Radiologists Role in the Communication of Imaging Examination Results to Patients: Perceptions and Preferences of Patients

Medical Physics and Informatics Original Research Mangano et al. Communication of Results Medical Physics and Informatics Original Research Mark D. Mangano 1 Arifeen Rahman 1 Garry Choy 2 Dushyant V. Sahani 3 Giles W. Boland 3 Andrew J. Gunn 1 Mangano MD, Rahman A, Choy G, Sahani DV, Boland GW, Gunn AJ Keywords: patient-centered radiology, quality improvement, radiology reporting DOI:10.2214/AJR.14.12470 Received January 1, 2014; accepted after revision February 20, 2014. 1 Department of Radiology, Massachusetts General Hospital and Harvard Medical, School, FND 216, 55 Fruit St, Boston, MA 02114. Address correspondence to A. J. Gunn (agunnmd@gmail.com). 2 Department of Radiology, Division of Emergency Radiology and Teleradiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. 3 Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA. AJR 2014; 203:1034 1039 0361 803X/14/2035 1034 American Roentgen Ray Society Radiologists Role in the Communication of Imaging Examination Results to Patients: Perceptions and Preferences of Patients OBJECTIVE. It has been suggested that radiology reporting practices would be improved if radiologists were to discuss the results of an examination directly with the patient. The attitudes and preferences of patients with regard to direct communication with the radiologist are not well-defined. The purpose of this study was to survey patients about their preferred method of receiving radiologic results. MATERIALS AND METHODS. An anonymous survey was distributed to adult patients undergoing contrast-enhanced CT or MRI over a 2-week period in June 2013. RESULTS. The response rate was 58.4% (642 responses). For normal examination results, the preferred mode of communication was a telephone call from the ordering physician (34.1%); only 12% of respondents opted for a telephone call from the radiologist, and 2.6% chose a face-to-face meeting with the radiologist. For abnormal test results, the preferred mode of communication was also a telephone call from the ordering physician (49.8%); 14.4% of respondents selected a telephone call from the radiologist, and 8.3% chose a faceto-face meeting with the radiologist. Patients preferred receiving very detailed versions of radiology reports for both normal (46.4%) and abnormal (81.8%) test results. Patients also expressed a desire to have access to at least key images from their examinations. CONCLUSION. Patients prefer receiving both normal and abnormal examination results from the physicians who ordered the examination rather than the radiologist. They also prefer to receive very detailed examination results rather than a brief summary in lay terms. T he radiology report is the primary interface between radiologists, the patient, and the patient s health care providers and serves as both medical and legal documentation of provided care [1]. Proper reporting practices are an essential component of quality, coordinated patient care in both the inpatient and outpatient settings [2]. As such, there has been considerable interest in the radiology literature in improving reporting practices, mostly through survey- and focus group based data collected by solicitation of the opinions and preferences of both patients and referring physicians with respect to report quality, format, language, length, content, turnaround time, and mode of result delivery to patients [3 17]. Unfortunately, despite these efforts, dissatisfaction with reporting practices among referring physicians and patients remains [14, 15]. It has been suggested [18 23] that radiologists can improve reporting practices, increase patient satisfaction, and enhance the visibility of the specialty through the proactive approach of delivering examination results directly to patients. This direct communication with patients could take a variety of forms, such as a short in-person consultation at the time of the examination, providing the patient with a hard copy of preliminary results at the time of the examination, or providing the patient with an electronic or hard copy of the full issued report when it becomes available. Other methods of delivering examination results to patients, such as online portals or patient gateways through which patients can access their own results, may also have an increasing role. Although early reports in the radiology literature have generally been supportive of the aforementioned practices, referring physicians are often hesitant to accept such changes in traditional reporting practices [15, 17, 18]. Patient attitudes and opinions regarding these practices are not well understood and would provide useful data for radiologists and referring physicians as they develop appropriate patient-centered communication 1034 AJR:203, November 2014

