How do I export DICOM key images to a PDF for a case report?

Most PACS viewers can export selected key images directly to PDF or to JPEG/PNG which you then assemble into a PDF. Pick the key images while reading, export at diagnostic resolution (do not over-compress), then bring the images into a layout tool to combine with your text findings. For teaching files, lay out one or two images per page with captions describing the finding (arrow on the mass, annotation on the calcification). Avoid screenshots of the PACS viewer chrome — crop tight to the image. So: export key images from PACS, lay out in a PDF with captions, ship as a single file.

How do I de-identify a case for a teaching file?

Two layers: the DICOM metadata and the burned-in image pixels. DICOM metadata is stripped or replaced (patient name, MRN, DOB, study date precision reduced or shifted) using a dedicated de-identification tool — do this before export. Burned-in identifiers — facility name, MRN printed on the image itself, the corner overlay — must be removed at the pixel level, typically by cropping or blacking out a region on the exported image before adding it to your PDF. Always preview the final PDF page by page before sharing externally. The HIPAA Safe Harbor de-identification standard lists the 18 identifiers to remove. So: strip DICOM tags, redact burned-in pixels, preview before sharing.

What is the right layout for a comparison case (prior vs current)?

Side-by-side on a single page so the eye can move between the two without scrolling. Use a two-column landscape layout with matching image positions, label which is prior and which is current with the date, and orient them identically (same anatomical level, same window/level). Add a third row below with the impression: what changed. For a multi-prior comparison, use a horizontal strip of three to five images per page with dates underneath. So: landscape, matched orientation, dated, with the “what changed” impression underneath.

Can I annotate images inside the PDF itself?

Yes. After your case PDF is assembled, you can add arrows, circles, and text annotations directly to the PDF pages using a PDF annotator. Two flavours: non-flatten annotations (arrows live as PDF objects that a viewer can hide or remove) and flatten annotations (the annotations are rasterised into the image and become permanent). For teaching files use flatten so trainees cannot accidentally toggle them off; for working drafts use non-flatten so you can revise. So: arrows and labels in PDF, flatten for distribution, leave editable for drafts.

What resolution should my radiology image exports be?

High enough that the diagnostic finding is clearly visible, low enough that the PDF stays manageable in size. As a rule of thumb, export at the native acquisition resolution for the region of interest (often 512×512 or 1024×1024 for CT/MR slices) and place those into the PDF without resampling. For chest radiographs and mammograms which are very large native images, downsample to roughly 2000 pixels on the long edge for a teaching-file PDF — anything more bloats the file without adding diagnostic value at typical viewing distance. Apply lossless or high-quality lossy compression. So: native resolution for cross-sections, 2000-px-long-edge for plain films, mid-high JPEG quality.

How do I bundle a tumour-board packet quickly?

Build a template that does the heavy lifting: cover page with case ID and date, page 1 history and labs (de-identified), pages 2–4 key images with captions, page 5 your impression and questions for the board. Save this as a master template and duplicate it for each case so you are only filling in the variable content, not reformatting from scratch. Merge any outside reports into the back of the packet. Distribute as one combined PDF the morning of board so participants can pull it up on their tablets. So: templated structure, key images plus impression, one combined PDF distributed the morning of.

Can I e-sign a case report for an outside facility?

For administrative attestations and read-back acknowledgements, a typed e-signature is usually accepted; for formal interpretive reports the regulatory and licensure requirements vary by jurisdiction and facility policy. Many facilities accept a typed name with credentials and a date as the report signature, generated through the dictation/PACS reporting pipeline rather than added in a PDF tool. If you do add a signature in PDF, use a digital-signature tool (with a cryptographic certificate) rather than just an image of your handwriting. Confirm the receiving facility's policy before sending. So: typed signature usually fine for attestations; check policy for interpretive reports; prefer digital signatures over image scans.

PDF for radiologists — case reports and…

By ScoutMyTool Editorial Team · Last updated: 2026-05-23

Most of the PDF work in a radiology department is the same handful of templates over and over: teaching files, tumour-board packets, outside-read summaries, comparison cases. The hard parts are not the layout — those are the same five page formats — but two non-negotiable craft details: getting de-identification right so a teaching file cannot be re-identified, and laying out comparison images so the eye can actually see change. This companion to our first radiologist PDF guide walks the actual workflow.

Common radiology PDF types

Use case	What goes in it
Teaching file	De-identified case for residents — history, key images, findings, discussion
Tumour-board packet	Patient case bundled for multidisciplinary review
Outside-read report	Reading another facility's study — concise impression PDF
Conference case	CME or grand-rounds presentation handout
Patient-facing summary	Plain-language explanation with annotated images
Comparison series	Prior-vs-current images on the same page for progression review

Step by step: from PACS to teaching-file PDF

Select key images in PACS. Pick the slices/views that show the finding clearly.
Strip DICOM metadata. Run a de-identification tool that scrubs the 18 HIPAA identifiers.
Crop or black out burned-in PHI. Remove facility names, MRNs, and corner overlays at the pixel level.
Export at appropriate resolution. Native for cross-sections, ~2000 px long edge for plain films.
Lay out the case PDF. Cover, history, key images with captions, impression, discussion.
Annotate finding markers. Add arrows or circles with PDF Editor; flatten for distribution.
Preview every page. Confirm no PHI remains anywhere — DICOM tags, burned-in pixels, captions.
Distribute as one PDF. Combine with Merge PDF if there are outside reports.

