From guidelines to practice: how reporting templates promote the use of radiology practice guidelines

Harnessing artificial intelligence in radiology to augment population health

This review article serves to highlight radiological services as a major cost driver for the healthcare sector, and the potential improvements in productivity and cost savings that can be generated by incorporating artificial intelligence (AI) into the radiology workflow, referencing Singapore healthcare as an example. More specifically, we will discuss the opportunities for AI in lowering healthcare costs and supporting transformational shifts in our care model in the following domains: predictive analytics for optimising throughput and appropriate referrals, computer vision for image enhancement (to increase scanner efficiency and decrease radiation exposure) and pattern recognition (to aid human interpretation and worklist prioritisation), natural language processing and large language models for optimising reports and text data-mining. In the context of preventive health, we will discuss how AI can support population level screening for major disease burdens through opportunistic screening and democratise expertise to increase access to radiological services in primary and community care.

Association between clinical history in the radiographic request and diagnostic accuracy of thorax radiographs in dogs: A retrospective case-control study

BACKGROUND

The effect of clinical history on the interpretation of radiographs has been widely researched in human medicine. There is, however, no data on this topic in veterinary medicine.

HYPOTHESIS/OBJECTIVES

Diagnostic accuracy would improve when history was supplied.

ANIMALS

Thirty client-owned dogs with abnormal findings on thoracic radiographs and confirmation of the disease, and 30 healthy client-owned controls were drawn retrospectively.

METHODS

Retrospective case-control study. Sixty radiographic studies of the thorax were randomized and interpreted by 6 radiologists; first, with no access to the clinical information; and a second time with access to all pertinent clinical information and signalment.

RESULTS

A significant increase in diagnostic accuracy was noted when clinical information was provided (64.4% without and 75.2% with clinical information; P = .002). There was no significant difference in agreement between radiologists when comparing no clinical information and with clinical information (Kappa 0.313 and 0.300, respectively).

CONCLUSIONS AND CLINICAL IMPORTANCE

The addition of pertinent clinical information to the radiographic request significantly improves the diagnostic accuracy of thorax radiographs of dogs and is recommended as standard practice.

Time for change? Radiologists highly concordant assessing change in stenoses on follow-up cervical spine MRI

OBJECTIVE

There is considerable variability among radiologists when grading spinal canal and foraminal stenosis on MRI. However, to date, studies have not evaluated radiologists' agreement when assessing interval change in cervical spine stenoses. The purpose of this study was to evaluate radiologists' concordance for change in cervical spine stenoses on follow-up MRIs, a major indication for these exams.

METHODS

Initial and follow-up cervical MRIs were retrospectively reviewed by three blinded radiologists. Spinal canal and foramina from C1 through T1 were rated for interval change and concordance between the blinded raters was calculated. The original MRI reports were also reviewed for specific language assessing interval change on the follow-up exams.

RESULTS

40 cervical MRI exams and 40 corresponding MRI follow-ups were assessed. Agreement for interval change in spinal canal and foraminal stenosis was near perfect amongst all readers (kappa values of 0.78-0.94). 97% of the original MRI reports used the standard severity scale. 68% of follow-up MRI reports specifically assessed for change.

DISCUSSION

Blinded radiologists had high agreement when assessing for change in spinal canal and foraminal stenosis on follow-up cervical spine MRIs. Because of inter-rater variability in stenosis grading, reports that do not emphasize change assessment, may imply change that is not truly present. For clarity and consistency in reporting of cervical spine stenoses, change assessment should be emphasized and added to structured reporting templates.

The FIND Program: Improving Follow-up of Incidental Imaging Findings

Incidental findings are findings identified on imaging which are unrelated to the original reason for examination and require follow-up. The Radiology Finding Incidental Disease (FIND) Program was designed to track and improve follow-up of incidental imaging findings. The purpose of this study was to determine the frequency of incidental findings on cross-sectional imaging and the adherence to suggested follow-up of incidental findings prior to and after implementation of a structured reporting and tracking system. A retrospective analysis of 2000 patients with computed tomographic cross-sectional imaging was performed: 1000 patients prior to implementation of the FIND Program and 1000 patients 1 year after establishment of the program. Data collected included the frequency of incidental findings, inclusion of follow-up recommendations in the radiology report, and adherence to suggested follow-up. There was a higher rate of completion of recommended follow-up imaging in the post-implementation group (34/67, 50.7%) compared to the pre-implementation (16/52, 30.8%) (p = 0.03). Implementation of an incidental findings tracking program resulted in improved follow-up of incidental imaging findings. This has the potential to reduce the burden of clinically significant incidental findings possibly resulting in later presentation of advanced disease.

Structured Reporting of Head and Neck Sonography Achieves Substantial Interrater Reliability

Purpose Ultrasound examinations are often criticized for having higher examiner dependency compared to other imaging techniques. Compared to free-text reporting, structured reporting (SR) of head and neck sonography (HNS) achieves superior time efficiency as well as report quality. However, there are no findings concerning the influence of SR on the interrater reliability (IRR) of HNS. Materials and Methods Typical pathologies (n=4) in HNS were documented by video/images by two certified head and neck ultrasound instructors. Consequently, structured reports of these videos/images were created by n=9 senior physicians at departments of otolaryngology or maxillofacial surgery with DEGUM instructors on staff. Reports (n=36) were evaluated regarding overall completeness and IRR. Additionally, user satisfaction was assessed by a visual analog scale (VAS). Results SR yielded very high report completeness (91.8%) in all four cases with a substantial IRR (Fleiss' κ 0.73). Interrater agreement was high at 87.2% with very good user satisfaction (VAS 8.6). Conclusion SR has the potential to ensure high-quality examination reports with substantial comparability and very high user satisfaction. Furthermore, big data collection and analysis are facilitated by SR. Therefore, process quality, workflow, and scientific output are potentially enhanced by SR.

Utility of a Rule-Based Algorithm in the Assessment of Standardized Reporting in PI-RADS

RATIONALE AND OBJECTIVES

Adoption of the Prostate Imaging Reporting & Data System (PI-RADS) has been shown to increase detection of clinically significant prostate cancer on prostate mpMRI. We propose that a rule-based algorithm based on Regular Expression (RegEx) matching can be used to automatically categorize prostate mpMRI reports into categories as a means by which to assess for opportunities for quality improvement.

