Influence of radiology report format on reading time and comprehension

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.

Comparison of the clinical usefulness of structured and free-text reports for interpretation of jaw lesions on cone beam computed tomography images

OBJECTIVE

This study compared the clinical usefulness of structured reports (SRs) and free-text reports (FTRs) of lesions depicted on cone beam computed tomography (CBCT) images from the perspectives of report providers and receivers.

STUDY DESIGN

In total, 36 CBCT images of jaw lesions obtained between February 2020 and August 2020 were evaluated. A working group of 3 oral and maxillofacial radiologists (OMRs) established a reporting system and prepared reports. Evaluation group I (2 OMRs) wrote SRs and FTRs for each case and assessed the reporting process for the criteria of convenience and organization. Evaluation group II (3 general practitioners [GPs] and 3 oral and maxillofacial surgeons [OMSs]) assessed the reports for the criteria of productivity, consistency, and organization. A 5-point Likert scale was used to assess the usefulness of each report. Scores were statistically compared according to report type with the paired Wilcoxon signed-rank test.

RESULTS

The SRs scored significantly higher for all criteria as assessed by evaluation group I and the GPs of group II (P < .001). The FTRs scored significantly higher for productivity and organization as assessed by the OMSs of group II (P = .005 for both criteria).

CONCLUSIONS

The clinical usefulness of reports may differ according to roles of the report recipients in diagnosis and treatment.

Time Is Money: Considerations for Measuring the Radiological Reading Time

Timestamps in the Radiology Information System (RIS) are a readily available and valuable source of information with increasing significance, among others, due to the current focus on the clinical impact of artificial intelligence applications. We aimed to evaluate timestamp-based radiological dictation time, introduce timestamp modeling techniques, and compare those with prospective measured reporting. Dictation time was calculated from RIS timestamps between 05/2010 and 01/2021 at our institution (n = 108,310). We minimized contextual outliers by simulating the raw data by iteration (1000, vector size (µ/sd/λ) = 100/loop), assuming normally distributed reporting times. In addition, 329 reporting times were prospectively measured by two radiologists (1 and 4 years of experience). Altogether, 106,127 of 108,310 exams were included after simulation, with a mean dictation time of 16.62 min. Mean dictation time was 16.05 min head CT (44,743/45,596), 15.84 min for chest CT (32,797/33,381), 17.92 min for abdominal CT (n = 22,805/23,483), 10.96 min for CT foot (n = 937/958), 9.14 min for lumbar spine (881/892), 8.83 min for shoulder (409/436), 8.83 min for CT wrist (1201/1322), and 39.20 min for a polytrauma patient (2127/2242), without a significant difference to the prospective reporting times. In conclusion, timestamp analysis is useful to measure current reporting practice, whereas body-region and radiological experience are confounders. This could aid in cost–benefit assessments of workflow changes (e.g., AI implementation).

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.

Tips for Reporting Musculoskeletal Imaging Studies: Lessons Learned

This paper is designed to be read by radiological trainees who are starting out with reporting musculoskeletal imaging studies. Based on the author's experience of over 25 years, it provides tips on how to report musculoskeletal imaging succinctly and effectively using a prose style report.

Radiograph report style preferences of referrers at a district general hospital in the West Midlands, England, UK

INTRODUCTION

Many articles and guidelines have been published proposing suggestions for the optimal radiology report style; it is likely that different referrers will prefer different styles owing to a number of clinical variables. The aim of this study is to assess the x-ray report style preferences of referrers at a district general hospital.

METHOD

This electronic survey study used convenience sampling. An email invitation was sent to all referrers who had requested imaging examinations in the six months prior to the study start date. Participants were asked their opinions on the inclusion of recommendations and advice and to indicate their preferences of mock reports with combinations of the following; short/long, in-depth/brief and paragraph/bullet points. Manual analysis was undertaken in Excel.

RESULTS

There were 114 participants from the identified population of 356, giving a response rate of 32%. Nearly all participants find the inclusion of recommendations and advice to be useful (n = 109, 96%). Seventy-nine participants (69.3%) request skeletal x-ray examinations, and 100 (87.7%) request chest x-ray examinations. More than half of skeletal referrers (n = 42, 53.2%) and the majority of chest referrers (n = 45, 45%) prefer reports with short sentences, brief, bullet point format.

CONCLUSION

The most preferred report style for skeletal and chest x-ray reports is short sentences, brief with bullet-point format. These findings add to the current knowledge base and provide different report style options. Tailoring report styles could optimise service users' experience depending on clinical variables and might improve reporting workflow.

