 10 days, unless it is urgent when the report will be telephoned to your GP.

After the examination you may eat and drink normally.

Any Questions?

If you have any questions about the service, please contact the X-ray Department at the Bristol General Hospital on 0117 342 6250.

Any comments you have about the service will be gratefully received.

Issue May ‘11

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