MATERIALS AND METHODS

All prostate mpMRIs performed in the Duke University Health System from January 2, 2015, to January 29, 2021, were analyzed. Exclusion criteria were applied, for a total of 5343 male patients and 6264 prostate mpMRI reports. These reports were then analyzed by our RegEx algorithm to be categorized as PI-RADS 1 through PI-RADS 5, Recurrent Disease, or "No Information Available." A stratified, random sample of 502 mpMRI reports was reviewed by a blinded clinical team to assess performance of the RegEx algorithm.

RESULTS

Compared to manual review, the RegEx algorithm achieved overall accuracy of 92.6%, average precision of 88.8%, average recall of 85.6%, and F1 score of 0.871. The clinical team also reviewed 344 cases that were classified as "No Information Available," and found that in 150 instances, no numerical PI-RADS score for any lesion was included in the impression section of the mpMRI report.

CONCLUSION

Rule-based processing is an accurate method for the large-scale, automated extraction of PI-RADS scores from the text of radiology reports. These natural language processing approaches can be used for future initiatives in quality improvement in prostate mpMRI reporting with PI-RADS.

Clinical Routine and Necessary Advances in Soft Tissue Tumor Imaging Based on the ESSR Guideline: Initial Findings

Soft tissue sarcomas are malignant diseases with a complex classification and various histological subtypes, mostly clinically inconspicuous appearance, and a rare occurrence. To ensure safe patient care, the European Society of Musculoskeletal Radiology (ESSR) issued a guideline for diagnostic imaging of soft tissue tumors in adults in 2015. In this study, we investigated whether implementation of these guidelines resulted in improved MRI protocol and report quality in patients with soft tissue sarcomas in our cancer center. All cases of histologically confirmed soft tissue sarcomas that were treated at our study center from 2006 to 2018 were evaluated retrospectively. The radiological reports were examined for their compliance with the recommendations of the ESSR. Patients were divided into two groups, before and after the introduction of the 2015 ESSR guidelines. In total, 103 cases of histologically confirmed sarcomas were studied. The distribution of, age, gender, number of subjects, performing radiology, and MRI indication on both groups did not show any significant differences. Only using the required MRI sequences showed a significant improvement after the introduction of the guidelines (p = 0.048). All other criteria, especially the requirements for the report of findings, showed no improvement. The guidelines of the European Society for Musculoskeletal Radiology are not regularly followed, and their establishment did not consistently improve MRI quality in our study group. This poses a risk for incorrect or delayed diagnosis and, ultimately, therapy of soft tissue tumors. However, this study is the first of its kind and involves a limited collective. A European-wide multicenter study would be appreciated to confirm these results.

Radiological Structured Report Integrated with Quantitative Imaging Biomarkers and Qualitative Scoring Systems

The benefits of structured reporting (SR) in radiology are well-known and have been widely described. However, there are limitations that must be overcome. Radiologists may be reluctant to change the conventional way of reporting. Error rates could potentially increase if SR is used improperly. Interruption of the visual search pattern by keeping the eyes focused on the report rather than the images may increase reporting time. Templates that include unnecessary or irrelevant information may undermine the consistency of the report. Last, the lack of support for multiple languages may hamper the adaptation of the report to the target audience. This work aims to mitigate these limitations with a web-based structured reporting system based on templates. By including field validators and logical rules, the system avoids reporting mistakes and allows to automatically calculate values and radiological qualitative scores. The system can manage quantitative information from imaging biomarkers, combining this with qualitative radiological information usually present in the structured report. It manages SR templates as plugins (IHE MRRT compliant and compatible with RSNA's Radreport templates), ensures a seamless integration with PACS/RIS systems, and adapts the report to the target audience by means of natural language extracts generated in multiple languages. We describe a use case of SR template for prostate cancer including PI-RADS 2.1 scoring system and imaging biomarkers. For the time being, the system comprises 24 SR templates and provides service in 37 hospitals and healthcare institutions, endorsing the success of this contribution to mitigate some of the limitations of the SR.

Structured Reports and Radiology Residents: Friends or Foes?

Structured reports offer overall improvement in quality and safety, largely centered upon more effective communication. Structured reporting is helpful to trainees as a method to develop organized search patterns and include pertinent positive and negative findings. However, limitations of structured report use include lack of development of individualized search patterns and failure to recognize key elements of the report to be formulated in the impression. Instruction on the value of a structured reporting approach, its impact on patient care and clinical service, and compliance with billing requirements must be balanced with early and consistent feedback on appropriate use and reporting errors. It is incumbent upon radiology educators to integrate and optimize structured reporting in the learning environment. This manuscript addresses the impact of structured reporting on radiology education, reviewing quality and safety considerations, detailing benefits and drawbacks for trainees, and offering strategies for optimizing the use of structured reporting/templates in the training environment.

[Structured reporting in radiology : German and European radiology societies' point of view]

Zahlreiche Publikationen belegen den herausragenden Wert einer strukturierten Befundung sowohl für die Kommunikation mit zuweisenden klinischen Kollegen als auch für die Weiterverwendung der Befunddaten in anderen Kontexten. Obwohl das Thema bereits seit vielen Jahren in der Radiologie bekannt ist, hat sich die strukturierte Befundung noch nicht flächendeckend in der klinischen Routine etablieren können. Alle größeren radiologischen Fachgesellschaften haben sich klar für die strukturierte Befundung ausgesprochen und verfolgen etliche Initiativen auf diesem Gebiet. Dazu zählt der Aufbau frei zugänglicher Sammlungen von Befundvorlagen und die Qualitätssicherung derselben sowie die Pflege und Entwicklung standardisierter Begriffslexika. Im vorliegenden Artikel werden insbesondere die Aktivitäten der Deutschen Röntgengesellschaft und der European Society of Radiology dargestellt sowie ein kurzer Überblick über Vor- und Nachteile und verfügbare Ressourcen gegeben.

Meaningful words in rectal MRI synoptic reports: How "polypoid" may be prognostic

PURPOSE

This study explored the clinicopathologic outcomes of rectal tumor morphological descriptors used in a synoptic rectal MRI reporting template and determined that prognostic differences were observed.

