vRad Blog

One could argue that in terms of direct patient care, the Impression section of the ACR guidelines is the most important of any radiology report. Although the Findings section can be viewed as a “laundry list” describing the normal structures evaluated and any abnormalities identified, the Impression section is the summary that will guide the care of the patient.

The Impression should include the following information, usually listed in descending order of importance:

1. Any abnormality that might account for the submitted reason for exam (positive for appendicitis, left lower lobe pneumonia, intracranial hemorrhage).
2. All pertinent normal findings, usually as determined by the submitted reason for exam (negative for pulmonary embolism, no evidence for renal or ureteral stones).
3. All findings that might be unrelated to the patient’s current problem but are, or could be, important to the care of the patient (abdominal aortic aneurysm, lung nodule, indeterminate renal lesion, small adrenal mass).
4. Recommendations for additional studies (MRI abdomen to better evaluate a liver mass, ultrasound pelvis to characterize an ovarian cyst).
5. Recommendations for follow-up (CT chest should be repeated in 6 months).
6. Any significant patient reaction should be reported.

Although it is hoped that the referring physician will read the entire radiology report, it should not be assumed that each abnormality mentioned under Findings will be noted.  The impression should clearly note all findings that are important to the care of the patient, either acutely or as an important incidental finding, provide a differential diagnosis if the definitive cause cannot be determined from the imaging findings alone, and direct the ordering physician to appropriate additional imaging modalities or follow-up as needed.