This is the current release of the guideline.

Any disease or condition requiring diagnostic radiologic imaging

To provide guidelines for effective communication of diagnostic imaging findings to clinicians responsible for treatment decisions

Patients undergoing diagnostic radiologic imaging

Not stated

The Medline literature search is based on keywords provided by the topic author. The two general classes of keywords are those related to the condition (e.g., ankle pain, fever) and those that describe the diagnostic or therapeutic intervention of interest (e.g., mammography, MRI).

The search terms and parameters are manipulated to produce the most relevant, current evidence to address the Practice Guideline or Technical Standard topic being reviewed or developed. Combining the clinical conditions and diagnostic modalities or therapeutic procedures narrows the search to be relevant to the topic. Exploding the term "diagnostic imaging" captures relevant results for diagnostic topics.

The following criteria/limits are used in the searches.

1. Articles that have abstracts available and are concerned with humans.
2. Restrict the search to the year prior to the last topic update or in some cases the author of the topic may specify which year range to use in the search. For new topics, the year range is restricted to the last 5 years unless the topic author provides other instructions.
3. May restrict the search to Adults only or Pediatrics only.
4. Articles consisting of only summaries or case reports are often excluded from final results.

The search strategy may be revised to improve the output as needed.

The total number of source documents identified as the result of the literature search is not known.

Not applicable

Not stated

Recommendations are formulated through iterative review by committee, collaborating societies, and membership. Suggested recommendations are reviewed by the committee and agreement is reached by consensus.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Each practice guideline and technical standard, representing a policy statement by the American College of Radiology (ACR), has undergone a thorough consensus process in which it has been subjected to extensive review, requiring the approval of the Commission on Quality and Safety as well as the ACR Board of Chancellors, the ACR Council Steering Committee, and the ACR Council.

Effective communication is a critical component of diagnostic imaging. Quality patient care can only be achieved when study results are conveyed in a timely fashion to those responsible for treatment decisions. An effective method of communication should: (a) be tailored to satisfy the need for timeliness, (b) support the role of the interpreting physician as a consultant by encouraging physician communication, and (c) minimize the risk of communication errors.

Various factors and circumstances unique to a clinical scenario may influence the methods of communication between interpreting physicians and referring clinicians. Timely receipt of the report is more important than the method of delivery.

Communication of information is only as effective as the system that conveys the information. There is a reciprocal duty of information exchange. The referring physician or other relevant health care provider also shares in the responsibility for obtaining results of imaging studies he or she has ordered. Formulating an imaging interpretation requires the commitment and cooperation of administrators, clinicians, and interpreting physicians.

Whenever possible, previous reports and images should be available for review and comparison with the current study. A request for imaging should include relevant clinical information, a working diagnosis, and/or pertinent clinical signs and symptoms. In addition, including a specific question to be answered can be helpful. Such information helps tailor the most appropriate imaging study to the clinical scenario, enhances the clinical relevance of the report, and thus promotes optimal patient care.

Diagnostic Imaging Reports

An official interpretation (final report) must be generated and archived following any examination, procedure, or officially requested consultation regardless of the site of performance (hospital, imaging center, physician office, mobile unit, etc.).

1. Components of the Report

   The following is a suggested format for reporting:

   1. Demographics
      1. The facility or location where the study was performed
      2. Name of patient and another identifier
      3. Name(s) of referring physician(s) or other health care provider(s). If the patient is self referred (a patient who seeks medical care without a physician referral), that should be stated.
      4. Name or type of examination
      5. Date of the examination
      6. Time of the examination, if relevant (e.g., for patients who are likely to have more than one of a given examination per day)
      7. Inclusion of the following additional items is encouraged:
         1. Date of dictation
         2. Date and time of transcription
         3. Patient's date of birth or age
         4. Patient's gender
   2. Relevant clinical information
   3. Body of the report
      1. Procedures and materials

         The report should include a description of the studies and/or procedures performed and any contrast media and/or radiopharmaceuticals (including specific administered activities, concentration, volume, and route of administration when applicable), medications, catheters, or devices used, if not recorded elsewhere. Any known significant patient reaction or complication should be recorded.

      2. Findings

         The report should use appropriate anatomic, pathologic, and radiologic terminology to describe the findings.

      3. Potential limitations

         The report should, when appropriate, identify factors that may compromise the sensitivity and specificity of the examination.

      4. Clinical issues

         The report should address or answer any specific clinical questions. If there are factors that prevent answering of the clinical question, this should be stated explicitly.

      5. Comparison studies and reports

         Comparison with relevant examinations and reports should be part of the radiologic consultation and report when appropriate and available.

