POAC Funded X-Ray
Principles of funding: POAC will fund a same-day plain X-ray where ALL of the following apply:
It is safe to manage the patient in the community, AND
Required within 24-48 hours, or patient would otherwise be sent acutely to ED, AND
The result of the x-ray will inform immediate clinical management, AND
The condition is not related to trauma or accident (unless specifically outlined below)
X-ray - Adult
X-ray Chest - Adult
Refer for acute assessment without imaging:
Haemoptysis with “red flags” including if
Significant (e.g., more than 20ml (1 tablespoon) in a single episode) or life-threatening (e.g., more than 100 ml/hour) haemoptysis
Haemodynamically unstable
Haemoptysis with hoarseness or stridor
Acute dyspnoea and/or chest pain
Severe respiratory distress
Suspected large pneumothorax with significant pain, breathlessness, tachycardia
Suspected active Tuberculosis and the patient is acutely unwell – follow the Tuberculosis pathway
POAC will fund X-ray within 24 hours for:
Suspected community-acquired pneumonia (CAP) with unexpectedly severe or atypical presentation, or where the patient is considered at risk of underlying lung pathology (e.g. lung cancer)
Respiratory tract infection with possible left ventricular failure
Guidance:
In patients with an acute lower respiratory tract infection a chest x-ray does not change the management in most cases.
X-ray for symptoms or signs concerning lung cancer should be requested with 48 hours via Access to Diagnostics or eReferral for hospital outpatient radiology.
Refer Auckland Regional HealthPathways:
X-ray Abdomen - Adult
Refer for acute assessment without imaging:
Acute abdomen including suspected obstruction
POAC will fund X-ray within 24-48 hours where:
Diagnosis of constipation where patient history is unobtainable.
Secondary care clinician or Primary Care Radiology Liaison or radiologist advises referral for acute x-ray
Guidance:
As there is wide variation in the amount of normal faecal residue shown, abdominal X-ray does not reliably diagnose constipation nor should be used for monitoring response to treatment. The sensitivity and specificity of AXR is low in both the diagnosis and identifying underlying cause of bowel obstruction. As a more definitive test, CT is preferable and AXR may result in delays to a more definitive test such as CT.
X-ray Musculoskeletal - Adults
Ankle/Foot
Refer for acute assessment without initial imaging all cases of suspected septic arthritis
POAC funding may be considered within 48 hours where specified by secondary care clinician or Primary Care Radiology Liaison
Spine
Refer for acute assessment without initial imaging all cases of suspected septic arthritis
Suspected spinal infection e.g. back pain and one or more of fever, history of recent infection, IV drug use, immunosuppression - seek acute orthopaedic advice
Suspicion of cauda equina syndrome i.e. acute back pain with any of:
sphincter disturbance
gait disturbance
saddle anaesthesia
loss of bowel or bladder control
abnormal reflexes, or loss of muscle power or feeling in the legs
POAC funding may be considered within 48 hours where specified by secondary care clinician or Primary Care Radiology Liaison
Wrist, Hands, Elbow, Knee, , Shoulder
Elbow, Knee, Pelvis/Hip, Shoulder, Wrist/Hand
Refer for acute assessment without initial imaging all cases of suspected septic arthritis
No POAC funded imaging
Paediatric X-ray
X-ray Chest - Paediatric
Refer child for acute assessment without requesting imaging if any of:
Respiratory distress- tachycardia, tachypnoea, stridor
Breathing difficulties and SpO2 92% or lower
Acute severe asthma o Suspected inhaled foreign body
Chest x-ray is rarely required in suspected community acquired pneumonia (CAP).
Consider POAC funded X-ray within 24 hours if:
diagnostic uncertainty or atypical presentation
not making expected clinical progress and complications are suspected o recurrent pneumonia symptoms (i.e. suggestive of underlying respiratory disease)
Secondary care clinician, Primary Care Radiology Liaison or radiologist advises referral for same or next day x-ray
Refer Auckland Regional HealthPathways:
X-Ray Abdomen - Paediatric
Refer for acute assessment without initial imaging:
History of foreign body ingestion and any of:
Suspected oesophageal obstruction (e.g. drooling or reluctance to swallow)
Known or suspected disc / button battery ingestion
Multiple magnets ingested o Large object (more than 5cm long and / or 2cms wide)
Acute abdomen
POAC will fund X-ray within 24-48 hours where:
History of suspected ingestion of a foreign body but type of object is unclear, the child is asymptomatic, there are no red flags requiring hospital admission, and an acute x-ray advised by secondary care specialist or Primary Care Radiology Liaison
Secondary care clinician, Primary Care Radiology Liaison or radiologist advises referral for same or next day x-ray
Guidance:
The majority of ingested foreign bodies (FBs) are low risk objects and can be managed without imaging or intervention.
X-rays, when required, should include neck, chest, and abdomen and with lateral as well as frontal views of the neck and chest.
Refer Auckland Regional HealthPathways:
X-ray Musculoskeletal - Paediatric
Pelvis/Hip
Refer for acute assessment without initial imaging all cases of suspected septic arthritis or osteomyelitis
POAC will fund X-ray within 24 hours for:
Child presenting with non-acute symptoms where diagnosis of SUFE is suspected - arrange hip X-ray with AP pelvis film and frog lateral view. Be aware that very early slips may be subtle and missed on X-ray and have a low threshold for seeking orthopaedic advice.
Wrist, Hands, Feet, Elbow, Knee, Spine, Shoulder
Refer for acute assessment without initial imaging all cases of suspected septic arthritis
No POAC funded imaging
ACC/Injury Related X-ray
In most situations, injury related x-ray is excluded from POAC and should be under ACC.
The exception here is for injury cases initiated by St John, hospital, Emergency Q Voucher or ARC/hospice for portable x-ray for immobile patients requiring acute radiology to exclude fracture and determine admission requirements. In these situations, POAC will fund the ACC co-payment only.