METHODS

This retrospective study was conducted at a comprehensive cancer center. Fifty patients with rectal tumors for whom the synoptic descriptor "polypoid" was chosen by three experienced radiologists were compared with ninety comparator patients with "partially circumferential" and "circumferential" rectal tumors. Two radiologists re-evaluated all cases. The outcome measures were agreement among two re-interpreting radiologists, clinical T staging with MRI (mrT) and descriptive nodal features, and degrees of wall attachment of tumors (on MRI) compared with pathological (p) T and N stage when available.

RESULTS

Re-evaluation by two radiologists showed moderate to excellent agreement in tumor morphology, presence of a pedicle, and degree of wall attachment (k = 0.41-0.76) and excellent agreement on lymph node presence and size (ICC = 0.83-0.91). Statistically significant lower mrT stage was noted for polypoid morphology, wherein 98% were mrT1/2, while only 7% and 2% of partially circumferential and circumferential tumors respectively were mrT1/2. Pathologic T and N stages among the three morphologies also differed significantly, with only 14% of polypoid cases higher than stage pT2 compared to 48% of partially circumferential cases and 60% of circumferential cases.

CONCLUSION

Using a "polypoid" morphology in rectal cancer MRI synoptic reports revealed a seemingly distinct phenotype with lower clinical and pathologic T and N stages when compared with alternative available descriptors.

PRECIS

"Polypoid" morphology in rectal cancer confers a lower clinical and pathologic T and N stage and may be useful in determining whether to proceed with surgery versus neoadjuvant treatment.

How to Use LI-RADS to Report Liver CT and MRI Observations

Primary liver cancer is the fourth leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) comprising the vast majority of primary liver malignancies. Imaging plays a central role in HCC diagnosis and management. As a result, the content and structure of radiology reports are of utmost importance in guiding clinical management. The Liver Imaging Reporting and Data System (LI-RADS) provides guidance for standardized reporting of liver observations in patients who are at risk for HCC. LI-RADS standardized reporting intends to inform patient treatment and facilitate multidisciplinary communication and decisions, taking into consideration individual clinical factors. Depending on the context, observations may be reported individually, in aggregate, or as a combination of both. LI-RADS provides two templates for reporting liver observations: in a single continuous paragraph or in a structured format with keywords and imaging findings. The authors clarify terminology that is pertinent to reporting, highlight the benefits of structured reports, discuss the applicability of LI-RADS for liver CT and MRI, review the elements of a standardized LI-RADS report, provide guidance on the description of LI-RADS observations exemplified with two case-based reporting templates, illustrate relevant imaging findings and components to be included when reporting specific clinical scenarios, and discuss future directions. An invited commentary by Yano is available online. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide and a major healthcare burden in most societies. Computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the medical care of patients with or at risk for hepatocellular carcinoma (HCC). When stringent imaging criteria are fulfilled, CT and MRI allow for diagnosis, staging, and assessment of response to treatment, without the need for invasive workup, and can inform clinical decision making. Owing to the central role of these imaging modalities in HCC management, standardization is essential to facilitate proper imaging technique, accurate interpretation, and clear communication among all stakeholders in both the clinical practice and research settings. The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system that provides standardization across the continuum of HCC imaging, including ordinal probabilistic approach for reporting that directs individualized management. This review discusses the up-to-date role of CT and MRI in HCC imaging from the LI-RADS perspective. It also provides a glimpse into the future by discussing how advances in knowledge and technology are likely to enrich the LI-RADS approach.

Improving Billing Accuracy Through Enterprise-Wide Standardized Structured Reporting With Cross-Divisional Shared Templates

OBJECTIVE

We describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured template adoption.

METHODS

Enterprise-wide standardized structured CXR reporting was implemented in a large urban health care enterprise in two phases from September 2016 to March 2019: initial implementation of division-specific structured templates followed by introduction of auto launching cross-divisional consensus structured templates. Usage was tracked over time, and potential radiologist time savings were estimated. Correct-to-bill (CTB) rates were collected between January 2018 and May 2019 for radiography.

RESULTS

CXR structured template adoption increased from 46% to 92% in phase 1 and to 96.2% in phase 2, resulting in an estimated 8.5 hours per month of radiologist time saved. CTB rates for both radiographs and all radiology reports showed a linearly increasing trend postintervention with radiography CTB rate showing greater absolute values with an average difference of 20% throughout the sampling period. The CTB rate for all modalities increased by 12%, and the rate for radiography increased by 8%.

DISCUSSION

Change management strategies prompted adoption of division-specific structured templates, and exposure via auto launching enforced widespread adoption of consensus templates. Standardized structured reporting resulted in both economic gains and projected radiologist time saved.

Comparative analysis of machine learning algorithms for computer-assisted reporting based on fully automated cross-lingual RadLex mappings

Computer-assisted reporting (CAR) tools were suggested to improve radiology report quality by context-sensitively recommending key imaging biomarkers. However, studies evaluating machine learning (ML) algorithms on cross-lingual ontological (RadLex) mappings for developing embedded CAR algorithms are lacking. Therefore, we compared ML algorithms developed on human expert-annotated features against those developed on fully automated cross-lingual (German to English) RadLex mappings using 206 CT reports of suspected stroke. Target label was whether the Alberta Stroke Programme Early CT Score (ASPECTS) should have been provided (yes/no:154/52). We focused on probabilistic outputs of ML-algorithms including tree-based methods, elastic net, support vector machines (SVMs) and fastText (linear classifier), which were evaluated in the same 5 × fivefold nested cross-validation framework. This allowed for model stacking and classifier rankings. Performance was evaluated using calibration metrics (AUC, brier score, log loss) and -plots. Contextual ML-based assistance recommending ASPECTS was feasible. SVMs showed the highest accuracies both on human-extracted- (87%) and RadLex features (findings:82.5%; impressions:85.4%). FastText achieved the highest accuracy (89.3%) and AUC (92%) on impressions. Boosted trees fitted on findings had the best calibration profile. Our approach provides guidance for choosing ML classifiers for CAR tools in fully automated and language-agnostic fashion using bag-of-RadLex terms on limited expert-labelled training data.

Lexicon for renal mass terms at CT and MRI: a consensus of the society of abdominal radiology disease-focused panel on renal cell carcinoma

PURPOSE

There is substantial variation in the radiologic terms used to characterize renal masses, leading to ambiguity and inconsistency in clinical radiology reports and research studies. The purpose of this study was to develop a standardized lexicon to describe renal masses at CT and MRI.

