What information should be included when writing an imaging requisition?

How to Write an Imaging Requisition

An effective imaging requisition must include essential patient demographics, comprehensive clinical information including symptoms and their characteristics, the suspected diagnosis with clinical question, relevant medical history and contraindications, and prior imaging for comparison. 1

Essential Components of an Imaging Requisition

Administrative and Patient Demographics

• Patient name, date of birth, medical record number, and contact information are fundamental identifiers that must be included on every requisition 1
• Age and sex are critical demographic elements that influence interpretation of imaging findings and estimation of disease likelihood 1
• Include insurance/payer information for billing purposes 1
• Provide referring physician identification, ideally with National Physician Identifier for tracking purposes 1

Clinical History and Symptoms

• Document current symptoms with specific characteristics: location, duration, and quality of pain or other presenting complaints 1
• For pain complaints, specify inflammatory features: morning stiffness duration, night pain, improvement with activity versus rest 1
• Include symptom duration and progression, as this provides essential context for image interpretation 1
• For follow-up examinations, explicitly state changes in clinical symptoms since prior imaging 1
• Document relevant physical examination findings that prompted the imaging request 2

Suspected Diagnosis and Clinical Question

• State the suspected clinical diagnosis clearly and indicate possible alternative explanations for symptoms 1
• Specify whether imaging is requested for: primary diagnosis, assessment of disease activity, or evaluation of treatment response 1
• Articulate the specific clinical question you need answered—this guides protocol selection and interpretation focus 1, 3

Relevant Medical History and Risk Factors

• Include pertinent past medical history that affects image interpretation or acquisition 1
• Document relevant risk factors specific to the clinical scenario (e.g., HLA-B27 status for suspected spondyloarthritis, cardiovascular risk factors for cardiac imaging) 1
• List current medications that may affect imaging or interpretation 1
• Include history of prior relevant diagnoses (e.g., whether spondyloarthritis was previously diagnosed) 1

Contraindications and Safety Information

• Document any contraindications to specific imaging modalities (e.g., pacemakers for MRI, pregnancy for radiation-based studies) 1
• List allergies, particularly to contrast media 1
• Include renal function status when contrast administration is anticipated 1
• Document patient weight for contrast dosing calculations 1

Prior Imaging Information

• Provide access to prior imaging studies for comparison, or at minimum include the reports if images are unavailable 1
• This received the highest level of agreement (95%) in recent guidelines as it is critical for detecting interval changes 1
• Include dates and locations of prior relevant imaging 1

Additional Context-Specific Information

• For musculoskeletal imaging: document physically demanding activities or history of childbirth (number of children and date of most recent delivery), as these affect interpretation of sacroiliac joint findings 1
• For cardiac stress imaging: document estimated exercise capacity in METs (metabolic equivalents) 1
• For cardiovascular imaging: include height, weight, blood pressure, and specific risk factors (hypertension, dyslipidemia, diabetes, tobacco use, family history of coronary disease) 1

Common Pitfalls to Avoid

Incomplete Clinical Information

• Studies show that 21-26% of requisitions contain inadequate or incomplete clinical information 4, 3
• Missing clinical indications occur in approximately 29% of cases, significantly impairing radiologist interpretation 4
• Incomplete requisitions increase the risk of misinterpretation and potentially preventable lawsuits—12.6% of radiologists have experienced lawsuits potentially preventable with sufficient requisition information 3

Illegibility and Missing Contact Information

• Ensure your name and contact information (pager/phone number) are legible and complete 4
• Studies show resident names are illegible in 44% of cases and pager numbers missing in 84% of cases 4
• Provide callback contact information for urgent or unexpected findings 1

Transcription Errors

• When requisitions are transcribed by clerical staff, only 73% accurately copy the clinical indication written by the ordering physician 4
• Electronic medical record systems improve conformity but only when properly utilized—paper requisitions show high variability in quality 5

Lack of Standardization

• Quality of requisitions correlates directly with the level of standardization of the forms used 5
• Electronic requisitions with structured fields show significantly higher conformity rates (66.8%) compared to free-text paper forms 5

Quality Improvement Considerations

• Three categories are key indicators of requisition quality: clinical impression, clinical findings, and specific clinical question 3
• Standardization of imaging requisitions increases speed and accuracy of radiologist interpretations 3
• Technologist notes supplementing requisition information are important for interpretation in 69.2% of cases, particularly for radiographic examinations, regardless of completeness of physician-provided history 2
• Consider implementing structured electronic requisition systems with mandatory fields for essential information 5, 3