The Radiologist’s Duty
The duty of the radiologist is not limited to detecting and reporting pertinent findings following a radiologic study. The radiologist’s duty extends to ensuring that the report was received, understood and acted upon, as well as ensuring that active communication and information exchange between the healthcare providers occurs. Of particular concern are abnormal or critical findings in radiology reports.
To ensure appropriate medical care, the radiologist and other individuals responsible for the patient’s care should consider the following communication factors:
- How immediate is the need for treatment?
- What is the degree of harm that is likely to result from inattention?
- Was the diagnostic test incomplete?
- Who is responsible for communicating with the patient?
- Is there a discrepancy between current findings and those previously reported?
- Is there adequate clinical information in the request (e.g., working diagnosis, symptoms, etc.) to develop an appropriate diagnosis?
- Has the person who should be notified been identified?
American College of Radiology Recommendations
The American College of Radiology (ACR) published a guideline for communicating diagnostic imaging findings. The ACR recommends that radiologists:
- Prepare a formal, written report for all studies that includes review of previous reports and comparison of previous images when possible.
- Transmit the report to the referring physician or healthcare provider, who provides clinical follow-up care.
The ACR explains that routine reporting can be handled through the usual channels established by the practice or facility. However, the communication of a diagnostic imaging report should be expedited in emergent or other non-routine clinical situations. There should be efforts made to ensure timely receipt of findings when there is evidence of something that would require an immediate or urgent intervention (e.g. pneumothorax, pneumoperitoneum, or a significantly misplaced line or tube); when a final interpretation differs from the preliminary report (this can be a particular issue with images interpreted by emergency department personnel), or a subsequent review of a final report that has been submitted reveals discrepancies; or the radiologist believes there are findings that would seriously affect the patient’s health and are unexpected by the treating or referring physician. The ACR also recommends that diagnostic imagers document all non-routine communications and include time and method of communication as well as the name of the person to whom the communication was made.
Methods of communication may vary, and when using some methods of communication that may not assure receipt of communication, e.g. text pager, facsimile, voice message, it would be appropriate to request confirmation of receipt of the report by the receiving clinician.
Medical Professional Liability Risks
Communication errors may give rise to claims of malpractice when information that was delayed or not received could have been used to benefit the health of the patient. Common communication problems include the following:
- Radiologic findings that are delayed or not received by the referring physician.
- Failure to mention an inconclusive or incidental finding to the treating physician.
- Failure to notify a self-referred patient of an abnormal result.
Risk Management Recommendations
- Prepare a formal, written report for all studies that includes review of previous reports and comparison of previous images when possible.
- State if previous reports and images are not available and any attempts to obtain them.
- In a group setting, ensure that all radiologists consistently document review of previous reports and comparisons of previous images.
- Ensure timely receipt of findings for critical results by implementing a system to confirm receipt of the report by the referring physician.
- If the referring physician cannot be located, leave a message with a nurse or associate who will be accountable for notifying the referring physician of urgent findings.
- If no one is available, contact the patient directly.
- Communicate by phone or in-person, as appropriate, to confirm receipt of findings.
- Document notification of critical test results in the patient’s medical record or in the radiology report.
- Include the date, time and method of communication, as well as the name of the person to whom the communication was made and what was discussed.
- In a group setting, ensure that all radiologists consistently document notification of critical test results in the patient’s medical record or in the radiology report.
- Directly communicate results to a self-referred patient and advise appropriate follow-up.
- Consider communicating critical or unexpected findings directly to a patient when the patient has been referred by a third party, e.g., an insurance company or employer.
- Develop a system to ensure that radiographic studies are interpreted and the interpretation reported to the referring physician or another designated individual in a timely manner during holidays, periods of illness or any other time the communication of results could be delayed.
- Avoid informal consultations (see “The Risks Associated with ‘Curbside’ Consults for Radiologists” to learn more); instead, recommend a formal referral for situations that are complex or focused on a particular patient.
Additional Resource
American College of Radiology. ACR Practice Guideline for Communication of Diagnostic Imaging Findings. Revised 2010 (Resolution II). (accessed: 6/9/2017)
