This page gives advice for those wanting to refer patients for nuclear medicine investigations at University College London Hospitals NHS Foundation Trust. Given at the end of this page are appropriate referral guidelines for the tests we perform.
All medically qualified doctors with GMC registration can make a referral for a nuclear medicine test. If you are a junior doctor, the consultant in charge of the patient should be identified as being the referrer. GPs can also make referrals for certain nuclear medicine investigations.
Non-medical referrals can be made by Nuclear Medicine approved registered healthcare professionals from within UCLH. Non-medical referrals from outside UCLH are not possible currently. If you want to become a non-medical referrer, please email uclh.
For all referrals, please ensure that the patient is informed that they will be sent for a test before sending in the referral request. For many tests, a dose will be ordered in advance for each patient. Where patients cancel at short notice, we are unable to use the dose for another patient. All efforts will be made to process requests as soon as possible upon receipt.
Internal referrals within UCLH
All referrals should be made through EPIC. Please use the generic NM provisional codes when making your request. The Nuclear Medicine consultant will ensure that the correct test is arranged for you.
External referrals from outside UCLH
Please inform us at the earliest opportunity if you wish to cancel the nuclear medicine investigation. Wherever possible this should be done via telephone to confirm that the message has been received, and that the patient does not continue to have the test. Furthermore, all our investigations require pre-ordered radiopharmaceuticals which will be wasted if we are not informed about a cancellation.
In alignment with UCLH policy, patients will be allowed two non-attendances before the request is cancelled. If you intend to re-refer the patient after non-attendance, please inform them how it important it is for them to attend their appointment.
Under the IR(ME)R 2017 regulations, certain information should be provided by the referrer. The table below taken from RCR guidance gives details of Essential, Expected and Desirable Information to be given with the referral.
Accurate, up-to-date patient identification information
|Relevant clinical history||Clinical diagnosis|
Information related to research trials (where relevant)
|Information related to pregnancy and breastfeeding (where appropriate)|
|Signature or e-signature||Name and contact details of referrer for results, reports and any potential escalation|
|Clinical findings on examination||Mobility status (e.g., requires a hoist)|
|Co-morbidities (where relevant)||Medication|
Carer or comforter requirements or other relevant radiation protection information
Patients referred internally within UCLH will have images on PACS and reports available on EPIC once they are finalised.
External reports and images will be sent via Image Exchange Portal (IEP). Reports to GPs will be sent via DocMan.
A weekly check of data sends is performed by the nuclear medicine booking team in UCLH.
If you are concerned that reports or images have not been made available, please contact the booking team using the contacts given below.
|Booking||020 3447 firstname.lastname@example.org|
Referral guidelines for specific tests
Please refer to the latest RCR referral guidelines for PET-CT imaging studies. The radiation exposure for common PET investigations is given in the table below.
Please note that whole-body PET-CT investigations also have an additional 8.4 mSv associated with the CT, where brain and heart imaging typically add a further 1 mSv of radiation exposure.
|Radiopharmaceutical and Investigation||Effective Dose||Radiopharmaceutical and Investigation||Effective Dose|
Fluorodeoxyglucose (FDG) Whole body tumour imaging
|7.6 mSv||Fluorodeoxyglucose (FDG) Infection Imaging||7.6 mSv|
Fluorodeoxyglucose (FDG) Dementia/Epilepsy Imaging
|4.8 mSv||Florbetaben Cerebral Amyloid Assessment||5.8 mSv|
Fluoride (NaF) Bone Imaging
|4.3 mSv||Fluorodopa Congenital Hyperinsulinism||7 mSv|
Rubidium Myocardial Perfusion Imaging
|2.2 mSv||Gallium Dotatate Somatostatin receptor Imaging||6.4 mSv|
Gallium PSMA Prostate Imaging
|4.6 mSv||Fluorine PSMA Prostate Imaging||4.0 mSv|
Referral to PET-MRI can be made through the same processes described above. For many indications listed for PET-CT, PET-MRI provides an alternative with lower radiation exposures because of the lack of CT irradiation – the PET radiation exposures are the same as those listed above.
PET-MRI may therefore be preferred where radiation exposure is particularly sensitive, such as in paediatric patients. Additional synergism between PET and more detailed MRI exists for some indications such as problem solving in neuro-oncology, head and neck cancer, multiple myeloma, hepatopancreatico-biliary and pelvic malignancies. These may be accommodated. Please leave contact details on referral and a member of our team would be in contact.
Please be aware however, that as with standard MR, safety screening for metal and electronic implants will be necessary. The device may also not be appropriate for patients who are claustrophobic.
Glomerular Filtration Rate (GFR)
||2.9 mSv – 3.9 mSv + CT dose if SPECT-CT|
||4.6 mSv – 5.4 mSv|
|DMSA (Kidney scan)||
|Lung V/Q scan||
||1.5 mSv – 2.8 mSv|
|MAG3 Kidney scan||
|Sentinel Lymph Node||
||0.02 mSv –
Please note if patient is having a CT scan with contrast same day as this may affect the Bone Density images; in this case, the Bone Density must be done first.
Bone density cannot be done within 7 days of CT with contrast.
|Hip and Lumbar Spine||
|Total Body Composition||
The department performs the following therapies:
Iodine-131 therapy for benign thyroid conditions such as hyperthyroidism and euthyroid goitre
Iodine-131 MIBG therapy for the treatment of MIBG avid neuroendocrine tumours and neuroblastoma
Lutetium-177 therapy for somatostatin receptor positive neuroendocrine tumours and neuroblastoma
Radium-223 treatment targeting bone metastases in castration-resistant prostate cancer
Lutetium-177 therapy for metastatic castration-resistant prostate cancer (mCRPC)
Referrals for all therapies should be made via discussion with the nuclear medicine department and be presented through the UCLH Molecular Radiotherapy MDT.
Referral guidelines for other tests and radionuclide therapies, and specific referral information on the tests mentioned above are given in British Nuclear Medicine Society and European Association of Nuclear Medicine procedure guidelines.
These guidelines also provide information on radiation exposure associated with tests, which is also available from the UKHSAs ARSAC notes for guidance.