SM Universal Resident Reporting Scoring System — v3.2

Created by Dr. Sharad Maheshwari
Email: imagingsimplified@gmail.com
Date: 10.01.2026

SM Radiology Reporting Doctrine

Universal Resident Reporting Scoring System — v3.2

SM UNIVERSAL RESIDENT REPORTING SCORING CALCULATOR

Important: This calculator evaluates clinical thinking, not writing style. All inputs are dropdowns representing explicit cognitive states.

SECTION A — Pre-Findings Cognitive Setup

History vs Indication	Clearly separated & correct Mentioned but conflated Indication unclear/incorrect Indication missing
Prior surgery / intervention	Explicit and anatomically correct Mentioned but vague Missed despite presence Not applicable
Prior imaging comparison	Compared with change stated Compared, change unclear Mentioned only Available but not compared No prior imaging
Study limitations	Stated with diagnostic impact Stated without impact Present but not stated No significant limitation
Lines / tubes (if applicable)	All described correctly Partially described Missed Not applicable
Global survey / pattern recognition	Clear global pattern evident Implicit only Pure organ-by-organ review

SECTION A2 — Technique & Protocoling (Modality-Specific)

-- Select Modality -- CT MRI

CT Technique

kVp / mAs	Appropriate Acceptable Inappropriate Not assessed
Protocol selection	Correct protocol Extra phases but safe Insufficient phases Wrong protocol
Contrast dose / rate	Appropriate Acceptable Inappropriate Non-contrast justified
Timing	Appropriate Suboptimal Incorrect Not relevant
Phase omission awareness	Justified omission No omission Unjustified omission Critical omission unknown

MRI Technique

Core sequences	All present One non-critical missing Critical missing Wrong protocol
Contrast usage	Appropriate Low incremental value Required contrast not given Unnecessary contrast used Non-contrast appropriate
Image quality	Diagnostic Artefact but usable Non-diagnostic Non-diagnostic not acknowledged

SECTION B — Organ / System Review

Disease-specific completeness	All mandatory elements One non-critical omission Critical omission Multiple omissions
Interpretive accuracy	Accurate Minor error Major error Misleading
Quantification relevance	Decision-driving Present but irrelevant Important missing Not required

SECTION C — Defining Moment

Explicit & management-linked Recognized but vague Not applicable Missed / implied

SECTION D — Impression Quality

Answers clinical question	First line answers Answered but delayed Does not answer
Prioritization	Correct Flat list Wrong priority
Language style	Clinician-style Mixed Purely descriptive
Next-step guidance	Clear plan Vague None

SECTION E — Reporting Hygiene

Logical flow	Clear Minor jumps Disorganized
Internal consistency	No contradictions Contradictions present

How to Use This Tool

This tool is designed for faculty assessment, resident feedback, and self-audit. Select the dropdown option that best reflects the resident’s actual cognitive behavior. Do not “average” performance or compensate across sections.

• FAIL overrides all scores
• CAP limits the maximum grade regardless of numeric total
• Not applicable must be defensible

The SM Radiology Reporting Doctrine

1. Clinical History ≠ Clinical Indication

Clinical history provides context. Clinical indication defines the question. A report that does not explicitly answer the indication has failed its primary purpose.

2. Prior Imaging Is Interpretation

Comparison is not optional. Stability, progression, or response are interpretive acts, not clerical statements.

3. Technique Defines Diagnostic Truth

You cannot interpret beyond acquisition. Protocol choice, timing, and contrast usage define what conclusions are legitimate.

4. Post-operative Imaging Starts with Lines and Tubes

Hardware defines expected anatomy. Missing drains or malpositioned tubes are management-changing errors.

5. Limitations Must State Diagnostic Impact

A limitation without consequence is meaningless. Transparency protects patients and the radiologist.

6. Disease-Specific Obligations Exist

Every disease has mandatory descriptors. Omission invalidates the report, even if other sections are correct.

7. The Defining Moment

A Defining Moment is a finding that changes management. If it is present, it must be stated explicitly. Implication is unsafe.

8. Impression Is a Clinical Decision Note

The impression should read as if written by the treating clinician: prioritized, decisive, and actionable.

9. FAIL and CAP Rules

FAIL represents unsafe cognition. CAP represents incomplete but non-fatal reasoning. Both exist to protect patients, not punish trainees.

10. Educational Intent

This doctrine exists to make expert thinking explicit, teachable, auditable, and compatible with future AI-assisted radiology.