MATERIALS AND METHODS

This multi-institutional, prospective, quality improvement project was exempt from IRB oversight. Thirteen radiologists belonging to the Society of Abdominal Radiology (SAR) disease-focused panel on renal cell carcinoma representing nine academic institutions participated in a modified Delphi process to create a lexicon of terms used to describe imaging features of renal masses at CT and MRI. In the first round, members voted on terms to be included and proposed definitions; subsequent voting rounds and a teleconference established consensus. One non-voting member developed the questionnaire and consolidated responses. Consensus was defined as ≥ 80% agreement.

RESULTS

Of 37 proposed terms, 6 had consensus to be excluded. Consensus for inclusion was reached for 30 of 31 terms (13/14 basic imaging terms, 8/8 CT terms, 6/6 MRI terms and 3/3 miscellaneous terms). Despite substantial initial disagreement about definitions of 'renal mass,' 'necrosis,' 'fat,' and 'restricted diffusion' in the first round, consensus for all was eventually reached. Disagreement remained for the definition of 'solid mass.'

CONCLUSIONS

A modified Delphi method produced a lexicon of preferred terms and definitions to be used in the description of renal masses at CT and MRI. This lexicon should improve clarity and consistency of radiology reports and research related to renal masses.

Structured prostate MRI reporting: how and why

Over the past decade, the Prostate Imaging-Reporting and Data System (PI-RADS) has revolutionized the manner in which prostate cancer is screened for, detected, biopsied, and managed. The single greatest contribution of PI-RADS has been the standardization of interpretation and reporting of findings on MRI of the prostate. This standardization has led to the wide acceptance of the PI-RADS lexicon at a time when structured reporting templates are becoming more widespread in radiology and other medical fields. The author reviews the benefits of structured reporting templates with a focus on prostate MRI, prior studies on this topic, and details of a suggested template.

Innovative standardized reporting template for prostate mpMRI improves clarity and confidence in the report

PURPOSE

The goal of the current study was to evaluate the effect of a standardized prostate mpMRI reporting template on urologists' understanding and confidence in counselling a patient on the results of the MRI. To do this we performed a survey study to assess the understanding and confidence of urologists reviewing reports prior to (pre) and after (post) adoption of a standardized mpMRI template.

METHODS

Six urologists reviewed ten pre- and post- mpMRI templated reports and completed a survey to assess the clarity of key elements and the confidence in counseling the patient. The urologists were blinded to the study objective. Nonparametric constrained permutation test for significance was performed to compare the results prior to and after implementation of the template.

RESULTS

29 pre- and 30 post-template mpMRI reports were reviewed. The average score for the post-template reports was significantly higher (10.7 ± 0.6 vs 7.5 ± 2.7 [ p< 0.001]) regardless of the reviewer. Urologists were also overall more confident in counselling patients when the standardized mpMRI reporting template had been used.

CONCLUSION

Implementation of a standardized template for reporting of prostate mpMRI findings resulted in improved clarity and confidence in counselling patients. Radiologists should consider implementing a standardized reporting template to improve clinicians' understanding and confidence of the report.

Reporting on Renal Masses, Recommendations for Terminology, and Sample Templates

Given the incidence of small renal masses, from benign cysts to malignancy, most radiologists encounter these lesions multiple times during their career. Radiologists have an opportunity to provide critical data that will further refine the understanding of the impact of these masses on patient outcomes. This article summarizes and describes recent updates and understanding of the critical observations and descriptors of renal masses. The templates and glossary of terms presented in this review article facilitate the radiology reporting of such data elements, giving radiologists the opportunity to improve diagnostic accuracy and influence management of small renal masses.

Common Data Elements in Head and Neck Radiology Reporting

Radiologists must convert the complex information in head and neck imaging into text reports that can be understood and used by clinicians, patients, and fellow radiologists for patient care, research, and quality initiatives. Common data elements in reporting, through use of defined questions with constrained answers and terminology, allow radiologists to incorporate best practice standards and improve communication of information regardless of individual reporting style. Use of common data elements for head and neck reporting has the potential to improve outcomes, reduce errors, and transition data consumption not only for humans but future machine learning systems.

Ontology-Based Radiology Teaching File Summarization, Coverage, and Integration

Radiology teaching file repositories contain a large amount of information about patient health and radiologist interpretation of medical findings. Although valuable for radiology education, the use of teaching file repositories has been hindered by the ability to perform advanced searches on these repositories given the unstructured format of the data and the sparseness of the different repositories. Our term coverage analysis of two major medical ontologies, Radiology Lexicon (RadLex) and Unified Medical Language System (UMLS) Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), and two teaching file repositories, Medical Imaging Resource Community (MIRC) and MyPacs, showed that both ontologies combined cover 56.3% of terms in the MIRC and only 17.9% of terms in MyPacs. Furthermore, the overlap between the two ontologies (i.e., terms included by both the RadLex and UMLS SNOMED CT) was a mere 5.6% for the MIRC and 2% for the RadLex. Clustering the content of the teaching file repositories showed that they focus on different diagnostic areas within radiology. The MIRC teaching file covers mostly pediatric cases; a few cases are female patients with heart-, chest-, and bone-related diseases. The MyPacs contains a range of different diseases with no focus on a particular disease category, gender, or age group. MyPacs also provides a wide variety of cases related to the neck, face, heart, chest, and breast. These findings provide valuable insights on what new cases should be added or how existent cases may be integrated to provide more comprehensive data repositories. Similarly, the low-term coverage by the ontologies shows the need to expand ontologies with new terminology such as new terms learned from these teaching file repositories and validated by experts. While our methodology to organize and index data using clustering approaches and medical ontologies is applied to teaching file repositories, it can be applied to any other medical clinical data.

The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency

PURPOSE

Free text reports (FTR) of head and neck ultrasound studies are currently deployed in most departments. Because of a lack of composition and language, these reports vary greatly in terms of quality and reliability. This may impair the learning process during residency. The purpose of the study was to analyze the longitudinal effects of using structured reports (SR) of head and neck ultrasound studies during residency.

METHODS

Attending residents (n = 24) of a tripartite course on head and neck ultrasound, accredited by the German Society for Ultrasound in Medicine (DEGUM), were randomly allocated to pictures of common diseases. Both SRs and FTRs were compiled. All reports were analyzed concerning completeness, acquired time and legibility. Overall user contentment was evaluated by a questionnaire.

