Survey of hospital clinicians' preferences regarding the format of radiology reports

doi:10.1016/j.crad.2008.11.009

Clinical Radiology

Volume 64, Issue 4, April 2009, Pages 386-394

https://doi.org/10.1016/j.crad.2008.11.009 Get rights and content

Aim

To determine hospital consultants' preferences for the format and content of radiology reports.

Materials and methods

Ninety-nine questionnaires were sent to consultant staff with responsibility for requesting ultrasound examinations. The participants were invited to rank a variety of hypothetical reports in order of preference. They were also asked whether they felt other commonly included features of a radiology report were of value. Rank data were analysed by the Friedman statistic, Fisher's multiple comparisons least significant difference test, and the Kemeny–Young method.

Results

Forty-nine responses were received. There was a preference for more detailed reports that included a clinical comment by the radiologist, for both normal and abnormal results (p < 0.05). Reports presented in tables were preferred. The combination of a detailed tabular report with a radiologist's comment was the most popular single structure, preferred by 43% of respondents for normal reports and 51% for abnormal reports.

Conclusion

Detailed reports with a radiologists' comment are preferred to briefer reports, even for normal examinations. Tabular reports are preferred to prose, with the combination of a detailed report presented in a tabular format accompanied by a radiologist's comment being the most preferred style.

Introduction

Written reports are the main form of information transfer from the radiology department to the referring clinician. However, there is a relative paucity of research concerning the style and content of reports preferred by clinicians. Furthermore, it is not clear how clinicians prefer this content to be presented. There have been several explorations of these issues in the literature; however, the majority come from North America.1, 2, 3 To the authors' knowledge, there are no published reports of UK clinician preferences for style, content, or format of radiology reports.

The advent of more sophisticated radiology information systems (RIS) with better integration with picture archiving and communication systems (PACS) has allowed the possibility of alternative formats to the traditional prose report. Tabular formats can be generated as a proforma within the RIS and, potentially, voice recognition could be used to provide the information within these tables.⁴ Although this approach may have benefits in terms of rapid generation of reports and bypass of the dictation step, it is unclear whether these alternative formats are appealing, or indeed acceptable, to clinicians.

Therefore, there is a gap in the UK literature regarding clinician preferences for radiology reports, with regard to both format and content. The aim of the present study was to explore this under-researched area.

Section snippets

Materials and methods

A questionnaire was sent to 99 consultants requesting radiology examinations from our trust (Appendix 1). The main body of the questionnaire was divided into three sections. The first asked how satisfied clinicians were with the radiology reports they receive on a 10-point scale and what they felt should be included in a report. Multiple yes/no options of commonly included features of reports were provided and the participants invited to decide whether they felt each item was appropriate for

Demographics

Of the 99 questionnaires sent, 49 replies were received (49% reply rate). A wide range of specialties were represented, including general medicine, general surgery, cardiology, chest medicine, gastroenterology, rheumatology, anaesthesia and intensive care, otorhinolaryngology, trauma and orthopaedics, urology and vascular surgery. The average number of reports read per week was estimated by them to be around 15.

Satisfaction rates

Satisfaction rates with the radiology reports were generally good, for both clarity

Discussion

It is unclear at present how much information regarding a radiological investigation is appreciated by clinicians, and in what format this should be presented. Detailed reports potentially serve to communicate the maximum information to the clinician to aid in patient care, serve as a medicolegal record, and aid in retrospective interpretation of images or in multidisciplinary team meetings. However, superfluous information can detract from the main message of a radiological report and

