Download RadiologyClerkship-LanguageofRadiology

Primer on Radiologic Terminology
and Communication
Christina LeBedis, MD,
Radiology Clerkship Director
Boston University School of Medicine
Learning Objectives
• Be able to state common terms employed in
radiology
• Be able to describe how radiologists convey
results from imaging studies
• Be able to interpret radiologic reports
Common Radiologic Terms
• Most abbreviations are related to modality and
the technique
• Each modality has specific words that are used
to describe both normal and abnormal findings
The Language of Radiology
• Radiographs (x-rays): Opacities, densities, lucencies
• CT: Density (hypodense, isodense, hyperdense)
• MRI: Intensity (hypointense, isointense, hyperintense)
• US: Echogenicity (hypoechoic, isoechoic, hyperechoic)
Ordering Radiology Studies
• Choose correct examination
• Be aware of appropriateness criteria; consult radiologist
if not sure which study will best answer your clinical
question
• Provide appropriate clinical history
• Must include a sign and/or symptom
• Provide a complete history to ensure your clinical
question is answered
• Inform patient about what to expect during the
test so that he/she can fully cooperate
Communication: The Written Report
BASIC REPORT ORGANIZATION
1. Indication(s)
• Summarizes the available clinical information provided
by the ordering physician
2. Comparison
• States whether there are available comparison studies
which would permit assessment of any change
3. Technique
• Provides details regarding imaging sequences and/or
contrast or radiotracer administration
Communication: The Written Report
BASIC REPORT ORGANIZATION
4. Findings
• Includes pertinent positives and negatives
• Includes any complications related to a study, including
complications incurred in an image-guided procedure
5. Impression
• Summarizes key findings (but is not simply a
restatement of the findings)
• Includes specific statement answering the clinical
question
Breast Imaging: A Special Case
Every report will have a BIRADS (Breast Imaging
Reporting and Data System) Assessment Code
0
1
2
3
Incomplete assessment
Negative
Benign finding
Probably benign finding
A Short interval follow-up suggested (6 months)
B Follow-up in 12 months
4 Suspicious abnormality, biopsy should be considered
A Low probability
B Intermediate probability
C Higher likelihood of malignancy
5 Highly suggestive of malignancy (> 95%)
6 Biopsy-proven malignancy
Image-Guided Procedures
• An addendum may be added to the original
report correlating the histopathology to the
imaging findings to determine whether further
action is necessary (particularly in breast
imaging)
• The radiologist will usually call the referring
physician with results of the procedure and any
recommendations
Verbal Communication
• Clarify the clinical history or question being
asked
• Report any significant findings that warrant
immediate action or subacute intervention
• Inform the referring physician that a procedure
is indicated, was cancelled, or a complication
was incurred.
Verbal Communication
• Many radiologists have substantial contact
with patients, e.g., body radiology, breast
imaging, interventional radiology, and
pediatric radiology
• Discuss results of imaging examinations with patients
• Discuss risks/benefits of image-guided procedure for
either diagnosis or treatment
• Discuss post-procedural instructions
• If available, convey histopathologic findings and
recommend further action as needed
Interpreting Reports
• Confirm report belongs to correct patient
• Read entire report
• Make certain that clinical question is answered
in the impression
• Based on results, decide if additional imaging
or intervention is warranted
Indication: Shortness of breath
Comparison: None. (Note that
comparison to old studies may
be helpful in order to detect
subtle change.)
Findings: A left-sided pacemaker
is noted. The
cardiomediastinal silhouette is
enlarged. There are moderate
perihilar opacities and small
bilateral effusions. No
pneumothorax.
Impression: Moderate pulmonary
edema, with small bilateral
pleural effusions, and
cardiomegaly and/or
pericardial effusion.
PA chest
radiograph
Indication: Abdominal
distention and pain
Technique: Supine and
upright views of the
abdomen.
Comparison: None.
Findings: There are
multiple dilated small
bowel loops with airfluid levels on the
upright study. No free
intraperitoneal air is
seen. No acute bony
abnormality.
Impression: Partial small
bowel obstruction.
Abdominal
Radiograph
Head CT
Indication: Right-sided weakness
Technique: 3 mm contiguous axial
images of the head were obtained
without intravenous contrast
Findings: There is a large left parietal
hypodense area with mass effect on
the frontal horn of the left lateral
ventricle and midline shift to the
right. There is no hemorrhagic
component. No extra-axial
collection. No fractures.
Impression: Large left MCA
distribution non-hemorrhagic infarct
with associated mass effect.
Indication: Pain, menorrhagia
Technique: Transabdominal and
transvaginal ultrasound imaging was
performed.
Comparison: None.
Findings: The uterus is enlarged,
measuring 15 x 7 x 9 cm. There are
multiple hypoechoic masses, the
largest of which is submucosal and
measures 3 cm. The endometrium is
homogeneous and measures 15 mm
in diameter. The right ovary is not
visualized. The left ovary measures
3 x 2.5 x 3 cm and contains a 1.5 cm
physiologic cyst. There are no
adnexal masses and no free fluid.
Impression: Multiple uterine fibroids,
with dominant 3 cm submucosal
fibroid. No adnexal masses.
Pelvic
ultrasound
Comparison: 7/5/11
Findings: The breast tissues are
heterogeneously dense which
somewhat lowers the sensitivity of
mammography. There is a cluster
of calcifications in the upper outer
left breast. Additional imaging
evaluation is warranted at this
time. No dominant mass or area of
architectural distortion is seen.
This study was interpreted with the
aid of the R2 Checkmate Ultra
CAD system.
Impression: Left breast calcifications
which warrant additional imaging
evaluation at this time.
BIRADS Category 0 – Incomplete
Assessment
Screening
mammogram
Any questions?