Advertisement

Structured Reporting in Radiology

Published:October 10, 2017DOI:https://doi.org/10.1016/j.acra.2017.08.005
      Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports. The Association of University Radiologists—Radiology Research Alliance Structured Reporting Task Force convened to explore the current and future role of structured reporting in radiology and summarized its finding in this article. We review the advantages and disadvantages of structured radiology reports and discuss the current prevailing sentiments among radiologists regarding structured reports. We also discuss the obstacles to the use of structured reports and highlight ways to overcome some of those challenges. We also discuss the future directions in radiology reporting in the era of personalized medicine.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alfaro D.
        • Levitt M.A.
        • English D.K.
        • et al.
        Accuracy of interpretation of cranial computed tomography scans in an emergency medicine residency program.
        Ann Emerg Med. 1995; 25: 169-174
        • Arhami Dolatabadi A.
        • Baratloo A.
        • Rouhipour A.
        • et al.
        Interpretation of computed tomography of the head: emergency physicians versus radiologists.
        Trauma Mon. 2013; 18: 86-89
        • Gatt M.E.
        • Spectre G.
        • Paltiel O.
        • et al.
        Chest radiographs in the emergency department: is the radiologist really necessary?.
        Postgrad Med J. 2003; 79: 214-217
        • Kang M.J.
        • Sim M.S.
        • Shin T.G.
        • et al.
        Evaluating the accuracy of emergency medicine resident interpretations of abdominal CTs in patients with non-traumatic abdominal pain.
        J Korean Med Sci. 2012; 27: 1255-1260
        • Weiner S.N.
        Radiology by nonradiologists: is report documentation adequate?.
        Am J Manag Care. 2005; 11: 781-785
        • Sistrom C.
        • Lanier L.
        • Mancuso A.
        Reporting instruction for radiology residents.
        Acad Radiol. 2004; 11: 76-84
        • Bosmans J.M.
        • Weyler J.J.
        • Parizel P.M.
        Structure and content of radiology reports, a quantitative and qualitative study in eight medical centers.
        Eur J Radiol. 2009; 72: 354-358
        • Heikkinen K.
        • Loyttyniemi M.
        • Kormano M.
        Structure and content of 400 CT reports in four teaching hospitals using a new, Windows-based software tool.
        Acta Radiol. 2000; 41: 102-105
        • Naik S.S.
        • Hanbidge A.
        • Wilson S.R.
        Radiology reports: examining radiologist and clinician preferences regarding style and content.
        AJR Am J Roentgenol. 2001; 176: 591-598
        • Wallis A.
        • McCoubrie P.
        The radiology report—are we getting the message across?.
        Clin Radiol. 2011; 66: 1015-1022
        • Bosmans J.M.
        • Peremans L.
        • Menni M.
        • et al.
        Structured reporting: if, why, when, how-and at what expense? Results of a focus group meeting of radiology professionals from eight countries.
        Insights Imaging. 2012; 3: 295-302
        • Weiss D.L.
        • Langlotz C.P.
        Structured reporting: patient care enhancement or productivity nightmare?.
        Radiology. 2008; 249: 739-747
        • Bosmans J.M.
        • Neri E.
        • Ratib O.
        • et al.
        Structured reporting: a fusion reactor hungry for fuel.
        Insights Imaging. 2015; 6: 129-132
        • Bender L.C.
        • Linnau K.F.
        • Meier E.N.
        • et al.
        Interrater agreement in the evaluation of discrepant imaging findings with the Radpeer system.
        AJR Am J Roentgenol. 2012; 199: 1320-1327
        • Borgstede J.P.
        • Lewis R.S.
        • Bhargavan M.
        • et al.
        RADPEER quality assurance program: a multifacility study of interpretive disagreement rates.
        Journal of the American College of Radiology : JACR. 2004; 1: 59-65
        • Donald J.J.
        • Barnard S.A.
        Common patterns in 558 diagnostic radiology errors.
