© American Roentgen Ray Society. OBJECTIVE. Patient perceptions of radiology reports are largely unknown. The objective of the present study is to describe our experience receiving structured feedback from patients on actual radiology reports as a means of improving reporting practices. MATERIALS AND METHODS. Eight reports (two for radiographs, two for ultrasound images, two for CT scans, and two for MR images) were randomly selected from our system for review. For each report, patients were asked to rate their level of comprehension, identify any problems in the report, and, in the free-text portion of the feedback form, indicate any questions about the report that they may have. Potentially confounding factors were also examined. RESULTS. A total of 104 patients (46 men and 58 women) participated in the study (for a total of 832 evaluations). The median score for report comprehension was 2.5 (on a scale of 1-5), with the most common problems affecting comprehension identified as "unclear or technical language" (mentioned in 59.6% of evaluations) and the report being "too long" (mentioned in 10.2% of evaluations). A request for an explanation of the report in lay terms (noted in 20.1% of evaluations) was the most common request mentioned in the free-text portion of the feedback form. An inverse relationship existed between report length and patient comprehension (p < 0.001). Patients who had prior experience with their own radiology reports indicated having greater comprehension than did patients with no prior experience (p = 0.003). No correlation between the educational status and report comprehension of the patients was identified (p = 0.488). CONCLUSION. Radiology reports are not well understood by patients, who identify technical language and the long length of reports as the most common problems affecting their comprehension. Longer reports tend to be less well understood.