Radiology reports: examining radiologist and clinician preferences regarding style and content

Contrasting pediatric specialty provider opinion between contextualized and structured radiology reports

BACKGROUND

Structured reporting (SR) replaced narrative (free text) reporting and utilizes templated headings and subheadings with findings typically based on the anatomy included in the examination. Its use has been widely advocated by radiology and non-radiology organizations as the new reporting standard. There are, however, shortcomings to SR, such as templated text not addressing a specific clinical indication. Contextual reporting (CR) fills this gap. CR is a type of SR which is tailored to a narrow clinical indication by including pertinent positive and negative findings for that specific clinical entity.

OBJECTIVE

This study assesses provider preferences for CR as compared to SR in the pediatric practice environment using a survey methodology.

METHODS & MATERIALS

Surveys with examples of SR and CR reports were sent electronically to two groups. One group was focused on neurological diseases and included pediatric specialists in neurosurgery, neurology, ENT, ED, and ophthalmology (190 people), referred to as the pediatric neuroimaging group. The pediatric neuroimaging group survey contained examples of CR and SR reports of an orbital CT for orbital cellulitis and a head CT for stroke. The other group was focused on gastrointestinal diseases, and included pediatric specialists in gastroenterology, general surgery, and the ED (159 people), referred to as the pediatric gastrointestinal (GI) imaging group. The pediatric GI imaging group survey contained example reports of an abdominal CT for appendicitis and an MRI enterography for Crohn's disease. Surveys utilizing a 5-point Likert scale were analyzed via Fischer's exact test with a p-value deemed statistically significant at less than 0.05.

RESULTS

349 individuals were contacted to participate in the survey. There were 81 (23 %, 81/349) survey respondents; 41 (22 %, 41/190) from the neuro group, and 40 (25 %, 40/159) from the GI group. 56 % (45/81) of all respondents preferred CR reports over traditional SR reports, while 29 % (23/81) did not. Most respondents (59 %, 48/81) indicated that CR reports are easier to interpret than traditional SR reports. Respondents from the pediatric neuroimaging group favored CR reports to a lesser degree (44 %, 36/81) compared to respondents from the pediatric GI imaging group (68 %, 55/81).

CONCLUSIONS

We learned from this survey that it would be beneficial to be very intentional about selecting clinical indications where CR would be most valued rather than trying to develop CR for any specific clinical indication. The study results indicate it is reasonable to continue further efforts at exploring the utility of contextualized reports.

From omission to excellence: Reducing the percentage of incomplete trainee reports by ensuring documentation of comparison studies

The inclusion of comparison studies within radiology reports is an important, standard practice. Despite this, we identified that after-hours preliminary reports rendered by trainees within our institution often omitted reference to comparison studies for pediatric inpatient portable radiographs. We addressed this issue through a quality improvement project targeting pediatric radiographs. Key interventions included modifying the structured reports by removing default text in the comparison field, designating the comparison field as mandatory, and restructuring the report templates to remove extraneous information. We also initiated a targeted educational campaign. 392 reports before and 267 reports after intervention (total 732 reports) were evaluated to determine the number of reports lacking comparison information when comparisons were available. Following the interventions, there was a statistically significant decrease in incomplete reports from 12.5% to 6%. This project highlights the success of utilizing structured reporting to improve the quality of trainee reports.

Synoptic Reporting of Focal Liver Masses in at Risk Patients: Algorithmic Diagnosis and CEUS LI-RADS

OBJECTIVES

Reporting contrast-enhanced ultrasound (CEUS) for focal liver masses in at risk patients is a challenging task. Traditionally used prose reporting (PR) is inconsistent and lacks standardization. We propose synoptic reporting (SR), encompassing algorithmic interpretation and liver imaging and reporting data system (LI-RADS) categorization.

METHODS

A software worksheet from Kailo Medical (Melbourne, AU), incorporates the CEUS algorithm for liver interpretation and CEUS LI-RADS categorization. Part 1. Feasibility of SR: twenty participants of varying experience were presented a brief lecture on SR, algorithmic approach to liver mass interpretation, and CEUS LI-RADS categorization. Ten representative liver masses were shown as unknown cases. Participants inputted data into SR worksheets. Results and LI-RADS category were generated solely by SR. Data were categorized as "correct" or "incorrect." Part 2. Prospective Analysis: Ninety-one patients for SR and 56 for PR, all were tested for completeness, efficiency, and user satisfaction.

RESULTS

Part 1: Junior participants, pass rate 81.6%, and senior participants, pass rate 83.3% showed no difference in performance. Part 2: Completeness: SR 98.4% and PR 87.0%. Efficiency: Average total time to completion: SR 11 minutes and PR 20 minutes. User satisfaction: Ultrasound technologists, all referring physicians, and six out of seven radiologists preferred SR over PR. Major benefits cited were total time saved, consistency and accuracy in documentation, and report completeness.

CONCLUSIONS

SR is a reliable and useful tool in clinical practice to report liver masses on ultrasound and assign an appropriate LI-RADS categorization and management pathway. This ultimately improves communication with referring clinicians and leads to better patient outcomes.

Investigating the impact of structured reporting on the linguistic standardization of radiology reports through natural language processing over a 10-year period

OBJECTIVES

To investigate how a transition from free text to structured reporting affects reporting language with regard to standardization and distinguishability.

METHODS

A total of 747,393 radiology reports dictated between January 2011 and June 2020 were retrospectively analyzed. The body and cardiothoracic imaging divisions introduced a reporting concept using standardized language and structured reporting templates in January 2016. Reports were segmented by a natural language processing algorithm and converted into a 20-dimension document vector. For analysis, dimensionality was reduced to a 2D visualization with t-distributed stochastic neighbor embedding and matched with metadata. Linguistic standardization was assessed by comparing distinct report types' vector spreads (e.g., run-off MR angiography) between reporting standards. Changes in report type distinguishability (e.g., CT abdomen/pelvis vs. MR abdomen) were measured by comparing the distance between their centroids.

RESULTS

Structured reports showed lower document vector spread (thus higher linguistic similarity) compared with free-text reports overall (21.9 [free-text] vs. 15.9 [structured]; - 27.4%; p < 0.001) and for most report types, e.g., run-off MR angiography (15.2 vs. 1.8; - 88.2%; p < 0.001) or double-rule-out CT (26.8 vs. 10.0; - 62.7%; p < 0.001). No changes were observed for reports continued to be written in free text, e.g., CT head reports (33.2 vs. 33.1; - 0.3%; p = 1). Distances between the report types' centroids increased with structured reporting (thus better linguistic distinguishability) overall (27.3 vs. 54.4; + 99.3 ± 98.4%) and for specific report types, e.g., CT abdomen/pelvis vs. MR abdomen (13.7 vs. 37.2; + 171.5%).

CONCLUSION

Structured reporting and the use of factual language yield more homogenous and standardized radiology reports on a linguistic level, tailored to specific reporting scenarios and imaging studies.

CLINICAL RELEVANCE

Information transmission to referring physicians, as well as automated report assessment and content extraction in big data analyses, may benefit from standardized reporting, due to consistent report organization and terminology used for pathologies and normal findings.

