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Ginocchio LA, Dane B, Smereka PN, Megibow AJ, Remzi FH, Esen E, Huang C. Structured versus non-structured reporting of pelvic MRI for ileal pouch evaluation: clarity and effectiveness. Abdom Radiol (NY) 2023; 48:2978-2985. [PMID: 36871233 DOI: 10.1007/s00261-023-03858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Given that ileal pouch-anal anastomosis (IPAA) surgery is a technically challenging and high-morbidity procedure, there are numerous pertinent imaging findings that need to be clearly and efficiently communicated to the IBD surgeons for essential patient management and surgical planning. Structured reporting has been increasingly used over the past decade throughout various radiology subspecialties to improve reporting clarity and completeness. We compare structured versus non-structured reporting of pelvic MRI for ileal pouch to evaluate for clarity and effectiveness. METHODS 164 consecutive pelvic MRI's for ileal pouch evaluation, excluding subsequent exams for the same patient, acquired between 1/1/2019 and 7/31/2021 at one institution were included, before and after implementation (11/15/2020) of a structured reporting template, which was created with institutional IBD surgeons. Reports were assessed for the presence of 18 key features required for complete ileal pouch assessment: anastomosis (IPAA, tip of J, pouch body), cuff (length, cuffitis), pouch body (size, pouchitis, stricture), pouch inlet/pre-pouch ileum (stricture, inflammation, sharp angulation), pouch outlet (stricture), peripouch mesentery (position, mesentery twist), pelvic abscess, peri-anal fistula, pelvic lymph nodes, and skeletal abnormalities. Subgroup analysis was performed based on reader experience and divided into three categories: experienced (n = 2), other intra-institutional (n = 20), or affiliate site (n = 6). RESULTS 57 (35%) structured and 107 (65%) non-structured pelvic MRI reports were reviewed. Structured reports contained 16.6 [SD:4.0] key features whereas non-structured reports contained 6.3 [SD:2.5] key features (p < .001). The largest improvement following template implementation was for reporting sharp angulation of the pouch inlet (91.2% vs. 0.9%, p < .001), tip of J suture line and pouch body anastomosis (both improved to 91.2% from 3.7%). Structured versus non-structured reports contained mean 17.7 versus 9.1 key features for experienced readers, 17.0 versus 5.9 for other intra-institutional readers, and 8.7 versus 5.3 for affiliate site readers. CONCLUSION Structured reporting of pelvic MRI guides a systematic search pattern and comprehensive evaluation of ileal pouches, and therefore facilitates surgical planning and clinical management. This standardized reporting template can serve as baseline at other institutions for adaptation based on specific radiology and surgery preferences, fostering a collaborative environment between radiology and surgery, and ultimately improving patient care.
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Affiliation(s)
- Luke A Ginocchio
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA.
| | - Bari Dane
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Paul N Smereka
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Alec J Megibow
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Feza H Remzi
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Eren Esen
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
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Reporting of acute pancreatitis by radiologists-time for a systematic change with structured reporting template. Abdom Radiol (NY) 2020; 45:1277-1289. [PMID: 32189022 PMCID: PMC7223113 DOI: 10.1007/s00261-020-02468-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis has a wide array of imaging presentations. Various classifications have been used in the past to standardize the terminology and reduce confusing and redundant terms. We aim to review the historical and current classifications of acute pancreatitis and propose a new reporting template which can improve communication between various medical teams by use of appropriate terminology and structured radiology template. The standardized reporting template not only conveys the most important imaging findings in a simplified yet comprehensive way but also allows structured data collection for future research and teaching purposes.
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Liu Y, Feng Z, Qin S, Yang J, Han C, Wang X. Structured reports of pelvic magnetic resonance imaging in primary endometrial cancer: Potential benefits for clinical decision-making. PLoS One 2019; 14:e0213928. [PMID: 30908525 PMCID: PMC6433257 DOI: 10.1371/journal.pone.0213928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Yi Liu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zonghao Feng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Shengtang Qin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Chao Han
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
- * E-mail:
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Kok EM, Abed A, Robben SGF. Does the Use of a Checklist Help Medical Students in the Detection of Abnormalities on a Chest Radiograph? J Digit Imaging 2018; 30:726-731. [PMID: 28560508 PMCID: PMC5681473 DOI: 10.1007/s10278-017-9979-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The interpretation of chest radiographs is a complex task that is prone to diagnostic error, especially for medical students. The aim of this study is to investigate the extent to which medical students benefit from the use of a checklist regarding the detection of abnormalities on a chest radiograph. We developed a checklist based on literature and interviews with experienced thorax radiologists. Forty medical students in the clinical phase assessed 18 chest radiographs during a computer test, either with (n = 20) or without (n = 20) the checklist. We measured performance and asked participants for feedback using a survey. Participants that used a checklist detected more abnormalities on images with multiple abnormalities (M = 50.1%) than participants that could not use a checklist (M = 41.9%), p = 0.04. The post-experimental survey shows that on average, participants considered the checklist helpful (M = 3.25 on a five-point scale), but also time consuming (M = 3.30 on a five-point scale). In conclusion, a checklist can help medical students to detect abnormalities in chest radiographs. Moreover, students tend to appreciate the use of a checklist as a helpful tool during the interpretation of a chest radiograph. Therefore, a checklist is a potentially important tool to improve radiology education in the medical curriculum.