        J Med Imaging Radiat Oncol. 2012; 56: 173-178
        • Hsu W.
        • Han S.X.
        • Arnold C.W.
        • et al.
        A data-driven approach for quality assessment of radiologic interpretations.
        J Am Med Inform Assoc. 2016; 23: e152-e156
        • McCreadie G.
        • Oliver T.B.
        Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error and discrepancy with particular emphasis on CT.
        Clin Radiol. 2009; 64 (discussion 500–501): 491-499
        • Berlin L.
        • Berlin J.W.
        Malpractice and radiologists in Cook County, IL: trends in 20 years of litigation.
        AJR Am J Roentgenol. 1995; 165: 781-788
        • Halpin S.F.
        Medico-legal claims against English radiologists: 1995–2006.
        Br J Radiol. 2009; 82: 982-988
        • Pinto A.
        • Acampora C.
        • Pinto F.
        • et al.
        Learning from diagnostic errors: a good way to improve education in radiology.
        Eur J Radiol. 2011; 78: 372-376
        • Thomson 3rd, N.B.
        • Patel M.
        Radiology liability update: review of claims, trends, high-risk conditions and practices, and tort reform alternatives.
        J Am Coll Radiol. 2012; 9: 729-733
        • Lee C.S.
        • Nagy P.G.
        • Weaver S.J.
        • et al.
        Cognitive and system factors contributing to diagnostic errors in radiology.
        AJR Am J Roentgenol. 2013; 201: 611-617
        • Graber M.L.
        • Wachter R.M.
        • Cassel C.K.
        Bringing diagnosis into the quality and safety equations.
        JAMA. 2012; 308: 1211-1212
        • Lin E.
        • Powell D.K.
        • Kagetsu N.J.
        Efficacy of a checklist-style structured radiology reporting template in reducing resident misses on cervical spine computed tomography examinations.
        J Digit Imaging. 2014; 27: 588-593
        • Quattrocchi C.C.
        • Giona A.
        • Di Martino A.C.
        • et al.
        Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study.
        Insights Imaging. 2013; 4: 301-308
        • Semaan H.B.
        • Bieszczad J.E.
        • Obri T.
        • et al.
        Incidental extraspinal findings at lumbar spine magnetic resonance imaging: a retrospective study.
        Spine. 2015; 40: 1436-1443
        • McKee B.J.
        • Regis S.M.
        • McKee A.B.
        • et al.
        Performance of ACR Lung-RADS in a clinical CT lung screening program.
        J Am Coll Radiol. 2015; 12: 273-276
        • Rosskopf A.B.
        • Dietrich T.J.
        • Hirschmann A.
        • et al.
        Quality management in musculoskeletal imaging: form, content, and diagnosis of knee MRI reports and effectiveness of three different quality improvement measures.
        AJR Am J Roentgenol. 2015; 204: 1069-1074
        • Ghoshhajra B.B.
        • Lee A.M.
        • Ferencik M.
        • et al.
        Interpreting the interpretations: the use of structured reporting improves referring clinicians' comprehension of coronary CT angiography reports.
        J Am Coll Radiol. 2013; 10: 432-438
        • Brook O.R.
        • Brook A.
        • Vollmer C.M.
        • et al.
        Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning.
        Radiology. 2015; 274: 464-472
        • Marcal L.P.
        • Fox P.S.
        • Evans D.B.
        • et al.
        Analysis of free-form radiology dictations for completeness and clarity for pancreatic cancer staging.
        Abdom Imaging. 2015; 40: 2391-2397
        • Sahni V.A.
        • Silveira P.C.
        • Sainani N.I.
        • et al.
        Impact of a structured report template on the quality of MRI reports for rectal cancer staging.
        AJR Am J Roentgenol. 2015; 205: 584-588
        • Gunn A.J.
        • Alabre C.I.
        • Bennett S.E.
        • et al.
