During each patient's ED evaluation, the emergency physician decides what, if any, imaging studies are required. For those patients who receive imaging studies, an accurate interpretation is necessary to guide treatment and disposition. Depending on the institution, imaging modality, and even time of day, studies may be read initially by the emergency physician only, by a radiology attending or resident, or by a teleradiologist. This initial interpretation is often a preliminary interpretation and definitive final interpretations are often rendered by an attending radiologist after the patient has been treated and discharged from the emergency department. There is a potential for variance between the preliminary and final interpretations.

Where there is a discrepancy between the preliminary and final interpretations, a reliable system for notification of the patient or appropriate physician is imperative. This system should minimize the medical consequences and therefore the medico-legal risk associated with an inaccurate preliminary interpretation. Routinely inform patients regarding the potential for revision of a preliminary radiological interpretation and assure reliable contact information.

In those cases where an incidental finding of potential significance is noted, such as a pulmonary nodule, notification of or referral to a primary care physician for follow up is needed. When the discrepancy is significant and would alter patient care, expeditious intervention is required. For admitted patients, physicians caring for the patient in-house should be promptly notified of the change. If the patient was discharged from the emergency department, the patient should be notified and advised as circumstances dictate. Based on the specific findings, some patients will be directed to collect a prescription while others should be advised to return to the emergency department or to contact an appropriate physician. It is essential, therefore, that a current phone number is recorded when emergency department patients are registered. Meticulous documentation of all actions and communications can mitigate medicolegal risk.