IMPLICATIONS FOR PRACTICE

Potential differences in style preferences may exist between community and hospital referrers. Consequently, focussed research regarding the report style preferences of GPs is recommended as an area for further research.

Natural Language Processing in Dutch Free Text Radiology Reports: Challenges in a Small Language Area Staging Pulmonary Oncology

Reports are the standard way of communication between the radiologist and the referring clinician. Efforts are made to improve this communication by, for instance, introducing standardization and structured reporting. Natural Language Processing (NLP) is another promising tool which can improve and enhance the radiological report by processing free text. NLP as such adds structure to the report and exposes the information, which in turn can be used for further analysis. This paper describes pre-processing and processing steps and highlights important challenges to overcome in order to successfully implement a free text mining algorithm using NLP tools and machine learning in a small language area, like Dutch. A rule-based algorithm was constructed to classify T-stage of pulmonary oncology from the original free text radiological report, based on the items tumor size, presence and involvement according to the 8th TNM classification system. PyContextNLP, spaCy and regular expressions were used as tools to extract the correct information and process the free text. Overall accuracy of the algorithm for evaluating T-stage was 0,83 in the training set and 0,87 in the validation set, which shows that the approach in this pilot study is promising. Future research with larger datasets and external validation is needed to be able to introduce more machine learning approaches and perhaps to reduce required input efforts of domain-specific knowledge. However, a hybrid NLP approach will probably achieve the best results.

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.

Redefining the structure of structured reporting in radiology

Structured reporting is advocated as a means of improving reporting in radiology to the ultimate benefit of both radiological and clinical practice. Several large initiatives are currently evaluating its potential. However, with numerous characterizations of the term in circulation, “structured reporting” has become ambiguous and is often confused with “standardization,” which may hamper proper evaluation and implementation in clinical practice. This paper provides an overview of interpretations of structured reporting and proposes a clear definition that differentiates structured reporting from standardization. Only a clear uniform definition facilitates evidence-based implementation, enables evaluation of its separate components, and supports (meta-)analyses of literature reports.

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.

New RANZCR clinical radiology written report guidelines

The Royal Australian and New Zealand College of Radiologists (RANZCR) Radiology Written Report Guideline was first issued in 2011. A survey-based consultation of clinical radiology members of the college in 2015 found that the vast majority of 235 respondents supported all components of the guideline. Since the original guideline was developed, considerable new research has been published about radiology reporting, particularly regarding structured/template reports. In 2016/17 a RANZCR working group used the consultation results, stakeholder feedback and recent research to develop revised guidelines. This article outlines the consultation survey results and guideline revision process as well as some of the supporting evidence from the literature.

Structured Reporting in Radiology

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.

Exploring eye movements of experienced and novice readers of medical texts concerning the cardiovascular system in making a diagnosis

This study used the eye-tracking method to explore how the level of expertise influences reading, and solving, two written patient cases on cardiac failure and pulmonary embolus. Eye-tracking is a fairly commonly used method in medical education research, but it has been primarily applied to studies analyzing the processing of visualizations, such as medical images or patient video cases. Third-year medical students (n = 39) and residents (n = 13) read two patient case texts in an eye-tracking laboratory. The analysis focused on the diagnosis made, the total visit duration per text slide, and eye-movement indicators regarding task-relevant and task-redundant areas of the patient case text. The results showed that almost all participants (48/52) made the correct diagnosis of the first patient case, whereas all the residents, but only 17 students, correctly diagnosed the second case. The residents were efficient patient-case-solvers: they reached the correct diagnoses, and processed the cases faster and with a lower number of fixations than did the students. Further, the students and residents demonstrated different reading patterns with regard to which slides they proportionally paid most attention. The observed differences could be utilized in medical education to model expert reasoning and to teach the manner in which a good medical text is constructed. Eye-tracking methodology appears to have a great deal of potential in evaluating performance and growing diagnostic expertise in reading medical texts. However, further research using medical texts as stimuli is required. Anat Sci Educ 10: 23-33. © 2016 American Association of Anatomists.

Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning

PURPOSE

To compare structured versus nonstructured reporting of multiphasic computed tomography (CT) for staging of pancreatic cancer and the effects of both types of reporting on subjective assessment of resectability.

