New Protocol Helps Radiologists Navigate Difficult Conversations

Framework offers seven-step approach to delivering sensitive results with clarity and compassion

BY MELISSA SILVERBERG December 05, 2025

Orthmann

Harvey

For many patients, the moment a radiologist delivers difficult news is one they will remember for the rest of their lives. How those conversations unfold can shape not only patients’ trust in their care but also their ability to process and adjust to a diagnosis.

Recognizing the importance of these critical interactions, Natália C. Orthmann, MD, a breast radiologist in Brazil, and colleagues developed a structured communication mnemonic and protocol for radiologists called RADNEWS. Published in RadioGraphics, the protocol adapts strategies from oncology and other specialties into a concise, seven-step framework designed for radiology’s fast-paced, image-driven encounters.

“RADNEWS was created based on the idea of providing an approach and methodology so that residents and practicing radiologists have a starting point to communicate sensitive results to patients in a compassionate and humane way,” Dr. Orthmann said.

Breaking bad news is especially complex in radiology. Unlike oncologists or primary care physicians, radiologists may meet patients for the first and only time when delivering critical results.

“Diagnostic radiology is for the most part uniquely a behind-the-scenes specialty. We often deliver life-altering findings in a single interaction without prior rapport or ongoing follow-up,” Dr. Orthmann explained. “This demands we swiftly build trust, translate complex imaging results into clear, compassionate language, and outline next steps in mere minutes with limited clinical context.”

Jennifer Harvey, MD, chair of imaging sciences and a breast radiologist at the University of Rochester Medical Center in New York, has been teaching follow-up communication skills since co-authoring a primer on breaking bad news in breast imaging nearly 20 years ago. She said the impact of communication lasts far beyond the exam room.

“A lot of these women are going to remember the conversation you had with them years later,” Dr. Harvey said. “It’s kind of a position of honor to be able to help a patient through that life-changing news.”

Seven Steps for Empathy and Clarity

The RADNEWS mnemonic provides radiologists with a structured, practical guide:

R: Recap the Clinical Context – Review images and the referral before speaking with the patient.
A: Ambiance and Self-Introduction – Create a comfortable setting, introduce yourself and set the tone.
D: Describe the Examination and Its Purpose – Use plain language to explain what was done and why.
N: Notify with Clear, Empathetic Language – Deliver findings directly but with compassion.
E: Ensure Empathetic Engagement – Pause, acknowledge emotions and validate concerns.
W: Welcome Questions and Share Next Steps – Outline the plan and invite questions.
S: Support Stressful Reactions – Stay calm and provide reassurance if distress arises.

Dr. Harvey said creating the right environment can help patients feel safe. “I really prefer to have my patients moved to a room that’s kind of like a living room with casual chairs, ambient lighting and the ability to sit across from the patient at eye level,” she said.

Drs. Orthmann and Harvey both emphasized the need to tailor language to the situation. For example, in patients with grouped calcifications that are BI-RADS 4, Dr. Harvey avoids alarming terminology. “I’m not going to use the word ‘cancer’ if I can avoid it,” she said. “I’ll say, ‘There’s a group of calcifications that look like sand on the mammogram. Sometimes this can represent something of concern really early going on in that area. I think we should sample it.’”

For more worrisome BI-RADS 5 findings, Dr. Harvey is candid and more direct and will say, “I’m pretty concerned about this area.”

“If the patient responds by inquiring about how much concern there is, then I will add, ‘I think there’s a really good chance your biopsy is going to show cancer,’ Dr. Harvey said. “If possible and appropriate, I’ll add any good news, such as, ‘But you know what? It’s only the size of a pea,’ or ‘This looks like early stuff. I’m so glad you got your screening mammogram this year.’”

“Radiologists should avoid assuming a patient’s beliefs, values or level of health literacy. Instead, they should ask questions to understand each person’s cultural background and preferences, then tailor examples, metaphors and communication to honor any religious or spiritual practices.”

— NATÁLIA C. ORTHMANN, MD

According to Dr. Orthmann, a key element of RADNEWS is adaptability to patients’ backgrounds, literacy levels and needs. “Radiologists should avoid assuming a patient’s beliefs, values or level of health literacy. Instead, they should ask questions to understand each person’s cultural background and preferences, then tailor examples, metaphors and communication to honor any religious or spiritual practices,” Dr. Orthmann said.

She recommended using plain language, visual aids and careful confirmation of understanding. For patients with hearing impairments, maintaining eye contact and providing qualified sign-language interpreters are essential.

For patients with vision impairments, offering detailed verbal descriptions of the exam process helps reduce anxiety. For patients with cognitive disabilities, patience, repetition and involving family members or caregivers can ensure comprehension and support.

“These empathetic, flexible strategies ensure truly equitable, patient-centered imaging care,” Dr. Orthmann said.

Both experts also highlighted some important pitfalls to avoid. One is overuse of medical jargon that patients may not understand. “Radiologists commonly assume patients are familiar with terms like ‘biopsy,’” Dr. Orthmann said. “That can create unnecessary anxiety. We need to explain procedures in plain language and build in emotional checkpoints.”

False reassurance is another trap. “I would be very cautious about using the word curable,” Dr. Harvey said. “Sometimes the biopsy you’re expecting to be DCIS turns out to be high-grade invasive cancer. We never really know who’s going to survive their cancer outcome.”

Equally unhelpful, Dr. Orthmann added, is minimizing complications or comparing patients to one another. Each conversation should be individualized and grounded in honesty and empathy.

Two people seated at a table with only their arms and the tabletop in view. One, a doctor, in a white coat rests her hand on the arm of the other, a patient, wearing a blue dress shirt

From Reading Room to Policy

Implementing RADNEWS at the department level can make the approach consistent and sustainable.

Dr. Orthmann recommends embedding the framework into policy, training and electronic health record templates, with interpreter services available to meet the needs of patients with disabilities or limited English proficiency.

She also suggested regular peer-review sessions to discuss real cases. “Readers should view RADNEWS as a flexible starting point rather than a rigid script,” she said. “Each clinician’s personal style and the nuances of different patient encounters will naturally shape how the framework is applied.”

Dr. Harvey said the protocol is especially useful for trainees. “I would love to post the infographic from the study authors in the reading rooms for reference and education,” she said. “It would serve as a reminder about effective steps to follow during hard conversations.”

Nearly two decades after her first article on breaking bad news, Dr. Harvey said progress has been made among dedicated breast imagers, but gaps remain for those who are less specialized. She sees RADNEWS as an important step toward making communication a core competency across radiology.

“This really should be a core competency for our trainees, especially residents and absolutely fellows,” she said.

For Dr. Orthmann, the goal is clear: “Contrary to what we might think, this type of conversation can reduce patients’ anxiety by involving them in the discussion about their own health,” she said. “Translating this information into something clear and easy for patients to understand makes all the difference in care.”

Dr. Harvey agreed, underscoring the privilege and responsibility radiologists carry in these moments. “It is a conversation that most of us won’t remember by the time we get home for dinner,” she said. “But for that patient, it can be a life-changing moment. If we can do a really good job in that moment, we greatly impact how well the patient copes with a new cancer diagnosis.”