KEY POINTS

• Natural language processing and t-distributed stochastic neighbor embedding can transform radiology reports into numeric vectors, allowing the quantification of their linguistic standardization. • Structured reporting substantially increases reports' linguistic standardization (mean: - 27.4% in vector spread) and distinguishability (mean: + 99.3 ± 98.4% increase in vector distance) compared with free-text reports. • Higher standardization and homogeneity outline potential benefits of structured reporting for information transmission and big data analyses.

Standardized Reporting on the Preoperative CT Assessment of Potential Living Renal Transplant Donors: Can We Create a Universal Report Standard to Meet the Needs of Transplant Urologists?

Purpose: Determine whether standardized template reporting for the preoperative assessment of potential living renal transplant donors improves the comprehensiveness of radiology reports to meet the needs of urologists performing renal transplants. Methods: Urologist and radiologist stakeholders from renal transplant centres in our province ratified a standardized reporting template for evaluation of potential renal donors. Three centres (A, B, and C) were designated "intervention" groups. Centre D was the control group, given employment of a site-specific standardized template prior to study commencement. Up to 100 consecutive CT scan reports per centre, pre- and post-implementation of standardized reporting, were evaluated for reporting specific outcome measures. Results: At baseline, all intervention groups demonstrated poor reporting of urologist-desired outcome measures. Centre A discussed 5/13 variables (38%), Centre B discussed 6/13 variables (46%), and Centre C only discussed 1/13 variables (8%) with ≥90% reliability. The control group exhibited consistent reporting, with 11/13 variables (85%) reported at ≥90% reliability. All institutions in the intervention group exhibited excellent compliance to structured reporting post-template implementation (Centres A = 95%, B = 100%, and C = 77%, respectively). Additionally, all intervention centres demonstrated a significant improvement in the comprehensiveness of reports post-template implementation, with statistically significant increases in the reporting of all variables under-reported at baseline (P > .01). Conclusion: Standardized templates across our province for CT scans of potential renal donors promote completeness of reports. Radiologists can reliably provide our surgical colleagues with needed preoperative anatomy and incidental findings, helping to determine suitable transplant donors and reduce potential complications associated with organ retrieval.

ChatGPT-4 Assistance in Optimizing Emergency Department Radiology Referrals and Imaging Selection

PURPOSE

The quality of radiology referrals influences patient management and imaging interpretation by radiologists. The aim of this study was to evaluate ChatGPT-4 as a decision support tool for selecting imaging examinations and generating radiology referrals in the emergency department (ED).

METHODS

Five consecutive clinical notes from the ED were retrospectively extracted, for each of the following pathologies: pulmonary embolism, obstructing kidney stones, acute appendicitis, diverticulitis, small bowel obstruction, acute cholecystitis, acute hip fracture, and testicular torsion. A total of 40 cases were included. These notes were entered into ChatGPT-4, requesting recommendations on the most appropriate imaging examinations and protocols. The chatbot was also asked to generate radiology referrals. Two independent radiologists graded the referral on a scale ranging from 1 to 5 for clarity, clinical relevance, and differential diagnosis. The chatbot's imaging recommendations were compared with the ACR Appropriateness Criteria (AC) and with the examinations performed in the ED. Agreement between readers was assessed using linear weighted Cohen's κ coefficient.

RESULTS

ChatGPT-4's imaging recommendations aligned with the ACR AC and ED examinations in all cases. Protocol discrepancies between ChatGPT and the ACR AC were observed in two cases (5%). ChatGPT-4-generated referrals received mean scores of 4.6 and 4.8 for clarity, 4.5 and 4.4 for clinical relevance, and 4.9 from both reviewers for differential diagnosis. Agreement between readers was moderate for clinical relevance and clarity and substantial for differential diagnosis grading.

CONCLUSIONS

ChatGPT-4 has shown potential in aiding imaging study selection for select clinical cases. As a complementary tool, large language models may improve radiology referral quality. Radiologists should stay informed about this technology and be mindful of potential challenges and risks.

Documentation of polysomnographic and home sleep apnea test interpretations: room for improvement?

STUDY OBJECTIVES

Obstructive sleep apnea (OSA), a heterogeneous disorder with many different presentations, is diagnosed with sleep studies. In standard clinical practice, test data are reviewed and scored, and interpretations are documented. Little standardization exists regarding what should be included in interpretations. We aimed to determine how consistently the documented interpretation included references to study quality parameters and accepted disease phenotypes.

METHODS

This study was performed at a single academic center in January 2021. From the literature, we formulated a list of test and titration quality criteria and OSA phenotypes that should be reflected in study interpretations, including total recording time, total sleep time, positionality, and supine rapid eye movement (REM) sleep during titration. We retrospectively reviewed the documentation of sleep studies to determine how often these factors were reflected in interpretation reports or clinical notes.

RESULTS

Of 134 patients in the study, 81 were diagnosed with OSA. A finding of inadequate total recording time during polysomnography or total sleep time on home sleep apnea testing was most often not documented. Positionality of OSA was not documented in 33% of applicable studies. The absence of supine REM sleep during positive airway pressure titration was not mentioned in 15% of interpretations.

CONCLUSIONS

The documentation of quality concerns and clinically important OSA phenotypes in interpretations was inconsistent. Documentation of meaningful test quality information and sleep apnea phenotypes might be improved with report standardization or by developing enhanced data displays.

CITATION

Herberts MB, Morgenthaler TI. Documentation of polysomnographic and home sleep apnea test interpretations: room for improvement? J Clin Sleep Med. 2023;19(6):1043-1049.

Impact of a structured reporting template on the quality of HRCT radiology reports for interstitial lung disease

PURPOSE

This QI study compared the completeness of HRCT radiology reports before and after the implementation of a disease-specific structured reporting template for suspected cases of interstitial lung disease (ILD).

MATERIALS AND METHODS

A pre-post study of radiology reports for HRCT of the thorax at a multicenter health system was performed. Data was collected in 6-month period intervals before (June 2019-November 2019) and after (January 2021-June 2021) the implementation of a disease-specific template. The use of the template was voluntary. The primary outcome measure was the completeness of HRCT reports graded based on the documentation of ten descriptors. The secondary outcome measure assessed which descriptor(s) improved after the intervention.

RESULTS

521 HRCT reports before and 557 HRCT reports after the intervention were reviewed. Of the 557 reports, 118 reports (21%) were created using the structured reporting template. The mean completeness score of the pre-intervention group was 9.20 (SD = 1.08) and the post-intervention group was 9.36 (SD = 1.03) with a difference of -0.155, 95% CI [-0.2822, -0.0285, p < 0.0001]. Within the post-intervention group, the mean completeness score of the unstructured reports was 9.25 (SD = 1.07) and the template reports was 9.93 (SD = 0.25) with a difference of -0.677, 95% CI [-0.7871, -0.5671, p < 0.0001]. After the intervention, the use of two descriptors improved significantly: presence of honeycombing from 78.3% to 85.1% (p < 0.0039) and technique from 90% to 96.6% (p < 0.0001).

DISCUSSION

Shifting to disease-specific structured reporting for HRCT exams of suspected ILD is beneficial, as it improves the completeness of radiology reports. Further research on how to improve the voluntary uptake of a disease-specific template is needed to help increase the acceptance of structured reporting among radiologists.