Communication of Results strategies. We decided to survey our patient population to better understand their views. Materials and Methods This study was approved by our institutional review board and was HIPAA compliant. The survey (Appendix 1) was developed in conjunction with radiology support staff to directly assess patient preferences regarding the receipt of radiology examination results, the complexity of information contained in the report provided to the patient, and the patient s desire for an opportunity to formally meet with a radiologist. These preferences were assessed for the hypothetic situations of both a normal and an abnormal test result, although we did not specifically define normal or abnormal for the patients within the context of the survey. The complexity of information contained within the report was separated into three tiers: less detailed (e.g., Your results are abnormal and should be discussed with your physician ), moderately detailed (a brief summary of the results), or very detailed (exactly what physicians receive). Awareness of, ability to access, and use of our institutional online portal for reviewing radiologic results were specifically addressed within the survey, even though the portal also allows patients to review their entire electronic medical record (including pathology results, laboratory test results, radiologic results, and physician notes). The survey was made as succinct as possible to decrease the burden on participating patients. Our practice is at a large academic tertiary care medical center that also operates two outpatient imaging facilities at off-campus locations, which primarily provide CT and MRI services. All adult patients who presented for contrast-enhanced CT or contrast-enhanced MRI at these outpatient facilities over a 2-week period in June 2013 were invited to participate in the survey. Patients undergoing contrast-enhanced examinations were invited to participate because at our institution they are required to fill out a short medical history before the examination. Consequently, it was thought that the most efficient method for distributing the survey would be for radiology support staff to include it with the paperwork these patients are already asked to fill out. Because no such paperwork is required for patients undergoing unenhanced examinations, they were not routinely invited to participate. Voluntary participation in the survey was accepted as informed consent. Patient responses were collected anonymously. Incomplete surveys and those with multiple selections made for a single question were included in the data analysis. Percentage of Respondents 30 25 20 15 10 5 0 4.1 9.6 18.8 18 30 31 40 41 50 51 60 61 70 71 80 > 80 Age (y) Fig. 1 Bar graph shows respondent ages. Highest participation was by patients 51 60 years old (24.6% of all respondents). Percentage of Responses 40 35 30 25 20 15 10 5 0 12 Phone, Radiologist a 34.1 Phone, Ordering b 2.6 Meet With Radiologist c Results Patient Characteristics A total of 642 patients (231 men, 411 women) participated in the survey, resulting in a 58.4% response rate. The respondents ages are shown in Figure 1. The highest rate of participation was by patients 51 60 years old. Respondents reported being satisfied with their overall experience in the radiology department (mean, 4.5 on a 1 5 scale; 25th percentile, 4.0; 75 percentile, 5.0). Among the respondents, 87.4% had Internet access either at home or at work. A significant difference was found between age groups with regard to Internet access (χ 2 = 77.4, p < 0.0001, df = 6). Those younger than 30 years had proportionally the most access, and those older than 80 years reported the least access. 24.6 14.4 Meet With Ordering d 23.2 13.6 24.2 25.2 Fig. 2 Bar graph shows patient preferences for receiving normal examination results. Telephone call from physician who ordered examination was most preferred method of communication (34.1% of total responses). a Telephone call from radiologist who interpreted test. b Telephone call from physician who ordered test. c Faceto-face meeting with radiologist who interpreted test. d Face-to-face meeting with physician who ordered test. e Mailed copy of report to home. f E-mailed copy of report. g View results online. Mail e Email f Preferences Regarding Receipt of Examination Results We asked patients to indicate their preferred method of receiving radiology test results. Patient preferences for receiving hypothetically normal results are summarized in Figure 2. The preferred mode of communication was a telephone call from the ordering physician (34.1%), and only 12.0% and 2.6% of respondents opted for a telephone call from the radiologist or a face-to-face meeting with the radiologist, respectively. For normal examination results, 61.0% of the respondents chose to receive their results through postal mail, e-mail, or an online portal. Patient preferences for receiving hypothetically abnormal results are summarized in Figure 3. In comparison with the choice about receiving normal results, significantly more respondents (49.8%) selected receiving abnormal results over the telephone from the ordering physician (Z = 5.5, p < 0.0001), whereas 14.4% and 8.3% of respondents selected a telephone call from the radiologist or a face-to-face meeting with the radiologist, respectively.. Notably, a greater percentage of respondents (22.7%) desired interaction with the radiologist (either over the telephone or in person) for abnor- 6 11.6 Online g AJR:203, November 2014 1035