        Structured feedback from referring physicians: a novel approach to quality improvement in radiology reporting.
        AJR Am J Roentgenol. 2013; 201: 853-857
        • Hawkins C.M.
        • Hall S.
        • Hardin J.
        • et al.
        Prepopulated radiology report templates: a prospective analysis of error rate and turnaround time.
        J Digit Imaging. 2012; 25: 504-511
        • McGurk S.
        • Brauer K.
        • Macfarlane T.V.
        • et al.
        The effect of voice recognition software on comparative error rates in radiology reports.
        Br J Radiol. 2008; 81: 767-770
        • Hawkins C.M.
        • Hall S.
        • Zhang B.
        • et al.
        Creation and implementation of department-wide structured reports: an analysis of the impact on error rate in radiology reports.
        J Digit Imaging. 2014; 27: 581-587
        • Duszak Jr, R.
        • Nossal M.
        • Schofield L.
        • et al.
        Physician documentation deficiencies in abdominal ultrasound reports: frequency, characteristics, and financial impact.
        J Am Coll Radiol. 2012; 9: 403-408
        • Faggioni L.
        • Coppola F.
        • Ferrari R.
        • et al.
        Usage of structured reporting in radiological practice: results from an Italian online survey.
        Eur Radiol. 2017; 27: 1934-1943
        • Powell D.K.
        • Silberzweig J.E.
        State of structured reporting in radiology, a survey.
        Acad Radiol. 2015; 22: 226-233
        • Bosmans J.M.
        • Weyler J.J.
        • De Schepper A.M.
        • et al.
        The radiology report as seen by radiologists and referring clinicians: results of the COVER and ROVER surveys.
        Radiology. 2011; 259: 184-195
        • Gunderman R.B.
        • McNeive L.R.
        Is structured reporting the answer?.
        Radiology. 2014; 273: 7-9
        • Srinivasa Babu A.
        • Brooks M.L.
        The malpractice liability of radiology reports: minimizing the risk.
        Radiographics. 2015; 35: 547-554
        • Winter T.C.
        The propaedeutics of structured reporting.
        Radiology. 2015; 275: 309-310
        • Hall F.M.
        The radiology report of the future.
        Radiology. 2009; 251: 313-316
        • Manoonchai N.
        • Kaewlai R.
        • Wibulpolprasert A.
        • et al.
        Satisfaction of imaging report rendered in emergency setting: a survey of radiology and referring physicians.
        Acad Radiol. 2015; 22: 760-770
        • Krupinski E.A.
        • Hall E.T.
        • Jaw S.
        • et al.
        Influence of radiology report format on reading time and comprehension.
        J Digit Imaging. 2012; 25: 63-69
        • Sistrom C.L.
        • Honeyman-Buck J.
        Free text versus structured format: information transfer efficiency of radiology reports.
        AJR Am J Roentgenol. 2005; 185: 804-812
        • Johnson A.J.
        • Chen M.Y.
        • Swan J.S.
        • et al.
        Cohort study of structured reporting compared with conventional dictation.
        Radiology. 2009; 253: 74-80
        • Vache T.
        • Bratan F.
        • Mege-Lechevallier F.
        • et al.
        Characterization of prostate lesions as benign or malignant at multiparametric MR imaging: comparison of three scoring systems in patients treated with radical prostatectomy.
        Radiology. 2014; 272: 446-455
        • Houssami N.
        • Boyages J.
        • Stuart K.
        • et al.
        Quality of breast imaging reports falls short of recommended standards.
        Breast. 2007; 16: 271-279
        • Margolies L.R.
        • Pandey G.
        • Horowitz E.R.
        • et al.
        Breast imaging in the era of big data: structured reporting and data mining.
        AJR Am J Roentgenol. 2016; 206: 259-264
      1. Radiology reporting initiative.
        (Available at:)
        • Morgan T.A.
        • Helibrun M.E.
        • Kahn Jr, C.E.
