Radiology: Structured reporting beats conventional free text

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Exploiting input from radiologists and referring physicians, structured reporting provides physicians with clearer and more thorough radiologic findings—but the development of an efficient system remains a major challenge for radiology, according to a study published online April 25 in Radiology.

The growth of imaging and advancement of technology have made for an ever-increasing trove of radiology findings and reports that needs to be efficiently integrated with other specialties. “Remarkably, despite these changes, the style and format of radiology reports have generally remained unaltered,” said Lawrence H. Schwartz, MD, and co-authors from Memorial Sloan-Kettering Cancer Center in Manhattan, N.Y.

The majority of radiology reports still include free-form text and follow a loose outline of an introductory section that defines the exam-type, a body with a description of findings and a conclusion with overall impressions on the case, explained Schwartz and colleagues.

“[T]he broader radiologic community has been slow to adopt structured reporting even as other medical disciplines, including pathology, endoscopy and surgery, have embraced it,” with several studies indicating important benefits from the method, according to Schwartz et al.

The authors evaluated the differences in content and clarity reported by 11 physicians who made use of conventional and structured reporting. The group included six radiologists, three surgeons and two oncologists, each of whom read 15 conventional and 15 structured reports (no physicians read the same reports) on body CT scans.

Conventional reports earned a mean content satisfaction rating of 7.61 out of 10, which was significantly lower than the 8.33 score tacked onto structured reports. Structured reports likewise significantly outscored conventional ones in clarity, receiving a mean score of 8.25, compared with 7.45 for conventional reports.

Structured reports also received a total of 90 perfect scores for content and clarity, vs. 28 for conventional reports. Although nonradiologists expressed greater satisfaction with structured reports than radiologists, the difference fell shy of significance.

Conventional reports also earned more poor scores for clarity and content than did structured reports.

“In our study, physicians displayed significantly greater satisfaction with the content and clarity of structured reports than with the content and clarity of conventional reports. Since satisfaction with the content and clarity of conventional reporting was high, the fact that a significant improvement could be achieved with structured reporting is remarkable,” Schwartz and colleagues wrote.

The authors noted that this improvement in satisfaction was larger for referring physicians than for radiologists. Schwartz and colleagues emphasized the importance of consulting with referring physicians in developing the templates for structured reports. “We believe that this intense involvement of radiologists and referring physicians greatly facilitated user acceptance of structured reporting.”

“[A] key feature of evidence-based medicine is the ability to assess quality, and structured reporting makes the evaluation of quality indicators for both radiologic studies and reports much easier, since individual elements measuring quality are more easily defined in a structured report.” However, Schwartz and colleagues noted, “Developing user-friendly systems for structured reporting that do not diminish efficiency by imposing new distractions remains a major challenge.”