Mangano et al. mal results than for normal results (14.6%) (Z = 3.7, p = 0.0002). Moreover, only 20.5% of respondents chose to receive abnormal results through the mail, e-mail, or the online portal, which was significantly less than the percentage for normal results (Z = 15.1, p < 0.0001). Less than half (44.2%) of respondents were even aware of the capability of accessing their radiologic results online. Of those aware of the online capability, 46.7% had taken advantage of the service. Accessing radiologic results online was the chosen method of delivery for only 11.6% of respondents when the results were normal and for even fewer respondents (4.8%; Z = 4.4, p < 0.0001) when the results were abnormal. Preferences Regarding Report Content We were also interested in knowing the level of detail, including the possibility of providing key images, desired by patients receiving direct access to their examination results though interaction with the radiologist, either electronically by e-mail or an online portal or through traditional mail. These results are summarized in Figures 4 and 5. When the results are abnormal, 81.8% of respondents preferred to receive a report identical to that provided the ordering physician; this percentage was significantly greater than the 46.4% who desired such detail for normal examination findings (Z = 12.9, p < 0.0001). Similarly, a greater percentage of patients (89.2%) wanted the report to include key images if the results are abnormal in comparison with normal examination findings (62.4%; Z = 10.9, p < 0.0001) even though most patients wanted images included in the reports in both situations. Preferences Regarding Information Provided at the Time of the Examination Finally, we asked patients what, if any, type of information they would like to receive at the completion of the examination. Among the respondents, 51.6% chose to receive the contact information for the radiologist interpreting the examination, and 50.3% selected to receive a card with a link to a website explaining commonly used terminology in radiology reports. Only 15% of respondents requested a time and location to meet with a radiologist to discuss the examination results. Percentage of Responses 60 50 40 30 20 10 0 14.4 Phone, Radiologist a 49.8 Phone, Ordering b 8.3 Meet With Radiologist c 27.7 Meet With Ordering d 8.8 6.9 4.8 Fig. 3 Bar graph shows patient preferences for receiving abnormal examination results. Telephone call from physician who ordered examination was most preferred method of communication (49.8% of total responses). a Telephone call from radiologist who interpreted test. b Telephone call from physician who ordered test. c Faceto-face meeting with radiologist who interpreted test. d Face-to-face meeting with physician who ordered test. e Mailed copy of report to home. f E-mailed copy of report. g View results online. 14.2% 39.4% Mail e E-mail f 46.4% Less Detailed Moderately Detailed Very Detailed Fig. 4 Bar graph shows amount of detail patients desire in radiology reports that are provided directly when results are normal. Very detailed (i.e., exactly what ordering physician receives) was most commonly selected option (46.4%). 2.6% 15.5% 81.8% Less Detailed Moderately Detailed Very Detailed Fig. 5 Bar graph shows amount of detail patients desire in radiology reports provided directly when results are abnormal. Very detailed (i.e., exactly what ordering physician receives) was most commonly selected option (81.8%). Online g Discussion There has been growing discussion in the radiology community regarding a patientcentered approach to practice in which radiologists use their knowledge and expertise to interact more fully with both patients and referring physicians, thereby becoming more integrated into the communication and care delivery processes [18 23]. This fact is highlighted by the development of the Radiology Cares campaign by the Radiological Society of North America, which aims to assist radiologists in becoming more comfortable in their interactions with patients, improve the patient experience in radiology, and increase patient awareness of the role radiologists play in delivering quality care [24]. In addition, the American College of Radiology spearheaded the Face of Radiology campaign, which included advertisements and informational resources for patients regarding radiologists and radiologic examinations [25]. The campaign also encouraged radiologists to enhance their visibility among patients by interacting with at least five patients per day. These attempts to optimize the radiologist-patient relationship are important in developing a patient-centered culture within a radiology practice, especially in an era in which patients are becoming more empowered and sophisticated regarding their health care and health information. Given this in- 1036 AJR:203, November 2014

Communication of Results creasing focus on patient-centered radiology, it is prudent to directly assess patient opinions concerning the communication of radiologic findings and understand their preferences regarding direct interaction with the radiologist. Such information could provide an important reference point for patient-centered radiologists in discussing changes to their reporting practices with their partners, patients, and referring physicians. The current data represent the largest, to our knowledge, single-center survey to date of patient attitudes toward direct communication of examination results. These data provide both congruency with and contrasts to previous reports in the literature. For instance, our respondents preferred receiving, either by telephone or in person, their examination results from the physician who ordered the examination rather than the radiologist who interpreted the examination in both the hypothetically normal (48.5% of total responses) and abnormal (77.5% of total responses) scenarios (Figs. 2 and 