Can a healthcare provider, such as a radiologist or primary care physician, interpret an x-ray (x-radiograph)?

Can Healthcare Providers Interpret X-rays?

Yes, healthcare providers including radiologists, primary care physicians, emergency physicians, and other appropriately trained specialists can legally and clinically interpret x-rays, though radiologists remain the recognized imaging experts and preferred interpreters for optimal patient outcomes. 1

Who Can Interpret X-rays

Radiologists as Primary Interpreters

• Radiologists are the recognized experts in medical imaging, and their contribution to healthcare extends beyond simply providing interpretive reports. 1
• Radiology is a deeply-embedded and essential part of modern patient care at all levels of service delivery, encompassing hospital-based medicine, primary care investigation, and screening activities. 1
• Nobody in modern medical practice could function and maintain standards of clinical service in the absence of diagnostic imaging services, including specialist radiologist interpretation, consultation, and intervention. 1

Non-Radiologist Physicians

• Other physicians can interpret imaging within their scope of practice and training, though this varies by specialty, state regulations, and clinical context. 1
• Primary care physicians routinely order and review x-rays as part of initial patient workup, though complex cases benefit from radiologist consultation. 1
• Emergency physicians frequently make preliminary interpretations of x-rays for immediate clinical decision-making, particularly in trauma settings where timely diagnosis is critical. 2

Quality and Training Considerations

Professional Standards

• All physicians interpreting imaging should maintain the same high professional standard of quality regardless of their specialty or location. 1
• State laws and medical malpractice regulations determine liability for image interpretation, and physicians who interpret studies assume responsibility for their interpretations. 1
• Physicians must maintain appropriate licensure and be in good standing with state medical boards when providing interpretive services. 1

Subspecialty Expertise

• Split interpretation arrangements exist where non-radiologist specialists interpret images within their anatomic area of expertise (e.g., gastroenterologists interpreting colonic CT images), while radiologists interpret extracolonic findings. 1
• Each physician should sign separate reports for their respective interpretations to clearly delineate responsibility and reduce liability risks. 1

Clinical Context and Limitations

When Radiologist Interpretation is Essential

• Complex imaging, subspecialty cases, and situations requiring comprehensive evaluation of all anatomic regions benefit most from radiologist interpretation. 1
• Radiologists provide value through clinical decision support, facilitating choice of the most appropriate imaging investigation and indicating when imaging represents low-value care. 1
• Access to prior imaging, electronic medical records, and complete clinical information significantly impacts interpretation quality—limitations in these areas may necessitate preliminary reports only. 1

Primary Care and Emergency Settings

• X-rays and Extended Focused Assessment with Sonography for Trauma (eFAST) serve as first-line imaging in acute trauma settings, though CT remains the most sensitive modality to avoid misdiagnosis. 2
• Primary care physicians can use x-ray findings (such as sacroiliitis) as triggers for specialist referral, even without formal radiologist interpretation in some screening contexts. 1
• Electronic consultation platforms connecting primary care providers with radiologists have proven highly valuable, altering patient management in 55% of cases and avoiding unnecessary testing in 28%. 3

Communication and Patient Care

Radiologist-Physician Collaboration

• Communication between interpreting radiologists and referring providers should be readily and bidirectionally available. 1
• Teleradiology services should maintain the same engagement standards as on-site radiologists, including availability for consultation even days after interpretation. 1
• Radiologists should be engaged throughout the imaging continuum: test selection, protocol supervision, contrast decisions, interpretation, results communication, and quality improvement. 1

Patient Expectations

• Approximately 48% of patients and 59% of referring physicians favor radiologists directly disclosing imaging results to patients. 4
• Patients expect immediate therapeutic recommendations (72%) and rapid result communication, with 75% expecting diagnosis disclosure within 30 minutes. 4
• Patient-centered radiology consultation clinics have demonstrated high satisfaction (4.8/5 rating) and improved patient understanding of radiologist roles. 5

Critical Pitfalls to Avoid

• "Ghost reading"—signing reports without personally reviewing images—is definitively fraudulent and has resulted in criminal convictions. 1
• Lack of access to prior imaging and clinical information yields less valuable interpretations and may cause unnecessary additional testing and patient anxiety. 1
• Under-resourced radiology services create bottlenecks that increase emergency department length of stay by 56-64 minutes per advanced imaging study ordered. 1
• Interpretations made without adequate subspecialty training or experience may miss critical findings, particularly in extracolonic or complex anatomic regions. 1