PDF for radiologists (primer).
Real PDF redaction: irrevocably remove PHI.
PDF editor: add annotations to images.
Merge PDF: assemble multi-source packets.
PDF/A archival: long-life teaching-file storage.
Redact PDF tool: remove PHI safely.
All ScoutMyTool PDF tools.

FAQ

How do I export DICOM key images to a PDF for a case report?: Most PACS viewers can export selected key images directly to PDF or to JPEG/PNG which you then assemble into a PDF. Pick the key images while reading, export at diagnostic resolution (do not over-compress), then bring the images into a layout tool to combine with your text findings. For teaching files, lay out one or two images per page with captions describing the finding (arrow on the mass, annotation on the calcification). Avoid screenshots of the PACS viewer chrome — crop tight to the image. So: export key images from PACS, lay out in a PDF with captions, ship as a single file.
How do I de-identify a case for a teaching file?: Two layers: the DICOM metadata and the burned-in image pixels. DICOM metadata is stripped or replaced (patient name, MRN, DOB, study date precision reduced or shifted) using a dedicated de-identification tool — do this before export. Burned-in identifiers — facility name, MRN printed on the image itself, the corner overlay — must be removed at the pixel level, typically by cropping or blacking out a region on the exported image before adding it to your PDF. Always preview the final PDF page by page before sharing externally. The HIPAA Safe Harbor de-identification standard lists the 18 identifiers to remove. So: strip DICOM tags, redact burned-in pixels, preview before sharing.
What is the right layout for a comparison case (prior vs current)?: Side-by-side on a single page so the eye can move between the two without scrolling. Use a two-column landscape layout with matching image positions, label which is prior and which is current with the date, and orient them identically (same anatomical level, same window/level). Add a third row below with the impression: what changed. For a multi-prior comparison, use a horizontal strip of three to five images per page with dates underneath. So: landscape, matched orientation, dated, with the “what changed” impression underneath.
Can I annotate images inside the PDF itself?: Yes. After your case PDF is assembled, you can add arrows, circles, and text annotations directly to the PDF pages using a PDF annotator. Two flavours: non-flatten annotations (arrows live as PDF objects that a viewer can hide or remove) and flatten annotations (the annotations are rasterised into the image and become permanent). For teaching files use flatten so trainees cannot accidentally toggle them off; for working drafts use non-flatten so you can revise. So: arrows and labels in PDF, flatten for distribution, leave editable for drafts.
What resolution should my radiology image exports be?: High enough that the diagnostic finding is clearly visible, low enough that the PDF stays manageable in size. As a rule of thumb, export at the native acquisition resolution for the region of interest (often 512×512 or 1024×1024 for CT/MR slices) and place those into the PDF without resampling. For chest radiographs and mammograms which are very large native images, downsample to roughly 2000 pixels on the long edge for a teaching-file PDF — anything more bloats the file without adding diagnostic value at typical viewing distance. Apply lossless or high-quality lossy compression. So: native resolution for cross-sections, 2000-px-long-edge for plain films, mid-high JPEG quality.
How do I bundle a tumour-board packet quickly?: Build a template that does the heavy lifting: cover page with case ID and date, page 1 history and labs (de-identified), pages 2–4 key images with captions, page 5 your impression and questions for the board. Save this as a master template and duplicate it for each case so you are only filling in the variable content, not reformatting from scratch. Merge any outside reports into the back of the packet. Distribute as one combined PDF the morning of board so participants can pull it up on their tablets. So: templated structure, key images plus impression, one combined PDF distributed the morning of.
Can I e-sign a case report for an outside facility?: For administrative attestations and read-back acknowledgements, a typed e-signature is usually accepted; for formal interpretive reports the regulatory and licensure requirements vary by jurisdiction and facility policy. Many facilities accept a typed name with credentials and a date as the report signature, generated through the dictation/PACS reporting pipeline rather than added in a PDF tool. If you do add a signature in PDF, use a digital-signature tool (with a cryptographic certificate) rather than just an image of your handwriting. Confirm the receiving facility's policy before sending. So: typed signature usually fine for attestations; check policy for interpretive reports; prefer digital signatures over image scans.

Citations

HHS — “Methods for De-identification of PHI” (Safe Harbor & Expert Determination). hhs.gov/hipaa/for-professionals/special-topics/de-identification
Wikipedia — “DICOM,” medical imaging standard. en.wikipedia.org/wiki/DICOM
NIST — Digital Signature Standard (DSS) overview. csrc.nist.gov/projects/digital-signatures

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PDF for radiologists — case reports and image annotations

Introduction

Common radiology PDF types

Step by step: from PACS to teaching-file PDF

Related reading and tools

FAQ

Citations

Build case reports without uploading PHI