Using Brain Tumor MRI Structured Reporting to Quantify the Impact of Imaging on Brain Tumor Boards

Multidisciplinary tumor boards (TB) are an essential part of brain tumor care, but quantifying the impact of imaging on patient management is challenging due to treatment complexity and a lack of quantitative outcome measures. This work uses a structured reporting system for classifying brain tumor MRIs, the brain tumor reporting and data system (BT-RADS), in a TB setting to prospectively assess the impact of imaging review on patient management. Published criteria were used to prospectively assign three separate BT-RADS scores (an initial radiology report, secondary TB presenter review, and TB consensus) to brain MRIs reviewed at an adult brain TB. Clinical recommendations at TB were noted and management changes within 90 days after TB were determined by chart review. In total, 212 MRIs in 130 patients (median age = 57 years) were reviewed. Agreement was 82.2% between report and presenter, 79.0% between report and consensus, and 90.1% between presenter and consensus. Rates of management change increased with increasing BT-RADS scores (0-3.1%, 1a-0%, 1b-66.7%, 2-8.3%, 3a-38.5%, 3b-55.9, 3c-92.0%, and 4-95.6%). Of 184 (86.8%) cases with clinical follow-up within 90 days after the tumor board, 155 (84.2%) of the recommendations were implemented. Structured scoring of MRIs provides a quantitative way to assess rates of agreement interpretation alongside how often management changes are recommended and implemented in a TB setting.

White Paper: Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging

PURPOSE

Actionable incidental findings (AIFs) are common in radiologic imaging. Imaging is commonly performed in emergency department (ED) visits, and AIFs are frequently encountered, but the ED presents unique challenges for communication and follow-up of these findings. The authors formed a multidisciplinary panel to seek consensus regarding best practices in the reporting, communication, and follow-up of AIFs on ED imaging tests.

METHODS

A 15-member panel was formed, nominated by the ACR and American College of Emergency Physicians, to represent radiologists, emergency physicians, patients, and those involved in health care systems and quality. A modified Delphi process was used to identify areas of best practice and seek consensus. The panel identified four areas: (1) report elements and structure, (2) communication of findings with patients, (3) communication of findings with clinicians, and (4) follow-up and tracking systems. A survey was constructed to seek consensus and was anonymously administered in two rounds, with a priori agreement requiring at least 80% consensus. Discussion occurred after the first round, with readministration of questions where consensus was not initially achieved.

RESULTS

Consensus was reached in the four areas identified. There was particularly strong consensus that AIFs represent a system-level issue, with need for approaches that do not depend on individual clinicians or patients to ensure communication and completion of recommended follow-up.

CONCLUSIONS

This multidisciplinary collaboration represents consensus results on best practices regarding the reporting and communication of AIFs in the ED setting.

Eye-tracking differences between free text and template radiology reports: a pilot study

Purpose

One possible limitation of structured template radiology reports is that radiologists look back and forth between viewing and dictation monitors, thereby impacting the length of time spent reviewing images and generating a report. We hypothesize that the total time spent viewing case images is diminished and/or the total time spent creating a report is prolonged when the report is generated using a structured template compared with free text format.

Approach

Three neuroradiologists and three senior residents viewed five brain magnetic resonance imaging cases with unique findings while eye position was recorded. Participants generated reports for each case utilizing both structured templates and free text dictation. The time spent viewing images was compared with the time spent looking at the dictation screen.

Results

The two main hypotheses were confirmed: the total time viewing images diminished with templates versus free text dictation and the total time to create a report was prolonged with templates. The mean time (s) spent on the "image" region of interest approached statistical significance as a function of the report type [free: attendings = 236.79 (154.43), residents = 223.55 (77.79); template: attendings = 163.40 (73.42), residents = 182.48 (77.47)] and was overall lower with the template reporting for both attendings and residents ( F = 3.77 , p = 0.0623 ), but it did not differ as a function of seniority ( F = 0.017 , p = 0.8977 ).

Conclusions

Template-based radiology reports have significant potential to alter the way radiologists view images and report on them, spending more time viewing the report monitor rather than diagnostic images compared with free text dictation. Many radiologists prefer templates for reporting as the structured format may aid in conducting a more systematic or thorough search for findings, although prior work on this assumption is mixed. Future eye-tracking studies could further elucidate whether and how templates and free reports impact the detection and classification of radiographic findings.

A brain tumor reporting and data system to optimize imaging surveillance and prognostication in high-grade gliomas

BACKGROUND AND PURPOSE

High-grade glioma (HGG), including glioblastoma, is the most common primary brain neoplasm and has a dismal prognosis. After initial treatment, follow-up decisions are guided by longitudinal MRI performed at routine intervals. The Brain Tumor Reporting and Data System (BT-RADS) is a proposed structured reporting system for posttreatment brain MRIs. The purpose of this study is to determine the relationship between BT-RADS scores and overall survival in HGG patients.

METHODS

Chart review of grade 4 glioma patients who had an MRI at a single institution from November 2018 to November 2019 was performed. BT-RADS scores, tumor characteristics, and overall survival were recorded. Likelihood of improvement, stability, or worsening on the subsequent study was calculated for each score. Survival analysis was performed using Kaplan-Meier method, log-rank test, and a time-dependent cox model. Significance level of .05 was used.

RESULTS

The study identified 91 HGG patients who underwent a total of 538 MRIs. Mean age of patients was 57 years old. Score with the highest likelihood for worsening on the next follow-up was 3b. The risk of death was 53% higher with each incremental increase in BT-RADS scores (hazard ratio, 1.53; 95% confidence interval [CI], 1.07-2.19; p = .019). The risk of death was 167% higher in O-6-methylguanine-DNA-methyltransferase unmethylated tumors (hazard ratio, 2.67; 95% CI, 1.34-5.33; p = .005).

CONCLUSIONS

BT-RADS scores can be used as a reference guide to anticipate whether patients' subsequent MRI will be improved, stable, or worsened. The scoring system can also be used to predict clinical outcomes and prognosis.

Quantifying the Effects of Structured Reporting on Report Turnaround Times and Proofreading Workload in Neuroradiology

RATIONALE AND OBJECTIVES

To assess the effects of a change from free text reporting to structured reporting on resident reports, the proofreading workload and report turnaround times in the neuroradiology daily routine.

MATERIALS AND METHODS

Our neuroradiology section introduced structured reporting templates in July 2019. Reports dictated by residents during dayshifts from January 2019 to March 2020 were retrospectively assessed using quantitative parameters from report comparison. Through automatic analysis of text-string differences between report states (i.e. draft, preliminary and final report), Jaccard similarities and edit distances of reports following read-out sessions as well as after report sign-off were calculated. Furthermore, turnaround times until preliminary and final report availability to clinicians were investigated. Parameters were visualized as trending line graphs and statistically compared between reporting standards.

RESULTS

Three thousand five hundred thirty-eight reports were included into analysis. Mean Jaccard similarity of resident drafts and staff-reviewed final reports increased from 0.53 ± 0.37 to 0.79 ± 0.22 after the introduction of structured reporting (p < .001). Both mean overall edits on draft reports by residents following read-out sessions (0.30 ± 0.45 vs. 0.09 ± 0.29; p < .001) and by staff radiologists during report sign-off (0.17 ± 0.28 vs. 0.12 ± 0.23, p < .001) decreased. With structured reporting, mean turnaround time until preliminary report availability to clinicians decreased by 20.7 minutes (246.9 ± 207.0 vs. 226.2 ± 224.9; p < .001). Similarly, final reports were available 35.0 minutes faster on average (558.05 ± 15.1 vs. 523.0 ± 497.3; p = .002).

