The new ‘normal’: Quality initiative brings clarity to radiology reporting

Radiology reports can be difficult for referring physicians to decipher and even more so for patients. One institution recently undertook a quality initiative to make these documents more digestible, reporting positive early results.

That’s according to research led by Brigham and Women’s Hospital experts, who sought to incorporate more acceptable and preferred phrases into imaging reports. After a nearly one-year implementation period, the measure led to fewer ambiguous terms and more uses of the word “normal.”

Radiologists have been historically hesitant to describe findings as "normal" in their reporting, but it may be necessary as the field looks to embrace more consumer-oriented care, David P. Alper, with Harvard Medical School, and colleagues wrote.

“The impact of equivocal phrases is increasingly relevant as patients demand more transparency and access to their health information, including their radiology reports,” Alper et al. wrote Feb. 5 in the American Journal of Roentgenology. “As radiologists consider modifications to their reports to better suit this new audience, simplifying wording and avoiding unnecessarily ambiguous language are important goals.”

Researchers from the Boston-based institution convened an oversight committee to draw the line between acceptable descriptions (“normal”), acceptable negative statements and potentially ambiguous terminology (“unremarkable” or “within normal limits”).

The intervention automatically populated the term “normal” within the “findings” heading as users chose how to describe abdominal organ subheadings within CT and MRI report templates. They were also allowed to choose more ambiguous phrases via a pick-list option.

Alper and colleagues recorded how many times “normal” was used in more than 21,000 reports prior to the intervention, and compared it to use of the preferred word in 23,000 situations after the study period.

Result showed an uptick in the use of “normal,” with attending radiologists leading the way. They picked the term in 49% of cases prior to the intervention, compared to 59% after. In contrast, radiology trainees used more acceptable negative statements, with a slight uptick in their use of less-ambiguous terminology.

This difference may be a byproduct of trainees being less confident in identifying “normal” findings, the team hypothesized.

The results are positive, however, and indicate a shift toward more precise reporting. A goal radiologists must embrace, the authors added.

“To provide the most value to patients and referring physicians, reports must be concise, actionable, unambiguous, and structured in a clear and organized manner,” Alper et al. wrote.