MATERIALS AND METHODS

This institutional review board-approved, HIPAA-compliant retrospective study with waiver of informed consent included all patients who were referred for presurgical multiphasic CT of the pancreas between December 2006 and April 2011 at one institution before and after implementation (April 2008) of a structured reporting template. The template was created specifically for reporting multiphasic CT results to stage pancreatic cancer in patients and contained specific information relevant to surgical and oncologic planning. Multiphasic CT reports were assessed for the presence of 12 key features required for staging and surgical planning, including location, size, enhancement, node status, and vascular involvement. Three pancreatic surgeons evaluated the reports to assess resectability, surgical planning, and ease of extracting information before and after reviewing the multiphasic CT images blinded to the patient identifiers. The Student t test and χ(2) test were used for statistical analysis.

RESULTS

Forty-eight (40%) structured and 72 (60%) nonstructured multiphasic CT reports were reviewed. Nonstructured reports contained a mean ± standard deviation of 7.3 key features ± 2.1 (range, 1-11) and structured reports contained 10.6 ± 0.9 (range, 9-12) features (P < .001). Information for surgical planning was deemed easily accessible in 94%, 60%, and 98% of structured and 47%, 54%, and 32% of nonstructured reports by the three surgeons, respectively (P < .001, .79, < .001). Surgeons had sufficient information for surgical planning in 96%, 69%, and 98% of structured and 31%, 43%, and 25% of nonstructured reports (P < .001, .009, and < .001). When surgeons reviewed reports in combination with multiphasic CT images, they were more likely to convert an answer of "unsure" regarding resectability to a definitive answer (ie, resectable or unresectable) when the reports were structured than when they were nonstructured.

CONCLUSION

Structured reporting of pancreatic multiphasic CT provided superior evaluation of pancreatic cancer and facilitated surgical planning. Surgeons were more confident regarding decisions about tumor resectability when they reviewed structured reports before review of multiphasic CT images.

Preferences for structured reporting of measurement data: an institutional survey of medical oncologists, oncology registrars, and radiologists

RATIONALE AND OBJECTIVES

The aim of this study was to determine whether key radiology report "consumers" in our institution prefer structured measurement reporting in a dedicated report section over the current practice of embedding measurements throughout the "Findings" section, given the availability of new tools for quantitative imaging interpretation that enable automated structured reporting of measurement data.

MATERIALS AND METHODS

Oncologic clinicians and radiologists at our institution were surveyed regarding their preferences for a standard report versus three reports each having uniquely formatted dedicated "Measurements" sections and regarding their impressions of various characteristics of report quality demonstrated by these reports. The online survey was completed by 25 radiologists, 16 oncologists, and 17 oncology nurses and research assistants (registrars).

RESULTS

Aggregation of respondents' preferences by group into single orderings using the Kemeny-Young method revealed that both oncology groups preferred all proposed reports to the standard report but that radiologists only preferred two of the proposed reports to the standard report. All preferences for proposed reports in the two oncology groups were statistically significant based on Wilcoxon tests, but the preference for only one of the proposed reports was significant for radiologists. Additional results suggest that these preferences are driven by respondent favor for the readability of and confidence conveyed by the proposed reports compared to the standard report.

CONCLUSIONS

Oncologic clinicians responding to our survey preferred communication of lesion measurements in a separate report section to the current practice of embedding measurements throughout the "Findings" section, based on their assessments of reports containing simulated measurement sections assembled from a single sample report using standardized formatting.

Cross-specialty integrated resident conferences: an educational approach to bridging the gap

RATIONALE AND OBJECTIVES

Radiologists play a pivotal role in patient management, primarily through interacting with referring clinicians. Despite this extensive cross-specialty interaction, radiology resident education rarely involves direct education from clinicians outside the department. We surveyed resident attitudes toward integrated conferences with subspecialty referring physicians both before and after a pilot lecture series at our institution.

MATERIALS AND METHODS

Three thoracic-themed multidisciplinary conferences were organized, which involved a variety of clinicians lecturing during normal resident conference times. Resident surveys were administered before and after the complete lectures series as well as immediately after each individual lecture.

RESULTS

The prelecture series survey indicated residents felt neutral about their confidence in knowing what clinicians want from radiology reports and the current level of "clinician-focus" in the curriculum. Residents indicated a desire for more clinician involvement in lectures. After completion of the series, residents expressed that the integrated conferences were useful and that they had greater confidence in understanding the clinicians' expectation of reports. Resident interest in clinician participation in lectures was higher after series completion. Most residents indicated that prespecified, self-identified learning objectives were met by the lectures. After the completion of the series, most residents indicated that they wanted the series to continue, with the most commonly indicated desired frequency being once or twice a month.

CONCLUSION

Subspecialty clinician participation in a cross-specialty integrated resident lecture series was highly favored and well received. An "Integrated Clinical Lecture Series" may be a beneficial addition to radiology residency curriculums.