CONCLUSION

Structured reporting is beneficial in the neuroradiology daily routine, as resident drafts require fewer edits in the report review process. This reduction in proofreading workload is likely responsible for lower report turnaround times.

Performance of an Artificial Intelligence-Based Platform Against Clinical Radiology Reports for the Evaluation of Noncontrast Chest CT

RATIONALE AND OBJECTIVES

Research on implementation of artificial intelligence (AI) in radiology workflows and its impact on reports remains scarce. In this study, we aim to assess if an AI platform would perform better than clinical radiology reports in evaluating noncontrast chest computed tomography (CT) scans.

MATERIALS AND METHODS

Consecutive patients who had undergone noncontrast chest CT were retrospectively identified. The radiology reports were reviewed in a binary fashion for reporting of pulmonary lesions, pulmonary emphysema, aortic dilatation, coronary artery calcifications (CAC), and vertebral compression fractures (VCF). CT scans were then processed using an AI platform. The reports' findings and the AI results were subsequently compared to a consensus read by two board-certificated radiologists as reference.

RESULTS

A total of 100 patients (mean age: 64.2 ± 14.8 years; 57% males) were included in this study. Aortic segmentation and calcium quantification failed to be processed by AI in 2 and 3 cases, respectively. AI showed superior diagnostic performance in identifying aortic dilatation (AI: sensitivity: 96.3%, specificity: 81.4%, AUC: 0.89) vs (Reports: sensitivity: 25.9%, specificity: 100%, AUC: 0.63), p <0.001; and CAC (AI: sensitivity: 89.8%, specificity: 100, AUC: 0.95) vs (Reports: sensitivity: 75.4%, specificity: 94.9%, AUC: 0.85), p = 0.005. Reports had better performance than AI in identifying pulmonary lesions (Reports: sensitivity: 97.6%, specificity: 100%, AUC: 0.99) vs (AI: sensitivity: 92.8%, specificity: 82.4%, AUC: 0.88), p = 0.024; and VCF (Reports: sensitivity:100%, specificity: 100%, AUC: 1.0) vs (AI: sensitivity: 100%, specificity: 63.7%, AUC: 0.82), p <0.001. A comparable diagnostic performance was noted in identifying pulmonary emphysema on AI (sensitivity: 80.6%, specificity: 66.7%. AUC: 0.74) and reports (sensitivity: 74.2%, specificity: 97.1%, AUC: 0.86), p = 0.064.

CONCLUSION

Our results demonstrate that incorporating AI support platforms into radiology workflows can provide significant added value to clinical radiology reporting.

Myeloma Response Assessment and Diagnosis System (MY-RADS): strategies for practice implementation

Structured reporting systems have been developed for many organ systems and disease processes beginning with BI-RADS in 1993. Numerous reports indicate that referring health care providers prefer structured reports. Reducing variability of reports from one radiologist to another helps referring physician and patient confidence. Changing radiologists practice habits from completely free text to structured reports can be met with some resistance, but most radiologists quickly find that structured reports make their job easier. Whole-body MR studies are recommended as first-line imaging, by the International Myeloma Working Group (IMWG), for all patients with suspected diagnosis of asymptomatic myeloma and/or initial diagnosis of solitary plasmacytoma. Whole-body MR imaging (WBMRI) has been shown to have equal or greater sensitivity and specificity compared to PET/CT for detection of bone marrow involvement. Changing to WBMRI from other imaging modalities can be difficult for referring providers. Patient acceptance is high. MY-RADS is for myeloma patients who have WBMRI studies done. The intent of the system is to promote uniformity in MR imaging acquisition, diagnostic criteria, and response assessment and to diminish differences in the subsequent interpretation and reporting. A secondary benefit is a report template that provides a guide for interpretation for radiologists who may not have previously dictated these difficult studies. The characterization of bone marrow abnormalities in myeloma patients usually is fairly straightforward. To date, there is no standardized scoring or risk stratification of abnormalities nor is there an imaging atlas of abnormalities.

Structured Reporting of Computed Tomography and Magnetic Resonance in the Staging of Pancreatic Adenocarcinoma: A Delphi Consensus Proposal

Background: Structured reporting (SR) in radiology has been recognized recently by major scientific societies. This study aims to build structured computed tomography (CT) and magnetic resonance (MR)-based reports in pancreatic adenocarcinoma during the staging phase in order to improve communication between the radiologist and members of multidisciplinary teams. Materials and Methods: A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi process was used to develop the CT-SR and MRI-SR, assessing a level of agreement for all report sections. Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. Results: The final CT-SR version was built by including n = 16 items in the “Patient Clinical Data” section, n = 11 items in the “Clinical Evaluation” section, n = 7 items in the “Imaging Protocol” section, and n = 18 items in the “Report” section. Overall, 52 items were included in the final version of the CT-SR. The final MRI-SR version was built by including n = 16 items in the “Patient Clinical Data” section, n = 11 items in the “Clinical Evaluation” section, n = 8 items in the “Imaging Protocol” section, and n = 14 items in the “Report” section. Overall, 49 items were included in the final version of the MRI-SR. In the first round for CT-SR, all sections received more than a good rating. The overall mean score of the experts was 4.85. The Cα correlation coefficient was 0.85. In the second round, the overall mean score of the experts was 4.87, and the Cα correlation coefficient was 0.94. In the first round, for MRI-SR, all sections received more than a good rating. The overall mean score of the experts was 4.73. The Cα correlation coefficient was 0.82. In the second round, the overall mean score of the experts was 4.91, and the Cα correlation coefficient was 0.93. Conclusions: The CT-SR and MRI-SR are based on a multi-round consensus-building Delphi exercise derived from the multidisciplinary agreement of expert radiologists in order to obtain more appropriate communication tools for referring physicians.

HCC Detection on Surveillance US: Comparing Focused Liver Protocol Using US LI-RADS Technical Guidelines to a General Complete Abdominal US Protocol

OBJECTIVE

Focused US examinations of the liver in the routine hepatocellular carcinoma (HCC) screening reduce the time spent on evaluating other structures deemed irrelevant to the clinical setting. It is still unknown, however, if such a strategy may additionally improve the frequency of nodules detection. We aimed to assess the impact of an HCC surveillance program in high-risk patients by means of targeted liver US following LI-RADS technical guidelines in comparison to a complete upper abdominal scan.

METHODS

In this IRB-approved, single-center, prospective study, patients at high-risk for HCC enrolled from 06/2016 to 09/2019 were randomly assigned to 1 of the 2 institutional protocols: Group A (targeted liver US) or Group B (complete upper abdominal scan). Twenty examiners with similar experience in abdominal US were randomly assigned to perform the examinations exclusively in 1 of the groups (10 in each group). Frequency of hepatic nodules between groups was compared by using Fisher's exact test.

RESULTS

Four hundred and sixty-five patients were enrolled, with no significant differences in both groups regarding sex, age, etiology of liver disease, MELD scores, and alpha-fetoprotein levels. A significantly higher frequency of nodules detection was found in Group A (230 patients; 23 nodules detected; 10% of the sample) in comparison to Group B (235 patients; 3 nodules; 1.3% of the sample) (p <.001). Five patients in Group A and 1 in Group B were positive for HCC after full diagnostic work-up.

CONCLUSION

Adopting an HCC screening program based on targeted liver US improved the detection of hepatic nodules among high-risk individuals.