RESULTS

SRs achieved significantly higher ratings regarding completeness (95.6% vs. 26.4%, p < 0.001), description of pathologies (72.2% vs. 58.9%, p < 0.001) and legibility (100% vs. 52.4%, p < 0.001) with a very high inter-rater reliability (Fleiss' kappa 0.9). Reports were finalized significantly faster (99.1 s vs. 115.0 s, p < 0.001) and user contentment was significantly better when using SRs (8.3 vs. 6.3, p < 0.001). In particular, only SRs showed a longitudinally increasing time efficiency (- 20.1 s, p = 0.036) while maintaining consistent completeness ratings.

CONCLUSIONS

The use of SRs of head and neck ultrasound studies results in an increased longitudinal time-efficiency while upholding the report quality at the same time. This may indicate an additive learning effect of structured reporting. Superior outcomes in terms of comprehensiveness, legibility and time-efficiency can be observed immediately after implementation.

How scientific mobility can help current and future radiology research: a radiology trainee's perspective

One of the ways in which modern radiology is manifesting itself in higher education and research is through the increasing importance of scientific mobility. This article seeks to provide an overview and a prospective of radiology fellows in their last year of training about the current trends and policy tools for promoting mobility among young radiologists, especially inside the European Union. Nowadays, the need to promote international cooperation is even greater to ensure that the best evidence-based medical practices become a common background of a next cross-border generation of radiologists. Organisations such as the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA) are called upon to play as guarantors of the training of young radiologists building know-how and world-class excellence. Today, it is not just being certified radiologist that matters, the place where the training was done plays an important role in enhancing chances when applying for a high-level job or fellowship. The article argues that the mobility of radiology trainees is an indispensable prerequisite to face new challenges, including the application of artificial intelligence to medical imaging, which will require a large multicentre collaboration.

What do we know about volumetric medical image interpretation?: a review of the basic science and medical image perception literatures

Interpretation of volumetric medical images represents a rapidly growing proportion of the workload in radiology. However, relatively little is known about the strategies that best guide search behavior when looking for abnormalities in volumetric images. Although there is extensive literature on two-dimensional medical image perception, it is an open question whether the conclusions drawn from these images can be generalized to volumetric images. Importantly, volumetric images have distinct characteristics (e.g., scrolling through depth, smooth-pursuit eye-movements, motion onset cues, etc.) that should be considered in future research. In this manuscript, we will review the literature on medical image perception and discuss relevant findings from basic science that can be used to generate predictions about expertise in volumetric image interpretation. By better understanding search through volumetric images, we may be able to identify common sources of error, characterize the optimal strategies for searching through depth, or develop new training and assessment techniques for radiology residents.

Radiologist and multidisciplinary team clinician opinions on the quality of MRI rectal cancer staging reports: how are we doing?

AIM

To evaluate the current opinion of magnetic resonance imaging (MRI) reports amongst specialist clinicians involved in colorectal cancer multidisciplinary teams (CRC MDTs).

MATERIALS AND METHODS

Active participants at 16 UK CRC MDTs across a population of 5.7 million were invited to complete a questionnaire, this included 22 closed and three open questions. Closed questions used ordinal (Likert) scales to judge the subjective inclusion of tumour descriptors and impressions on the clarity and consistency of the MRI report. Open (free-text) questions allowed overall feedback and suggestions.

RESULTS

A total of 69 participants completed the survey (21 radiologists and 48 other CRC MDT clinicians). Both groups highlighted that reports commonly omit the status of the circumferential resection margin (CRM; 83% versus 81% inclusion, other clinicians and radiologists, respectively, p>0.05), presence or absence of extra-mural venous invasion (EMVI; 67% versus 57% inclusion, p>0.05), and lymph node status (90% inclusion in both groups). Intra-radiologist agreement across MRI examinations is reported as 75% by other clinicians. Free-text comments included suggestions for template-style reports.

CONCLUSION

Both groups recognise a proportion of MRI reports are suboptimal with key tumour descriptors omitted. There are also concerns around the presentation style of MRI reports and inter- and intra-radiologist report variability. The widespread implementation of standardised report templates may improve completeness and clarity of MRI reports for rectal cancer and thus clinical management and outcomes in rectal cancer.

Role of US LI-RADS in the LI-RADS Algorithm

The US Liver Imaging Reporting and Data System (LI-RADS) was released in 2017 and is the newest of the four American College of Radiology (ACR) LI-RADS algorithms. US LI-RADS provides standardized terminology, technical recommendations, and a reporting framework for US examinations performed for screening or surveillance in patients at risk for developing hepatocellular carcinoma (HCC). The appropriate patient population for screening and surveillance includes individuals who are at risk for developing HCC but do not have known or suspected cancer. This includes patients with cirrhosis from any cause and subsets of patients with chronic hepatitis B virus infection in the absence of cirrhosis. In an HCC screening or surveillance study, US LI-RADS recommends assigning two scores that apply to the entire study: the US category, which determines follow-up, and a visualization score, which communicates the expected level of sensitivity of the examination but does not affect management. Three US categories are possible: US-1 negative, a study with no evidence of HCC; US-2 subthreshold, a study in which an observation less than 10 mm is depicted that is not definitely benign; and US-3 positive, a study in which an observation greater than or equal to 10 mm or a new thrombus in vein is identified, for which diagnostic contrast material-enhanced imaging is recommended. Three visualization scores are possible: A (no or minimal limitations), B (moderate limitations), and C (severe limitations). ©RSNA, 2019.

Impact of structured reporting on developing head and neck ultrasound skills

BACKGROUND

Reports of head and neck ultrasound examinations are frequently written by hand as free texts. This is a serious obstacle to the learning process of the modality due to a missing report structure and terminology. Therefore, there is a great inter-observer variability in overall report quality. Aim of the present study was to evaluate the impact of structured reporting on the learning process as indicated by the overall report quality of head and neck ultrasound examinations within medical school education.

METHODS

Following an immersion course on head and neck ultrasound, previously documented images of three common pathologies were handed out to 58 medical students who asked to create both standard free text reports (FTR) and structured reports (SR). 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 two independent raters (Paired Wilcoxon test, 95% CI). Ratings were assessed for inter-rater reliability (Fleiss' kappa). Additionally, a questionnaire was utilized to evaluate user satisfaction.