   4. Impression (conclusion or diagnosis)
      1. Unless the report is brief, each report should contain an "impression" section.
      2. A specific diagnosis should be given when possible.
      3. A differential diagnosis should be rendered when appropriate.
      4. Follow-up or additional diagnostic studies to clarify or confirm the impression should be suggested when appropriate.
      5. Any significant patient reaction should be reported.
   5. Standardized computer-generated template reports

      Standardized computer-generated template reports should be designed to satisfy the above criteria.

2. Principles of Reporting (Final Report)
   1. The final report is the definitive documentation of the results of an imaging examination or procedure.
   2. The final report should be proofread to minimize typographical errors, accidentally deleted words, and confusing or conflicting statements. Use of abbreviations or acronyms should be limited to avoid ambiguity.
   3. The final report should be completed in accordance with appropriate state and federal requirements (see the "Final Regulations, Mammography Quality Standards Act for Mammography Reporting"). Electronic or rubber-stamp signature devices, instead of a written signature, are acceptable unless contrary to state law, if access to such devices is secure.
   4. The final report should be transmitted to the referring physician or health care provider who provides the clinical follow-up in accordance with the appropriate state and federal requirements. The referring physician or other relevant health care provider also shares in the responsibility of obtaining results of imaging studies he or she has ordered.
   5. When feasible, a copy of the final report should accompany the transmittal of relevant images to other health care professionals, when such images are requested.
   6. A copy of the final report should be archived by the imaging facility as part of the patient's medical record and be retrievable for future reference. Retention and distribution of these records must be in accordance with state and federal regulations and facility policies.

3. Communications Other Than the Final Report
   1. Preliminary report

      A preliminary report precedes the final report. It may be rendered for the purpose of directing immediate patient management or to meet the needs of a particular practice environment. It very likely will contain limited information or incomplete information. It should not be expected to contain all the information subsequently found in the final report.

      Preliminary reports may be communicated in writing, electronically, or verbally, and communication should be documented. These preliminary communications should be reproduced into a permanent format as soon as practical and appropriately labeled as a preliminary report, distinct from the final report, and archived since clinical decisions may have been based on the preliminary report.

      As soon as possible a change between the preliminary and final interpretation should be reported in a manner that reliably ensures receipt by the referring or treating health care provider when such changes may impact patient care. Documentation of communication of any discrepancy should be incorporated into the final report.

   2. Non-routine communications

      Routine reporting of imaging findings is communicated through the usual channels established by the hospital or diagnostic imaging facility. However, in emergent or other non-routine clinical situations, the interpreting physician should expedite the delivery of a diagnostic imaging report (preliminary or final) in a manner that reasonably ensures timely receipt of the findings.

      1. Situations that may require non-routine communication
         1. Findings that suggest a need for immediate or urgent intervention:

            Generally, these cases may occur in the emergency and surgical departments or critical care units and may include pneumothorax, pneumoperitoneum, or a significantly misplaced line or tube.

         2. Findings that are discrepant with a preceding interpretation of the same examination and where failure to act may adversely affect patient health:

            These cases may occur when the final interpretation is discrepant with a preliminary report or when significant discrepancies are encountered upon subsequent review of a study after a final report has been submitted.

         3. Findings that the interpreting physician reasonably believes may be seriously adverse to the patient's health and are unexpected by the treating or referring physician:

            These cases may not require immediate attention but, if not acted on, may worsen over time and possibly result in an adverse patient outcome.

      2. Documentation of non-routine communications

         Interpreting physicians should document all non-routine communications and include the time and method of communication and specifically name the person to whom the communication was delivered. Documentation is best placed in the radiology report or the patient's medical record but may be entered in a department log and/or personal journal. Documentation preserves a history for the purpose of substantiating certain findings or events. Documentation may also serve as evidence of such communication, if later contested.

      3. Methods of communication

         Communication methods are dynamic and varied. It is important, however, that non-routine communications be handled in a manner most likely to reach the attention of the treating or referring physician in time to provide the most benefit to the patient. Communication by telephone or in person to the treating or referring physician or his/her representative is appropriate and assures receipt of the findings. This may be accomplished directly by the interpreting physician or, when judged appropriate, by the interpreting physician's designee. There are other forms of communication that provide documentation of receipt which may also suffice to demonstrate that the communication has been delivered and acknowledged.

         While other methods of communication may be considered, including text pager, facsimile, voice messaging and other nontraditional approaches, these methods may not assure receipt of the communication. Therefore, in these instances, the interpreting physician may consider initiating a system that explicitly requests confirmation of receipt of the report by the clinician. If confirmation or other response is not received within a time appropriate to the diagnosis after the initial communication, a staff person should notify the clinician to document follow-up. Regardless of the method selected, it must be in compliance with state and federal law.

   3. Informal communications

      Occasionally, an interpreting physician may be asked to provide an interpretation that does not result in a "formal" report but is used to make treatment decisions. Such communications may take the form of a "curbside consult," a "wet reading," or an "informal opinion" that may occur during clinical conferences, interpretations while involved in other activities, or review of an outside study. These circumstances may preclude immediate documentation and may occur in suboptimal viewing conditions without comparison studies and their accompanying reports or adequate patient history.

