Diagnostic Imaging Authorized Prescriber Guideline - 2024

1. Requesting general radiography studies allows for:

• a. Increased efficiency in the delivery of primary health care to Nova Scotians.
• b. Effective and efficient referral or clinical management of neuromusculoskeletal care with minimal delays to necessary patient care.
• c. The ability of regulated health care providers to function within their scope of practice in Nova Scotia as part of health care teams to relieve pressure on existing resources.

2. The Physiotherapist must adhere to all standards, guidelines and legislation related to personal health information, such as the Personal Health Information Act (PHIA).

3. Prescribing Physiotherapists must ensure they have the theoretical and practical knowledge to safely and effectively prescribe plain view radiographs.

1. To become an Authorized Prescriber, the Physiotherapist will apply to the College. See appendix C for requirements.

2. The Physiotherapist will ensure that radiation exposure is kept as low as reasonably attainable (ALARA). This will be done through thorough assessment and following principles and guidance consistent with current recommendations such as found at https://choosingwiselycanada.org/recommendation/radiology/ and https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria. See appendix D for more resources.

3. The physiotherapist will assess for previous radiological studies within the past year to avoid unnecessary duplication of x-ray studies. Private sector Physiotherapists do not have access to the records system; this will require the client/patient be asked if they have had the radiograph already. Physiotherapists employed through NS Health/IWK Health will review records through PACS or XERO for patient history.

4. The Physiotherapist will complete and sign an approved NS Health/IWK Health radiology requisition including the following information:

• a. General Radiography studies required,
• b. Relevant clinical background,
• c. Name and phone number/fax number of the requesting Physiotherapist to ensure timely communication of results, and,
• d. Name and phone/pager number of the patient’s MRHCP (most responsible health care provider, e.g., family doctor, nurse practitioner) if applicable.

5. The patient will be given the requisition and provided the appropriate information to schedule an appointment.

6. Radiology reports will be available in NS Health/IWK Health via PACS or XERO after sign off by the Radiologist. It will also be sent by the Diagnostic Imaging department directly to the Physiotherapist, the client’s primary care provider and a specialist identified on the requisition as appropriate. Results will be faxed to the appropriate private clinic indicated by the Physiotherapist.

7. After completion of the x-ray, the Physiotherapist may discuss the findings with a collaborating Physician/Nurse practitioner in clinic, when appropriate.

8. In the case of findings that are out of scope and therefore require follow up by the patient’s MRHCP (most responsible health care provider, e.g., family doctor, nurse practitioner), the Physiotherapist will contact the MRHCP via telephone to ensure they received the report and to confirm follow up.

• a. If the client does not have a primary physician MRHCP, the Physiotherapist will direct the client to an appropriate outpatient facility, or local emergency department, along with a note indicating the concerns and referencing the x-ray report. Options for care are available via YourHealthNS.
• b. The Physiotherapist may not comment on findings outside their scope of practice.

1. Diagnostic Imaging (DI) staff is responsible for sending the general radiography studies report to:

• a. The referring Physiotherapist via fax or electronic transfer.
• b. The MRHCP by fax or electronic transfer.

2. The Physiotherapist is responsible to communicate general radiography study findings that are within their scope of practice to the patient.

3. For findings that are not within scope of practice and/or require follow up, the Physiotherapist is responsible to direct the patient as follows:

• a. To their primary physician/MRHCP for further medical care.
• b. If the patient does not have a primary physician/MRHCP:
• i. In the case of a non-critical result, to a walk-in clinic and including a note indicating the concern and referencing the general radiographic studies report.
• ii. For a critical result, direct the patient to an emergency department and include a note indicating the concern and referencing the general radiography studies report.

Critical Results Contact Number: In the event of a critical result requiring emergency care the referring physiotherapist is responsible for following up and ensuring the patient is informed and directed to the appropriate care. While this is not a frequent occurrence the referring Physiotherapist is responsible for ensuring they can be contacted outside of clinic hours if needed. There should be someone available to take calls at this number 24 hours a day.

4. The Physiotherapist shall recognize and accept responsibility for the impact of conducting and requesting radiographic studies on the overall costs and sustainability of the health care system, including ensuring clinical necessity for all studies requested and that the results cannot be obtained from another source.

5. Nova Scotia College of Physiotherapists is responsible to:

• a. Provide and maintain a current list of registered Physiotherapists and submit to IMIT (Information Management and Information Technology – NSH) as the register changes.
• b. Ensure all registered Physiotherapists have required Professional Liability and Comprehensive General Liability Insurance as per The Physiotherapy Act and Regulations.
• c. Provide members any updated legislation, regulations, standards and policies applicable to the referral of patients for general radiography studies in Nova Scotia.
• d. House the DI authorized physiotherapists prescriber roster and ensure the list of registrants is available and updated and ensure IMIT has a current list of all registered Physiotherapists using the prescribed form.