RESULTS

SRs received significantly better ratings in terms of report completeness (97.7% vs. 53.5%, p < 0.001) regarding all items. In addition, pathologies were described in more detail using SRs (70% vs. 51.1%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 54.4%, p < 0.001). Mean time to complete was significantly lower (79.6 vs. 205.4 s, p < 0.001) and user satisfaction was significantly higher when using SRs (8.5 vs. 4.1, p < 0.001). Also, inter-rater reliability was very high (Fleiss' kappa 0.93).

CONCLUSIONS

SRs of head and neck ultrasound examinations provide more detailed information with a better readability in a time-saving manner within medical education. Also, medical students may benefit from SRs in their learning process due to the structured approach and standardized terminology.

Standardizing Magnetic Resonance Imaging Protocols, Requisitions, and Reports in Multiple Sclerosis: An Update for Radiologist Based on 2017 Magnetic Resonance Imaging in Multiple Sclerosis and 2018 Consortium of Multiple Sclerosis Centers Consensus Guidelines

The advent of magnetic resonance imaging has improved our understanding of the pathophysiology and natural course of multiple sclerosis (MS). The ability of magnetic resonance imaging to show the evolution of MS lesions on sequential scans has brought it to be one of the endpoints in clinical trials for disease-modifying therapies. Based on the most updated consensus guidelines from the American (Consortium of MS Centers) and European (Magnetic Resonance Imaging in MS) boards of experts in MS, this document shows the most relevant landmarks related to imaging findings, diagnostic criteria, indications to obtain a magnetic resonance, scan protocols and sequence options for patients with MS. Although incorporating the knowledge derived from the research arena into the daily clinical practice is always challenging, in this article, the authors provide useful recommendations to improve the information contained in the magnetic resonance report oriented to facilitate communication between radiologists and specialized medical teams involved in MS patients' multidisciplinary care.

How We Do It: Creating Consistent Structure and Content in Abdominal Radiology Report Templates

OBJECTIVE

The purposes of this article are to describe the creation of template report formats and content for a variety of abdominal and pelvic CT and MRI examinations and discuss a review-of-systems approach to text and avoidance of pitfalls of report templates.

CONCLUSION

Organ system-specific report templates for CT and MRI incorporate radiologist preferences. Disease-specific report templates are created from these reports to provide a consistent radiologist and referring physician experience across the report templates.

Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017

PURPOSE

To propose guidelines based on an expert-panel-derived unified approach to the technical performance, interpretation, and reporting of MRI for baseline and post-treatment staging of rectal carcinoma.

METHODS

A consensus-based questionnaire adopted with permission and modified from the European Society of Gastrointestinal and Abdominal Radiologists was sent to a 17-member expert panel from the Rectal Cancer Disease-Focused Panel of the Society of Abdominal Radiology containing 268 question parts. Consensus on an answer was defined as ≥ 70% agreement. Answers not reaching consensus (< 70%) were noted.

RESULTS

Consensus was reached for 87% of items from which recommendations regarding patient preparation, technical performance, pulse sequence acquisition, and criteria for MRI assessment at initial staging and restaging exams and for MRI reporting were constructed.

CONCLUSION

These expert consensus recommendations can be used as guidelines for primary and post-treatment staging of rectal cancer using MRI.

Objective Comparison Using Guideline-based Query of Conventional Radiological Reports and Structured Reports

BACKGROUND

This feasibility study of text-mining-based scoring algorithm provides an objective comparison of structured reports (SR) and conventional free-text reports (cFTR) by means of guideline-based key terms. Furthermore, an open-source online version of this ranking algorithm was provided with multilingual text-retrieval pipeline, customizable query and real-time-scoring.

MATERIALS AND METHODS

Twenty-five patients with suspected stroke and magnetic resonance imaging were re-assessed by two independent/blinded readers [inexperienced: 3 years; experienced >6 years/Board-certified). SR and cFTR were compared with guideline-query using the cosine similarity score (CSS) and Wilcoxon signed-rank test.

RESULTS

All pathological findings (18/18) were identified by SR and cFTR. The impressions section of the SRs of the inexperienced reader had the highest median (0.145) and maximal (0.214) CSS and were rated significantly higher (p=2.21×10^-5 and p=1.4×10^-4, respectively) than cFTR (median=0.102). CSS was robust to variations of query.

CONCLUSION

Objective guideline-based comparison of SRs and cFTRs using the CSS is feasible and provides a scalable quality measure that can facilitate the adoption of structured reports in all fields of radiology.

Objective Comparison Using Guideline-based Query of Conventional Radiological Reports and Structured Reports

BACKGROUND

This feasibility study of text-mining-based scoring algorithm provides an objective comparison of structured reports (SR) and conventional free-text reports (cFTR) by means of guideline-based key terms. Furthermore, an open-source online version of this ranking algorithm was provided with multilingual text-retrieval pipeline, customizable query and real-time-scoring.

MATERIALS AND METHODS

Twenty-five patients with suspected stroke and magnetic resonance imaging were re-assessed by two independent/blinded readers [inexperienced: 3 years; experienced >6 years/Board-certified). SR and cFTR were compared with guideline-query using the cosine similarity score (CSS) and Wilcoxon signed-rank test.

RESULTS

All pathological findings (18/18) were identified by SR and cFTR. The impressions section of the SRs of the inexperienced reader had the highest median (0.145) and maximal (0.214) CSS and were rated significantly higher (p=2.21×10^-5 and p=1.4×10^-4, respectively) than cFTR (median=0.102). CSS was robust to variations of query.

CONCLUSION

Objective guideline-based comparison of SRs and cFTRs using the CSS is feasible and provides a scalable quality measure that can facilitate the adoption of structured reports in all fields of radiology.

Reporting of Inferior Vena Cava Filter Complications on CT: Impact of Standardized Macros

OBJECTIVE

The objective of our study was to report the effect of implementing standardized inferior vena cava filter (IVCF) macros on the reporting of IVCFs and filter-related complications in abdominal CT reports.

MATERIALS AND METHODS

Retrospective analysis was performed of all abdominal CT reports performed between October 2014 and January 2015 before implementation of IVCF macros (n = 5143). Duplicated examinations and studies requested specifically to evaluate known IVCFs were excluded. In March 2016, normal and abnormal standardized IVCF macros were implemented. Two radiologists reviewed all CT abdominal reports using IVCF macros between March 2016 to July 2016 to assess for missed IVCF complications.