3). These findings seem to run counter to those from a survey of 261 patients [19] in which 92% of those surveyed wanted the radiologist to tell them the results of their examination if the results were normal and 87% did so if the results were abnormal. In a survey of 86 patients [20], 98% of respondents were comfortable receiving results from the radiologist, 99% answered that reviewing their examinations with a radiologist would be useful, and 41% had their anxiety associated with the examination reduced after consultation with a radiologist. Our data seem to correspond with other reports in the literature, such as that by Basu et al. [21], who surveyed 129 patients and found that a plurality preferred receiving both normal (41%) and abnormal (41%) examination results from the referring physician. Those investigators also found that only 12% of respondents opted to receive normal examination results from a radiologist and that 6% chose to receive abnormal results from a radiologist. In addition, results of a 2012 patient survey [22] showed that 73% of respondents preferred receiving normal results from the ordering physician; that number increased to 77% when the results were abnormal. The reasons underlying this apparent discordance are likely complex and multifactorial, although inherent selection bias associated with survey-based methods is certainly at play, as is variance introduced into the results by the actual wording of the different surveys. Our survey also did not take into account situations in which the radiologist is already in contact with the patient, such as fluoroscopy, interventional radiology, and mammography, or situations in which the patient specifically asks to speak with the radiologist. If it had, one can certainly imagine different results. Regardless of who delivers the results, respondents to our survey preferred to receive a very detailed radiology report, which was defined as exactly what physicians receive, as opposed to simplified versions of the actual report in both the hypothetically normal (46.4% of responses) and abnormal (81.8% of responses) scenarios (Figs. 4 and 5). Patients would also prefer to receive at least the key images from the examination. These preferences appear to be accentuated when the results are abnormal. A significantly greater proportion of patients favored receiving a very detailed report (p < 0.0001) that contains key images (p < 0.0001) in this scenario. These findings are somewhat unexpected given the recommendations of the Radiology Cares campaign, which suggest that radiologists could improve communication with patients by providing an additional practical explanation of the findings in addition to the traditional report [24]. Likewise, patient focus group data have previously suggested that patients prefer to receive their results in writing with the details explained in lay terms [14]. The inconsistency of these findings may reflect an evolving patient population that is taking more ownership in their own health care, though further research is required to verify this proposition. The implementation of these preferences into clinical practice could also prove to be complicated because report terminology is often medically detailed and complex and may not be decipherable by patients in a meaningful manner within the context of their medical condition. Thus, it would be helpful for the radiologist to consult with the referring physician to develop a strategy that is both mutually agreeable and patient centered. A 2012 report from a focus group [16] showed that patients strongly supported the idea of having access to their radiology reports and the ability to view images from those examinations through an online portal. At our institution, all patients are eligible to enroll in a secure patient gateway through which they can to log in to their own electronic medical record and view test results, including radiology reports. We were interested in knowing whether delivering examination results to patients through this online portal was a feasible and acceptable alternative. Despite the reported widespread access to the Internet among our respondents, less than one half (44.2%) were even aware of their ability to access radiologic results online, and only 46.7% of those patients had made use of this service. It is unclear whether the relatively low use of this online resource is a function of a lack of patient awareness or a rejection of the idea as a whole. Although the focus group data seem to support the former, there are indications within our data to suggest the latter as a potential cause, because only 11.6% of our respondents chose to receive normal results via the Internet and even less (4.8%) selected this option for abnormal results. It may be that if we had presented the option of receiving radiologic results online as an addition to consultation with the referring physician or radiologist instead of an alternative, we would see a greater acceptance of this practice, but this has to be verified. Few, if any, physicians would advocate online access as the sole means for patients to learn their examination results. Nevertheless, our results suggest that we have much room for improvement in educating our patients about this service at the time of their examinations. On initial review, the results of our survey would appear disheartening to radiologists who seek to establish a more patient-centered