The Pros and Cons of Structured Reports

Rethinking radiology reports: A survey of referring physicians' perspectives

BACKGROUND

Radiology reports play a crucial role in clinical decision-making. High report quality and completeness are essential for efficient patient care. However, the clarity and comprehensiveness of radiology reports are often points of contention among referring physicians. This study evaluated referring physicians' views on the quality and clinical utility of radiology reports.

METHODS

A prospective, anonymous online survey was conducted from June 2023 to March 2025, targeting 258 practicing physicians in Germany, including 93 internists, 90 surgeons and 75 general practitioners. The survey included rating scales, multiple-choice questions and net promoter scores (NPS).

RESULTS

Referring physicians' satisfaction with the completeness of radiology reports was moderate, with an average score of 38.4 ± 24.3 on a scale from -100 to + 100. Among the specialties surveyed, surgeons reported the highest level of dissatisfaction (p < 0.05). Internists and surgeons showed significantly stronger preferences for structured reporting compared to general practitioners (p < 0.05). According to the surveyed referring physicians, the most frequently missing information in reports included "determination of a diagnosis" (39 %) and "recommendations for further diagnostic measures or follow-up examinations" (23 %). A large majority of referring physicians (84.9 %) found multidisciplinary case conferences to be valuable (5-7 out of 7 stars) for enhancing their understanding of reports.

CONCLUSION

Reporting preferences vary across specialties and radiologists must address the clinical needs of referring physicians, who are the primary audience for radiology reports. Integrating imaging into multidisciplinary meetings can further improve radiology report comprehension of referring physicians.

Impact of Structured Reporting of Lower Extremity CT Angiography on Report Quality and Workflow Efficiency

We assessed the effects of structured reporting (SR) of lower extremity CT angiography (CTA) on report quality and workflow efficiency compared with conventional reports (CR). Surveys were conducted at an academic radiology department before and after the introduction of an SR template. Participants (n = 39, 21) rated report quality and report creation effort (1: very dissatisfied/low to 10: very satisfied/high) and whether SR represents an improvement over CR (1: completely disagree to 5: completely agree). Four residents and two supervising radiologists created both CR and SR of 40 CTA examinations. Report creation time was measured and the factual accuracy of residents' reports was judged. Report completeness (median 8.0 vs. 7.0, p = 0.016) and clinical usefulness (7.0 vs. 4.0, p = 0.029) were rated higher for SR. Supervising radiologists found report clarity improved by SR (8.0 vs. 4.5, p = 0.029). Report creation effort was unchanged (7.0 vs. 6.0, p > 0.05). SR was considered an improvement over CR (median 4.0, IQR,3.0-5.0). Report supervision was shortened by SR (6.2 ± 2.0 min vs. 10.6 ± 3.5 min, p < 0.001) but total time for report creation remained unchanged (36.6 ± 12.8 min vs. 36.4 ± 11.0 min, p > 0.05). Factual accuracy of residents' SR was deemed higher (8.0/9.5 vs. 7.0/7.0, p = 0.006/ < 0.001). In conclusion, SR has the potential to improve report quality and workflow efficiency for lower extremity CTA.

Structured reporting in radiology enables epidemiological analysis through data mining: urolithiasis as a use case

PURPOSE

To investigate the epidemiology and distribution of disease characteristics of urolithiasis by data mining structured radiology reports.

METHODS

The content of structured radiology reports of 2028 urolithiasis CTs was extracted from the department's structured reporting (SR) platform. The investigated cohort represented the full spectrum of a tertiary care center, including mostly symptomatic outpatients as well as inpatients. The prevalences of urolithiasis in general and of nephro- and ureterolithasis were calculated. The distributions of age, sex, calculus size, density and location, and the number of ureteral and renal calculi were calculated. For ureterolithiasis, the impact of calculus characteristics on the degree of possible obstructive uropathy was calculated.

