Radiopaedia Blog

Deciding what to include in the conclusion of a report is one of the most difficult but important challenges faced by a radiologist. It will come as no surprise to you that clinicians love a conclusion, so much so that it is often the first and only thing they read. And so here's my list of the...

1. Not having a conclusion

If your report is longer than three or four sentences then it really should have a conclusion. In my experience, radiologists most often omit a conclusion when they are unsure how to interpret the findings. Unfortunately this is precisely when a conclusion is most valuable, as it's likely the clinician will find the case difficult too.

Solution: Don’t be afraid to admit when you are uncertain.  Write your conclusion as if you are talking face to face to the referring clinician.

e.g. The parenchymal appearances in the lung bases are of uncertain significance and not clearly pathological. Comparison with previous imaging or a follow-up study may be helpful.

 

2. Repetition

Repeating your findings and descriptions such that the conclusion is almost as long as the body of the report defeats the whole purpose!  Often I find it is the radiologists who are insecure about the significance of their many findings that are most tempted to repeat them all in the conclusion.

Solution: Restrict your conclusion to short relevant descriptions only and never have a whole sentence without an interpretation.

e.g. Right anterior cranial fossa mass with appearances characteristic of a meningioma.

 

3. Not answering the question

Good clinicians almost always ask one or more specific questions in their referral. Ignoring or failing to address a question is a sure-fire way to alienate a referrer and may stop them ever sending a patient to you again!

Solution: Explicitly address the clinician's question in your conclusion.

​e.g. Normal study, with no evidence of appendicitis.

4. Irrelevant incidental findings

Including irrelevant incidental findings in a conclusion makes the important points harder to find. When the study is otherwise normal then it might be permissible to add one irrelevant incidental finding to the conclusion but even this is a questionable practice.

Solution: Only include an incidental finding in the conclusion if it warrants its own follow-up or management (e.g. Bosniak 2F renal cyst) or if it impacts the management of the primary condition (e.g. deviated nasal septum in a patient undergoing transsphenoidal surgery).

 

5. Guess what I am thinking

Many conclusions I read never actually state what the author thinks is going on. A statement of facts can mean nothing to a clinician without an encompassing impression.  For example, “Gallstones. Dilated common bile duct.” is nowhere near as useful as “Gallstones. Although choledocholithiasis is not definitely seen, given the common bile duct is dilated, a small distal stone is suspected.”

Solution: Always assume the clinician reading your report is tired, rushed and not familiar with the condition. Don't hide your diagnosis or the patient may be managed incorrectly.  

 

So that rounds out the top 5 mistakes made in radiology report conclusions. Hopefully now you can successfully avoid these pitfalls in your next reporting session. If you think of other important ones to add to these five then please leave a comment below.

Here is November's Neuroradiology and Neuropathology meeting cases from  Royal Melbourne Hospital

This meeting comprises 4 unusual and rare cases with imaging and histology. It is a pleasure to be able to share these cases with you, so that more individuals from around the globe can learn from them. 

Click here to view current cases (November 2013)

Past meetings:

17th Nov 2013 09:05 UTC

December Donation Drive

Just a quick note to let you know that in December we will be running our first, and hopefully yearly, donation drive. We sincerely hope you will be able to support us, and ensure that Radiopaedia.org continues to grow, and remains free. 

You will see some new banners and social media posts about it, which will make the whole process extremely easy. 

Thanks in advance

Frank

Founder and Editor 

 

We have been struggling with the existing text editor on the site for quite some time (years actually) since support for it was discontinued. Finally we are rolling out a new and much improved editor, which you will now see when you 'contact user' (through their profile page). 

Once we have kicked the tires we will deploy it to the rest of the site. So, in the mean time, please let us know if you have any problems with it.. 

Thanks for your patience, 

Frank

November 8 is the International Day of Radiology, an event which aims to promote awareness of the amazing work done by Radiologists around the world. 

The 2013 theme is Lung Imaging and so at Radiopaedia.org we have decided to celebrate with a chest x-ray quiz! 

  • Can you correctly identify the abnormalities?
  • How do you compare to a radiologist?
  • View annotated answers to learn what a radiologist would see.
  • Share the quiz with your friends to help spread the word!

Here's what a Radiologist would've seen...

Woman B has a lung cancer hiding in the apical region often termed a Pancoast tumor (green arrow). These can be very difficult for the untrained eye to spot and this area is an important "check area" for radiologists when interpreting chest x-rays.

Woman A has a breast shadow on the right (white arrow) but does not have one on the left because she has had a mastectomy for breast cancer. Such asymmetric density can cause an inexperienced film reader to mistakenly diagnose a lung abnormality.  

Patient A has a small punctured lung (aka pneumothorax) which can be a difficult but very important diagnosis to make. Air is seen outside the lung with a thin line representing the lung margin, known as the pleura, evident in the upper chest (green arrow).

Patient B has fibrosis in their right lung apex (white arrow) which has lead to a reduction in lung volume with elevation of the diaphragm on that side. This was a case of radiation induced fibrosis.    

Patient A has multiple calcified pleural plaques on the surface of the lung which is a hallmark of asbestos exposure. These are classically described as being geographic, looking somewhat like continents on a world map (green shading). On the diaphragm they appear as thick white lines (green arrow).

Calcified pleural plaques are themselves benign and do not indicate asbestosis (pulmonary fibrosis due to asbestos) or mesothelioma although the patient would be at increased risk of developing these deadly conditions.

Patient B has a fungal infection within dilated bronchi in the right upper lobe of the lung (white arrow) known as allergic bronchopulmonary aspergillosis. This occurs most often in asthmatics and produces what is described as a 'finger in glove' appearance.     

 

 

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