Non-Medical Radiology Referring

INTRODUCTION
Expanding the non-medical workforce to include radiology referral is a positive step toward responsive, patient-centred care. Nurses, paramedics, and advanced clinical practitioners (ACPs) increasingly act as first contact clinicians and need to request timely, appropriate imaging. As a non-medical referrer, you are legally and professionally responsible for ensuring imaging requests are clinically justified, appropriate, and safe. This module summarises key requirements to practise lawfully, competently, and confidently across primary, secondary, emergency and urgent care.

LEGAL FRAMEWORKS AND REGULATION
All imaging requests involving ionising radiation fall under the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R 2017, and IR(ME)R NI 2018). These define the “referrer” as a registered healthcare professional entitled by their employer to refer patients for medical exposure. Referrers must comply with local employer protocols and IR(ME)R requirements.

The four legal duty holders under IR(ME)R are:

• Employer: creates procedures, entitlements, and protocols
• Referrer: provides clinical information to justify the request
• Practitioner: authorises the exposure
• Operator: carries out the procedure

Note that the Referrer and Practitioner may be the same person.

Non-ionising modalities (e.g. ultrasound, MRI) do not fall under IR(ME)R but still require robust local governance, best-practice protocols, and clear clinical reasoning.

ELIGIBILITY CRITERIA
To be a non-medical referrer, you must:
– Be registered with a recognised professional body (NMC, HCPC, etc.)
– Demonstrate clinical competence in assessment, history-taking, and clinical reasoning
– Complete suitable IR(ME)R training, covering:

• Principles of radiation protection
• Risks vs benefits of medical imaging
• Justification of exposures
• Legal responsibilities under IR(ME)R
  – Work within your local employer’s entitlement, scope of practice and written protocols

Registered nursing associates, for example, are not eligible to act as referrers because they cannot independently assess and plan care.

TRAINING AND CPD REQUIREMENTS
Before entitlement, you must evidence:
– Training in IR(ME)R awareness and safety
– Practical knowledge of referral guidelines (e.g. Royal College of Radiologists iRefer)
– Understanding of dose implications and alternative investigations
– Familiarity with local systems (e.g. electronic requesting)

Continuing professional development is mandatory. Non-medical referrers must keep up to date with refresher training at least every three years, and regularly audit their practice.

ROLES AND RESPONSIBILITIES
Your key responsibilities as a non-medical referrer include:
– Providing enough clinical data for justification by the practitioner
– Ensuring accuracy of patient details
– Complying with local protocols and IR(ME)R guidance
– Recording and acting upon the outcomes of radiology reports
– Communicating results to the patient and arranging appropriate follow-up

In autonomous advanced practice roles, you must be confident to take responsibility for the next steps after the report, documenting and acting on any significant findings without delay.

GOVERNANCE AND AUDIT
Employers, supported by their local radiology departments, must maintain a register of entitled non-medical referrers, specifying their scope of practice. Audit, quality assurance, and incident reporting processes should be in place to safeguard patient safety.

Electronic requesting systems help limit referral privileges to entitled staff only, but you must never use another clinician’s login or pre-signed paper forms.

Failure to comply with governance, or repeatedly requesting inappropriate tests, may lead to removal of entitlement until further training is completed.

LIMITATIONS AND BOUNDARIES
Non-medical referrers must know their own boundaries. High-dose examinations (e.g. CT, PET-CT) should usually only be requested as part of a multidisciplinary team pathway or consultant-led pathway. Requests involving radionuclide substances, for example, must comply with local agreements with the ARSAC licence holder.

Referrers must also appreciate MRI and ultrasound safety issues, following local employer policies and MHRA best-practice guidelines.

PROFESSIONAL STANDARDS AND ACCOUNTABILITY
As a non-medical referrer, you remain professionally accountable under your regulator’s code of conduct, for example the NMC Code or HCPC Standards of Proficiency. You must:
– Work within your scope of practice
– Provide justified, evidence-based referrals
– Maintain detailed, accurate records
– Communicate results and act promptly on critical findings

Professionalism includes safeguarding patients through safe, appropriate referrals — not simply requesting images to reassure yourself or the patient.

GOVERNING BODIES’ POSITIONS
– Nursing and Midwifery Council: supports appropriately trained nurses acting as non-medical referrers, providing they work within their scope and follow the Code
– Health and Care Professions Council: expects paramedics and AHPs to comply with professional standards, IR(ME)R, and local policies
– Royal College of Radiologists & Society of Radiographers: endorse non-medical referral with appropriate governance, training and audit
– British Institute of Radiology: advises robust governance, a formal entitlement process, and clear procedures for removing entitlement if concerns arise

SUMMARY
Non-medical referral in radiology is a recognised, valuable role that enhances patient-centred care across the NHS. However, it carries significant legal, professional, and clinical responsibilities.

If you are a nurse, nurse practitioner, paramedic, or ACP seeking to become a non-medical referrer, ensure you:
– Undertake accredited training
– Understand IR(ME)R and local protocols
– Practise within a clearly defined scope
– Commit to audit and continuous CPD
– Communicate effectively with patients and the wider team

Competent, safe, and justified referrals not only improve patient outcomes but also demonstrate advanced practice at its best.
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