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The Radiology Report Part III

January 15, 2008
Written by: , Filed in: Practice Management
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A carefully crafted report requires as much care as the observation of findings. Both are essential components of our expertise.

The Radiology Report: Impression and Resulting Recommendations.
Stephen R. Baker, MD Special Presentation for Practical Reviews in Radiology

To an extent greater than any other activity in this era of PACS, we as radiologists communicate with referring physicians predominantly through the radiology report. Our written consultation lays bare our demonstration of competence.

Thus, how we frame what we see and interpret defines, in large measure, our ethos in the estimation of referring physicians who are our customers, if you will, in the knowledge of transactions we participate in numerous times each day.

What we write in this report is permanent and we are responsible for everything put in and left out. The report should be journalistic in its aptness and brevity. It should be pertinent, accurate, specific, anatomically correct, incisive in its observations, humanistic in its considerations, and stylistically unobtrusive.

At the same time, it should be free as much as possible of obscurantism. A good rule of thumb is, if you want to be understood by a few, use jargon, but if you don’t want to be misunderstood by many, use English.

Things to avoid in the report are nonspecific words like “some” and “aspect”; euphemisms, like “unremarkable,” neologisms like “hyperdensity,” and non-informative phrases such as “the ET tube is in good position.” A carefully crafted report requires as much care as the observation of findings. Both are essential components of our expertise.

Author: Stephen R. Baker, MD

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