Structured reporting in radiology: a systematic review to explore its potential

OBJECTIVES

Structured reporting (SR) in radiology reporting is suggested to be a promising tool in clinical practice. In order to implement such an emerging innovation, it is necessary to verify that radiology reporting can benefit from SR. Therefore, the purpose of this systematic review is to explore the level of evidence of structured reporting in radiology. Additionally, this review provides an overview on the current status of SR in radiology.

METHODS

A narrative systematic review was conducted, searching PubMed, Embase, and the Cochrane Library using the syntax 'radiol*' AND 'structur*' AND 'report*'. Structured reporting was divided in SR level 1, structured layout (use of templates and checklists), and SR level 2, structured content (a drop-down menu, point-and-click or clickable decision trees). Two reviewers screened the search results and included all quantitative experimental studies that discussed SR in radiology. A thematic analysis was performed to appraise the evidence level.

RESULTS

The search resulted in 63 relevant full text articles out of a total of 8561 articles. Thematic analysis resulted in 44 SR level 1 and 19 level 2 reports. Only one paper was scored as highest level of evidence, which concerned a double cohort study with randomized trial design.

CONCLUSION

The level of evidence for implementing SR in radiology is still low and outcomes should be interpreted with caution.

KEY POINTS

• Structured reporting is increasingly being used in radiology, especially in abdominal and neuroradiological CT and MRI reports. • SR can be subdivided into structured layout (SR level 1) and structured content (SR level 2), in which the first is defined as being a template in which the reporter has to report; the latter is an IT-based manner in which the content of the radiology report can be inserted and displayed into the report. • Despite the extensive amount of research on the subject of structured reporting, the level of evidence is low.

Study on structured method of Chinese MRI report of nasopharyngeal carcinoma

Background

Image text is an important text data in the medical field at it can assist clinicians in making a diagnosis. However, due to the diversity of languages, most descriptions in the image text are unstructured data. The same medical phenomenon may also be described in various ways, such that it remains challenging to conduct text structure analysis. The aim of this research is to develop a feasible approach that can automatically convert nasopharyngeal cancer reports into structured text and build a knowledge network.

Methods

In this work, we compare commonly used named entity recognition (NER) models, choose the optimal model as our triplet extraction model, and present a Chinese structuring algorithm. Finally, we visualize the results of the algorithm in the form of a knowledge network of nasopharyngeal cancer.

Results

In NER, both accuracy and recall of the BERT-CRF model reached 99%. The structured extraction rate is 84.74%, and the accuracy is 89.39%. The architecture based on recurrent neural network does not rely on medical dictionaries or word segmentation tools and can realize triplet recognition.

Conclusions

The BERT-CRF model has high performance in NER, and the triplet can reflect the content of the image report. This work can provide technical support for the construction of a nasopharyngeal cancer database.

Computed Tomography for Abdominal Pain: Do Radiology Reports Answer the Clinical Question?

RATIONALE AND OBJECTIVES

To assess whether abdominopelvic computed tomography (CT) radiology reports directly address a cause for pain when pain is included in the scan indication.

MATERIALS AND METHODS

Four hundred and ninety-five random abdominopelvic CT reports containing "pain" in the indication were retrospectively reviewed. The position of pain descriptors within the indication, the presence of an oncology-related indication in addition to pain and whether a cause for pain was addressed in the impression were recorded. Linguistic analysis of indication and impression sections was performed. Comparisons between reports that addressed pain and those that did not were conducted using Chi-square, Fisher exact, and two-tailed t-tests.

RESULTS

A cause for pain was addressed in 454 of 495 (91.7%) report impressions. Indications with both oncology-related and pain-related descriptors were less likely to have pain directly addressed (χ² (1, N = 495) = 16.4, p < .001). There was no significant association between where pain appeared within the indication and whether pain was addressed (χ² (1, N = 495) = 3.2, p = .07). Whether an impression conveyed a normal result did not influence if pain was addressed (p = .49). Impression word count and complexity were higher in the addressed group compared to the not addressed group (word count 66.6 vs. 51.9, p= .02, Composite grade level 30.1 vs. 25.3, p= .02).

CONCLUSION

Radiologists at our institution consistently addressed a cause for pain on abdominopelvic CTs when pain was in the indication. However, oncology patients who also had an indication of pain were less likely to have a cause for pain addressed. Impression complexity was high for all reports, though higher in those where pain was addressed.

What information is required in a preliminary clinical evaluation? A service evaluation

INTRODUCTION

The preliminary clinical evaluation (PCE) abnormality flagging system is a progression from the red dot system. The need for a PCE service may be reduced by immediate "hot" reporting services, however, PCE can be valuable in those Trusts that do not have a "hot reporting"service, as well as in the out of hours setting. This study aimed to identify what information clinicians require within the PCE to aid decision making.

METHODS

Emergency Department (ED) clinicians and Radiology reporters were approached to complete a paper survey seeking their preferences on various aspects of the What, Where, How model, regarding their usefulness. Questions were a combination of multiple choice, Likert scale, and free-text.

RESULTS

Thirty participants (20 ED clinicians and 10 Radiology Reporters) provided a 100% response rate. Overall, Where was considered to be most significant (n = 18, 60%), followed by What (n = 11, 37%). Half of participants (n = 15, 50%) considered How to be least significant. ED clinicians found all aspects of the What, Where, How useful, in particular the Where, but to a slightly lesser extent regarding how much displacement was involved. Overall, the information ranked as least useful was how much movement, followed by direction of movement, and type of fracture. The preferred style for a PCE comment is a bullet format.

CONCLUSION

PCE content should accommodate the preferences of ED referrers. Our findings suggest clinicians want information pertaining to what the abnormality is (i.e. the type of injury), where it was (more specific than simply which bone) and if displacement is present.

IMPLICATIONS FOR PRACTICE

These findings add to the current knowledge base and provide support to the local department when implementing the PCE system.

Objective comparison of errors and report length between structured and freeform abdominopelvic computed tomography reports

PURPOSE

To objectively compare structured and freeform abdominopelvic CT reports based on the number and types of errors as well as report length.

METHODS

90 structured and 89 freeform reports from abdominopelvic CT scans with IV contrast obtained for the indication of abdominal pain were randomly selected for review. Each report was reviewed for errors, which were counted and categorized based on the type of error. The total number of words in each report was tallied.

RESULTS

105 total errors were found in the structured reports, compared to 157 total errors in freeform reports. There were 1.16 errors per structured report and 1.76 errors per freeform report (p < 0.001). 48% of structured reports contained at least one error, while 71% of freeform reports contained at least one error (p = 0.002). When a difference existed between the styles with regard to error categories, more errors were observed in freeform reports, with the exception of the duplicated period error where structured reports had more errors. No difference on the basis of average words per report existed, with 219.2 words per report for each reporting style.

CONCLUSION

The use of structured reporting for abdominopelvic CT results in less errors in the report when compared to freeform reporting, potentially reducing clinically significant adverse outcomes in patient care. The report length on the basis of number of words per report is not different between the two reporting styles.

Discrepant Reporting Style Preferences Between Clinicians and Radiologists

RATIONALE AND OBJECTIVES

To compare preferences in reporting styles between radiologists and clinicians in structured vs unstructured reporting styles in order to facilitate better communication.

