The radiology report is undoubtedly the most important work product submitted by radiologists. At RSNA 2017 in Chicago, Curtis P. Langlotz, MD, PhD, professor of radiology at Stanford University Medical Center in Stanford, Calif., shared best practices when writing a radiology report.

Langlotz, who has also written a book about this topic, says he sees too many mistakes being in radiology reports. He estimates the errors in radiology reports can be as high as four percent. “Often reports don’t answer the clinical questions that we asked,” he said. “Clinicians are not satisfied sometimes with what they see.”

1. The summary is important.

Langlotz estimates that only 38 percent of referring physicians read the radiology report in its entirety and 43 percent read only the summary of longer reports. He recommends answering the clinical questions asked and including only relevant findings. Listing significant findings in order of importance is crucial and extraneous information can be omitted from the report. “If you want the clinician to take note of something, make sure it’s in the summary,” he said. “Summary should have a list of findings in order of importance.”

2. Drill down and get to the most specific expression of the finding.

“Using various words and adjectives are counterproductive to the transmission of clear information to your colleagues,” Langlotz said.

Using short, declarative sentences, expressing uncertainty and quantifying severity are crucial when writing a radiology report. The more specific the framework of sentences in the report, the better for the clinician. An observation sentence should have certain elements within it including anatomy, anatomy modifiers, observation, observation modifiers, spatial relationship uncertainty and location on the images.

Uncertainty is an inherent part of medicine and radiology, Langlotz explained. He told attendees about Memorial Sloan Kettering Cancer Center in New York City, which developed an “uncertainty lexicon” that matches words with probability levels. An observation that uses the phrase “consistent with” has a probability rate greater than 90 percent, and phrases such as “less likely” and “unlikely” have probability rates of 25 percent and less than 10 percent, respectively.

“I find it difficult to use more than three severity levels with any consistency,” Langlotz said. “I think when radiologists try to interpolate mild to moderate, it’s not that they are trying to say north-northeast and give an exact direction. They are really straddling across multiple severities.”

3. Embrace the word “normal."

“When we are certain or we think we are certain, it is great to use the word ‘normal,’” Langlotz said. “It is a powerful word. It means all abnormalities have been considered and excluded.”

Langlotz said “normal” is a definitive answer that halts a potential workup, which is good news for both the clinician and the patient.