Radiology Critical Results List: Tiered by Urgency

What is a radiology critical results list?

The short answer

It is the hospital’s written list of imaging findings that need nonroutine, direct communication, with a time frame for each tier. Most lists follow the three tiers described by the ACR Actionable Reporting Work Group: Category 1 (minutes, direct phone call), Category 2 (hours) and Category 3 (days). The list on this page is a conservative starting point, not a mandate. Your medical staff decides the final list, who may receive calls, and the time frames.

3 tiersminutes, hours, days
6 elementsto document on every call
15 minTeleRads critical call standard

The standards behind this list

Joint Commission NPSG.02.03.01
ACR Practice Parameter for Communication of Diagnostic Imaging Findings
ACR Actionable Reporting Work Group tiers
Read-back on every call
Your medical staff approves the final list

Joint Commission NPSG.02.03.01

Requires hospitals to report critical results of tests and diagnostic procedures on a timely basis (Joint Commission NPSGs).

ACR communication parameter

The ACR Practice Parameter for Communication of Diagnostic Imaging Findings expects findings needing urgent action to be communicated directly and the communication documented (ACR, revised 2025).

Three tiers: minutes, hours, days

The Category 1, 2 and 3 model comes from the ACR Actionable Reporting Work Group (Larson et al., JACR 2014).

This page is the list itself. For how the call is made, who receives it and how the process breaks down at night, read critical results communication in radiology.

The list: Category 1, 2 and 3 findings

Starting list · adapt with your medical staff · telerads.co/radiology-critical-results-list/

Category 1

Critical: call within minutes

MinutesDirect phone call to the ordering clinician or the responsible caregiver, with read-back.

Brain, head and spine

Acute intracranial hemorrhage, new or enlarging
Large-vessel occlusion on CT angiography
Acute infarct during a stroke alert
New mass effect with midline shift or herniation
Acute hydrocephalus
Unstable spine fracture or acute cord compression
Cervical artery dissection

Chest and heart

Tension pneumothorax
Acute pulmonary embolism (many lists move isolated subsegmental PE to Category 2)
Aortic dissection or intramural hematoma
Pericardial effusion with signs of tamponade
Suspected esophageal rupture

Abdomen and pelvis

Free intraperitoneal air that is not expected after surgery
Active extravasation or active bleeding
Ruptured or leaking aortic aneurysm
Bowel ischemia, or pneumatosis with portal venous gas
Closed-loop obstruction or volvulus

Pelvis, OB and scrotum

Ectopic pregnancy, suspected or ruptured
Testicular torsion
Ovarian torsion

Lines and tubes

Endotracheal tube in a mainstem bronchus or the esophagus
Enteric feeding tube in the airway or lung
Central catheter in an artery or an unexpected location

Soft tissue and pediatric

Soft-tissue gas suggesting necrotizing infection
Intussusception in a child
Findings suggesting non-accidental injury in a child, before discharge

Category 2

Urgent: communicate within hours

HoursDirect communication, or another documented method your policy allows.

Brain and spine

New intracranial mass without herniation
Stable spine fracture

Chest

Pneumothorax, not under tension
New large pericardial effusion without tamponade signs
Isolated subsegmental pulmonary embolism, if your list places it here

Abdomen and pelvis

Appendicitis
Acute cholecystitis
Abscess, or diverticulitis with abscess
Bowel obstruction without signs of ischemia
Obstructing ureteral stone with hydronephrosis (call sooner with signs of infection)

Vessels and bones

Acute proximal deep vein thrombosis
Bone lesion at risk of pathologic fracture
Occult fracture that changes management, such as hip or scaphoid

Category 3

Significant, not urgent: within days

DaysCommunicated so follow-up is not lost: report flag, letter, or a call to the ordering clinician.

Possible malignancy

Mass suspicious for cancer: lung, kidney, liver, pancreas, ovary or bone
New unexplained lymphadenopathy

Incidental findings with follow-up

Lung nodule needing follow-up under your guideline
Adrenal, renal or thyroid nodule needing further imaging
Abdominal aortic aneurysm needing surveillance, without rupture

Findings that are stable and were already communicated usually don’t need a new call. The Work Group framed nonroutine communication around findings that are new or have significantly worsened. Write that rule into your policy so readers apply it the same way at 3 AM as at noon.

What should be documented for every critical call?

