CT: incidental 7 mm solid RLL nodule, low-risk patient, no priors. Best impression line:
Pulmonary nodule. Clinical correlation recommended.; 7 mm right lower lobe solid nodule: CT chest at 6–12 months, then consider 18–24 months (Fleischner 2017, low risk).; Lung cancer cannot be excluded.; Tiny nodule, likely nothing.
Answer: 7 mm right lower lobe solid nodule: CT chest at 6–12 months, then consider 18–24 months (Fleischner 2017, low risk).. Size, location, the exact interval, and the cited system — the clinician can order from that sentence. 'Clinical correlation' delegates your job; 'cannot be excluded' frightens without informing.
US: 1.6 cm TR4 thyroid nodule. Best impression:
TR4 nodule; consider possible FNA versus follow-up versus clinical correlation.; Thyroid nodule, follow endocrinology.; 1.6 cm right mid-pole TR4 nodule — meets ACR TI-RADS size threshold; FNA recommended.; Possible malignancy of the thyroid.
Answer: 1.6 cm right mid-pole TR4 nodule — meets ACR TI-RADS size threshold; FNA recommended.. The TR level plus size plus the threshold verdict is complete and auditable. The option that lists FNA, follow-up and clinical correlation together recommends everything, which is the same as recommending nothing.
CXR: new consolidation in a febrile patient; prior film 2 days ago was clear. Best impression:
Airspace disease.; New right lower lobe consolidation, consistent with pneumonia in the clinical setting.; Findings could represent pneumonia, edema, hemorrhage, atelectasis, or mass; correlate.; Infiltrate versus infiltrate.
Answer: New right lower lobe consolidation, consistent with pneumonia in the clinical setting.. A NEW finding with a 48-hour-clear prior and a fever earns a committed read. The full differential belongs in uncertain cases, not everywhere — hedging on an easy case erodes trust for the hard ones.
MRI shoulder: full-thickness supraspinatus tear, 2 cm retraction, Goutallier 3 fatty infiltration. The impression must include:
The sequence parameters; The tear only — muscle detail is for the body of the report; Tear dimensions, retraction, AND the muscle quality, because repairability depends on it; A recommendation for physical therapy
Answer: Tear dimensions, retraction, AND the muscle quality, because repairability depends on it. Repairability lives in the muscle, not the tendon: a surgeon deciding repair versus tendon transfer needs Goutallier-class information in the conclusion, not buried in FINDINGS.
CT abdomen for RLQ pain: appendix not identified, no secondary inflammatory signs. Best impression:
Nondiagnostic study.; Normal appendix.; Appendix not definitively visualized; no secondary signs of appendicitis.; Appendicitis excluded.
Answer: Appendix not definitively visualized; no secondary signs of appendicitis.. Never claim an organ you did not see. The honest formulation still answers the clinical question (no secondary signs) while documenting the limitation that protects everyone when the 6-hour re-scan shows it.
Head CT: 'Acute infarct cannot be excluded' is a poor impression because:
Early infarcts are often CT-occult, so the sentence is always true and therefore carries no information — state the actual finding and route to MRI if the question persists; CT never shows infarcts; It needs the word 'clinically'; It is too short
Answer: Early infarcts are often CT-occult, so the sentence is always true and therefore carries no information — state the actual finding and route to MRI if the question persists. A statement that is true of every normal head CT cannot guide anyone. Report what IS there, name the study that answers the question (DWI), and let the negative be a real negative.
Report body says 'left renal cyst'; the impression says 'right renal cyst'. The non-negotiable fix:
Reconcile laterality before signing; a side discrepancy is a report-invalidating error; Delete the impression; Hedge with 'bilateral'; Leave it — readers check the body
Answer: Reconcile laterality before signing; a side discrepancy is a report-invalidating error. Laterality discrepancies are the error class that reaches patients (wrong-side procedures) and courtrooms. Every draft pass — human or AI — ends with a left/right reconciliation.
Incidental 1.2 cm adrenal nodule, 4 HU on noncontrast CT. Best impression:
Probably benign adrenal finding.; Adrenal mass, cannot exclude metastasis.; 1.2 cm left adrenal nodule measuring 4 HU unenhanced: lipid-rich adenoma; no further workup.; Adrenal lesion — recommend washout CT, MRI, PET and biochemical panel.
Answer: 1.2 cm left adrenal nodule measuring 4 HU unenhanced: lipid-rich adenoma; no further workup.. ≤10 HU unenhanced IS the diagnosis of lipid-rich adenoma — the workup is already done. Ordering more tests for a solved problem is as much an error as missing an unsolved one.