SUBJECT: Radiological Imaging for the Emergency Department: Initial Findings/Re-Readings/Discrepancies


POLICY: All Emergency Room (ER)  patients requiring radiological services will have a “Wet” initial reading of their study by a radiology resident or attending.  If there is a subsequent discrepancy with the final reading, the Emergency Department will be notified promptly.


PURPOSE:  To insure rapid communication of emergency exam results and appropriate patient care and follow-up.




1.      All ER studies will have an initial reading by a radiology resident or attending

      radiologist.  The diagnostic reading will be written on a Request for ED Radiological

      Examination Form (Attached), which will be transmitted/returned to the Emergency

      Department to be reviewed by the physician caring for the patient.  In addition, any

      critical findings (See below) will be called directly to the ER.


2.      An attending radiologist will subsequently compare his/her final reading with the initial impression.


3.      If there are any discrepancies between initial and final readings, the attending radiologist will define the discrepancies in the final report.  The voice transcribed final report is immediately available on the hospital information system.  The change of interpretation is also written on the ER form and delivered to the ER.


4.      Any critical discrepancy (that requiring immediate change in management) will also be called directly to an ER Attending and recorded in the report including the date, time and M.D. called.


5.      Critical cases requiring direct radiologist communication to the Emergency Room:

Recommended Guidelines for Critical Cases

Cerebral Hemorrhage                                             Portal Venous Air

Brain Tumor                                                           Volvulus

Depressed Skull Fracture                                        Traumatic Visceral Injury

Cervical Spine Fracture                                          Retroperitoneal Hemorrhage

Tension pneumothorax                                            Bowel Obstruction

Aortic Dissection                                                    Cord Compression

      Ruptured Aneurysm, or “Impending” Rupture          Ectopic Pregnancy

      Pulmonary Embolism                                              Testicular Torsion

      Mediastinal Emphysema                                          Fetal Demise

      Free Air

ISSUED BY:           APPROVED BY:                    DATE ISSUED:                      SUPERCEDES                      PAGE:

                                                                                                                                ISSUE DATED:                                     



D. Bader, M.D.       P. Sabel, M.D.                 10/1/2002                                                                       1 of 1