1. Positioning
Rotation is the most common reason a thoracic study cannot be fully interpreted. A rotated patient changes the apparent size of the cardiac silhouette, distorts lung fields asymmetrically and can create a pattern that was never there. Check symmetry of the ribs and sternum before accepting the image.
- Extend limbs clear of the thorax on lateral projections.
- Take thoracic images at peak inspiration where the patient allows it.
- Center the beam on the region of interest, not the patient as a whole.
2. Collimation
Tight collimation reduces scatter and improves contrast on exactly the region being questioned. Collimating too tightly, however, cuts off anatomy that gives context, so include the borders of the region rather than the lesion alone.
3. Exposure
Underexposed studies lose soft tissue detail; overexposed studies burn out lung and bone margins. Digital systems tolerate more than film did, but post-processing cannot recover information that was never captured.
4. Labeling and views
Left and right markers are not paperwork. A report describing the wrong side changes a surgical plan. Submit at least two orthogonal views of the region of interest, plus a third view for thorax and abdomen wherever possible.
5. File format
Send original DICOM. Exported JPEG and PNG images, phone photographs of a monitor and screenshots all discard the data a radiologist adjusts during a read. In CT and MR that matters even more, because window and level settings must remain adjustable across the full volume of images.
Modality-specific notes
- Ultrasound: submit cine loops rather than isolated still frames, sweeping each organ in two planes.
- CT: include every series and reconstruction, pre- and post-contrast, and state the contrast protocol.
- MR: include every sequence acquired in every plane, with the neurologic localization in the history.
- Fluoroscopy: record several complete cycles, because the diagnosis lives in the movement.
6. Clinical history
The final determinant of report quality is not an image at all. Signalment, duration, bloodwork, treatment given and a specific question turn an accurate description into a usable answer. When something limited the study, write that down too.
Frequently asked questions
Why does the report sometimes say a study is limited?
Because the images do not support a definite statement. Motion, rotation, incorrect exposure or missing views all restrict what can be concluded, and an honest report says so rather than implying confidence the data does not carry.
Should we send screenshots if DICOM export is slow?
No. Screenshots lock window and level settings, discard the original data and make subtle findings unreadable. Send original DICOM files, even if it takes a few minutes longer.
How many views are enough?
At least two orthogonal views of the region of interest, and a third view for thorax and abdomen wherever the patient tolerates it. A lesion can be silhouetted out on a single projection.
Does patient preparation affect Ultrasound quality?
Considerably. Clipping, contact and patient positioning determine how much of each organ can be seen, and gas obscures what lies beneath it. Sweeping each organ in two planes matters more than capturing a single perfect still image.
What if a patient will not tolerate correct positioning?
Submit what you safely obtained and say what happened in the history. A radiologist can work with a compromised study; what they cannot work with is a compromised study presented as a complete one.
Does the clinical history really change the read?
Yes. It directs attention, narrows differentials and turns a description of what is visible into an interpretation of what it means for that patient.
Related: the onboarding guide and the glossary.