When Patients See Their Reports

A few months ago, my hospital expanded its patient web access so that patients can read their diagnostic radiology reports a week after the report has been finalized. While in principle I think this is a good thing, the results for cancer patients were predictable. I now field multiple phone calls and emails each week from patients concerned about their report.

Most diagnostic radiology reports are inadequate to the interventional oncologist. You must personally review all imaging studies in order to plan and assess therapy. Diagnostic reports rarely tell you everything you need to know: where the tumor is and isn’t; relationship to non-target structures; status of arteries, veins, and ducts; arterial variants, shunts, and parasitization; and completeness of therapy using standard nomenclature. Part of the unique expertise of the interventional oncologist is that our diagnostic radiology training allows us to apply imaging in a more sophisticated way than our oncologic colleagues. This expertise also allows us to put written radiology reports in proper perspective and to filter out misinformation, errors, hedging, and unwarranted speculation.

This is particularly true compared to medical oncologists, whose decisions are usually based on written radiology reports with no reference to the source images. The burden on diagnostic radiologists to provide standardized reports on cancer patients has always been high, and in my experience rarely met. Most reports I receive fail to apply proper oncologic reporting standards such as RECIST; fail to integrate clinical information such as pathology, tumor markers, and interval therapy; and/or fail to indicate what comparison scans and lesions were used for assessment (if done at all). We have all had the experience of a post-ablation scan being read as disease progression based on the increased diameter of the ablation zone compared to the index tumor -- even for scans done at my own institution where the treatment images are available in the PACS! Other frequent errors include reporting subtle changes in tumor diameter as progression or response when in fact they meet the criteria for stable disease by RECIST, and reporting lesions as cancer that by standard criteria are indeterminate.

Tumor boards provide an independent review of images by all the treating physicians; this helps to filter out the noise in the diagnostic reports and apply uniform, standardized assessments. Not every patient has the benefit of tumor board review; several times each month I provide guidance to my oncologic colleagues to “clarify” an imaging report in order to prevent inappropriate treatment decisions -- usually followed by a sharp email to the diagnostic radiologist who issued the misleading report. With patients reading their own reports, the burden of interpreting results to a lay public has increased exponentially. They obsess over every number, every incidental finding, every nuance of interpretation. If diagnostic radiologists were not insulated from the anguish and despair engendered by careless reporting, perhaps they would hold themselves to a higher standard.

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January 17, 2013 10:26 AM by Ginna

The patients can then become incresingly anxious for sure.


The tolerable, the intolerable and the absolutely insane! Thank goodness for excellent support staff, such as NP and PA to help talk people down from the ledges.

advanced practice collaborators

January 17, 2013 01:09 PM by Michael C. Soulen, MD

This is a perfect example of what I discussed in the prior post ("Fire in the Belly"). Patients need someone to call with their concerns. Physicians do not have the availabilty to provide this important service well. Nurse practitioners and physician assistants are a critical link in the chain of care. I give all my new patients my email address, but coach them to direct phone calls to my nurse practioners.

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