How much structure do clinicians want in their musculoskeletal MRI reports?

Physicians desire some structure in their musculoskeletal MRI reports, but still want the narrative freedom to communicate their findings.

That’s according to a new survey of clinicians in Mount Sinai Health System’s orthopedics department, published Feb. 6 in Academic Radiology. Specialists were presented with three templates, and most preferred a “middle ground” structure style to help them decide between conservative and surgical treatment.

“We believe that in the field of musculoskeletal imaging, there should be some room for free narrative within a general report structure to allow the radiologist to logically narrate and construct the pathology picture,” Kishore Chundru, MD, with the New York City system's Department of Radiology, and colleagues wrote.

In a bid to improve consistency, radiology has moved toward more rigid reporting—and it’s been effective. Breast and body imaging experts have generated higher quality reports with noted improvements in communication between radiologists and referring providers. Many other subspecialties have adopted similarly structured templates as a result, but it remains unclear if MSK imaging would benefit from the change, the authors wrote.

Therefore, Chundru et al. surveyed clinicians, asking which knee MRI report template they preferred: unstructured free text, structured with headers, or highly structured and itemized. They received a small number of participant responses—53 residents, attendings and physician assistants—which the authors cited as a limitation of the study.

After they were presented with the three templates, a majority of clinicians preferred the structured template with headings, scoring higher across readability, usefulness and quality. This style still allows users to communicate individual tissue findings by group and organize them based on underlying injury pathology, the authors noted.

When judging based on coherence, 83% chose structured templates with headers, and 11% indicated they preferred to use a highly structured and itemized style.

Unstructured, free-text templates were considered the most disjointed (53%), followed by highly structured templates (43%) and the structured with header format (4%).

“Based on responses to surveys of different MRI templates, our results show that orthopedic clinicians at our institution prefer some level of structure in the report but not the rigorous itemization of anatomic tissues,” the authors wrote. “A ‘middle ground’ reporting structure which includes headers for different anatomic compartments and allows for grouping of relevant pathology is shown to be the preferred format.”