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Improved radiology reporting aims to reduce diagnostic and follow-up system errors.


By Anne Geske

Managing Editor, Brink


Getting the diagnosis right—what could be more important in assessing a patient’s symptoms? Imaging tests such as X-rays, CT scans, MRIs, ultrasounds and mammograms are essential tests within the diagnostic toolbox. So, it follows that any communication between the radiologists interpreting these exams and the clinicians who order them is essential. And yet, it’s not so simple.


The communication challenge

Radiology is a complex specialty, and radiologists use intricate language in test reports read by the medical professionals who order them. Because communication between radiologists and clinicians usually takes place within written reports and the electronic health record (EHR)—not in person or via phone—the potential for error is significant. MMIC found that the misinterpretation of tests and results, including radiologist-to-clinician communication, is a contributing factor in 27 percent of malpractice allegations.1 More effective communication between radiologists and ordering clinicians may have made a difference.


The reference process

In 2015, the American College of Radiology supported a process radiologists could use when communicating to referring clinicians through the radiology report: a standard management recommendation suggesting next steps for evaluation, along with a reference supporting that recommendation.

Sue A. Crook, MD, FACR, is a radiologist with Suburban Radiologic Consultants in Bloomington, MN, whose staff works with large Twin Cities health systems that have been rolling out the “reference process,” as it’s referred to in short, since 2015. “We help clinicians know what the next step is,” says Dr. Crook. “Following the impression of our report, we suggest further follow-up and what the evidence-based reference is for that.”


Reducing human error

Without such a process, the referring clinician interprets the complex terminology in the radiologist report and makes their own determination for next steps. And because clinicians are human, perceptions and second-guessing may come into play. Radiologists have sometimes had to strike a balance between what might be seen as over-diagnosing (making sure results aren’t dismissed that point to further work-up) and under-diagnosing, in which more serious issues might fall through the cracks.

“In the past, there have been lawsuits where a radiologist interpreted results correctly,” Dr. Crook explains, “but the referring physician thinks the radiologist overcalled it and decides to dismiss the issue. With this new process, I can say in my report, ‘I’m worried this patient may have cancer. We need to do the next test, and here is the evidence-based reference.’”

The reference process helps ensure that patients who need further evaluation get it. This relatively new patient-safety process may soon become a common best practice. Its implementation is recognized as a cutting-edge way to ensure that communication between radiologists and busy clinicians doesn’t fail. “Along with physicians, we have PAs and NPs referring patients to us,” Dr. Crook says. “They’re busy, and when they see the management recommendation, it pops out. It’s something they can pay attention to, to make sure that they understand the report.”


Culture shift

In Dr. Crook’s experience, health care culture is becoming more collaborative. More radiology groups are using management guidelines to prevent diagnostic error, prevent follow-up system failures and improve communication with clinicians.

As medicine gets more complicated, medical professionals are realizing they can’t do it all. “As we get more collaborative, physicians are happy for the help,” Dr. Crook says. “Health care is becoming more patient-centered and more of a team effort.”



  1. Brink, 2017 Spring Issue. Accessed July 6, 2018.


This article originally appeared in the Spring/Summer 2018 issue of Brink® magazine, published by Constellation. UMIA is a member of Constellation, a collective of MPL insurance and partner companies offering solutions that are good for care teams and good for business. To learn more, visit

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