Ultrasound Prioritization
Effective Date: May 30th, 2018.
Recommendations and Topics
- Scope
- Background
- Prioritization of Potential Diagnoses
- Abdomen and Pelvis
- Pediatrics
- Obstetrics and Gynecology
- Musculoskeletal/Extremity
- General
- Vascular
- Resources
Scope
This guideline summarizes suggested wait times for common indications where ultrasound is the recommended first imaging test. The purpose is to inform primary care practitioners of how referrals are prioritized by radiologists, radiology departments and community imaging clinics across the province. This guideline is an adaptation of the British Columbia Radiological Society (BCRS) Ultrasound Prioritization Guidelines (2016). Management of the listed clinical problems is beyond the scope of this guideline. However, in some cases, notes and alternative tests are provided for additional clinical context. Primary care practitioners are encouraged to consult a radiologist if they have any concerns or questions regarding which is the appropriate imaging test to choose for a particular problem.
Background
The BCRS Ultrasound Prioritization Guidelines (2016) were developed to provide imaging departments with a consistent, provincial approach to prioritizing commonly ordered ultrasound tests according to suggested maximum wait times. The Guidelines were developed by consensus and are based on best BC expert opinion with representation of radiologists from across the province. Several considerations apply:
- These are guidelines, and as such, are designed to apply in general terms. They are not intended to replace clinical judgement or physician-to-physician discussion.
- Prioritization levels were selected to match other similar guidelines for CT and MRI and are typically assigned by radiologists rather than referring physicians.
- These guidelines should not be applied rigidly to each case, as varying clinical factors may shift a particular indication from one priority level to another.
- Access to ultrasound and the ability to respond to emergent/urgent ultrasound requests will depend on local availability.
- The clinical topics included in this guideline represent broad examples, and do not encompass all possible scenarios or all requirements for ultrasound examinations.
- These guidelines do not apply to inpatients or emergency room patients.
Priority Level Definitions
The priority levels defined below (Table 1) are in alignment with the Canadian Association of Radiologist's national designation Five Point Classification System1.
Priority Level |
Clinical Example |
Maximum Suggested Wait Time |
---|---|---|
P1 |
An examination immediately necessary to diagnose and/or treat life-threatening disease. Such an examination will need to be done either stat or not later than the day of the request. |
Immediately to 24 hours |
P2 |
An examination indicated within one week of a request to resolve a clinical management imperative. |
Maximum 7 calendar days |
P3 |
An examination indicated to investigate symptoms of potential importance. |
Maximum 30 calendar days |
P4 |
An examination indicated for long-range management or for prevention. |
Maximum 60 calendar days |
P5 |
Timed follow-up exam or specified procedure date recommended by radiologist and/or clinician. |
|
Source: Adapted from the Canadian Association of Radiologists National Maximum Wait Time Access Targets for Medical Imaging.
Prioritization of Potential Diagnoses
The following potential diagnoses, where ultrasound is the recommended first test, are grouped according to system and then further subdivided into priority levels. For each system an overview table is presented followed by a more detailed table outlining additional notes and alternative tests where appropriate. Refer to Appendix A: Ultrasound Prioritization Guideline Summary for a one page summary of all potential diagnoses and prioritizations. Referring practitioners may consider noting the priority directly on the requisition.
Abdomen and Pelvis
P1 |
P2 |
P3 |
P4 |
P5 |
Immediately to 24 hours |
Max 7 calendar days |
Max 30 calendar days |
Max 60 calendar days |
Specified date |
|
|
|
Pediatrics
Obstetrics and Gynecology
P1 |
P2 |
P3 |
P4 |
Immediately to 24 hours |
Max 7 calendar days |
Max 30 calendar days |
Max 60 calendar days |
|
|
|
P1 |
P2 |
P3 |
P4 |
P5 |
---|---|---|---|---|
Immediately to 24 hours |
Max 7 calendar days |
Max 30 calendar days |
Max 60 calendar days |
Specified time |
|
|
Priority Level |
Potential Diagnosis |
Notes and Alternative Tests |
---|---|---|
P1 |
|
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P2 |
|
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P3 |
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P4 |
|
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Tendinopathy, chronic shoulder pain, non-operative rotator cuff tear |
|
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Bursitis |
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P5 |
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General
P1 |
P2 |
P3 |
P4 |
P5 |
---|---|---|---|---|
Immediately to 24 hours |
Max 7 calendar days |
Max 30 calendar days |
Max 60 calendar days |
Specified time |
|
|
|
Vascular
P1 |
P2 |
P3 |
P4 |
P5 |
---|---|---|---|---|
Immediately to 24 hours |
Max 7 calendar days |
Max 30 calendar days |
Max 60 calendar days |
Specified time |
|
|
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Resources
- Canadian Association of Radiology Diagnostic Imaging Referral Guidelines (2012)
www.car.ca/en/standards-guidelines/guidelines.aspx
- American College of Radiology Appropriateness Criteria
www.acr.org/Quality-Safety/Appropriateness-Criteria
- Society of Radiologists in Ultrasound
- Choosing Wisely Radiology Recommendations:
Radiology: choosingwiselycanada.org/radiology/
Endocrinology and Metabolism: choosingwiselycanada.org/endocrinology-and-metabolism/
Appendices
- Appendix A - Ultrasound Prioritization Guideline Summary (PDF, 126 KB) https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/ultrasound-summary.pdf
Associated Documents
The following documents accompany this guideline
BC Children’s Hospital Antenatal Hydronephrosis Imaging Guideline:
- Algorithm: www.childhealthbc.ca/sites/default/files/BCCH_Antenatal%20Hydronephrosis%20Imaging%20Guideline%202015.PDF
- Preamble to algorithm: www.childhealthbc.ca/sites/default/files/BCCH_Antenatal%20Hydronephrosis%20Imaging%20Guideline%20Preamble%2008%20April2015.pdf
References
- Canadian Association of Radiologists National Maximum Wait Time Access Targets for Medical Imaging (MRI and CT).
- Heimbach J, Kulik LM, Finn R, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2017; Jan 28. [Epub ahead of print].
- Doubilet PM, Benson CB, Bourne T, et al. Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester. N Engl J Med. 2013;369:1443-1451.
- Cotescu D, Guilbert E, Benadin J et al. Medical Abortion. J Obstet Gynaecol Can 2016;38(4):366-389.
- Levine D, Brown D, Andreotti RF et al. Management of Asymptomatic Ovarian and Other Adnexal Cysts Imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Ultrasound Quarterly. 2010;26(3):121-131.
- Mendelson EB, Böhm-Vélez M, Berg WA, et al. ACR BI-RADS® Ultrasound. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013.
This guideline is based on expert BC clinical practice current as of the Effective Date. This guideline was developed by the Guidelines and Protocols Advisory Committee based on the British Columbia Radiological Society Ultrasound Prioritization Guidelines (2016), and approved by the Medical Services Commission.
The principles of the Guidelines and Protocols Advisory Committee are to:
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Disclaimer The Clinical Practice Guidelines (the "Guidelines") have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problems. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.