How to Read a Radiology Report: What the Impression and Common Terms Mean

Many people now read their MRI, CT, or X-ray report in a patient portal before their doctor has called. The report is written by a radiologist for the doctor who ordered the scan, so it is full of medical terms and careful wording that can be hard to read and easy to worry about.

This guide explains how a radiology report is organized, what the impression is and why it matters most, what common terms such as “unremarkable” and “incidental finding” mean, and what to ask your doctor. It explains the language of reports in general. It cannot tell you what your own report means for you; only your doctor, who knows your symptoms and history, can do that.

What a radiology report is

A radiology report is the written result of an imaging exam. After your scan, a radiologist, a doctor who specializes in interpreting medical images, reviews the images and writes the report. The report goes to the provider who ordered the exam, who then discusses the results with you. Many health systems also release the report to your patient portal, sometimes before your provider has seen it. If you are still waiting for your report, see how long MRI results take.

The images and the report are separate. The images are the pictures from your scan, stored as DICOM files; the report is the radiologist’s written interpretation of those pictures.

The sections of a radiology report

Most reports follow the same order. RadiologyInfo, the patient site of the American College of Radiology and the Radiological Society of North America, describes these sections:

Some reports, especially for breast imaging, also include a standardized category score. These come from reporting systems such as BI-RADS; see our overview of reporting systems such as BI-RADS.

A sample report, section by section

This is an invented example written for this guide, not a real patient’s report. It shows how the sections fit together.

EXAM: MRI right knee without contrast.

HISTORY: Right knee pain after a twisting injury two months ago.

COMPARISON: None.

TECHNIQUE: Multiplanar, multisequence MRI of the right knee was performed without intravenous contrast.

FINDINGS: Menisci: The medial meniscus is intact. There is a small horizontal tear of the posterior horn of the lateral meniscus. Ligaments: The anterior and posterior cruciate ligaments are intact. The collateral ligaments are intact. Cartilage: Unremarkable. Bones: No fracture. Small joint effusion.

IMPRESSION:

1. Small horizontal tear of the posterior horn of the lateral meniscus.
2. Small joint effusion.
3. Ligaments intact.

How to read it:

• Exam, history, and comparison indicate this is a knee MRI performed after an injury, with no earlier MRI for comparison.
• The technique line says how the images were made. You can usually skip it.
• The findings go through each part of the knee. “Intact” and “unremarkable” mean nothing concerning was seen there. The two abnormal findings are the meniscus tear and the joint fluid (“effusion”).
• The impression repeats only what matters, in order of importance. Your doctor will use it, together with your symptoms and an exam of your knee, to decide what to do next.

What the impression means

The impression is the radiologist’s conclusion. RadiologyInfo calls it “the most important part of the radiology report for you and your doctor.” It usually:

• lists the most important findings first, often as a numbered list;
• answers the question in the history section, for example whether there is a fracture or a tear;
• may suggest possible causes when a finding could have more than one explanation;
• may include recommendations, such as another type of scan, a follow-up scan after a set time, a biopsy, or comparison with older scans from another facility.

If you only read one part of your report, read the impression. Then read the findings for detail, and write down anything you want your doctor to explain.

Do not judge your results by the length of the impression. A single line can still describe something important, and a long impression can be a list of minor, common findings. The length tells you little; what matters is what your doctor says about it in the context of your symptoms.

Common terms in radiology reports

Reports use a shared vocabulary. These are some of the terms patients ask about most. The definitions describe how the words are generally used; your doctor can tell you what they mean in your report.

Words that express uncertainty

Images do not always give a definite answer, so radiologists use words that show how confident they are: “likely,” “could,” “versus,” “nonspecific,” “cannot be excluded,” “suggestive of,” “consistent with.” These words are very common. A study of more than 640,000 report impressions, published in the Journal of Digital Imaging in 2020, found that about a third contained at least one such term, with “likely” the most common.

Roughly, “consistent with” and “likely” mean the radiologist thinks the explanation is probable. “Cannot be excluded” and “versus” mean more than one explanation is possible and the images alone cannot decide between them. “Nonspecific” means the finding has several possible causes and its appearance does not point to a single cause. In each case, the next step is a conversation with your doctor, who may already know the answer from your history, or may suggest another test.

