Radiographer Imaging Request Reflection: Driscoll

What?

A request arrived for a CT of the abdomen and pelvis with contrast for a young woman with abdominal pain. Reviewing the request, I noticed the clinical details were thin, there was no documented pregnancy status, and the history read more like a first-line ultrasound presentation than a CT indication. I telephoned the requesting doctor to query it. The conversation was initially tense - he was busy and said the consultant wanted the scan. I explained my legal duty under IR(ME)R to justify the exposure and asked specifically about pregnancy status and whether ultrasound had been considered. He checked with the consultant and called back: the patient had a positive pregnancy test taken after the request was submitted, and the plan changed to ultrasound. The CT did not go ahead.

So what?

The uncomfortable truth is how close I came to not phoning. The department was stacked, the request was signed by a consultant's team, and the path of least resistance was to assume the justification had been done upstream. What tipped me into calling was not confidence but a checklist habit: absent pregnancy status is a hard stop I do not negotiate with myself about. That matters, because it means my safety behaviour survived a moment when my assertiveness might not have. The initial tension in the call also taught me something about framing: the conversation changed the moment I moved from 'I'm not happy with this request' - which sounds like opinion - to naming my specific legal responsibility and asking two concrete questions. Structure lowered the temperature. Had that scan gone ahead, an early pregnancy would have received a significant radiation dose for an investigation that was not indicated, and I would have been the person who pressed the button.

Now what?

I will keep treating missing pregnancy status as an absolute stop, and I have started framing every query call the same way: my duty, then specific questions, never generalised doubt. I presented this case anonymously at our departmental governance meeting, and we agreed to feed back to the emergency department about incomplete requests, since mine was not an isolated example. I have also offered to walk our new band 5s through how I structure a challenge call, because I remember how exposed those conversations feel in your first year, and a script is easier to hold onto than courage.