How to Handle Uncertainty in Radiology Interpretation
When uncertain about radiology results, communicate this uncertainty clearly and directly to the referring physician, detailing specific areas of concern and suggesting appropriate next steps such as additional imaging or specialist consultation.
Communicating Uncertainty in Radiology Reports
- Radiologists should communicate any uncertainty in the interpretation of imaging findings or quality issues with the examination itself clearly in the conclusion section of the report to help referring physicians interpret results in the context of clinical findings 1
- Terms such as "likely" or "suspicion of" have been found to incompletely transfer the degree of certainty to the reader; instead, uncertainty should be communicated in a clear and unequivocal manner 1
- When findings are equivocal, their nonspecific nature should be stated together with the radiologist's rationale for their conclusion 1
Recommended Actions When Uncertain About Radiology Findings
- If examination findings are inconclusive, radiologists should suggest appropriate further imaging to enhance diagnostic yield 1
- For example, if MRI shows bone marrow edema limited to the mechanical load zone without definitive structural lesions, a CT scan could help depict or exclude joint surface erosion 1
- When uncertain about findings, consider whether an alternative imaging method may resolve uncertainty about whether suspicious lesions are inflammatory or mechanical in nature 1
Providing Differential Diagnoses
- Based on examination findings, differential diagnoses and their probability should be detailed, especially those more likely than the initially suspected condition 1
- Sometimes it can be useful to assign likelihoods to respective differential diagnoses to help guide further treatment decisions 1
- Include relevant imaging findings that support each differential diagnosis 1
Consulting with Specialists
- Direct consultation between referring clinicians and radiologists has measurable benefits for patient care, including obtaining more clinical information and formulating improved scanning protocols 2
- If imaging findings suggest a specific condition requiring specialist expertise (such as spondyloarthritis), the radiologist should recommend referral to the appropriate specialist (e.g., rheumatologist) for further assessment 1, 3
- Early diagnosis and treatment initiation by specialists is advantageous for patients with conditions that may have inflammatory or autoimmune etiology 3
Pitfalls to Avoid
- Avoid "ghost reading" (signing reports without personally interpreting images), which is considered unethical and fraudulent 1
- Ensure interpretations are made with complete availability of relevant collateral information, including previous imaging studies and clinical information 1
- When lacking proper comparisons or relevant patient information, clearly state this limitation in the report 1
- Be aware of common artifacts that may affect interpretation (e.g., surgical material, implantable devices, contrast material) and acknowledge these in your report 1
Communication Pathways
- Establish pathways for easy and prompt bidirectional communication between the interpreting radiologist and referring provider 1
- Different levels of acuity and criticality should be predefined, including the time frame during which critical test results should be communicated 1
- Remain available for consultation with referring physicians even if the request comes days after the date of interpretation 1