Incidental findings

An incidental finding is something the radiologist notices that is unrelated to the reason for your scan. The American College of Radiology describes it as a mass or lesion detected on CT, MRI, or another scan performed for an unrelated reason. Common examples are small cysts in the kidney or liver, small lung nodules, or a nodule in the thyroid seen at the edge of a neck or chest scan.

Incidental findings are common, especially on CT and MRI, because these scans show so much of the body. RadiologyInfo notes that many incidental findings will cause you no harm. The ACR publishes guidance to help radiologists and doctors decide which findings require action, which require a follow-up scan, and which require no action, partly to avoid unnecessary tests. If your report mentions an incidental finding, ask your doctor whether it needs follow-up and, if so, when.

If you read your report before your doctor

In the US, many health systems release imaging reports to patient portals such as MyChart as soon as they are finalized, so you may read yours before your doctor has. That can be useful: you can prepare questions and keep track of your own care. It can also be stressful, because the report is written for a doctor.

• Start with the impression, then read the findings.
• Look up terms in a reliable source, such as RadiologyInfo or the glossary above, rather than searching symptoms.
• Remember what the report cannot tell you: it is one piece of information, and your doctor will combine it with your symptoms, exam, and history.
• If something in the report worries you, send your doctor a message through the portal or call the office instead of waiting.
• If your symptoms worsen, contact your doctor or seek urgent care; do not wait for a discussion of results.

Questions to ask your doctor

• What does the impression mean for me?
• Does this explain my symptoms?
• Are any of the findings new, or have they been there before?
• Is any follow-up imaging or other testing recommended, and when?
• Does anything here need treatment, or is it something to watch?
• Should I keep a copy of these images for future comparison?

If your doctor cannot answer a question about the images themselves, RadiologyInfo suggests you can ask to speak to a radiologist at the imaging facility, and notes that many radiologists are happy to answer patients’ questions.

Your images, a second look, and the next step

The report is a summary; the images are the full record. You have a right to a copy of your images, usually on a CD, a USB drive, or a download link. Keeping them helps the radiologist compare and see what has changed on your next scan.

• To view your images at home, follow our guide on how to view an MRI CD, or open them in the free online DICOM viewer, which runs in your browser with no account required. It is for personal and educational viewing, not diagnosis.
• If you face a major decision, such as surgery, or your findings are unclear, a second radiologist’s review can help; see our guide to getting a radiology second opinion.

Radiologists are also working to make reports clearer, including through standardized templates and categories. If you are curious about how that works, see our article on structured reporting.

Frequently asked questions

What does “impression” mean on a radiology report?

The impression is the radiologist’s summary and conclusion: the most important findings, possible causes, and any recommendations. RadiologyInfo calls it the most important part of the report for you and your doctor.

What does “impression” mean on MyChart?

The same thing. When an imaging report appears in MyChart or another patient portal, the impression section is the radiologist’s summary of the key findings. You may see it before your doctor has reviewed it.

What does “unremarkable” mean on an MRI report?

It means nothing concerning was seen in that area. “Unremarkable” is the radiologist’s way of saying the structure looks normal.

What is the difference between findings and impression?

The findings describe what the radiologist saw in each part of the scan, in detail. The impression summarizes only the findings that matter most and adds any recommendations. Read the impression first, then the findings.

What is an incidental finding?

Something seen on a scan that is unrelated to the reason for the scan. Incidental findings are common, and many cause no harm. Your doctor can tell you whether yours needs any follow-up.

Can I talk to the radiologist who read my scan?

Often, yes. Start with the doctor who ordered the scan. If you have questions they cannot answer, you can ask the imaging facility whether a radiologist is available to talk with you.

Do doctors call right away with bad results?

Not necessarily. Radiologists contact the ordering doctor directly about urgent findings, but how quickly you hear depends on your doctor’s practice. A quick call does not mean bad news. For typical timelines, see how long MRI results take.

This article explains common terms in general. It is not medical advice and cannot interpret your own report. Ask your doctor to explain what your results mean for you.

Sources

• All About Your Radiology Report, RadiologyInfo.org
• How to Read Your Radiology Report, RadiologyInfo.org
• Incidental Findings, American College of Radiology
• Vague language in radiology reports (Callen et al., Journal of Digital Imaging, 2020), Radiology Business
• If Clinically Indicated, Clinically Correlate, Radiology Business