How to Communicate With Radiologists: Tips for New Sonographers

The relationship between sonographers and radiologists is one of the most clinically important in the hospital. You acquire the images; they interpret them. Your ability to communicate findings, flag concerns, and ask the right questions directly affects patient outcomes. This is a skill set that most training programs cover lightly but that makes an enormous difference in practice.

Understanding the Radiologist's Perspective

Radiologists read hundreds of studies per day in a busy department. They rely on:

1. Quality images that answer the clinical question
2. Accurate image labeling and measurements
3. Relevant clinical context on the order (not always complete)
4. Your verbal flag when something unexpected or urgent is found

They are not watching you scan in real time. They read what you give them. Your role is to give them everything they need to write an accurate, complete report.

When to Call the Radiologist During or After a Scan

Always notify immediately for:

• Suspected ruptured AAA
• Cardiac tamponade signs
• Free fluid with suspected ruptured ectopic pregnancy
• Absent fetal cardiac activity not previously documented
• New vascular occlusion (hepatic artery thrombosis in transplant)
• Any finding so unexpected that delay could harm the patient

Notify promptly (same day) for:

• Unexpected malignancy findings in a scan ordered for something else
• Significant change from prior imaging
• Critical laboratory correlation (patient is clinically deteriorating + imaging is abnormal)
• Equivocal findings where you need guidance on additional views

Don't notify for:

• Every finding that is abnormal but not urgent — let the report process work
• Findings clearly expected based on the clinical indication
• Questions about normal variants you know are benign

How to Deliver a Verbal Flag

When you walk up to a radiologist, be concise and clinical. They don't have time for a long narrative.

Structure:

1. Who: "I have a study on [patient name or MRN] in [room/area]."
2. What: The key finding. One sentence.
3. Why it matters: If not obvious.

Example: "I just scanned a 67-year-old with abdominal pain. I'm seeing an 8 cm infrarenal aortic aneurysm with complex periaortic fluid. Patient is hypotensive."

Then be quiet and let the radiologist respond.

Not: "So I was scanning, and you know how sometimes the aorta can be hard to see, but this one was actually pretty easy, and so I found something I think might be concerning…"

Clarity and brevity = faster response = better patient care.

Asking Radiologists for Feedback

The most growth-oriented sonographers regularly ask for feedback on their images. Most radiologists appreciate the question when asked well.

Good timing:

• During a low-volume period (not when they're clearing a stack of 50 studies)
• After completing a study where you were uncertain about image quality
• When you have a specific question

Good phrasing:

• "Do you have a moment to look at a study with me? I wasn't sure I got the best views of the IVC."
• "When you're reading [patient], could you let me know if there's anything I could have done differently technically?"
• "I saw a finding I wasn't sure how to describe — can I show you what I was looking at?"

Avoid:

• "Did I do okay?" (Too vague, no educational value)
• Asking when they're clearly overwhelmed
• Defensiveness if the feedback is critical

Learning From Discrepancies

Sometimes you will scan something as benign and the radiologist will call it a significant finding — or vice versa. When this happens, the instinct can be to feel embarrassed or defensive. Resist this.

Instead:

• Ask to see the image and understand why the interpretation changed
• If the discrepancy was technical (you missed a window, didn't get additional views), note it and fix it
• If the discrepancy was interpretive, that's outside your scope — but you can learn to acquire better images that make the interpretation clearer

Discrepancies are how you grow. The ones you don't know about don't help you.

When You Disagree With the Radiologist's Interpretation

This happens — especially as you develop clinical experience. A radiologist may not have access to all the information you had at the bedside (patient symptoms, clinical deterioration, what the area looked like on real-time Doppler that didn't save to an image).

Appropriate response:

• Flag additional information that may not have been communicated: "I wanted to mention — the patient said the pain onset was 3 hours ago and it's been getting worse."
• Ask respectfully: "I was concerned because on real-time imaging the flow looked very sluggish — is there additional information that might warrant a comment in the report?"

Inappropriate response:

• Telling the patient "the radiologist got it wrong"
• Overriding or attempting to alter reports
• Arguing during a patient case without new clinical information

If you have ongoing concerns about a discrepancy pattern, bring it to your lead sonographer or department chief through proper channels.

Communicating With Other Team Members

Radiologists aren't the only people you communicate with.

Ordering physicians (ED docs, hospitalists, PCPs): They may approach you in the hallway asking for preliminary findings. Know your department's policy — many departments restrict sonographers from providing preliminary interpretations verbally. A safe response: "I've completed the images — they'll be reviewed by radiology as soon as possible. If this is urgent, I can flag the read as stat."

Nursing staff: They often bring patients to you and have valuable clinical information. "The patient was febrile at 103 and has right flank pain" is more useful than an order that says "abdominal pain." Ask questions. Nurses often know things about patients that aren't on the order.

Other sonographers: Your team is your most immediate resource. If you see something unusual and want a second opinion before releasing the study, ask. "Can you look at this image with me?" is always appropriate.

Building a Professional Reputation

Your reputation as a sonographer is built over thousands of small interactions. The things that build it:

• Being reliable: starting on time, completing studies without gaps
• Being accurate: consistent measurements, complete protocols
• Being communicative: flagging what needs to be flagged, asking for help when unsure
• Being teachable: receiving feedback without defensiveness
• Being trustworthy: if you say you got the views, you got the views

Radiologists who trust the sonographers in their department give more weight to technical comments, flag concerning studies for quick read, and generally create a better working environment. That trust is earned one study at a time.

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SonoBuddy keeps you sharp on the clinical content — measurements, protocols, and pathology — so you're more confident in what you're communicating when you do talk to the radiologist.