RESULTS

The prevalence of urolithiasis in the investigated cohort was 72%. Of those patients, 25% had nephrolithiasis, 40% ureterolithiasis, and 35% combined nephro- and ureterolithiasis. The sex distribution was 2.3:1 (M:F). The median patient age was 50 years (IQR 36-62). The median number of calculi per patient was 1. The median size of calculi was 4 mm, and the median density was 734 HU. Of the patients who suffered from ureterolithiasis, 81% showed obstructive uropathy, with 2nd-degree uropathy being the most common. Calculus characteristics showed no impact on the degree of obstructive uropathy.

CONCLUSION

SR-based data mining is a simple method by which to obtain epidemiologic data and distributions of disease characteristics, for the investigated cohort of urolithiasis patients. The added information can be useful for multiple purposes, such as clinical quality assurance, radiation protection, and scientific or economic investigations. To benefit from these, the consistent use of SR is mandatory. However, in clinical routine SR usage can be elaborate and requires radiologists to adapt.

Implementation of structured reporting in clinical routine: a review of 7 years of institutional experience

BACKGROUND

To evaluate the implementation process of structured reporting (SR) in a tertiary care institution over a period of 7 years.

METHODS

We analysed the content of our image database from January 2016 to December 2022 and compared the numbers of structured reports and free-text reports. For the ten most common SR templates, usage proportions were calculated on a quarterly basis. Annual modality-specific SR usage was calculated for ultrasound, CT, and MRI. During the implementation process, we surveyed radiologists and clinical referring physicians concerning their views on reporting in radiology.

RESULTS

As of December 2022, our reporting platform contained more than 22,000 structured reports. Use of the ten most common SR templates increased markedly since their implementation, leading to a mean SR usage of 77% in Q4 2022. The highest percentages of SR usage were shown for trauma CT, focussed assessment with ultrasound for trauma (FAST), and prostate MRI: 97%, 95%, and 92%, respectively, in 2022. Overall modality-specific SR usage was 17% for ultrasound, 13% for CT, and 6% for MRI in 2022. Both radiologists and referring physicians were more satisfied with structured reports and rated SR better than free-text reporting (FTR) on various attributes.

CONCLUSIONS

The increasing SR usage during the period under review and the positive attitude towards SR among both radiologists and clinical referrers show that SR can be successfully implemented. We therefore encourage others to take this step in order to benefit from the advantages of SR.

KEY POINTS

1. Structured reporting usage increased markedly since its implementation at our institution in 2016. 2. Mean usage for the ten most popular structured reporting templates was 77% in 2022. 3. Both radiologists and referring physicians preferred structured reports over free-text reports. 4. Our data shows that structured reporting can be successfully implemented. 5. We strongly encourage others to implement structured reporting at their institutions.

Improving data adequacy of ultrasonography reports for non-alcoholic fatty liver disease (NAFLD) through a national structured template

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a prevalent disorder that increases due to lifestyle, the rising rate of obesity, and population ages worldwide. Diagnostic ways, including sonography, do not have an explicit reporting structure.

PURPOSE

To create a structure template for NAFLD reporting, investigate its completeness, and assess the specialist opinions of using it in clinical practice.

MATERIAL AND METHODS

A structured reporting template (SRT) was designed and implemented in four stages. At first, important features were extracted from a comprehensive literature review and were evaluated by 10 radiologists and gastroenterologists using the Likert scale. Finally, the usefulness of the SRT in comparison with the conventional reporting template (CRT) was judged by 10 gastroenterologists completing the questionnaire.

RESULTS

Demographic information and sonography of the liver, gallbladder, and spleen organs were the most critical features. The completeness scores of SRT reports were higher than CRT scores for almost all the factors studied. The difference in the scores was significant for most of the parameters. Moreover, the total completeness score increased from 42% in CRT to 92% in SRT. A comparison of the report adequacy of two reports was seen in all items. The SRT obtained more rates from specialists.

CONCLUSION

Introduction of the SRT for NAFLD significantly enhanced the completeness of reporting to reduce variability in the interpretation of the related reports by clinicians. Nevertheless, more studies are needed to generalize the results in real scales for patients with NAFLD.