Impression Preferences & Guidelines

Teach the AI your personal reporting style so it generates impressions the way you would write them.

Your administrator must enable this feature under Integration Settings → Enable Impression Preferences. This feature is currently in BETA.

What Are Impression Preferences?

Instead of getting generic, one-size-fits-all impressions, you can customize how the AI writes impressions to match your style. Think of it as training the AI to write impressions the way you would.

What you control:

  • Should the AI suggest diagnoses or just describe findings?

  • How should incidental findings be handled?

  • Which degenerative changes make it into the impression?

  • What order should findings be listed?

These settings apply to your account only - your colleagues can have different preferences.

Where to Find It

User Profile → Preferences → Impression Preferences

Your Preference Options

Diagnostic Mode

What it does: Controls whether AI suggests diagnoses or sticks to descriptive findings.

Your options:

Setting
What You Get
Best For

Disabled (default)

Descriptive impressions only "Right lower lobe consolidation"

Most radiologists who prefer to provide their own diagnoses

Enabled

Diagnosis suggestions included "Right lower lobe consolidation, likely pneumonia"

When you want AI assistance with differential diagnoses

Example difference:

Disabled: "3 cm left renal mass with enhancement characteristics"
Enabled:  "3 cm left renal mass with enhancement characteristics,
           suspicious for renal cell carcinoma"

When enabled, always review AI diagnosis suggestions carefully. The AI provides possibilities, not definitive diagnoses.

Incidental Findings Format

What it does: Determines how non-acute or incidental findings appear in your impression.

Your options:

Threshold Based (default) ⭐ Recommended

Only includes incidental findings if they're clinically significant.

What gets included:

  • ✅ "6 mm pulmonary nodule, recommend CT follow-up in 6 months"

  • ✅ "Moderate hepatosplenomegaly"

What gets excluded:

  • ✗ "Trace free fluid"

  • ✗ "Mild hepatic steatosis"

Best for: Most radiologists - gives a balanced impression without clutter

Summary Statement

Groups all minor findings into a single summary line.

Example impression:

1. Acute pulmonary embolism in the right main pulmonary artery
2. Right lower lobe pneumonia
3. Other non-acute findings as described above

Best for: High-volume practices, streamlined reporting, or when referring providers prefer concise impressions

List All

Every finding gets its own numbered impression point, regardless of significance.

Example impression:

1. Acute pulmonary embolism in the right main pulmonary artery
2. Right lower lobe pneumonia
3. Trace bilateral pleural effusions
4. Mild cardiomegaly
5. Hepatic steatosis
6. Cholelithiasis
7. Small hiatal hernia

Best for: Completeness-focused reporting or specific institutional requirements

Omit Non-Acute

Excludes all incidental and non-acute findings from the impression entirely.

Example impression:

1. Acute pulmonary embolism in the right main pulmonary artery
2. Right lower lobe pneumonia

(No mention of chronic or incidental findings)

Best for: Emergency radiology where only acute findings matter

Degenerative Changes Reporting

What it does: Controls which age-related changes (arthritis, disc disease, etc.) appear in impressions.

Your options:

Setting
What Gets Included
Example

Severe Only (default)

Only "severe", "advanced", or "extensive" degenerative changes

✅ "Severe multilevel lumbar spondylosis" ✗ "Mild disc space narrowing at L4-L5"

All Changes

Every degenerative change, regardless of severity

✅ "Mild degenerative changes at L4-L5" ✅ "Moderate facet arthropathy"

Never Include

No degenerative changes in impression at all

✗ No degenerative findings listed

When to use each:

  • Severe Only: Standard for most practices - avoids cluttering impressions with expected age-related changes

  • All Changes: Orthopedics, rheumatology, or pain management referrals where all changes matter

  • Never Include: Emergency radiology where acute pathology is the only concern

Chronic Findings Inclusion

What it does: Determines which stable/chronic conditions make it into the impression.

Your options:

Setting
Logic
Example Scenario

Relevant Only (default)

Includes chronic findings only if they relate to the clinical question

History: "Chest pain" ✅ "Stable moderate COPD" (could cause CP) ✗ "Stable nephrolithiasis" (unrelated)

Severe Only

Includes only if described as "severe", "advanced", or "extensive"

✅ "Severe cirrhosis" ✗ "Moderate COPD"

All Chronic

Includes all chronic findings regardless of relevance

✅ Everything gets listed

Never Include

Excludes all chronic findings

✗ No chronic findings in impression

Practical example:

Clinical history: "Shortness of breath"
Findings:
- Stable moderate COPD
- Stable nephrolithiasis
- Chronic compression fractures

Relevant Only:
1. Stable moderate COPD (✓ relates to SOB)
(Nephrolithiasis and fractures excluded as not relevant)

All Chronic:
1. Stable moderate COPD
2. Stable left renal calculus
3. Chronic T12-L1 compression fractures

Finding Priority Order

What it does: Controls the order in which findings are listed in your impression.

Your options:

Significance (default) ⭐

AI orders findings by clinical importance.

1. Acute pulmonary embolism (most critical)
2. Right lower lobe consolidation (acute but less critical)
3. Small pleural effusion (less significant)

Best for: General radiology - lets AI determine what's most important

Clinical Relevance

Findings related to the clinical history come first.

Clinical history: "Chest pain"

1. Coronary artery calcification (relates to CP)
2. Small pericardial effusion (relates to CP)
3. Incidental pulmonary nodule (unrelated, listed last)

Best for: When you focus heavily on answering the clinical question

Acuity Based

Most acute/life-threatening findings first, regardless of clinical history.