Physiotherapists should only request radiography studies when they are able to demonstrate the following kinds of theoretical knowledge to the College upon request:

• The kinds of radiography studies that are within the scope of physiotherapy practice.
• The formal rules that govern the use of radiation on patients.
• The risks associated with subjecting patients to radiation for investigations.
• The indications and contraindications that should influence whether radiography studies should be requested.
• The appropriate study to request in the context of the patient’s condition and body part that needs assessment.
• The normal anatomy of the relevant body part that will be investigated.
• The appropriate roles of the various health professionals involved in the process of requesting the investigation, (i.e., the physiotherapist, whose role is to request the study, the radiographer, whose role is to perform the radiological procedure, and the radiologist, whose role is to interpret the investigation and provide a report to the individual who requested it)

See appendix D for useful resources for available online.

Physiotherapists should only request radiography studies when they are able to demonstrate the following forms of practical knowledge to the College upon request:

• How the study they intend to request falls within their personal scope of practice and competence.
• The ability to identify patient specific indications or contraindications.
• The ability to assess the radiation load that their patients may have been exposed to, to determine that patients are not irradiated more than necessary.
• Practical knowledge relating to how radiography studies are requisitioned and what kind of information needs to be provided.

Physiotherapists are only permitted to request specific radiological studies. (For a complete list of the studies included see the attached Appendix B)

1. The Physiotherapist is responsible to:

a. Consider the benefits, limitations, contraindications and risks in determining whether the radiograph is required to reach an appropriate diagnosis, clinical impression and/or plan of care.

b. Take all reasonable steps to ensure no unnecessary duplication in the general radiography study within Nova Scotia Health/IWK.

c. Complete and sign a radiology requisition as provided by NSH/IWK and include the following information:

• i. General Radiography studies required,
• ii. Relevant clinical background,
• iii. Name and phone number/fax number of the requesting Physiotherapist to ensure timely communication of results, and
• iv. Name and phone/pager number of the patient’s MRHCP (most responsible health care provider, e.g. family doctor, nurse practitioner). (if applicable)

d. Communicate effectively to the patient the reason and process for requesting the radiograph to allow the patient to make an informed and voluntary decision regarding the radiographic studies requested.

e. Provide the patient with the requisition and instructions on booking process: https://booking.nshealth.ca or can call 902-473-7771 or toll-free at 1-833-952-2782, Monday to Friday, between the hours of 7:30 a.m. and 4 p.m. to schedule an appointment.

f. Ensure that all records including radiology requests and fax results for all patients are received and stored in a private manner that meets all privacy requirements and are part of the patient record

1. Member in good standing registered to practice with the Nova Scotia College of Physiotherapists.

2. Complete online application that will include the following the following:

• i. Attestation of competence (Physiotherapist to maintain records and provide on request)

Attestation of accuracy of the following:

• i. Sector
• ii. License #
• iii. First Name
• iv. Middle Name
• v. Last Name
• vi. Clinic Name
• vii. Office Address, Suite, City, Province, Postal Code
• viii. Office Phone
• ix. Office FAX
• a. required for receiving reports. Must be compliant with all health information standards, guidelines and legislation
• ii. Critical Results contact number
  • a. In the event of a critical result requiring emergency care the referring physiotherapist is responsible for following up and ensuring the patient is informed and directed to the appropriate care. While this is not a frequent occurrence the referring Physiotherapist is responsible for ensuring they can be contacted outside of clinic hours if needed. There should be someone available to take calls at this number 24 hours a day.
  Upon approving the application NSCP will send any changes to NSH/IWK to update their system with the relevant details.

• ACR Appropriateness Criteria® | American College of Radiology
• CAR_MSK_Referral_Guideline.pdf
• Recommendations - Choosing Wisely Canada
• Ottawa Ankle Rules - Physiopedia
• Ottawa Knee Rules - Physiopedia
• X-ray Radiographic Patient Positioning

Patient Education:

• Having an X-ray (nshealth.ca)
• Managing Low Back Pain (nshealth.ca)

Relevant NSH/IWK Policies:

• Diagnostic Test Requests – Authorized Prescriber
• Requesting General Radiography Studies by Physiotherapists
• Consultation for X-rays by Physiotherapists

• Diagnostic Imaging Request Form
• Diagnostic Imaging Requisition Form - How To Guide
• Request for Patient Health Care Information Form
• Please note - when requesting reports of previously completed images it may take up to 30 days for some reports/images to be delivered dependent on the number of requests received.

FAQ