practice through delivering examination results directly to patients. The reasons that patients seem to prefer to receive their radiology examination results from the ordering provider are not well-defined and are likely heterogeneous. However, potential explanations would include patients greater familiarity and comfort with the ordering physician, the ability of the ordering physician to place the examination results into a proper clinical context for the patient, patients relative inability to identify a radiologist as a physician [22], and a lack of awareness by the general public regarding the role of the radiologist in patient care [23]. There do appear to be avenues through which patient-centered radiologists can more fully integrate themselves into the schema of result delivery. First, in the current reporting paradigm, it may be most practical that the radiologist act as an adjunct to the ordering physician in delivering results to patients. In this scenario, the ordering physician may discuss the results with the patient, either in person or over the telephone, while the radiologist AJR:203, November 2014 1037

Mangano et al. delivers the results to the patient through either traditional mail or e-mail. Our results suggest this option is especially attractive to patients when the results of the examination are normal, given that traditional mail, e-mail, or an online portal was the preferred method of delivery for 61.0% of patients in this scenario. A second possibility would be to provide referring physicians the ability to either opt in or opt out of a radiologist-led result delivery program. This would have the benefits of increased collaboration with other specialties and increased visibility and contact with certain patients for radiologists. Third, significantly more respondents in our survey chose to receive their examination results from the radiologist, either by telephone or in person, when the results were abnormal (22.7%) compared with when the results were normal (14.6%) (p = 0.0002). This finding suggests that the radiologist may have a greater role in assisting referring physicians in explaining abnormal results to patients. This prompts the question of what constitutes normal as opposed to abnormal examination results, especially given the prevalence of incidental findings, which may or may not have clinical significance. This determination is often difficult and best determined on a case-bycase basis through correlation of imaging findings with the patient s medical history. Finally, our results are promising in that 51.6% of respondents wanted the contact information for the radiologist who would interpret their examination. Using this demand for potential supplemental follow-up may be one method of enhancing radiologists visibility and eventually shifting patient opinion toward more primary communication of results. Although all of the suggestions have potential merit, only a comprehensive, unified approach between radiologists and referring physicians will be truly efficacious. The data in this study were limited by a variety of factors. First is the inherent bias associated with survey-based approaches. We recognize that the survey population is geographically limited and that other patient populations may have differing views than those found in this survey. Moreover, the environment in which the study was generated may not entirely apply to smaller, community-based practices. Second, we instructed patients to choose a single best answer for each question. In tabulating the data, however, we found that several surveys were incomplete or contained questions with multiple answers selected. We opted to include these responses in our data calculations but realize that this is an additional limitation to our work. Third, we did not specifically address situations in which the radiologist is already in contact with the patient or in which the patient specifically asks to speak with a radiologist. Fourth, we did not define the term radiologist within the survey, which may have affected our results given that many patients do not understand that a radiologist is a physician participating in their care [22, 23]. Despite these limitations, this study provides an important perspective from patients about the role of radiologists in communicating examination results. Continued study in this arena is certainly warranted, especially with regard to potential effects on radiologist workflow and job satisfaction. Acknowledgments We thank Wayne A. Marshall and Annette La Pointe for administrative assistance and Mark Vangel for assistance with the statistical analysis. References 1. Friedman PJ. Radiologic reporting: structure. AJR 1983; 140:171 172 2. Fischer HW. Better communication between the referring physician and the radiologist. Radiology 1983; 146:845 3. Plumb AA, Grieve FM, Khan SH. Survey of hospital clinicians preferences regarding the format of radiology reports. Clin Radiol 2009; 64:386 394 4. Grieve FM, Plumb AA, Khan SH. Radiology reporting: a general practitioner s perspective. Br J Radiol 2010; 83:17 22 5. Johnson AJ, Ying J, Swan JS, Williams LS, Applegate KE, Littenberg B. Improving the quality of radiology reporting: a physician survey to define the target. J Am Coll Radiol 2004; 1:497 505 6. Coakley FV, Liberman L, Panicek DM. Style guidelines for radiology reporting: a manner of speaking. AJR 2003; 180:327 328 7. Naik SS, Hanbidge A, Wilson SR. Radiology reports: examining radiologist and clinician preferences regarding style and content. AJR 2001; 176:591 598 8. McLoughlin RF, So CB, Gray RR, Brandt R. Radiology reports: how much descriptive detail is enough? AJR 1995; 165:803 806 9. Lafortune M, Breton G, Baudouin JL. 