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Tips to write a good
radiological report
Dr/Ahmed Bahnassy
Consultant radiologist
RMH

•The ability to write clearly is a skill, not
an art, and it is learned by practice. Ferris M.
Hall1


What is radiological report
• The radiology report is the primary means of
communication between the radiologist and the
referring physician. The report reflects the
attitude, perception and capability of the
radiologist and serves as a legal document.


History
• The process of reporting,
progressed from the
earliest handwritten
reports to today's
sophisticated speech
recognition systems.
• Yet the form and content
of the radiologic report
itself have not evolved
along with the
technology that

facilitates its delivery to
the clinician.


THE FIRST RADIOLOGY
REPORTS
•

Dear Dr Stieglitz: The X ray
shows plainly that there is no
stone of an appreciable size in
the kidney. The hip bones are
shown & the lower ribs and
lumbar vertebrae, but no
calculus. The region of the
kidneys is uniformly penetrated
by the X ray & there is no sign
of an interception by any
foreign body. I only got the
negative today and could not
therefore report earlier. I will
have a print made tomorrow.
The picture is not so strong as I
would like, but it is strong
enough to differentiate the
parts."


Hospital based reports.
•

x-rays were welcomed as a
beneficial new technology.
Specialist physicians and
surgeons who were shown a
"penetrating photograph" of
their patients believed they
needed no one else to
interpret the meaning of those
images.

•

At Boston Hospital in 1901, xray pioneer Francis Williams
described the "standardized"
x-ray reporting and medical
record process:


• In the 1910s,
several private
practitioners took
full service reports
to innovative and
complex lengths.


The report body
• Most radiologists use the format:
Discussion:

Impression
This is logical and follows the inductive method. The
facts are weighed and a conclusion made. In the modern
hospital environment it has disadvantages. Those
listening to the report have to wait until the end to hear
the conclusion. The same problem is inherent in reading
reports online, the referring clinician may have to scroll,
to the conclusion.


The “C” factor
• The attributes of a good radiology report have
been summarized as the Six Cs. Reports should
be :
• clear, correct, concise, complete, consistent,
and have a high confidence level.


Be brief
• Clinicians have been asked what they want:
"brief description of the radiographic findings."


Most important finding first.
• Normal except for cancer RLL is unacceptable.
• The physician may stop at normal.


Quantitate Quantitate Quantitate.
• Measure if possible or use qualifiers- mild,

moderate, severe.


Compare, Compare,
Compare.
• Lack of comparison is a common factor in
physicians perplexity.


Call Results
• for unexpected, life-threatening problems.
Document the call in the report.


Make the referring physician look
good
• A common phrase "fracture is poorly aligned"
should be avoided.
• Extensive amount of post operative
pneumoperitoneum.


Be concise
• Eliminate unneeded or redundant words. "There
is an area of linear atelectasis in the right lower
lobe" should be - "Linear atelectasis right lower
lobe."


Don’t be poisonous

• Unfortunately it is not uncommon to find a new
malignancy on a mammogram or chest
radiograph which in retrospect was present and
reported out by a colleague as "normal"
•
•
•
•

Words or phrases to avoid:
missed
overlooked
not appreciated
should have been identified


Asking for Further Studies
•
•
•
•

the more specialized the physician the less
appreciated are recommendations
however, we cannot avoid responsibility to patient
if further imaging necessary, document why ("CT may
be helpful in staging....or localization.....or
characterization")
if biopsy necessary: don't state that tissue is needed,
rather recommend appropriate method to obtain tissue

("mass whould be amenable to bronchoscopic biopsy
or percutaneous needle aspiration or endoscopy")


Mark (to a limit )
• The pen is mightier than the sword
One of the most effective but least appreciated
tools is marking.
• Mark the end of all the lines and catheters. Mark
the carina. Mark the edge of the pneumothorax.
Outline collapsed lobes and anything else which
you feel important.
• Why?
• marks help convey what's important.


Be strong in serious findings
• Possibility of malignancy.
• Life threatening infections.
• Specific etiology (TB)


Don't be vague.
• Vague: Wandering, roaming, unsettled,
uncertain...not definite in meaning, not explicit or
precise, of indistinct ideas...absence of clear
perception or understanding...meaningless
• Be a journalist and not a reporter.
• Interpret.
• Put yourself in the referring physician's

shoes. .What would you conclude if you read this
report?


Radiologists between clarity and
fear of failure .
• Three quarters of a century ago, Enfield
criticized radiologists who issued written
radiology reports that:
• ...describe in detail all that the roentgenologist
sees in the film or on the screen but does not tell
what he thinks about it, what conclusions he
draws from it, and what it means to him.
• This kind of report "commits the roentgenologist
to nothing except accurate vision and good
description... It tells much, yet almost nothing,"


• Enfield exhorted radiologists to "give not only
their opinion but also their method of arriving at
that opinion."
• "it is the obligation of the radiologist to state what
has been found as clearly and pointedly as
possible."


• Clarity and meaningfulness were the most
valued qualities of radiology reports among 200
referring physicians, according to a Canadian
survey

Eyes and minds
• Radiologists should heed the words of
Rothman , who wrote that because radiologists
are paid for using both their eyes and their
brains, a complete radiology report must include
both sets of evaluations.
• The body of the report should contain a
complete description of all abnormalities—that
is, everything that is seen with the eyes—
• but the conclusion should discuss only those
findings that are important to the brain.


Don’t through the ball away from
you
• Radiologists should minimize, the use of such
phrases as "if clinically indicated " when
assessing abnormal radiographic findings.
• Because radiologists are acknowledged to
possess radiologic expertise they should not
relinquish to nonradiology physicians the
responsibility of evaluating the significance of a
radiographic finding that is unexpected or
unusual.