What should I do if my X-ray report shows an abnormality?

What to Do When Your X-ray Report Shows an Abnormality

When your X-ray report shows an abnormality, you should promptly follow up with your healthcare provider to discuss the findings and determine the appropriate next steps, which may include additional imaging or specialist referral.

Understanding Your X-ray Report

X-ray reports typically include:

• Clinical information that prompted the examination
• Technical details of how the X-ray was performed
• Description of findings (normal and abnormal)
• Conclusion with interpretation of findings
• Recommendations for further action if needed

Key Components of a Quality X-ray Report

The Assessment of Spondyloarthritis International Society (ASAS) recommends that radiologists should 1:

• Clearly state if findings are compatible with a specific diagnosis
• Indicate the confidence level in their interpretation
• Detail any active inflammation or structural changes
• List differential diagnoses, especially if more likely than the suspected condition
• Suggest further imaging when findings are inconclusive

Steps to Take When an Abnormality Is Reported

1. Contact Your Healthcare Provider

• Schedule a follow-up appointment to discuss the findings
• Bring a copy of the report if you have it
• Prepare questions about the significance of the abnormality

2. Understand the Nature of the Abnormality

Different types of abnormalities require different approaches:

• Bone abnormalities: May require additional views or advanced imaging
• Joint abnormalities: May need weight-bearing views to detect dynamic issues 1
• Soft tissue abnormalities: Often require additional imaging modalities

3. Consider Additional Imaging if Recommended

When X-rays show abnormalities or are normal despite clinical suspicion:

• MRI: Recommended when X-rays appear normal but clinical suspicion remains high 1, 2

  • Most sensitive for detecting occult fractures, bone marrow edema, and soft tissue injuries
  • Essential for early diagnosis of conditions like active Charcot neuro-osteoarthropathy 1

• CT scan: Better for detailed bone assessment 2

  • Gold standard for diagnosing conditions like diaphragmatic hernia (sensitivity 14-82%, specificity 87%) 1
  • Useful for complex fractures or when MRI is contraindicated

• Nuclear imaging: Consider when MRI is unavailable or contraindicated 1

4. Follow Recommended Timeframes

• Adhere to any timeframes specified in the report recommendations
• Shorter recommended timeframes are associated with higher rates of successful follow-up 3
• Reports with direct radiologist communication to ordering physicians have better follow-up rates 3

Common Pitfalls to Avoid

1. Misinterpreting terminology: Terms like "cannot exclude" or "too small to characterize" may cause unnecessary anxiety 4

   • "Benign cyst" causes minimal concern among radiologists, referring physicians, and patients
   • Phrases containing "not excluded" cause highest concern in all groups

2. Ignoring recommendations: Approximately 5% of radiology recommendations with substantial clinical risks are not followed up 3

3. Assuming all abnormalities are errors: Discrepancies between reports and outcomes don't always indicate errors 5

4. Failing to provide complete clinical history: Incomplete clinical information can lead to suboptimal interpretation 6

When to Seek Specialist Consultation

• When the radiologist explicitly recommends specialist referral
• For complex findings requiring specialized interpretation
• When findings are compatible with a specific condition requiring specialist management 1

Important Considerations

• Normal radiographs do not exclude all pathology—up to 15% of ligamentous injuries and 41% of osteochondral lesions may be missed on standard radiographs 2

• Weight-bearing radiographs may detect abnormalities not apparent on standard views 2

• Clinical correlation is essential, particularly in patients with persistent symptoms despite normal radiographs 2

Remember that radiologists are trained to identify and report abnormalities, but the clinical significance of these findings must be interpreted in the context of your overall health by your primary care provider or specialist.