As NHS waiting times for diagnostic scans including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) grow, many patients are seeking faster ways to access scans. As a result, many patients are now asking to refer themselves for a private MRI scan or CT scan and to book a scan without a referral from a doctor.

In this article, we will look at some of the issues around self-referral, and explain our approach to providing accessible, but high-quality and safe imaging services.

Self-referral for an MRI or CT scan – What’s the problem?

Whilst self referral may appear to be an easy and quick route to obtaining an MRI scan or CT scan, it is not recommended.   Both scan types are tests that produce detailed images to visualise tissues in the body, and can help diagnose a variety of medical conditions.  However, without the involvement of a healthcare professional, there is a risk that self-referral may lead to several issues:

The importance of specialist medical evaluation

Firstly, MRI scans and CT scans are medical procedures that require a comprehensive medical evaluation before they can be performed. This evaluation should always include a review of the patient’s story, their medical history and, where possible, a physical examination. Without this crucial stage, it would be easy for inappropriate or inadequate imaging to be requested. This could mean that the underlying cause of your symptoms may not be accurately diagnosed, and important medical conditions missed.

For example, the Queen Square Imaging Centre is a specialist neuroimaging unit, which offers detailed MRI scans of the brain. However, an MRI brain scan is not just a single type of scan. Rather, it is broad range of scans that involve the use of combinations of different types of MRI picture – or ‘sequence’.

Different sequences are used to show the brain in different ways. Some are used to look at brain anatomy, whereas others are used to look at the blood vessels. Other sequences can be used to look at brain function, rather than simple anatomy. We use the information on a referral to guide our selection of sequences which will allow us to answer the clinical question. Without this, it is easy for inadequate imaging to take place. This may mean that our radiologists (who review the scan images and write the written report) miss vital information. This means the report they produce will not provide the information you need to obtain an accurate diagnosis.

Our ability to use the information provided on a referral to ‘plan-ahead’ also enables us to scan patients correctly, providing the information they need in a single visit. Many departments will frequently recall patients for further imaging. This means the patient has the inconvenience of a return a visit and, quite often, additional cost. We recall very rarely because we can triage referrals and make sure every patient receives the exact scan they need.

There may also be a risk that a patient could refer themselves for a scan that could be unsafe. For example, certain metallic implants and devices can be unsafe in an MRI scanner. Even though our rigorous safety screening process would always identify these on the day, best practice would be that the referrer sending the patient for a scan could recognise this risk and consider alternative options before the patient wastes time booking a scan they may be unable to have. Without the initial clinical evaluation, there would inevitably be a delay in the patient’s care.

Further information about MRI scan safety is available in our article here.

The risk of exposure to ionising radiation: 

Whilst not as relevant for MRI scans, self-referral for CT scans could result in unnecessary or excessive exposure to ionising radiation. Proper evaluation by a healthcare provider is used by an imaging department to justify the radiation exposure. This means we can make certain that the benefit to the patient is maximised, whilst risks are minimised.

The risk of unnecessary exposure to contrast agents and other medications:

MRI and CT scans often involve the use of contrast agents. These enhance the look of certain structures on the scan. Contrast agents are safe when used appropriately and with proper checks taking place prior to examination. However, the use of contrast agents without vital information from a referring doctor could result in them being used needlessly. This could cause potential side effects.

Conversely, missing information may result in contrast agents not being given, when they may actually provide useful information. This could mean the difference between a definitive diagnosis and an uncertain scan result.

Further information about MRI contrast dyes and when we may prefer not to use them is available here.

A second look at self referral

In summary, self-referral for an MRI or CT scan is not a recommended practice because it bypasses the crucial involvement of specialists.  The specialist’s evaulation is essential because it ensures that the most appropriate scan is requested, and that the images are reviewed and interpreted correctly. It is always best to work with a healthcare provider to determine the best imaging tests for your needs, and to ensure the proper interpretation and use of the results.

How does the Queen Square Imaging Centre provide rapid access to scans?

There are ways that imaging providers such as the Queen Square Imaging Centre can streamline practices to improve accessibility to diagnostic scans for patients who have not been referred through a standard pathway.

Working in collaboration with private GP partnerships

One way we assist patients who do not have a referral, is through partnerships with private practices. These practices can offer patients an affordable and fast-tracked consultation with a doctor. Following a consultation, the doctor can then refer the patient for the most appropriate scan. They can also provide a follow up so that scan results are acted on.

The Queen Square Imaging Centre have recently partnered with GogoDoc, a private GP service in London. GogoDoc offer affordable telephone and in-person consultations for patients who wish to access diagnostic testing quickly and easily.

We are also partnered with Scan.com, who use their own medical professionals to review patient information. A written referral for the correct scan is then produced, which is then referred to one of their trusted partners.

Both routes offer a safe and fast pathway for patients to have a scan, and have an opportunity to discuss their results with a professional.

The use of screening and health assessment pathways

Some scans can also be accessed through dedicated screening and health assessment pathways. Our Lung Health Assessment service is one example. Patients who meet specific eligibility criteria can access low-dose CT scans of the lungs to enable in-depth lung health assessment.

Based on the National Lung Cancer Screening programme, the service offers patients a way of referring themselves to the service if they have particular concerns over their breathing or respiratory health. For more information about this service, please click here.