The four "Ds" of radiology reporting

The standard logical progression when reporting/reading a case, whether it be in training, the exam environment or in day-to-day clinical practice ,can, can be simplified into the following 4 basic sequential steps:

The 4 "D's":

1. Detect
2. Describe
3. Diagnosis or differential diagnoses
4. Decision

By sticking to this format, one can confidently approach any case or problem in a professional manner. This structure, in its various versions, was taught to me earlier in my training by many radiologists. I find this approach very useful when teaching junior trainees and also when taking senior trainees for viva exam practice sessions. I am sorry I can't single out any one specific to acknowledge or source to reference.

A closer look:

1. Detect
   • this is the first task of the radiologist.
   • knowledge of associated signs and pathologies in essential ie when you see finding A, you know to look for finding B and C and exclude finding D.
   • it should be included in the findings section of your report.
2. Describe
   • accurate anatomical localisation is scientific whereas radiological description can be more an art than a science.
   • it is essential to describe the findings in a concise, clear, unambiguous and well structured manner.
   • use of medical terms and correct nomenclature is paramount.
   • this is written for the radiologist i.e. a radiologist without the case in front of them on the other end of a phone should be able to form the same conclusion purely from your description alone.
   • it should be included in the findings section of your report.
3. Diagnosis or differential diagnoses
   • the crux of the case report.
   • it is the answer to the clinical question the referrer is asking.
   • order the differentials list in the most likely sequence.
   • it should be included in the conclusion/impression section of your report.
4. Decision
   • i.e. what to do next.
   • this is particularly important in viva exams.
   • do you need to tell someone about the result? And how urgently?
   • do you need to recommend another test?
   • do you need to recommend no further tests (e.g. a do not touch lesion)?
   • when urgent or critical results are notified to the referrer, document when and to whom the results were communicated.
   • it should be included in the conclusion/impression section of your report.