What does it take to optimize advanced visualization technology? The answer is comprised of many components. One of the most critical, and under-recognized, is structured reporting. A study published earlier this month in Journal of American College of Radiology detailed the value of clinician-centric reporting templates.
Coronary CT angiography (CCTA) is a cardiac imaging boon. Yet for all of its potential, CCTA is relatively powerless if clinicians cannot utilize the data in management decision making. Doing so requires clear, comprehensive and concise reports.
Brian B. Ghoshhajra, MD, MBA, of Massachusetts General Hospital (MGH) in Boston, and colleagues assessed the impact of adding a structured impression (SI) to the reporting template for CCTA.
“We hypothesized that a [SI] would facilitate understanding by referring clinicians and, therefore, result in more accurate interpretations of patients’ coronary artery disease (CAD) severity.”
The researchers assessed physicians’ understanding of coronary artery disease and report satisfaction via a survey that focused on 25 reports with a free-form impression (FFI) and 25 with an SI.
With most metrics, both formats sufficed. However, reliability regarding the number of coronary arteries with significant stenosis improved from fair at 53 percent with FFI to moderate at 68 percent with SI.
Despite the improvement, the researchers expressed concerns with the moderate reliability regarding the number of arteries plagued by significant stenosis. That’s because clinicians tended to over-estimate the number of arteries with significant stenosis, which in turn can spur a ripple of downstream testing.
Since publication of the study, Ghoshhajra et al attempted to address the issue. MGH has updated the impression template to prompt readers to precisely name vessels with moderate stenosis, severe stenosis or occlusions. The change resulted in significant improvement in agreement on the number of vessels with hemodynamically significant stenosis.
Still, the researchers noted additional room for improvement.
It’s a great reminder of the power of informatics tools and the need to question imaging practices. How is your practice progressing on this front? Please let us know.
Lisa Fratt, editor