METHODS

An online survey was distributed to 5280 clinicians, radiologists, and physicians in training surveying respondent preference for three different reporting styles: expanded structured, minimized structured, and unstructured.

RESULTS

A 7.5% response rate was achieved. Overall, the expanded structured reporting style was the most preferred (47%, 186/394). This contrasted with radiologists who preferred the unstructured reporting style (41%), whereas nonradiologists preferred the expanded structured reporting style (51%; P < 0.001). There was significance in emergency medicine physicians preferring the minimized structured reporting style (51%, 27/43), whereas all other specialties preferred the expanded structured report (49%, 168/341; P = 0.0038).

DISCUSSION

There is a discrepant reporting style preference between clinicians and radiologists. A structured reporting style with expanded standard statements is preferred by most physicians. Radiologists could consider using a structured reporting style with minimized normal statements in the emergency room setting.

Thyroid Ultrasound Reports: Will the Thyroid Imaging, Reporting, and Data System Improve Natural Language Processing Capture of Critical Thyroid Nodule Features?

BACKGROUND

Critical thyroid nodule features are contained in unstructured ultrasound (US) reports. The Thyroid Imaging, Reporting, and Data System (TI-RADS) uses five key features to risk stratify nodules and recommend appropriate intervention. This study aims to analyze the quality of US reporting and the potential benefit of Natural Language Processing (NLP) systems in efficiently capturing TI-RADS features from text reports.

MATERIALS AND METHOD

This retrospective study used free-text thyroid US reports from an academic center (A) and community hospital (B). Physicians created "gold standard" annotations by manually extracting TI-RADS features and clinical recommendations from reports to determine how often they were included. Similar annotations were created using an automated NLP system and compared with the gold standard.

RESULTS

Two hundred eighty-two reports contained 409 nodules at least 1-cm in maximum diameter. The gold standard identified three nodules (0.7%) which contained enough information to calculate a complete TI-RADS score. Shape was described most often (92.7% of nodules), whereas margins were described least often (11%). A median number of two TI-RADS features are reported per nodule. The NLP system was significantly less accurate than the gold standard in capturing echogenicity (27.5%) and margins (58.9%). One hundred eight nodule reports (26.4%) included clinical management recommendations, which were included more often at site A than B (33.9 versus 17%, P < 0.05).

CONCLUSIONS

These results suggest a gap between current US reporting styles and those needed to implement TI-RADS and achieve NLP accuracy. Synoptic reporting should prompt more complete thyroid US reporting, improved recommendations for intervention, and better NLP performance.

Carotid artery plaque characteristics: current reporting practices on CT angiography

PURPOSE

Extracranial ICA imaging has largely focused on the degree of luminal stenosis, but recent advances suggest specific plaque features are crucial in stroke risk assessment. We evaluated the current state of reporting carotid plaque features on neck CTAs at an academic institution.

METHODS

In this retrospective observational study, we included neck CTAs performed on patients over age 50 with any reported carotid plaque. We evaluated reports for mention of the following: degree of luminal stenosis, soft plaque, calcified plaque, plaque thickness, quantification of soft and calcified plaque, plaque ulceration, and increased risk associated with specific features. We used Fisher's exact test to compare how often each feature was mentioned.

RESULTS

We included a total of 651 reports from unique patients (mean age, 68.1 ± 13.3 years). A total of 639 reports (98.1%) explicitly mentioned degree of stenosis per NASCET criteria. Specific plaque features were less frequently characterized: soft plaque in 116 (17.8%); calcified plaque in 166 (25.5%); quantification of the amount of soft plaque and calcified plaque in 24 (3.7%) and 16 (2.5%) reports, respectively; plaque thickness in 12 (1.8%); plaque ulceration in 476 (73.1%); and increased risk associated with plaque in 2 (0.3%). Degree of stenosis was statistically more likely to be mentioned than any other plaque feature (p < 0.001).

CONCLUSION

Currently, nearly all reports mention the degree of luminal stenosis on neck CTAs while a significant minority mention specific plaque features. Despite mounting evidence of the importance of carotid plaque features in stroke risk assessment, radiology reports do not routinely report these findings.

Structured reporting of CT or MRI for perihilar cholangiocarcinoma: usefulness for clinical planning and interdisciplinary communication

PURPOSE

To compare the content and communication between the radiologist and the clinicians for treatment planning of structured reports (SRs) and narrative reports (NRs) for reporting CT/MRI findings in patients with perihilar cholangiocarcinoma.

MATERIALS AND METHOD

This retrospective study included 54 patients with perihilar cholangiocarcinoma who underwent CT/MRI before ERCP or surgery. For all patients, we generated both NRs and SRs for perihilar cholangiocarcinoma and compared the number of key features between NRs and SRs. In addition, three clinicians performed a questionnaire evaluation that included three questions regarding assessment of the sufficiency of information for surgical or procedural planning, the effort required for information extraction, and the report quality rated on a Likert scale.

RESULTS

SRs included significantly more predefined key features (6.89 ± 0.31) than NRs (5.87 ± 0.70) (p < 0.001). SRs provided greater sufficiency of information for clinical planning than NRs (89.9% vs. 18.5% of the cases, respectively; p < 0.001). Extraction of information was easier from SRs than NRs (94.4% vs. 9.3%, respectively) (p < 0.001). SRs received a higher overall report quality rating (5.96 ± 0.19) than NRs (4.31 ± 0.77) (p < 0.001).

CONCLUSIONS

SRs of CT/MRI findings for hilar cholangiocarcinoma can reveal more predefined key features, provide more sufficiency of information, and yield higher satisfaction levels, in comparison with NRs.

Clinicians' Behavior Toward Radiology Reports: A Cross-Sectional Study

Background

The radiology report is the way of communication between the radiologists and the clinicians of different specialties. Each part of the report is important and significant in the patient management plan. Therefore, knowledge of interpretation and behavior in understanding the final report is a variable crucial skill.

Methods

This is a cross-sectional survey study to explore the behavior and attitude of clinicians toward radiology reports in relation to their professional clinical demographic. A total of 107 physicians participated, including consultants, specialists, and residents among different specialties.

Results

Among the 107 responses, 58.9% were male and 41.1% were female. The majority of the physicians (78.5%) read the radiology report for every requested study for each patient, while 21.5% of participants didn’t read the radiology report for the studies they requested, instead, they only read it occasionally. Gender played a significant factor, as female practitioners were more likely to read the complete radiology report (P = 0.033). In addition, the age of the practitioner was also significant as clinicians in the age group 40-60 years old were more likely to check the requested radiology image prior to reading the report compared to age groups 20-39 and >60 years (P = 0.035). Lastly, specialists were significantly more likely to read the entire radiology report compared to consultants and residents (P = 0.006).

Conclusion

More emphasis and awareness should be provided to clinicians on the importance of reading the entire radiology report as some information can be missed if not being read completely.

Improving radiologic communication in oncology: a single-centre experience with structured reporting for cancer patients

Objectives

Our aim was to develop a structured reporting concept (structured oncology report, SOR) for general follow-up assessment of cancer patients in clinical routine. Furthermore, we analysed the report quality of SOR compared to conventional reports (CR) as assessed by referring oncologists.

