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GPs can expect more clinically relevant reports when they ask specific clinical questions and provide a diagnosis or differential diagnoses based on clinical findings in the referral requests. For example, when requesting a neck MRI, where incidental degenerative lesions are common, providing information that the patient has neck pain with progressive left-sided C7 radiculopathy and suspected disc herniation is likely to assist the radiologist in preparing a more specific and helpful report.
Talking to a radiologist about a patient prior to referral may help to determine the most appropriate imaging. This includes the use of contrast. Note that while contrast may be requested by the referring clinician, contrast studies may not always be done if the radiologist determines plain imaging to be more appropriate.
Equally important to consider and address are the imaging expectations of patients prior to referral. Patients need to be educated that structural changes do not necessarily correlate well with symptoms.
Understanding how radiologists are advised to write reports may help GPs to get the most from imaging reports. According to the RANZCR Radiology written report guideline,3 each imaging report should:
- address the clinical question or clearly state why this is not possible
- provide a diagnosis or differential diagnosis and, where a number of possibilities exist, state them and describe their relative likelihood
- provide a concise, clinically contextualised interpretation of the previously described imaging observations. If findings are normal or non-significant, this should be stated explicitly
- recommend further imaging, investigations, referral or treatment, where indicated. The report should describe:
- how it is expected that this will contribute to the diagnosis and/or management of the patient’s current medical problem
- the exact nature of the further investigation/referral/treatment that is recommended
- the suggested timing of this further investigation/referral/treatment if relevant, especially if this is urgent.