Texting imaging results poses several risks

November 17, 2010
Arun Krishnaraj, MD, MPH

The current generation of trainees in radiology and other medical specialties likely prefer texting to direct communication, but are we missing something in these electronic messages? I believe so.

10:15. 11:15. 12:15. I implored my wife to call her friend again. They had been communicating via Facebook during the week but had yet to settle on a location to meet for brunch. Two hours had passed since we last received a text, but still no confirmation on where to meet. Since his birth five months ago, our son has coopted my schedule and he dictates when and where I can eat. The window for going out for a meal can be ever so small. At 12:15 (and approaching nap number two) we had to call off the event. Later that afternoon we learned that the friend’s mobile phone reception was poor and she did not receive our phone message. While this may have spoiled our Sunday morning, it pales in comparison to the importance of accurate communication of radiology results in the hospital.

Two and a half billion text messages are sent each day in the U.S., and in today’s wired society, text messages have eclipsed phone conversations. The current generation of trainees in radiology and other medical specialties likely prefer texting to direct communication, but are we missing something in these electronic messages? I believe so.

Many of you reading this post wear pagers throughout each workday that allow other physicians, nurses, and support staff to contact you when necessary. This mode of communication has proven very effective in prompting a physician to phone back to a designated number. However, modern pagers go one step further, allowing full alphanumeric texts to be sent. I, along with many of my colleagues in radiology, am guilty of using the alphanumeric paging system to communicate study results. I find it more efficient as it allows me to continue to work through my queue. But this method of communication, I believe, is flawed and serves to hurt not only our profession but also patient care.

Lack of confirmation

When a text page or its analog, an e-mail alert, is sent regarding the results of a study, there is no way to know whether the alert has been received and acted on. For critical results, this could prove catastrophic. The American College of Radiology Practice Guidelines for Communication of Diagnostic Test Results do not permit the use of pages to relay critical results. In the Partners Healthcare system in which I work, Drs. Ramin Khorasani (Brigham and Women’s Hospital) and Scott Gazelle (Massachusetts General Hospital) have developed standards for communicating findings based on the urgency of results. These systems also allow for the auditing of communication data to determine practitioners’ adherence to those standards.

An additional consequence of texting imaging results is a missed opportunity for face-to-face contact with the referring physician. With the advent of PACS and digital imaging, radiology reports and images have become accessible anywhere in a healthcare enterprise. This has numerous benefits, but a major consequence is the drastic drop in the number of times referring providers visit the department for a consultation. If we continue to convey the results of our studies electronically, we move closer to a paradigm in which radiologists and their reports are commodities without differentiation in quality. This type of behavior will ultimately lead to our services going to the lowest bidder.

Lack of subtlety

Moreover, texting and e-mail reports lack the subtlety of a real-time conversation, whether over phone or face to face. One radiologist may use the phrase “this lesion is amenable to percutaneous sampling” to indicate that the lesion is easily accessible, while another may use the term to indicate that a biopsy is recommended to make a diagnosis. Patient care is compromised when a referring physician interprets an impression in a different manner than was intended by the radiologist.

Advances in digital communication have allowed us to multitask, be more efficient, and get interrupted less often. But these technologic improvements have often come at the expense of relationship-building and report accuracy. Until we reach a time when video conferencing becomes more practical, good old-fashioned face-to-face conversations and phone conversations still play an important role in our profession.


Dr. Krishnaraj is a clinical fellow in the abdominal imaging and intervention division, department of imaging, at Massachusetts General Hospital/Harvard Medical School. He can be reached at akrishnaraj@partners.org.

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