HNY Policy and Pathway Repository - Humber

Ultrasound imaging is provided to assist with the diagnosis and management of a range of conditions. All referrals to our service require a medical indication and clinical question that can be answered by this non-ionising radiation imaging modality. The range of scanning services provided include, hepatobiliary, urology/nephrology, gynaecology (including post-menopausal bleeding but excluding fertility investigations), male uro-genital, head and neck, musculoskeletal scans (diagnostic and therapeutic), early pregnancy, and obstetric imaging. An adjunct service is provided for patients presenting with non-site-specific symptoms which includes ultrasound, chest X-ray and / or CT imaging.

All referrals for ultrasound imaging or guided therapeutic injections must meet the agreed criterial documented in the Justification of Ultrasound Referrals Guidance (Please add link to the Justifications for Ultrasound Guidance) Please consult this guidance or utilise Advice and Guidance via NHS eReferrals to identify the most beneficial diagnostic.

• Patients with suspected testicular cancer can be referred directly for ultrasound imaging on a standard ERS referral pathway. An onward referral to the urology pathway is established dependent on whether the patient has a malignant or urgent non-malignant finding.
• Patients with haematuria, either visible or non-visible should be referred into the straight-to-test haematuria / urology urgent suspected cancer pathway.
• Patients with non-site-specific symptoms (NSSS) but with high suspicion of cancer should be referred to the straight-to-test Rapid Diagnostic Service via ERS
• Patients with post-menopausal bleeding should be referred to the straight-to-test PMB pathway via ERS.
• Any other site-specific suspected cancer should be referred directly to relevant secondary care pathway prior to imaging referral being made.
• Any pregnancy related clinical question / referral will need to be referred and managed via maternity services, this includes early pregnancy assessment.
• Suspected deep vein thrombosis needs to be referred to the community DVT service if patient is ambulatory, or SDEC at Hull Royal if patient has multiple co-mobilities.
• In cases where there is high clinical suspicion of significant pathology, and an urgent scan would help manage patients, advice and guidance can be requested for an urgent scan via hyp-tr.ultrasoundadviceandguidance@nhs.net (Please note that these requests can be made by Clinicians Only)

Ultrasound scans can assist in review and diagnosis for many conditions, Guidance for referral can be found in the Justification of Ultrasound Referrals Guide (ICB to use PDF below to update – link is old guidance) .

This document is intended to support referrers and providers in the appropriate selection of patients for whom ultrasound would be beneficial in terms of diagnosis and /or disease management. Whilst the document is primarily directed at primary care, the guidance is relevant for other referrer groups. It is written to facilitate the best use of resources, essential for sound financial management and good patient care.

The document is written with a pragmatic approach to managing referrals based on expert opinion. It is based on the 2022 BMUS justification of referrals document which been reviewed and revised by the Ultrasound service leads of Hull University Teaching Hospitals NHS Trust and representatives from primary care to reflect local best practice. Reference is made to the 2022 BMUS document (v 5) and evidence based iRefer publication.  This local guidance should be used in conjunction with these publications.

Referrals are accepted if they meet criteria documented. For patients with symptoms but in whom imaging is not indicated within the guidance, can be discussed on a case by case basis via the ultrasound advice and guidance email hyp-tr.ultrasoundadviceandguidance@nhs.net please include details and rational for the scan

Following the Ultrasound a report will be communicated from the Radiology team, which will also note any follow up imaging required.  On occasion this report might be from an out-sourced radiology company who may not be working to local guidelines.    All reports are checked against HUTH and National reporting guidance and managed accordingly. Any unnecessary referrals will be returned with advice.

Please consult the Ultrasound Justification Guidance on areas supported.

DO NOT REFER

Guidance for referral can be found in the  Justification of Ultrasound Referrals Guide   

When referrals are received in US they will be triaged and if they meet the criteria set in the guidance, they will be prioritised on clinical details and appointed appropriately.

 If referrals do not meet the criteria, they will be registered as a "radiology cancelled test". A report stating as such will be generated by a senior member of the US Team. Relevant advice regarding alternative imaging or pathways will be documented in the report which will be emailed via the radiology e-results with a yellow1 notification code to highlight the cancellation. This will be communicated to the GP via A&G/IDL.

Asymptomatic pregnant patients are not to be referred for reassurance purposes only.

Referral Criteria

All referrals received via ERS Searching Hull University Teaching Hospitals NHS Trust (RWA) and then Radiology and select Ultrasound.

Referrals should include all details of the patient, need for ultrasound and site to be scanned.  Where possible pleased use the referral form for Ultrasound (available via ARDENS).  If the referral is Urgent, please mark this clearly on the referral.

Once received, referrals are entered into the radiology system for triage and vetting. This process can take up to 4 days.

If an urgent referral has been placed on ERS requiring immediate attention, please contact the ultrasound department via email hyp-tr.ultrasound@nhs.net

https://digital.nhs.uk/services/e-referral-service

https://gettingitrightfirsttime.co.uk/wp-content/uploads/2025/07/National-Suspected-Cauda-Equina-Pathway-September-2025.pdf

• Hull University Teaching Hospitals