RESULTS

Before the implementation of the IVCF macros, 146 of 5143 (2.8%) abdominal CT studies (89 men and 57 women; mean age, 59 years) showed an IVCF. After implementation of IVCF macros, 105 abdominal CT studies using the IVCF macros were analyzed (48 men and 57 women; mean age, 58 years), including 73 normal macros and 32 abnormal macros). The rate of reported caval penetration and filter element-organ interaction improved from 12% (9/73) to 57% (28/49) (p < 0.001) and from 0% (0/53) to 36% (9/25) (p < 0.001) before and after macro implementation, respectively. However, one filter fracture and two filter-associated thrombi were missed when using the IVCF macros.

CONCLUSION

Implementation of standardized IVCF macros improves reporting of IVCFs and IVCF-associated complications in abdominal CT reports.

Structured radiology reporting on an institutional level-benefit or new administrative burden?

Significant technical advances have been made in radiology since the first discovery of X-rays. Diagnostic techniques have become more and more complex, workflows have been digitized, and data production has increased exponentially. However, the radiology report as the main method for communicating examination results has largely remained unchanged. Growing evidence supports that more structured radiology reports offer various benefits over conventional narrative reports. Various efforts have been made to further develop and promote structured reporting. However, regardless of the potential benefits, structured reporting has still not seen widespread implementation into the clinical routine. With recent technical advances, especially new research topics such as big data and machine learning, structured reporting could prove essential for the future of radiology. New interoperable solutions are needed to facilitate the implementation of template-based structured reporting into the clinical routine.

Structured Reporting of CT Angiography Runoff Examinations of the Lower Extremities

OBJECTIVES

The aim was to evaluate the effect of structured reporting of computed tomography angiography (CTA) runoff studies on clarity, completeness, clinical relevance, usefulness of the radiology reports, further testing, and therapy in patients with known or suspected peripheral arterial disease.

METHODS

Conventional reports (CRs) and structured reports (SRs) were generated for 52 patients who had been examined with a CTA runoff examination of the lower extremities. The sample size was based on power calculations with a power of 95% and a significance level of .007 (adjusted for multiple testing). CRs were dictated in a free text form; SRs contained a consistent ordering of observations with standardised subheadings. CRs were compared with SRs. Two vascular medicine specialists and two vascular surgeons rated the reports regarding their satisfaction with clarity, completeness, clinical relevance, and usefulness as well as overall satisfaction. Additionally, they made hypothetical decisions on further testing and therapy. Median ratings were compared using the Wilcoxon signed rank test and generalised linear mixed effects models.

RESULTS

SRs received higher ratings for satisfaction with clarity (median rating 9.0 vs. 7.0, p < .0001) and completeness (median rating 9.0 vs. 7.5, p < .0001) and were judged to be of greater clinical relevance (median rating 9.0 vs. 8.0, p < .0001) and usefulness (median rating 9.0 vs. 8.0, p < .0001). Overall satisfaction was also higher for SRs (median rating 9.0 vs. 7.0, p < .0001) than CRs. There were no significant differences in further testing or therapy.

CONCLUSION

Referring clinicians perceive SRs of CTA runoff examinations of the lower extremities as offering superior clarity, completeness, clinical relevance, and usefulness than CRs. Structured reporting does not appear to alter further testing or therapy in patients with known or suspected peripheral arterial disease.

Critical Test Result Notification via Mobile Phone-Based Automated Text Message System in the Radiologic Field: Single Institutional Experience

PURPOSE

To investigate the feasibility of sharing critical test result (CTR) notifications (CTRNs) via automated text messaging.

MATERIALS AND METHODS

CTRNs via automated text messaging was used to notify physicians of CTRs in a tertiary hospital with 1,786 beds. From June 2016 to September 2016, notifications for 545 CTRs were given via a CTRN system. Among them, 490 CTRs (292 male and 198 female patients; mean age, 53.6 years old [range, 1-88]) were included in analysis. CTR levels (CTRLs) were assigned to four categories (CTRL1 to CTRL3 and unclassified) when reported, and reclassified into three CTRLs according to their clinical relevance and urgency. Response time was defined as time lapse between CTR reporting and documentation by physicians. Analysis of variance was performed to compare response times according to CTRLs and patients' location.

RESULTS

Corresponding actions were taken in 404 of 490 cases (82.4%) without any delayed CTRN-related morbidity. There were 15 CTRL1 (3.1%), 50 CTRL2 (10.2%), 112 CTRL3 (22.9%) cases, and the remaining 313 CTRL cases were unclassified. After reclassification, CTRL1, CTRL2, and CTRL3 were 81 (16.5%), 177 (36.1%), and 232 cases (47.3%), respectively. Response time of reclassified CTRL3 was significantly longer than that of reclassified CTRL1 (median 23.0, [interquartile range 2.0-133.5] hours versus 4.0 [0.0-22.0] hours; P < .001). Response time of outpatient cases (80.0 [6.0 to 157.0] hours) was significantly longer (P < .001) than those of inpatient (3.0 [0.0-16.0]) and emergency department cases (5.0 [1.0-21.0]).

CONCLUSION

Automated text messaging could be a feasible option for CTRNs in the radiologic field. Further large-scale investigations regarding efficiency of this system are warranted.

ESR paper on structured reporting in radiology

Structured reporting is emerging as a key element of optimising radiology's contribution to patient outcomes and ensuring the value of radiologists' work. It is being developed and supported by many national and international radiology societies, based on the recognised need to use uniform language and structure to accurately describe radiology findings. Standardisation of report structures ensures that all relevant areas are addressed. Standardisation of terminology prevents ambiguity in reports and facilitates comparability of reports. The use of key data elements and quantified parameters in structured reports ("radiomics") permits automatic functions (e.g. TNM staging), potential integration with other clinical parameters (e.g. laboratory results), data sharing (e.g. registries, biobanks) and data mining for research, teaching and other purposes. This article outlines the requirements for a successful structured reporting strategy (definition of content and structure, standard terminologies, tools and protocols). A potential implementation strategy is outlined. Moving from conventional prose reports to structured reporting is endorsed as a positive development, and must be an international effort, with international design and adoption of structured reporting templates that can be translated and adapted in local environments as needed. Industry involvement is key to success, based on international data standards and guidelines.

