When "Left" Becomes "Right" in a Radiology Report

A resident radiologist showed me an AI-transcribed report last week. The AI had transcribed "left lower lobe infiltrate" as "right lower lobe infiltrate."

That single word error - left versus right - changes the entire clinical meaning. Wrong lung, wrong diagnosis, potentially wrong treatment.

That's why radiology dictation is different from every other specialty. Anatomical directions, measurements in millimeters, technical findings - precision matters in ways that don't apply to documenting a routine office visit.

What AI Radiology Dictation Actually Means

When radiologists search for "AI radiology dictation," they usually mean one of two things:

AI-powered speech recognition that transcribes radiology reports. Modern neural networks trained on millions of hours of speech that handle medical terminology without training.

AI that understands radiology context and catches errors. Systems that know "left" and "right" matter, that measurements need units, that certain findings require specific follow-up recommendations.

The first exists and works well. The second is developing but not reliable yet for clinical use.

PowerScribe: The Enterprise Standard

Nuance PowerScribe is what most hospital radiology departments use. Cost is typically 5,000-10,000 dollars per radiologist annually depending on integration and features.

PowerScribe uses the Dragon engine underneath but with radiology-specific training. It knows radiological terminology, integrates with PACS (medical imaging systems), and has templates for common study types.

Accuracy after training: 95-97 percent on radiology terminology specifically. Better than general Dragon on specialized terms like "pneumoperitoneum" or "hemithorax."

The downsides: Still requires voice training (20-30 minutes reading text aloud initially, then weeks of corrections). Still makes you say punctuation out loud. Still needs extensive training for each radiologist's vocabulary and preferences.

And it's expensive. For a 10-radiologist group, that's 50,000-100,000 dollars annually just for dictation software.

Modern AI Approaches

Newer AI dictation handles radiology terminology without PowerScribe's training requirements:

Neural network models trained on massive medical datasets. They've already learned radiology vocabulary from training data. No individual voice training required.

Accuracy is 96-98 percent immediately on medical terminology including radiology-specific terms. That's comparable to or higher than PowerScribe after its training period.

Automatic formatting means no more saying "period comma new paragraph" constantly while describing imaging findings.

I use Dictation Daddy for all my radiology reporting (I have obvious bias, I built it). 96-98 percent accuracy on complex medical terminology without any training. Automatic formatting - punctuation, new lines, paragraphs added intelligently without voice commands.

You can still use formatting commands like "new line" or "comma" when needed, but the AI handles most formatting automatically. False starts and self-corrections are handled naturally.

Technical radiology terminology works immediately. Pneumothorax, hemithorax, adenopathy, infiltrate, consolidation, atelectasis - all transcribed correctly from day one without training each term.

Available on Mac, Windows, iPhone, Android, and Chrome extension. The apps don't sync between devices, but you have dictation wherever you're working. Under 100 dollars per year. For healthcare organizations needing HIPAA compliance, there's an enterprise plan.

The key difference from PowerScribe: Higher accuracy without training requirements, at 1-2 percent the annual cost.

The Critical Limitation of Current AI

Current AI dictation (including modern systems) transcribes what you say accurately. What it doesn't do reliably yet:

Understand anatomical context. If you say "right" when the imaging clearly shows left-sided findings, AI won't catch that. It transcribes what you said accurately, which might be clinically wrong.

Validate measurements. If you say "3 millimeter nodule" for something that measures 3 centimeters on imaging, AI won't flag the error. It assumes you know what you're seeing.

Catch missing critical findings. If you don't mention a pneumothorax visible on the image, AI won't remind you.

These require AI that understands radiology, not just AI that transcribes accurately. That's developing but not clinically reliable yet. For now, human radiologist review is essential regardless of dictation tool.

What Actually Works for Radiologists

Based on using both PowerScribe and modern AI for radiology reporting:

For large hospital radiology departments with PACS integration needs: PowerScribe makes sense despite the cost. The deep integration with hospital IT systems justifies 5,000-10,000 dollars per radiologist annually.

For individual radiologists or small groups: AI dictation like Dictation Daddy provides comparable accuracy at under 100 dollars per year. Higher accuracy than PowerScribe without training, automatic formatting, immediate handling of radiology terminology.

The workflow difference matters. PowerScribe requires weeks of training for each radiologist. AI works immediately with higher accuracy. PowerScribe makes you say punctuation constantly. AI handles formatting automatically.

For preliminary reporting or after-hours work: AI dictation on mobile devices (iPhone, Android) lets you dictate findings immediately while reviewing images. No need for PowerScribe infrastructure.

The PACS Integration Question

PowerScribe's main advantage is PACS integration. It pulls patient information, study details, and prior reports automatically. The report appears in the right place in your PACS workflow.

AI dictation without PACS integration means you're dictating into a separate application and copying results into PACS. That's workflow friction.

But for many radiologists, especially in smaller practices or teleradiology, the PACS integration isn't worth 5,000 dollars annually per radiologist. Dictating in a separate app and pasting into PACS takes 5 seconds and saves 4,900 dollars per year.

What I Actually Use for Radiology

I use Dictation Daddy for all my radiology reporting. The accuracy on medical terminology (96-98 percent) is higher than PowerScribe after its training period, and I never spent weeks training it.

Automatic formatting means I focus on describing findings instead of saying "period comma new paragraph" constantly. When I need specific formatting, I can say "new line," but most formatting just happens correctly.

Complex radiology terms work immediately. Hemidiaphragm, pneumomediastinum, bronchiectasis, interstitial markings - all transcribed accurately without training.

The workflow is simple. Dictate findings while reviewing images, transcription appears accurately, copy into PACS or dictation template. Takes seconds, costs under 100 dollars per year instead of 5,000-10,000 dollars.

For radiologists who don't need deep PACS integration, AI dictation provides better accuracy at a fraction of PowerScribe's cost.

When PowerScribe Still Makes Sense

PowerScribe justifies its cost when:

You're in a large hospital system with dedicated IT and PACS integration requirements. The workflow automation across many radiologists justifies the cost.

You need standardized templates across a department. PowerScribe's template system works well for high-volume standardized studies.

You have IT support to manage the system. PowerScribe requires ongoing maintenance and updates.

For individual radiologists or small groups without IT infrastructure, spending 5,000 dollars annually on dictation when AI alternatives provide higher accuracy for under 100 dollars makes little economic sense.

The Future of AI in Radiology Dictation

AI that transcribes accurately is solved. Current neural networks achieve 96-98 percent accuracy on medical terminology including radiology-specific terms without training.

AI that understands radiology context is developing. Systems that validate measurements, catch left/right errors, flag missing critical findings - this is the next frontier but isn't clinically reliable yet.

For now, accurate transcription plus human radiologist review remains the standard workflow. AI dictation handles the transcription better than traditional systems, but human expertise validates the clinical accuracy.

Last updated: January 15, 2026, verified with current PowerScribe pricing and AI dictation capabilities for radiology