Language radiologists use in reports is crucial, new research shows
A new study highlights the importance of the language radiologists use in their exam interpretations.
Specifically, the paper details issues with indiscriminate language used in cases of CT exams used for ruling out acute appendicitis. Prior studies have estimated that up to 15% of initial radiology reports for appendicitis cases are classified as indeterminate, leaving ordering providers with unanswered questions that could delay care, authors of a new paper caution.
“When CT findings are inconclusive, clinical decision-making becomes more complex, and management pathways may vary considerably across providers,” Rathachai Kaewlai, with the department of radiology and faculty of medicine at Siriraj Hospital in Thailand, and co-authors noted. “Clear communication of diagnostic certainty in radiology reports is increasingly recognized as a critical component of effective interdisciplinary care. Wording used to express diagnostic confidence and a clear understanding of the meaning of these phrases can influence clinical decision-making.”
The team conducted a retrospective analysis on how radiologists' overall clinical judgment communicates diagnostic certainty to providers. They evaluated 983 CT examinations performed for suspected acute appendicitis between August 2021 and July 2025 to compare the diagnostic performance of original radiology reports, radiologist-adjudicated report impressions and two structured lexicon-based reporting schemes that categorized appendicitis likelihood based on specific CT findings (appendiceal diameter, wall thickening, wall hyperenhancement, periappendiceal fat stranding). Surgical, pathology and clinical outcomes served as the reference standard.
Acute appendicitis was confirmed in 40% of patients. Original radiology reports were classified as indeterminate in 15.5%, compared to 12% for adjudicated reports and 27.9% to 46.1% for the lexicon-based schemes. Adjudicated impressions yielded the strongest diagnostic performance, with sensitivity ranging from 85.2% to 98.7%, specificity from 85.9% to 97.1% and overall accuracy between 91% and 92.4%. Agreement with the final diagnosis also was highest for adjudicated reports. Researchers additionally identified several CT imaging features that were independently associated with indeterminate reporting, including wall thickening (47.1%), wall hyperenhancement (50.4%) and periappendiceal fat stranding (62.2%).
“Original reports showed an indeterminate rate of 15.5%, which decreased to 12% following adjudication. This reduction was achieved without re-reviewing CT images—adjudication involved only reassessment of report wording against predefined certainty thresholds, isolating the effect of language and certainty expression rather than image interpretation itself,” the group noted. “The fact that reclassification was possible through wording reassessment alone suggests that a meaningful proportion of indeterminacy in our cohort reflected imprecise language rather than unavoidable diagnostic ambiguity.”
The team suggested their findings “support efforts to standardize certainty language” in CT reporting for acute cases of appendicitis and similar diagnoses.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.