Methods

SOR was designed to provide standardised layout, tabulated tumour burden documentation and standardised conclusion using uniform terminology. A software application for reporting was programmed to ensure consistency of layout and vocabulary and to facilitate utilisation of SOR. Report quality was analysed for 25 SOR and 25 CR retrospectively by 6 medical oncologists using a 7-point scale (score 1 representing the best score) for 6 questionnaire items addressing different elements of report quality and overall satisfaction. A score of ≤ 3 was defined as a positive rating.

Results

In the first year after full implementation, 7471 imaging examinations were reported using SOR. The proportion of SOR in relation to all oncology reports increased from 49 to 95% within a few months. Report quality scores were better for SOR for each questionnaire item (p < 0.001 each). Averaged over all questionnaire item scores were 1.98 ± 1.22 for SOR and 3.05 ± 1.93 for CR (p < 0.001). The overall satisfaction score was 2.15 ± 1.32 for SOR and 3.39 ± 2.08 for CR (p < 0.001). The proportion of positive ratings was higher for SOR (89% versus 67%; p < 0.001).

Conclusions

Department-wide structured reporting for follow-up imaging performed for assessment of anticancer treatment efficacy is feasible using a dedicated software application. Satisfaction of referring oncologist with report quality is superior for structured reports.

Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: Implications for natural language processing tools

BACKGROUND

Reporting standards promote clarity and consistency of stress myocardial perfusion imaging (MPI) reports, but do not require an assessment of post-test risk. Natural Language Processing (NLP) tools could potentially help estimate this risk, yet it is unknown whether reports contain adequate descriptive data to use NLP.

METHODS

Among VA patients who underwent stress MPI and coronary angiography between January 1, 2009 and December 31, 2011, 99 stress test reports were randomly selected for analysis. Two reviewers independently categorized each report for the presence of critical data elements essential to describing post-test ischemic risk.

RESULTS

Few stress MPI reports provided a formal assessment of post-test risk within the impression section (3%) or the entire document (4%). In most cases, risk was determinable by combining critical data elements (74% impression, 98% whole). If ischemic risk was not determinable (25% impression, 2% whole), inadequate description of systolic function (9% impression, 1% whole) and inadequate description of ischemia (5% impression, 1% whole) were most commonly implicated.

CONCLUSIONS

Post-test ischemic risk was determinable but rarely reported in this sample of stress MPI reports. This supports the potential use of NLP to help clarify risk. Further study of NLP in this context is needed.

Institutional Implementation of a Structured Reporting System: Our Experience with the Brain Tumor Reporting and Data System

RATIONALE AND OBJECTIVES

Analyze the impact of implementing a structured reporting system for primary brain tumors, the Brain Tumor Reporting and Data System, on attitudes toward radiology reports at a single institution.

MATERIALS AND METHODS

Following Institutional Review Board approval, an initial 22 question, 5 point (1-worst to 5-best), survey was sent to faculty members, house staff members, and nonphysician providers at our institution who participate in the direct care of brain tumor patients. Results were used to develop a structured reporting strategy for brain tumors which was implemented across an entire neuroradiology section in a staged approach. Nine months following structured reporting implementation, a follow-up 27 question survey was sent to the same group of providers. Keyword search of radiology reports was used to assess usage of Brain Tumor Reporting and Data System over time.

RESULTS

Fifty-three brain tumor care providers responded to the initial survey and 38 to the follow-up survey. After implementing BT-RADS, respondents reported improved attitudes across multiple areas including: report consistency (4.3 vs. 3.4; p < 0.001), report ambiguity (4.2 vs. 3.2, p < 0.001), radiologist/physician communication (4.5 vs. 3.8; p < 0.001), facilitation of patient management (4.2 vs. 3.6; p = 0.003), and confidence in reports (4.3 vs. 3.5; p < 0.001). Providers were more satisfied with the BT-RADS structured reporting system (4.3 vs. 3.7; p = 0.04). Use of the reporting template progressively increased with 81% of brain tumor reports dictated using the new template by 9 months.

CONCLUSION

Implementing a structured template for brain tumor imaging improves perception of radiology reports among radiologists and referring providers involved in the care of brain tumor patients.

Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report.

Creating high-quality radiology reports in foreign languages through multilingual structured reporting

OBJECTIVES

Globalization and migration are increasing the demand for reports in different languages. We aimed to examine if structured reports created by non-German-speaking radiologists with multilingual templates show significant differences in quality to structured reports and free-text reports by German native speakers.

METHODS

We used structured templates that allow radiologists to report in their mother tongue and then switch the report language to German or English automatically using proprietary software. German- and English-speaking radiology residents created structured reports in both German and English with these templates. Reports for three different exam types were created (intensive care chest x-ray, shoulder x-ray specifically for degenerative processes, and CT pulmonary angiogram for pulmonary embolism). The report quality of automatically translated German structured reports by English-speaking radiologists and German structured reports by German radiologists was then evaluated by German clinicians with a standardized questionnaire. The questionnaire was designed to assess attributes including content, comprehensibility, clinical consequences, and overall quality.

RESULTS

Structured reports by English-speaking radiologists that were automatically translated into German and German structured reports by German radiologists both received very high or high overall quality ratings in the majority of cases, showing no significant differences in quality. Likewise, no significant differences were observed between the two report types regarding comprehensibility and clinical consequences. Structured reports by German radiologists received significantly better ratings for overall quality and comprehensibility compared to free-text reports by German radiologists.

CONCLUSIONS

Multilingual structured reporting templates may serve as a feasible tool for creating high-quality radiology reports in foreign languages.

KEY POINTS

• Multilingualism in structured reporting templates can be a useful tool for creating high-quality radiology reports in foreign languages. • German reports created with multilingual structured reporting templates by English-speaking radiologists and German structured reports by German radiologists exhibit no significant differences in overall report quality. • Multilingual structured reporting templates can help radiologists overcome communication barriers and facilitate teleradiology.

The value of structured radiology reports to categorize intracranial metastases following radiation therapy

PURPOSE

Radiology descriptions of intracranial metastases following radiotherapy are often imprecise. This study sought to improve such reports by creating and disseminating a structured template that encourages discrete categorization of intracranial lesions.

METHODS

Following initiation of the structured template, a retrospective review assessed patients with intracranial metastases that underwent radiotherapy, comparing 'pre-template' with 'post-template' reports. A total of 139 patients were included; 94 patients (67.6%) were imaged pre-template, 45 (32.4%) post-template. Reports were assessed for discrete versus non-specific descriptions of lesions: '(presumed) new metastases', 'treated metastases', and 'indeterminate lesions'. Non-specific language was subdivided based on the type of lesion(s) described: e.g. 'stable enhancing foci' was deemed a non-specific description of 'treated metastases'.

RESULTS

Non-specific descriptions of lesions were used in 25/94 reports (26.6%) pre-template, and eight reports (17.8%) post-template. No significant difference was found in the frequency of inappropriate/ambiguous descriptions of intracranial lesions following template initiation (P = 0.52). However, only 27/45 (60.0%) of the reports in the post-template time period used the structured report; the other reports were written as free prose. Of the reports that did use the structured template, the authors used significantly less ambiguous language structured template (P = 0.02).

CONCLUSION

When utilized, a structured report template resulted in decreased non-specific descriptions and improved discrete characterization of intracranial metastases in patients treated with radiation. However, the frequency of non-specific language usage before and after template initiation was unchanged, probably due to poor compliance with template utilization.

