Emergency findings
These include situations where the patient may come to harm if urgent medical action is not taken. Examples would include: pulmonary emboli, fractures, acute bleeding, etc. Rarely, individuals other than the patient may also come to harm if treatment is not started early, such as in the case of open tuberculosis. The need to communicate directly will of course depend on whether the diagnosis is suspected and mechanisms are in place to treat immediately, or whether it is unsuspected—for example, a pulmonary embolus found incidentally in a routine out-patient CT examination.
In emergency cases, the consequences for the patient are so severe that there will usually be little doubt that direct contact, usually by telephone, is made either to the referring doctor or someone who is able to take appropriate action. These cases may be very time consuming because of the need to locate a doctor who is in a position to see or contact the patient and take immediate action.
Unexpected findings
When there is a significant abnormality detected on imaging, such as a mass lesion or suspected malignancy, the referrer needs to take appropriate action within a short time-frame. To know whether the abnormality is completely unsuspected or might have been suspected by the referrer, the radiologist has to rely on the information available, usually the request card. On this basis, he/she has to make a judgement as to whether the diagnosis is unsuspected and whether any additional alert mechanism is necessary. Here, direct telephone communication is not usually necessary, and other methods can be used. They may be electronic, with alert or red flags attached to the reports on electronic systems, or involve physical means such as faxing or e-mailing the report. Where departmental protocols are in place, these mechanisms should be clearly outlined and adhered to, but individual judgement may have to be exercised if no protocols exist. This line of communication is also influenced by the radiologist’s knowledge of local processes and the individual referrer’s preferred system of tracking reports.
Incidental findings
This is a current area of debate. Usually, urgent communication is required only where action needs to be taken in a short time-frame. When further investigation is suggested but the incidental finding is not thought likely to be of urgent significance for the patient, the normal reporting processes will usually suffice.