KEY POINTS

• Standardisation of radiology report structure ensures completeness and comparability of reports. • Use of standardised language in reports minimises ambiguity. • Structured reporting facilitates automatic functions, integration with other clinical parameters and data sharing. • International and inter-society cooperation is key to developing successful structured report templates. • Integration with industry providers of radiology-reporting software is also crucial.

Multi-institutional survey on imaging practice patterns in pancreatic ductal adenocarcinoma

PURPOSE

To study the practice patterns for performance and interpretation of CT/MRI imaging studies in patients with pancreatic ductal adenocarcinoma (PDAC) at multiple institutions using a survey-based assessment.

METHODS

In this study, abdominal radiologists/body imagers on the Society of Abdominal Radiology disease-focused panel for PDAC and from multiple institutions participated in an online survey. The survey was designed to investigate the imaging and reporting practice patterns for PDAC. The survey questionnaire addressed the experience of referring providers, choice of imaging modality for diagnosis and follow-up of PDAC, structured imaging templates utilization for PDAC, and experiences with the use of structured reports.

RESULTS

The response rate was 89.6% (43/48), with majority of the respondents working in a teaching hospital or academic research center (95.4%). While 86% of radiologists reported use of structured reporting templates in their practice, only 60.5% used standardized templates specific to PDAC. This lower percentage was despite most of them (77%) being aware of existence of PDAC-specific templates and recognizing their benefits, such as preference by referring providers (83%), improved uniformity (100%), and higher accuracy of reports (76.2%). The common impediments to the use of PDAC-specific templates were interference with efficient workflow (67.5%), lack of interest (52.5%), and complexity of existing templates (47.5%). With regards to imaging practice, 92.7% (n = 40/43) of respondents reported performing dynamic multiphasic pancreatic protocol CT for evaluation of patients with initial suspicion or staging of PDAC.

CONCLUSION

Structured reporting templates for PDAC are not universally utilized in subspecialty abdominal/body imaging practices due to concerns of interference with efficient workflow and complexity of templates. Multiphasic pancreatic protocol CT is most frequently performed for evaluation of PDAC.

Structured vs narrative reporting of pelvic MRI for fibroids: clarity and impact on treatment planning

OBJECTIVES

To evaluate clarity and usefulness of MRI reporting of uterine fibroids using a structured disease-specific template vs. narrative reporting for planning of fibroid treatment by gynaecologists and interventional radiologists.

METHODS

This is a HIPAA-compliant, IRB-approved study with waiver of informed consent. A structured reporting template for fibroid MRIs was developed in collaboration between gynaecologists, interventional and diagnostic radiologists. The study population included 29 consecutive women who underwent myomectomy for fibroids and pelvic MRI prior to implementation of structured reporting, and 42 consecutive women with MRI after implementation of structured reporting. Subjective evaluation (on a scale of 1-10, 0 not helpful; 10 extremely helpful) and objective evaluation for the presence of 19 key features were performed.

RESULTS

More key features were absent in the narrative reports 7.3 ± 2.5 (range 3-12) than in structured reports 1.2 ± 1.5 (range 1-7), (p < 0.0001). Compared to narrative reports, gynaecologists and radiologists deemed structured reports both more helpful for surgical planning (p < 0.0001) (gynaecologists: 8.5 ± 1.2 vs. 5.7 ± 2.2; radiologists: 9.6 ± 0.6 vs. 6.0 ± 2.9) and easier to understand (p < 0.0001) (gynaecologists: 8.9 ± 1.1 vs. 5.8 ± 1.9; radiologists: 9.4 ± 1.3 vs. 6.3 ± 1.8).

CONCLUSION

Structured fibroid MRI reports miss fewer key features than narrative reports. Moreover, structured reports were described as more helpful for treatment planning and easier to understand.

KEY POINTS

• Structured reports missed only 1.2 ± 1.5 out of 19 key features, as compared to narrative reports that missed 7.3 ± 2.5 key features for planning of fibroid treatment. • Structured reports were more helpful and easier to understand by clinicians. • Structured template can provide essential information for fibroids treatment planning.

Structured Reporting of Rectal Magnetic Resonance Imaging in Suspected Primary Rectal Cancer: Potential Benefits for Surgical Planning and Interdisciplinary Communication

OBJECTIVES

The aim of this study was to evaluate the effect of structured reports (SRs) in comparison to nonstructured, free-text (FT) rectal magnetic resonance imaging (MRI) reports in patients with histologically proven rectal cancer and potential effects of both types of reporting on referring surgeons' satisfaction, interdisciplinary communication, and further clinical decision making.

MATERIALS AND METHODS

The institutional review board approved this retrospective study with waiver of informed consent. Forty-nine patients with histologically proven rectal cancer were included in this study. All patients underwent rectal MRI for local rectal cancer staging before surgery. Free-text reports and SRs for local MR staging of rectal cancer were generated for all subjects by radiologists. Two experienced abdominal surgeons evaluated a questionnaire that included 9 questions regarding satisfaction with content, presence of reported key features, effort for information extraction, and report quality.

RESULTS

Structured reports achieved significantly higher satisfaction rates with report content and clarity, and included significantly more of the 13 predefined key features compared with FT reports (SRs: mean ± SD, 12.2 ± 4.6 [range, 9-13] versus FT reports: mean ± SD, 9.2 ± 10.8 [range, 5-13]) (P < 0.001). Definite further clinical decision making (surgery vs neoadjuvant radiochemotherapy) was possible in 96% of SRs and only in 60% of FT reports (P < 0.001). In case of surgery, the reported information was considered to be sufficient for surgical planning in 94% of SRs versus only 38% in FT reports (P < 0.001). Structured report received a significantly higher overall report quality rated on a Likert scale from 1 to 6 (1, insufficient; 6, excellent) with a mean of 5.8 ± 0.42 (range, 5-6) in comparison to FT reports with 3.6 ± 1.19 (range, 1-5) (P < 0.001).

CONCLUSIONS

Structured reporting of rectal MRI in patients with rectal cancer facilitates surgical planning and leads to a higher satisfaction level of referring surgeons in comparison to FT reports. Abdominal surgeons were more confident about report correctness and further clinical decision making on the basis of SRs.