Critical result communication · document every element

Who called: The interpreting radiologist’s name
Who received it: The full name of the person told
Their role: Ordering physician, ED physician, charge nurse, or another role your policy allows
Date and time: When the call was completed, not when the read started
What was said: The finding communicated, in the words used on the call
Read-back: Confirmation that the receiver repeated the finding back

One line, in the report

The ACR parameter asks radiologists to document nonroutine communication of urgent findings; the elements above are what most hospital policies require to make that documentation auditable. Put them in the report itself, as a single critical-result line, so the chart and the call log agree. A sample radiology report shows what that line looks like.

The field most often missing: role

Without the role, an auditor can’t tell whether the person told could act on the finding. Make it a required field in your dictation template.

The critical-call loop, step by step

Step 01 of 05
Recognize
The radiologist identifies a finding on your list while reading and assigns its tier. A Category 1 finding stops the read: the call comes before the rest of the report is finished.
Step 02 of 05
Reach the right person
Call the ordering clinician or the responsible caregiver directly. A general voicemail, a fax or a switchboard message does not complete a Category 1 call. Your policy should name the escalation path when the first person can’t be reached.
Step 03 of 05
Read back
The receiver repeats the finding back. Read-back catches side, level and vessel errors, which matter most in stroke, spine and line-position calls.
Step 04 of 05
Document
Record who called, who received it, their role, the date and time, what was said and that read-back happened. One line, every time.
Step 05 of 05
Audit monthly
Review every call each month: how long from read to call, whether the role was captured, and any call that went past its tier’s time frame. A list that is never audited drifts.

How to adapt this list for your hospital

01
Start with your radiology group
They know which findings they already call and how often.
02
Add your ED and hospitalist leads
They decide what they need at 2 AM versus the morning.
03
Set the time frame per tier
In minutes and hours, not words like “promptly”.
04
Name who may receive calls
By role, including the escalation path.
05
Decide the Category 3 route
Report flag, letter or tracking system, so follow-up isn’t lost.
06
Give the same list to every reader
Including your teleradiology group, before go-live.
07
Review it yearly
Through your medical staff or quality committee.

How TeleRads uses your list

Your list, not ours

We read from your critical results list. It is loaded before go-live, and every reader follows it.

Called within 15 minutes

Critical results are called within 15 minutes, with a read-back.

Every call on your scorecard

Every critical call appears on your monthly scorecard.

Signed finals only

Every report is a signed final; we read finals only, never preliminaries.

Strokes first

Stroke studies are read first, and the radiologist stays available for your ED physicians to call back about a read.

Our board-certified radiologists are licensed in your state and approved by your medical staff office before they read a single study for you. See emergency department teleradiology for how that works across a night.

Questions

What is on a radiology critical results list?

Findings that need direct, nonroutine communication, grouped by urgency. Category 1 findings, called within minutes, include acute intracranial hemorrhage, large-vessel occlusion, tension pneumothorax, acute pulmonary embolism, aortic dissection, unexpected free air, ectopic pregnancy, testicular or ovarian torsion and a malpositioned endotracheal tube. Each hospital adapts the list with its radiology group and medical staff.

What are Category 1, 2 and 3 critical results?

The three tiers described by the ACR Actionable Reporting Work Group (JACR 2014). Category 1 findings need communication within minutes by direct call, Category 2 within hours, and Category 3, significant but not urgent findings such as a possible cancer, within days so follow-up is not lost.

What does the Joint Commission require for critical results?

National Patient Safety Goal NPSG.02.03.01 requires hospitals to report critical results of tests and diagnostic procedures on a timely basis. The hospital defines what is critical, who receives the result and the time frames in its own policy.

What should be documented when a critical result is called?

The radiologist who called, the name and role of the person who received it, the date and time, the finding communicated and confirmation of read-back. Putting all of it in one line of the report keeps the chart and the call log in agreement.

Is pneumothorax a critical result?

A tension pneumothorax is a Category 1 finding called within minutes. A pneumothorax without tension is usually Category 2, communicated within hours, though many hospitals call any new large pneumothorax right away.

Can we use this list as our hospital policy?

Use it as a starting point. Your radiology group, ED and medical staff should review each finding, set time frames in minutes and hours, name who may receive calls and approve the final list through your usual committee.

Does a teleradiology group use our critical results list?

It should. TeleRads loads your list before go-live, calls critical results within 15 minutes with a read-back, and shows every critical call on your monthly scorecard.