Why do imaging results need a written communication plan?
Many patients now read their imaging report before anyone explains it.
Your patient may open their imaging report tonight, alone, before anyone from your office calls. Will they understand it? In 2024, NYU Langone radiologists reported that 57.1% of reports were viewed when English was the patient’s preferred language, against 33.3% for other languages. Their portal offered reports only in English. For any practice serving patients in more than one language, that gap is the plan’s weak spot.
Below, I walk through a plan an ordering practice or imaging center can put in writing: who reviews each report and by when, what the portal notice tells patients, what front-desk staff can and cannot say to a worried caller, and how every attempt gets logged.
A results communication plan is a written agreement on who explains each imaging report to the patient, by when, and through which channel. Speed is no longer the hard part. Reach is.
A 2010 Italian study in Insights Imaging found that education level strongly predicted who asked for their results. The rates were 36.4% with elementary schooling, 41.5% with middle school, and 55.1% with high school or university education. Portals have not erased that pattern. In 2024, one large academic center reported that 64% of reports were viewed for patients aged 18 to 39, but only 34% for patients aged 80 and older. So who calls the patient who never logs in?
How fast do imaging reports reach the patient portal now?
Imaging reports now post to the patient portal within hours of finalization, often before the ordering clinician opens them. Your results plan has to start its clock at posting.
Check three things in your own system first:
- Does the portal post reports on finalization, or hold them?
- How long after posting does a clinician reach the patient?
- Which exams do your patients open most?
In 2024, a Mayo Clinic study in the American Journal of Roentgenology followed one health system that ended its 36-hour embargo (a fixed hold before release). Median time from finalization to patient access fell from 47.3 hours to 8.9 hours. The common assumption is that the doctor reads the report first. After the change, the 2024 study found that patients opened 44.0% of reports before the ordering provider did, up from 18.5%. Readers who want the full picture can see HelpSquad’s outsourced support for primary care practices.
It can be faster still. One patient read a magnetic resonance imaging (MRI) report in the portal before the emergency physician reached the bedside. A resident described reports going live minutes after the preliminary read.
Patients do open them. In 2024, NYU Langone radiologists reported that 54.1% of reports from 1,685,239 exams were viewed in the portal, and 70.2% of MRI reports. Combining 4 sources points to one pattern. The first reader is often the patient.
So I’d treat the hours right after posting as the busiest window in the plan. Covering it doesn’t always mean a full-time hire: HelpSquad quotes part-time engagements starting at 20 hours per week. Which leaves the harder question of whether those reports should wait for the doctor at all.
Should imaging results wait until the doctor has reviewed them?
Most patients say no, even when results are abnormal. The cost lands on patients who read bad, or badly worded, news alone. Plan for them.
In 2023, a study of just over 8,000 portal users at four academic medical centers, discussed by the federal Office of the National Coordinator for Health Information Technology (ONC), found that 95.7% wanted to keep getting results immediately. In that 2023 study, among patients with abnormal or non-normal results, 95.3% still did, even if it meant reading results before their providers. Yet abnormal results made worry nearly twice as likely.
That worry has faces. In a 2024 online discussion of a Washington Post report on portal results, one patient described learning of stage 3C ovarian cancer through the portal two weeks before their appointment. Another read about a sinus mass in a MyChart email and assumed cancer until the doctor called a couple of hours later. It was a cyst.
Wording adds its own harm. One patient was told in person that a head computed tomography (CT) scan looked great. The next day, the portal impression opened with “Significantly limited evaluation due to body habitus.” Nothing in the scan had changed. Only the reader had.
Can you simply hold the bad ones? Under current US rules, a clinician may withhold a result only to prevent physical harm. Emotional distress does not qualify. So I don’t see delay as the fix. The fix is making sure the first reader is never left alone for long, and that is what the plan below is built to do.
What will matter most for imaging results in the next 12 to 24 months?
Follow-up will matter more than release speed. Immediate posting looks permanent, so the practices that stand out will answer questions in the first hours, explain reports plainly and keep their callback promises.
Here is where I would put planning effort:
- The hours right after posting become the busy window. Weak signal: in 2023, the federal health IT office ONC published an interview in which researchers said patient messaging nearly doubled in the six hours after reviewing results, compared with the period before the US Cures Act rules. Why it matters: phones and inboxes need cover when reports post, not at tomorrow’s huddle.