        Reporting initiative of the Radiological Society of North America: progress and new directions.
        Radiology. 2014; 273: 642-645
      2. RadReport template library.
        (Available at:)
        http://www.radreport.org/
        Date accessed: May 1, 2017
        • Al-Hawary M.M.
        • Francis I.R.
        • Chari S.T.
        • et al.
        Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association.
        Gastroenterology. 2014; 146 (e1): 291-304
        • Larson D.B.
        • Towbin A.J.
        • Pryor R.M.
        • et al.
        Improving consistency in radiology reporting through the use of department-wide standardized structured reporting.
        Radiology. 2013; 267: 240-250
        • Anderson T.J.
        • Lu N.
        • Brook O.R.
        Disease-specific report templates for your practice.
        J Am Coll Radiol. 2017; 14: 1055-1057
        • Goldberg-Stein S.
        • Walter W.R.
        • Amis Jr, E.S.
        • et al.
        Implementing a structured reporting initiative using a collaborative multistep approach.
        Curr Probl Diagn Radiol. 2016; 46: 295-299
      3. 2016 radiology preferred specialty measure set.
        (Available at:)
        • Choksi V.R.
        • Marn C.S.
        • Bell Y.
        • et al.
        Efficiency of a semiautomated coding and review process for notification of critical findings in diagnostic imaging.
        AJR Am J Roentgenol. 2006; 186: 933-936
        • Zafar H.M.
        • Chadalavada S.C.
        • Kahn Jr, C.E.
        • et al.
        Code abdomen: an assessment coding scheme for abdominal imaging findings possibly representing cancer.
        J Am Coll Radiol. 2015; 12: 947-950
        • Sevenster M.
        • Travis A.R.
        • Ganesh R.K.
        • et al.
        Improved efficiency in clinical workflow of reporting measured oncology lesions via PACS-integrated lesion tracking tool.
        AJR Am J Roentgenol. 2015; 204: 576-583
        • Zimmerman S.L.
        • Kim W.
        • Boonn W.W.
        Informatics in radiology: automated structured reporting of imaging findings using the AIM standard and XML.
        Radiographics. 2011; 31: 881-887
        • Alkasab T.K.
        • Bizzo B.C.
        • Berland L.L.
        • et al.
        Creation of an open framework for point-of-care computer-assisted reporting and decision support tools for radiologists.
        J Am Coll Radiol. 2017; 14: 1184-1189
        • Taylor A.T.
        • Garcia E.V.
        Computer-assisted diagnosis in renal nuclear medicine: rationale, methodology, and interpretative criteria for diuretic renography.
        Semin Nucl Med. 2014; 44: 146-158
        • Wang K.C.
        • Jeanmenne A.
        • Weber G.M.
        • et al.
        An online evidence-based decision support system for distinguishing benign from malignant vertebral compression fractures by magnetic resonance imaging feature analysis.
        J Digit Imaging. 2011; 24: 507-515
        • Sadigh G.
        • Hertweck T.
        • Kao C.
        • et al.
        Traditional text-only versus multimedia-enhanced radiology reporting: referring physicians' perceptions of value.
        J Am Coll Radiol. 2015; 12: 519-524
        • Nayak L.
        • Beaulieu C.F.
        • Rubin D.L.
        • et al.
        A picture is worth a thousand words: needs assessment for multimedia radiology reports in a large tertiary care medical center.
        Acad Radiol. 2013; 20: 1577-1583
        • Oh S.C.
        • Cook T.S.
        • Kahn Jr, C.E.
        PORTER: a prototype system for patient-oriented radiology reporting.
        J Digit Imaging. 2016; 29: 450-454
        • Vining D.
        • Salem U.
        • Duran C.
        • et al.
        Development of the ViSion Ontology for Structured Reporting.
        (Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1–December 6, 2013, Chicago IL; Available at:)
        http://archive.rsna.org/2013/13023813.html
        Date accessed: April 21, 2017