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A Radiologist’s Guide to Reading Your Medical Imaging Report

Doctor with clipboard reading charts to older man

What will you find in a Standard Imaging Report? A radiologist provides a full breakdown.

Written by Dr. Bonnie O’Hayon, Radiologist

It can be stressful that something done to you, for you, is not easily understood by you. Your radiology report is about you but is written to your physician, the doctor who ordered the test for you. 

The following is meant to help you interpret some of the nuances or jargon in your report. When patients can read and comprehend their imaging reports, it makes care easier and allows for more meaningful conversations with your physician.

Let’s go piece by piece through the sections of a standard radiology report. Generally a report is separated into sections with titles, so let’s start with those.

TYPE OF EXAM: This is pretty straightforward, it’s either a CT scan, an ultrasound, an X-ray, an MRI or a procedure, and one of these will be listed at the top.

TECHNIQUE: This lists how the exam was done. For example you may have received an injection of contrast/dye in your arm for a CT or MRI and this will be indicated here. You don’t need to worry about this information too much, it’s actually most important for radiologists. For example, if you need a follow up exam, it’s helpful for the radiologist to know how your last test was done so that the follow up exam is done with the appropriate technique.  

CLINICAL INFORMATION: This is the information your doctor provided to the radiologist about you and your symptoms, to explain why the exam is being performed. This is where you get to check to see whether your doctor communicated your symptoms to the radiologist appropriately. Your doctor won’t provide an exhaustive summary, but clearly something like ‘Right lower quadrant pain and chronic bloody diarrhea, rule out Crohn’s disease’ is better than a  history of ‘Pain’ without any indication of where the pain is located or any associated symptoms. Or consider how history might change the radiologist’s explanation for what they find on your test when the history is ‘Right lower quadrant pain and bloody diarrhea two days after trip to the Dominican Republic’.  Something like Crohn’s disease or travelers’ diarrhea may have a similar appearance on a scan, but the clinical history is extremely helpful to make an appropriate diagnosis. A diagnosis can be clear sometimes without any clinical history, but a lack of relevant clinical information can occasionally make it difficult for the radiologist to provide a useful report.

COMPARISON: This indicates whether you’ve had any previous studies that are relevant to be used as a reference for the current one. Usually the prior study type and date would be listed here. If you’re having an ankle MRI, previous exams of your brain or abdomen won’t be relevant, but previous relevant imaging, like an ankle X-ray or ultrasound, will be listed.

FINDINGS: This is where most of the information about your study is located. It’s the longest part of the report and includes most of the details. For example, in an abdominal study—even if your doctor is only interested in the bowel—the radiologist will look at all the solid organs (liver, spleen, pancreas, kidneys, adrenal glands), the major blood vessels in the abdomen, the bones and even the bottom of the lungs that are partially visible on the scan, as well as the bowel. This information will be described in this section.

Now here is where you may see words like “unremarkable” listed frequently. As humans, we’re imperfect but some imperfections are not always relevant to our health, so the radiologist will not focus on these insignificant findings. Take a small benign cyst in a kidney, for example. Having one or two small, benign looking cysts in our kidneys is an extremely frequent finding on an abdominal ultrasound in a middle aged patient and the incidence only increases with age, kind of like freckles that appear on our skin, or gray hairs we acquire on our head. At the conclusion of  the report, your kidney may be categorized as “unremarkable” instead of “normal”, signaling that while technically not 100% “normal”, there’s nothing significant going on that requires extra attention or investigation.

IMPRESSION: This is where you should find the most meaningful information in your report. If I were scanning my own report for my results, this is where I would start. The radiologist has reviewed all of your findings and synthesized all that data to come up with a conclusion as to what it all means. It’s essentially his/her opinion about what your test shows. 

If you see the word “Unremarkable”, that essentially means it’s normal (see above). However, often there is a ‘differential diagnosis’ listed in the Impression, which means that there is more than one potential diagnosis to explain your findings. Generally, the radiologist will list the potential diagnoses in order of likelihood, in other words the first thing on the differential diagnosis list is most likely and the last is least likely. Occasionally the last condition on the list can be very unlikely, but it’s included for completeness. 

For example, an abdominal CT performed for right lower quadrant pain and bloody diarrhea may show inflamed bowel loops. The radiologist thinks that the underlying diagnosis/reason for the abnormal bowel is Crohn’s disease, but will include other options, so their differential diagnosis could include 1) inflammatory bowel disease/Crohn’s disease, 2) infectious enteritis (bowel infection), and 3) malignancy (cancer). The radiologist may feel that there’s a 95% chance it’s Crohn’s disease, a 4% chance it’s an infection and only 1% that it could be cancer, but all three are included in the differential diagnosis. Reading the report, it can be hard to know the likelihood of each potential diagnosis being the true culprit. This is where it’s very helpful to discuss the findings with your doctor, who can likely add some context.

More generally, the Impression may contain some confusing medical jargon. Referencing the relevant information in the Findings section may help, but ultimately you should review the report with your doctor. However, trying to make sense of the imaging report before reviewing it with your doctor may allow you to raise specific questions that lead to more meaningful conversations with your doctor. In turn, these conversations could be most useful to understanding your test results. Hopefully this review will help guide you through that process.

Understanding your medical reports shouldn’t be so stressful. With PocketHealth’s Report Reader feature, you can easily click on an unfamiliar medical term in your report and see its definition, without having to leave your PocketHealth account.

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