1. Acute aortic dissection (life-threatening)
2. Pulmonary embolism (acute critical)
3. Pneumonia (acute but less critical)
4. Chronic findings last

Best for: Emergency radiology where acuity determines priority

Anatomical

Findings organized by location or organ system.

1. Heart: Cardiomegaly with left ventricular hypertrophy
2. Lungs: Right lower lobe consolidation
3. Mediastinum: Lymphadenopathy
4. Pleura: Small bilateral effusions

Best for: Complex multi-organ studies (trauma, staging scans)

Impression Guidelines

In addition to your personal preferences, your organization may have Impression Guidelines that you can enable or disable.

What Are Guidelines?

Guidelines are organization-created rules that provide the AI with domain-specific instructions.

Examples:

  • "Lung nodules: Include Fleischner classification and follow-up recommendations"

  • "Fractures: Always mention alignment and displacement"

  • "Cardiac imaging: Comment on chamber sizes and ejection fraction if measurable"

How to Enable/Disable Guidelines

Navigate to: User Profile → Preferences → Impression Guidelines

  1. See the list of guidelines your organization has created

  2. Check the guidelines you want active for your reports

  3. Uncheck guidelines you don't want applied

  4. Changes save automatically

How It All Works

1

AI Processing Flow

  1. AI reads your findings section — understands what you dictated

  2. Applies your preferences — follows your personal settings

  3. Considers active guidelines — applies organization rules you've enabled

  4. Checks clinical history — uses context to determine relevance

  5. Generates impression — creates text matching your style

  6. You review and edit — final control before signing

2

Effect Timing

  • ✅ Changes apply immediately to new impressions

  • ✅ You can change preferences anytime

  • ❌ Existing reports are not retroactively modified

  • ❌ Preferences don't affect findings, only impressions

Getting Started

1

Step 1: Start with Defaults

Don't change anything for the first 2–3 weeks. This helps you understand the baseline AI behavior.

While using defaults:

  • Note what you find yourself editing frequently

  • Keep a list of patterns you'd like to change

  • See what your colleagues prefer

2

Step 2: Make One Change at a Time

After the trial period, adjust one preference and use it for a few days.

Why? If you change everything at once, you won't know which setting caused which change.

Example progression:

  • Week 1–3: Use defaults, take notes

  • Week 4: Change "Incidental Findings" to Summary Statement

  • Week 5: If you like it, adjust "Finding Priority Order"

  • Week 6: Fine-tune "Degenerative Changes Reporting"

3

Step 3: Match Your Workflow Type

Choose settings based on your practice.

Emergency Radiologist Setup

Diagnostic Mode: Disabled
Incidental Findings: Omit Non-Acute
Degenerative Changes: Never Include
Chronic Findings: Never Include
Finding Priority: Acuity Based

Result: Fast, acute-finding-only impressions

Musculoskeletal Subspecialist Setup

Diagnostic Mode: Enabled
Incidental Findings: Threshold Based
Degenerative Changes: All Changes
Chronic Findings: Relevant Only
Finding Priority: Anatomical

Result: Detailed, anatomically organized impressions

High-Volume General Radiology Setup

Diagnostic Mode: Disabled
Incidental Findings: Summary Statement
Degenerative Changes: Severe Only
Chronic Findings: Relevant Only
Finding Priority: Significance

Result: Concise, efficient impressions
4

Step 4: Share with Your Team

If you find settings that work well:

  • Share your preferences with colleagues

  • Discuss team standardization

  • Suggest organization-wide guidelines to your admin

This helps maintain consistency across your practice.

Tips for Success

Make Preferences Work for You

✅ Do:

  • Start conservative, adjust gradually

  • Note patterns in your edits to guide preference changes

  • Test new settings on routine cases first

  • Share successful configurations with colleagues

❌ Don't:

  • Change everything at once

  • Expect perfection immediately

  • Forget to re-test after changing settings

  • Ignore feedback from referring providers

Common Preference Combinations

"I want concise impressions"

Incidental Findings: Summary Statement
Degenerative Changes: Severe Only
Chronic Findings: Relevant Only

"I want comprehensive impressions"

Incidental Findings: List All
Degenerative Changes: All Changes
Chronic Findings: All Chronic

"I want emergency-focused impressions"

Incidental Findings: Omit Non-Acute
Degenerative Changes: Never Include
Chronic Findings: Never Include
Finding Priority: Acuity Based

"I want AI diagnostic assistance"

Diagnostic Mode: Enabled
Finding Priority: Clinical Relevance

Voice Your Feedback

Your administrator needs to hear:

  • Which preferences work well

  • Which need more options

  • Ideas for new organization guidelines

  • Technical issues you encounter

This helps improve the system for everyone.

Frequently Asked Questions

Will changing preferences affect reports I've already signed?

No. Preferences only affect new impression generation. Signed reports remain unchanged.

Can I have different preferences for different exam types?

Not currently. Preferences apply to all your reports. However, you can:

  • Manually edit impressions as needed

  • Use organization guidelines that activate based on study type

  • Change preferences between cases (though not ideal for workflow)

Do my preferences affect my colleagues' reports?

No. Each user has their own preference settings. Your choices don't impact anyone else.

How do I know if a guideline is mandatory?

Mandatory guidelines have a lock icon 🔒 and appear greyed out (cannot be unchecked).

Can I see what impression preferences my colleague uses?

Not directly through the interface. However, you can:

  • Ask them to share screenshots

  • Discuss preferences as a team

  • Have your admin create organization guidelines based on team consensus

What if I want the AI to do something not covered by these options

  • Create an organization guideline for the rule

  • Submit a feature request for a new preference option

Does Diagnostic Mode make the AI's diagnoses official?

No. When Diagnostic Mode is enabled, the AI provides suggestions that you should review and modify as appropriate. You are always responsible for the final diagnosis.

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