- Reports and portal notices get written for patients. Weak signal: in a 2023 survey, nearly 57% of portal users went looking for more information after reviewing results, most of them online. Why it matters: a report a patient cannot follow sends them to a search engine before your nurse calls.
- Expectations get set at the moment of ordering. Weak signal: Catherine DesRoches of OpenNotes described clinicians messaging patients at ordering: “You may see the results before I do. But I will call you.” Why it matters: the promise only works if someone keeps it.
What could change this? Robert Turer of UT Southwestern said it was “probably a little bit too early” to draw firm conclusions about psychological harms or benefits. If US rules ever allowed holding results for emotional distress, embargoes could return. Even then, someone would still have to make the call.
How do you build a results plan that reaches every patient?
Sort every report into a written tier, give each tier an owner and a deadline from posting, tell patients what to expect, script the front desk, and log every attempt.
Start with the tiers. Family physicians who triage results already split them roughly like this:
| Result tier | Channel | Who owns it |
| Normal | Portal message, or a mailed letter if the patient has no portal | Clinical staff |
| Abnormal, needs a recheck or follow-up | Scripted phone call | Medical assistant or nurse |
| New cancer, surgical or complex finding, urgent referral | Personal call, ideally before the patient reads it, or an in-person visit | Ordering physician |
| Any tier, no portal account | Staff call or letter | Clinical staff |
Next, give each tier a review deadline measured from posting. The evidence sets no single standard, so pick yours and write it down.
Then use the conversation at ordering. In 2023, a JAMA Network Open study reported by Fierce Healthcare found that 16.5% of patients with abnormal results felt more worried after seeing results before a clinician contacted them, against 5% with normal results. Pre-counseling before the test was ordered reduced that concern. So tell patients the report may arrive first, who will call, and by when. Put the same words in the portal notice.
Front-desk staff need two short lists. They can confirm the report has posted, explain who reviews it and when, book the callback, and escalate new symptoms at once. They cannot interpret findings or hint at good or bad news. Portal messages usually reach clinical staff first, not the provider, so the inbox needs the same script.
Finally, log every attempt: time posted, reviewer, each call or message with its time and outcome, and the next step. Flag abnormal reports nobody has opened by your deadline, and call those patients. A posted report is not a delivered result. If your team can’t reach every patient on that list in time, patient outreach support for medical practices can work through it.
Plan for outages too. In 2013, Diagnostic Imaging reported that when Zwanger-Pesiri Radiology’s portal went down during a switch to a new radiology information system, more than 1,000 patients called daily for results. The phone becomes the results channel overnight. I’d treat any portal migration as a phone surge and staff for it before go-live, because the second-tier calls keep coming while the portal is dark.
What will patients remember about your results process?
Patients remember who explained their report, not how fast it posted. Practices that call, script and log every abnormal result give patients a reason to come back.
In a 2019 European Radiology study by Gutzeit and colleagues, more patients who discussed their MRI results with a radiologist showed significantly higher “bonding” with the department, and they wanted future exams only in the department that offered that conversation. Loyalty follows the conversation.
Portal use will keep growing. In 2022, about 3 in 5 people in the US were offered and accessed a patient portal. I’d spend less energy on release timing and far more on follow-up. Start with one abnormal report from last month that nobody opened. Who called that patient?
Frequently Asked Questions: What else do people ask about imaging results in the portal?
Most questions come down to three worries: phone volume, who still calls the patient, and whether patients open their results at all.
Will releasing reports immediately flood the phones?
Not necessarily. Immediate release means a finished report posts to the portal as soon as it is final. In 2013, Diagnostic Imaging reported that the University of Pennsylvania tracked calls to radiologists and to clinics during its portal pilot and saw no change in either. I’d be careful leaning on that, though. One pilot from 2013 cannot settle what today’s volumes look like, and the evidence here does not answer it.
Do patients actually open their results?
Most portal users do. In 2022, 90% of US adults who accessed a portal viewed test results. Yet 1 in 5 had no online record or portal at all. A portal message cannot be your only channel.
Which portal will the patient check first?
Often the one at their family doctor. In 2022, 63% of US respondents had a portal at their primary care provider’s office. So the ordering practice’s phone is where the anxious question usually lands.
Does the radiologist still call when a result is bad?
The call should not disappear. In 2013, Steven Mendelsohn of Zwanger-Pesiri Radiology said that when results are bad, the radiologist still calls the referring physician, just as before patients had online access. The portal changes who reads first. It does not change who owns the next step.
