Many radiologists consider reporting to be a personal concept and, in some cases, an extension of their own creativity. But if the specialty wants to excel in a value-driven healthcare world, it’s going to have to adopt some level of standardization.
That was the argument from Adam E. Flanders, MD, co-director of Neuroradiology/ENT Radiology at Thomas Jefferson University Hospitals, who spoke on the topic Sunday during RSNA’s virtual meeting.
He said traditional, free-text reporting is fine for establishing diagnoses, defining the location of diseases and guiding therapy, among many other benefits, “but we can generate greater value.”
“What we really have is a single use for a radiology report,” he explained, pointing out that the more than half a billion reports produced each year are the field’s top products. “It’s created; maybe consumed once and it goes off to the trash burner.”
Flanders proposed overcoming this problem with a hybrid reporting approach: incorporating structure in the form of common data elements while retaining the free-prose many radiologists prefer.
CDEs, as they’re known, may include measurements like lymph node size, foraminal stenosis, enhancement characteristics, ASPECTS scoring, and structured data such as BI-RADS or TI-RADS information.
Once CDEs are regularly used within radiologists’ reports, such information can be extracted using artificial intelligence to drive dozens of additional downstream processes, essentially creating a reusable, actionable document.
Many others have lobbied for a similar strategy. During SIIM’s virtual meeting, Harvard Medical School informatics expert Tarik K. Alkasab, MD, PhD, said including common data elements would improve patient outcomes while also placing rads into a more advisory role.
“We’re not taking away free-text, but we’re inserting these concepts with a high degree of accuracy and precision to elevate the value of our reports,” Flanders added.
So where can rads start? RSNA and the ACR are already leading such efforts, including the RSNA RadLex project with more than 55,000 comprehensive radiology reporting terms. And RSNA’s template library—radreport.org—currently houses more than 250 best-practice templates, with 5 million downloads to-date.
A number of specialties—such as cardiology, gastroenterology and pathology—are already utilizing standardized reporting, he said. And radiology must begin forging its own path.
“If we don’t take the lead someone else will do it, and do it badly,” Flanders explained during his Sunday session.
The other side of this argument was also presented on Sunday. Stay tuned for that in the upcoming weeks.