How sure are you? Standardizing certainty terms bolsters communication

Communication between radiologists and referring physicians improved when a standard certainty lexicon was implemented for routine staging prostate MRI exams, according to a study published this month in the American Journal of Roentgenology.

Unitl now, the phrasing of a radiologist’s certainty has typically been left to the reporting radiologist and its interpretation left to the referring physician. “This approach has been shown to lead to frequent misunderstandings,” wrote Andreas Wibmer, MD, of Memorial Sloan-Kittering Cancer Center, and colleagues.

They noted that recent studies show structured reporting in radiology can result in more thorough communication of relevant diagnostic findings than unstructured reporting. Standardizing terminology is a critical component in structured reporting and reduces the likelihood of miscommunication regarding exam results.

The aim of Wibmer and colleagues' study was to evaluate the usefulness and accuracy of a 5-point standardized diagnostic certainty lexicon for the diagnosis of extracapsular extension (ECE) of prostate cancer on routine staging prostate MRI. There was a focus on the detection ECE of prostate cancer because determination of the presence or absence of ECE is explicitly mentioned in the majority of prostate cancer screening MRI reports, is highly relevant to a patient’s prognosis and therapy planning and the high incidence of ECE allows for reasonable statistical analysis, according to the authors.


The study analyzed prostate MRI reports before (254 participants) and after (211 participants) the establishment of the diagnostic certainty lexicon. Before the establishment of the five-word lexicon, results showed radiologists used 38 different terms to express their certainty level regarding the presence of ECE on MRI. After the lexicon was implanted, 85.3 percent of the radiologists adhered to the new reporting protocol and the MRI reports that used the five-point certainty lexicon had an AUC of 0.852 for diagnosing ECE.

Miscommunication between radiologists and referring physicians may be an underlying factor in adverse clinical outcomes and rising healthcare costs. The authors noted that in a recent survey of radiology opinions, only 50 percent of responding clinicians and 37 percent of responding radiologists agree that “language and style of radiology reports are mostly clear.”

“The implementation of a lexicon of diagnostic certainty dramatically reduced the number of expressions used by radiologists to indicate their levels of diagnostic certainty,” the authors concluded. “Therefore, the use of such a certainty lexicon can provide clinicians with reliable information for clinical decision making and reduce the chances of miscommunication of imaging findings.”