      Informal communications carry inherent risk, and frequently the referring clinician's documentation of the informal consultation may be the only written record of the communication. Interpreting physicians who provide consultations of this nature in the spirit of improving patient care are encouraged to document those interpretations. A system for reporting outside studies is encouraged.

Self-Referred and Third Party Referred Patients

Most patients having imaging procedures are referred by physicians or other health care professionals. Some patients, however, are self-referred, such as for mammography, or are referred by a third party, such as an insurer or employer.

1. Self-Referred Patients

   Interpreting physicians should recognize that performing imaging studies on self-referred patients establishes a doctor-patient relationship that includes responsibility for communicating the results of imaging studies directly to the patient and arranging for appropriate follow-up.

2. Third-Party Referred Patients

   It is not unusual for patients to be referred for imaging studies by insurance companies, employers, federal benefits programs, and in some instances lawyers. In such cases the reports of the studies are frequently communicated through the requesting entity to a clinician or directly to the third-party-designated clinician. The results of the examinations are then communicated to the patient either directly by the third party or by its designated clinician. Regardless of the source of the referral, the interpreting physician has an ethical responsibility to ensure communication of unexpected or serious findings to the patient. Therefore, in certain situations the interpreting physician may feel it is appropriate to communicate the findings directly to the patient.

Communication Polices

An imaging department's policy on communication can be an effective tool to promote patient care. The policy can provide guidance on the types of communications that are most critical, the individuals responsible for delivering and receiving communications, and the methods of communication that are most appropriate. To be effective, however, any written policy must be followed and shared with others within the institution where the interpreting physicians provide their services.

As new methods of communication evolve, interpreting physicians may wish to modify their actions to accommodate these changes while still conforming to the goals of this guideline.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Effective and timely communication of diagnostic imaging findings to the referring provider, patient, or third party

Not stated

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

American College of Radiology

Guidelines and Standards Committee of the Commission on General, Small, and Rural Practice

Reviewing Committee: Cynthia S. Sherry, MD, FACR, Chair; Mark J. Adams, MD, MBA, FACR; Leonard Berlin, MD, FACR; Laurie L. Fajardo, MD, MBA, FACR; G. Scott Gazelle, MD, MPH, PhD; David B. Haseman, MD, MBA, FACR; Harry C. Knipp, MD, FACR; Robert D. Tarver, MD, FACR; Julie K. Timins, MD, FACR

Guidelines and Standards Committee – General, Small, and Rural Practice: Julie K. Timins, MD, FACR, Chair; William R. Allen, Jr., MD, FACR; Lawrence R. Bigongiari, MD, FACR; Richard A. Carlson, MD, FACR; James P. Cartland, MD; Laura E. Danile, MD; Frank R. Graybeal, Jr., MD, FACR; Matthew S. Pollack, MD, FACR; Fred S. Vernacchia, MD; Geoffrey G. Smith, MD, FACR, Chair, Commission

Comments Reconciliation Committee: Michael M. Raskin, MD, MPH, JD, MBA, FACR, Co-Chair; Richard N. Taxin, MD, FACR, Co-Chair; Mark J. Adams, MD, MBA, FACR; Kimberly E. Applegate, MD, MS, FACR; Leonard Berlin, MD, FACR; Laurie L. Fajardo, MD, MBA, FACR; Howard B. Fleishon, MD, MMM, FACR; G. Scott Gazelle, MD, MPH, PhD; David B. Haseman, MD, MBA, FACR; Alan D. Kaye, MD, FACR; Harry C. Knipp, MD, FACR; Amy L. Kotsenas, MD; Paul A. Larson, MD, FACR; Lawrence A. Liebscher, MD, FACR; Darlene F. Metter, MD, FACR; Timothy V. Myers, MD; Cynthia S. Sherry, MD, FACR; Geoffrey G. Smith, MD, FACR; Robert D. Tarver, MD, FACR; Julie K. Timins, MD, FACR

Not stated

This is the current release of the guideline.

Electronic copies: Available in Portable Document Format (PDF) from the American College of Radiology (ACR) Web site.

Print copies: Available from the American College of Radiology, 1891 Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

The following are available:

• The process of developing ACR practice guidelines and technical standards. Reston (VA): American College of Radiology. Electronic copies: Available from the American College of Radiology (ACR) Web site .
• Purpose and intended use. Reston (VA): American College of Radiology. Electronic copies: Available from the ACR Web site .

None available

This NGC summary was completed by ECRI Institute on January 26, 2012.

Copyright © by the American College of Radiology, 1891 Preston White Dr., Reston, VA 20191-4397, 703-648-8900. All rights reserved. No reproduction of this material in any format, electronic or otherwise, is permitted except with prior written consent from the American College of Radiology.