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Affiliation(s)
- Ellen M Kok
- School of Health Professions Education, Department of Educational Research and Development, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Abdelrazek Abed
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Katholisches Karl-Leisner-Klinikum, Albersallee 5-7, 47533, Kleve, Germany
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Rinzler E. What Radiologists Can Learn From Fighter Pilots. J Am Coll Radiol 2017; 14:693-696. [DOI: 10.1016/j.jacr.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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Brook OR, Brook A, Vollmer CM, Kent TS, Sanchez N, Pedrosa I. Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning. Radiology 2014; 274:464-72. [PMID: 25286323 DOI: 10.1148/radiol.14140206] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Olga R Brook
- From the Departments of Radiology (O.R.B., A.B.) and Surgery (T.S.K., N.S.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Surgery, University of Pennsylvania, Philadelphia, Pa (C.M.V.); and Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Rd, 2nd Floor, Suite 202.Dallas, TX 75390-9085 (I.P.)
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John SD, Moore QT, Herrmann T, Don S, Powers K, Smith SN, Morrison G, Charkot E, Mills TT, Rutz L, Goske MJ. The Image Gently pediatric digital radiography safety checklist: tools for improving pediatric radiography. J Am Coll Radiol 2014; 10:781-8. [PMID: 24091048 DOI: 10.1016/j.jacr.2013.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/28/2013] [Indexed: 11/30/2022]
Abstract
Transition from film-screen to digital radiography requires changes in radiographic technique and workflow processes to ensure that the minimum radiation exposure is used while maintaining diagnostic image quality. Checklists have been demonstrated to be useful tools for decreasing errors and improving safety in several areas, including commercial aviation and surgical procedures. The Image Gently campaign, through a competitive grant from the FDA, developed a checklist for technologists to use during the performance of digital radiography in pediatric patients. The checklist outlines the critical steps in digital radiography workflow, with an emphasis on steps that affect radiation exposure and image quality. The checklist and its accompanying implementation manual and practice quality improvement project are open source and downloadable at www.imagegently.org. The authors describe the process of developing and testing the checklist and offer suggestions for using the checklist to minimize radiation exposure to children during radiography.
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Affiliation(s)
- Susan D John
- Department of Diagnostic and Interventional Imaging, The University of Texas Medical School, Houston, Texas; Department of Pediatrics, The University of Texas Medical School, Houston, Texas.
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Powell DK, Lin E, Silberzweig JE, Kagetsu NJ. Introducing radiology report checklists among residents: adherence rates when suggesting versus requiring their use and early experience in improving accuracy. Acad Radiol 2014; 21:415-23. [PMID: 24507429 DOI: 10.1016/j.acra.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES To retrospectively compare resident adherence to checklist-style structured reporting for maxillofacial computed tomography (CT) from the emergency department (when required vs. suggested between two programs). To compare radiology resident reporting accuracy before and after introduction of the structured report and assess its ability to decrease the rate of undetected pathology. MATERIALS AND METHODS We introduced a reporting checklist for maxillofacial CT into our dictation software without specific training, requiring it at one program and suggesting it at another. We quantified usage among residents and compared reporting accuracy, before and after counting and categorizing faculty addenda. RESULTS There was no significant change in resident accuracy in the first few months, with residents acting as their own controls (directly comparing performance with and without the checklist). Adherence to the checklist at program A (where it originated and was required) was 85% of reports compared to 9% of reports at program B (where it was suggested). When using program B as a secondary control, there was no significant difference in resident accuracy with or without using the checklist (comparing different residents using the checklist to those not using the checklist). CONCLUSIONS Our results suggest that there is no automatic value of checklists for improving radiology resident reporting accuracy. They also suggest the importance of focused training, checklist flexibility, and a period of adjustment to a new reporting style. Mandatory checklists were readily adopted by residents but not when simply suggested.
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Affiliation(s)
- Daniel K Powell
- Department of Radiology, Beth Israel Medical Center, First Ave at 16th St, 2K-01, New York City, NY 10003.
| | - Eaton Lin
- Department of Radiology, St. Luke's Roosevelt Hospital, New York City, NY
| | - James E Silberzweig
- Department of Radiology, Beth Israel Medical Center, First Ave at 16th St, 2K-01, New York City, NY 10003
| | - Nolan J Kagetsu
- Department of Radiology, St. Luke's Roosevelt Hospital, New York City, NY
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Iyer RS, Otjen JP, Weinberger E. Check, mate: integrating checklists within diagnostic radiology departments. J Am Coll Radiol 2013; 10:488-90. [PMID: 23499403 DOI: 10.1016/j.jacr.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Ramesh S Iyer
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington 98105, USA.
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