Radiology report format preferred by requesting physicians: prospective analysis in a population of physicians at a university hospital

Objective

To improve communication between attending physicians and radiologists by defining which information should be included in radiology reports and which reporting format is preferred by requesting physicians at a university hospital.

Materials and Methods

Respondents were asked to choose among reports with different formats and levels of detail, related to three hypothetical cases, and questioned as to which characteristics commonly found in radiology reports are appropriate for inclusion. To assign the absolute order of preference of the different reports, the Kemeny-Young method was used.

Results

Ninety-nine physicians completed the questionnaires (40.4% were resident physicians; 31.3% were preceptors of residency programs; and 28.3% were professors of medicine). For ultrasound with normal findings, ultrasound showing alterations, and computed tomography, respectively, 54%, 59%, and 53% of the respondents chose structured reports with an impression or comment. According to the respondents, the characteristics that should be included in the radiology report are the quality of the image, details of the clinical presentation, diagnostic impression, examination technique, and information about contrast administration, selected by 92%, 91%, 89%, 72%, and 68%, respectively. Other characteristics that were considered important were recommendations on follow-up and additional radiological or non-radiological investigation.

Conclusion

Requesting physicians apparently prefer structured reports with a radiologist impression or comment. Information such as the quality of the examination, the contrast agent used, and suggestions regarding follow-up and additional investigation are valued.

Structured reporting of head and neck ultrasound examinations

Background

Reports of head and neck ultrasound examinations are frequently written by hand as free texts. Naturally, quality and structure of free text reports is variable, depending on the examiner’s individual level of experience. Aim of the present study was to compare the quality of free text reports (FTR) and structured reports (SR) of head and neck ultrasound examinations.

Methods

Both standard FTRs and SRs of head and neck ultrasound examinations of 43 patients were acquired by nine independent examiners with comparable levels of experience. A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion, and readability by four independent raters with different specializations (Paired Wilcoxon test, 95% CI) and inter-rater reliability was assessed (Fleiss’ kappa). A questionnaire was used to compare FTRs vs. SRs with respect to user satisfaction (Mann-Whitney U test, 95% CI).

Results

By comparison, completeness scores of SRs were significantly higher than FTRs’ completeness scores (94.4% vs. 45.6%, p < 0.001), and pathologies were described in more detail (91.1% vs. 54.5%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 47.1%, p < 0.001). The mean time to complete a report, however, was significantly higher in SRs (176.5 vs. 107.3 s, p < 0.001). SRs achieved significantly higher user satisfaction ratings (VAS 8.87 vs. 1.41, p < 0.001) and a very high inter-rater reliability (Fleiss’ kappa 0.92).

Conclusions

As compared to FTRs, SRs of head and neck ultrasound examinations are more comprehensive and easier to understand. On the balance, the additional time needed for completing a SR is negligible. Also, SRs yield high inter-rater reliability and may be used for high-quality scientific data analyses.

Structured reports of pelvic magnetic resonance imaging in primary endometrial cancer: Potential benefits for clinical decision-making

BACKGROUND

Although evidence is increasing that the implementation of structured reports (SRs) may increase the standardization of reports and improve communication between radiologists and end-users, it is unclear whether these alternative formats of Chinese radiological narratives are appealing or even acceptable to radiologists and clinicians.

OBJECTIVE

To compare the effect of SRs and non-structured reports (NSRs) of pelvic magnetic resonance imaging (MRI) in patients with primary endometrial cancer on referring gynecologists' satisfaction, further decision-making and efficiency.

METHODS

Forty-one patients with histologically proven endometrial cancer were included in this study. SRs and NSRs for local MRI staging of endometrial cancer were generated for all subjects. NSRs were generated during clinical routine practice. The same 41 uterine studies were reviewed by the same radiologist using structured reporting system after a period of time. Two radiologists compared SRs on the number of key features related to cancer staging and writing efficiency with NSRs together. Five gynecologists filled in questionnaires regarding satisfaction with content, clinical usefulness, report' quality and time consumption. Statistical analysis included Kendall's W test, paired-sample t test and Wilcoxon signed rank test.

RESULTS

There was no significant difference in the number of key features in NSRs comparison to SRs (p = 0.055). A statistically significant difference was observed in the satisfaction with linguistic quality for NSRs versus SRs by three gynaecologists (reader 1: 4.02 vs. 4.63, p = 0.002; reader 3: 3.86 vs. 4.02, p = 0.035; reader 4: 4.05 vs. 4.27, p = 0.024). The radiologist spent less time finishing SRs compared with NSRs (727.22 ± 38.42 sec vs. 616.44 ± 60.00 sec, p = 0.037).

CONCLUSIONS

The application of SRs significantly increased the value of female pelvic MRI reports by increasing radiologists' work efficiency and gynaecologists' satisfaction.

Radiology report: what is the opinion of the referring physician?

Objective

To evaluate the opinion and perception of referring physicians regarding the radiology report, in order to develop tools that promote an improvement in its quality.

Materials and Methods

We prepared a questionnaire containing ten multiple choice questions about the radiology report, administering it to 70 physicians (35 specialists and 35 residents working in specialties other than radiology).

Results

Referring physicians (specialists and residents) showed a preference for structured reports, with a description explained in universal medical language and a complete conclusion listing the diagnostic possibilities with the degree of certainty. The examination technique should be described, and the final report is best presented when it contains the final chart, together with images, as hard copies and in digital format. The respondents also reported having confidence in the opinion of the radiologist and expressed the need for a direct channel of communication with the same.

Conclusion

Referring physicians seek detailed reports (including a description of the examination technique), preferably structured, with objective language and relevant conclusions (the position of the radiologist on the case is important). It is necessary to discuss the differential diagnoses and provide a form of contact between the parties. Although referring physicians consider the radiologist opinion relevant, they also want to analyze the images on their own.

Can the completeness of radiological cancer staging reports be improved using proforma reporting? A prospective multicentre non-blinded interventional study across 21 centres in the UK

OBJECTIVES

Following a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known to be inconsistently documented. We tested whether the completeness of cancer staging radiology reports could be improved through a nationally introduced pilot of proforma-based reporting for a selection of six common cancers.

DESIGN

Prospective interventional study comparing the completeness of radiology cancer staging reports before and after the introduction of proforma reporting.

SETTING

Twenty-one UK National Health Service hospitals.

PARTICIPANTS

1283 cancer staging radiology reports were submitted.

MAIN OUTCOME MEASURES

Radiology staging reports across the six cancers types were evaluated before and after the implementation of proforma-based reporting. Report completeness was assessed using scoring forms listing the presence or absence of predetermined key staging data. Qualitative data regarding proforma implementation and usefulness were collected from questionnaires provided to radiologists and end-users.

RESULTS

Electronic proforma-based reporting was successfully implemented in 15 of the 21 centres during the evaluation period. A total of 787 preproforma and 496 postproforma staging reports were evaluated. In the preproforma group, only 48.7% (5586/11 470) of key staging items were present compared with 87.3% (6043/6920) in the postproforma group. Thus, the introduction of proforma reporting produced a 78% improvement in staging completeness . This increase was seen across all cancer types and centres. The majority of participants found proforma reporting improved cancer reporting quality for their clinical practice .

CONCLUSION

The implementation of proforma reporting results in a significant improvement in the completeness of cancer staging reports. Proforma-based assessment of cancer stage enables objective comparisons of patient outcomes across centres. It should therefore become an auditable quality standard for cancer care.