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J Am Coll Radiol 2010; 7:281 289 16. Johnson AJ, Easterling D, Nelson R, Chen MY, Frankel RM. Access to radiologic reports via a patient portal: clinical simulations to investigate patient preferences. J Am Coll Radiol 2012; 9:256 263 17. Gunn AJ, Sahani DV, Bennett SE, Choy G. Recent measures to improve radiology reporting: perspectives from primary care physicians. J Am Coll Radiol 2013; 10:122 127 18. Hammerman HJ. Communicating imaging results to patients: OnSite results. AJR 2009; 192:852 853 19. Schreiber MH, Leonard M, Rieniets CY. Disclosure of imaging findings to patients directly by radiologists: survey of patients preferences. AJR 1995; 165:467 469 20. Pahade J, Couto C, Davis RB, Patel P, Siewert B, Rosen MP. Reviewing imaging examination results with a radiologist immediately after study completion: patient preferences and assessment of feasibility in an academic department. AJR 2012; 199:844 851 21. Basu PA, Ruiz-Wibbelsmann JA, Spielman SB, Van Dalsem VF, Rosenberg JK, Glazer GM. Creating a patient-centered imaging service: determining what patients want. AJR 2011; 196:605 610 22. Kuhlman M, Meyer M, Krupinski EA. Direct reporting of results to patients: the future of radiology? Acad Radiol 2012; 19:646 650 23. Miller P, Gunderman R, Lightburn J, Miller D. Enhancing patient s experiences in radiology through patient-radiologist interaction. Acad Radiol 2013; 20:778 781 24. Radiological Society of North America website. Radiology Cares campaign. www.rsna.org/radiology_cares. Accessed December 23, 2013 25. Neiman HL. Face of radiology campaign. Acad Radiol 2009; 16:517 520 (Appendix starts on next page) 1038 AJR:203, November 2014

Communication of Results APPENDIX 1: Survey Questions Distributed to Adult Patients Undergoing Contrast-Enhanced CT or MRI Over a 2-Week Period in June 2013 1. Age (circle one): 18 30 y 31 40 y 41 50 y 51 60 y 61 70 y 71 80 y > 80 y 2. Sex (circle one): M F 3. Do you have Internet access at your home or work? Yes No (circle one) 4. Please rate your overall experience of undergoing a radiology examination on a scale of 1 5, with 5 being most satisfied and 1 being least satisfied? 1 2 3 4 5 (circle one) 5. Are you aware that patients at this hospital can access their radiologic results online? Yes No (circle one) 6. If yes to question 5, have you accessed your own results online? Yes No (circle one) 7. How would you prefer to receive your radiology test results if they were NORMAL? (Please circle one of the following options) Option A: Telephone call from the radiologist who interpreted the test Option B: Telephone call from the physician who ordered the test for you Option C: Face-to-face meeting with the radiologist who interpreted the test Option D: Face-to-face meeting the physician who ordered the test for you Option E: Mailed copy of the report to your home Option F: E-mailed copy of the report Option G: View the results yourself over the Internet 8. How would you prefer to receive your radiology test results if they were ABNORMAL? (Please circle one of the following options) Option A: Telephone call from the radiologist who interpreted the test Option B: Telephone call from the physician who ordered the test for you Option C: Face-to-face meeting with the radiologist who interpreted the test Option D: Face-to-face meeting the physician who ordered the test for you Option E: Mailed copy of the report to your home Option F: E-mailed copy of the report Option G: View the results yourself over the Internet 9. How much detail would you want in a radiology report that is delivered to you, the patient, if the results of the test were NORMAL? (Please circle one of the following options) Option A: Less detailed (for example, your results are normal ) Option B: Moderate detail (for example, a brief summary of the results) Option C: Very detailed (for example, exactly what doctors receive) 10. How much detail would you want in a radiology report that is delivered to you, the patient, if the results of the test were ABNORMAL? (Please circle one of the following options) Option A: Less detailed (for example, your results are abnormal and should be discussed with your doctor ) Option B: Moderate detail (for example, a brief summary of the results) Option C: Very detailed (for example, exactly what doctors receive) 11. Would you, as a patient, want images from your radiology test included in the report that is delivered to you, the patient, if the results were NORMAL? (Circle one) Yes No 12. Would you, as a patient, want images from your radiology test included in the report that is delivered to you, the patient, if the results were ABNORMAL? (Circle one) Yes No 13. Which of the following options would you, as a patient, prefer to receive at the time of your radiology test? (Please circle all that apply) a. A card that has a link to a website that would explain terms used in a radiology report b. A contact number to speak with the radiologist who interpreted your test over the telephone c. A time and location to meet with a radiologist in-person to discuss your test results AJR:203, November 2014 1039