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Many articles and guidelines have been published proposing suggestions for the optimal radiology report style; it is likely that different referrers will prefer different styles owing to a number of clinical variables. The aim of this study is to assess the x-ray report style preferences of referrers at a district general hospital.
This electronic survey study used convenience sampling. An email invitation was sent to all referrers who had requested imaging examinations in the six months prior to the study start date. Participants were asked their opinions on the inclusion of recommendations and advice and to indicate their preferences of mock reports with combinations of the following; short/long, in-depth/brief and paragraph/bullet points. Manual analysis was undertaken in Excel.
There were 114 participants from the identified population of 356, giving a response rate of 32%. Nearly all participants find the inclusion of recommendations and advice to be useful (n = 109, 96%). Seventy-nine participants (69.3%) request skeletal x-ray examinations, and 100 (87.7%) request chest x-ray examinations. More than half of skeletal referrers (n = 42, 53.2%) and the majority of chest referrers (n = 45, 45%) prefer reports with short sentences, brief, bullet point format.
The most preferred report style for skeletal and chest x-ray reports is short sentences, brief with bullet-point format. These findings add to the current knowledge base and provide different report style options. Tailoring report styles could optimise service users’ experience depending on clinical variables and might improve reporting workflow.
Potential differences in style preferences may exist between community and hospital referrers. Consequently, focussed research regarding the report style preferences of GPs is recommended as an area for further research.
What information is required in a preliminary clinical evaluation? A service evaluation
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This preferred style implies that the PCE should be a short comment, without excessive wording, and is supported by a recent study which suggested a similar style.11 Bulleted or listed findings will likely provide clearer conveyance of the radiographer's interpretation, and provide a more consistent structure which is both helpful to the clinicians16,18 and the radiographer. The format and writing of a PCE has been considered a potential barrier to radiographers being confident in undertaking such a role,5,11,12 so the use of a structured tool to educate radiographers to produce a PCE may help facilitate overcoming this.
The preliminary clinical evaluation (PCE) abnormality flagging system is a progression from the red dot system. The need for a PCE service may be reduced by immediate “hot” reporting services, however, PCE can be valuable in those Trusts that do not have a “hot reporting”service, as well as in the out of hours setting. This study aimed to identify what information clinicians require within the PCE to aid decision making.
Emergency Department (ED) clinicians and Radiology reporters were approached to complete a paper survey seeking their preferences on various aspects of the What, Where, How model, regarding their usefulness. Questions were a combination of multiple choice, Likert scale, and free-text.
Thirty participants (20 ED clinicians and 10 Radiology Reporters) provided a 100% response rate. Overall, Where was considered to be most significant (n = 18, 60%), followed by What (n = 11, 37%). Half of participants (n = 15, 50%) considered How to be least significant. ED clinicians found all aspects of the What, Where, How useful, in particular the Where, but to a slightly lesser extent regarding how much displacement was involved. Overall, the information ranked as least useful was how much movement, followed by direction of movement, and type of fracture. The preferred style for a PCE comment is a bullet format.
PCE content should accommodate the preferences of ED referrers. Our findings suggest clinicians want information pertaining to what the abnormality is (i.e. the type of injury), where it was (more specific than simply which bone) and if displacement is present.
These findings add to the current knowledge base and provide support to the local department when implementing the PCE system.
Discrepant Reporting Style Preferences Between Clinicians and Radiologists
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To compare preferences in reporting styles between radiologists and clinicians in structured vs unstructured reporting styles in order to facilitate better communication.
An online survey was distributed to 5280 clinicians, radiologists, and physicians in training surveying respondent preference for three different reporting styles: expanded structured, minimized structured, and unstructured.
A 7.5% response rate was achieved. Overall, the expanded structured reporting style was the most preferred (47%, 186/394). This contrasted with radiologists who preferred the unstructured reporting style (41%), whereas nonradiologists preferred the expanded structured reporting style (51%; P < 0.001). There was significance in emergency medicine physicians preferring the minimized structured reporting style (51%, 27/43), whereas all other specialties preferred the expanded structured report (49%, 168/341; P = 0.0038).
There is a discrepant reporting style preference between clinicians and radiologists. A structured reporting style with expanded standard statements is preferred by most physicians. Radiologists could consider using a structured reporting style with minimized normal statements in the emergency room setting.
Ultrasound reports standardisation using rhetorical structure theory and domain ontology
2019, Journal of Biomedical Informatics: X
Ultrasound reporting plays an important role in diagnosis as images produced during an ultrasound examination do not give the whole view of the medical conditions. However, in practice there are many issues that are inherent to ultrasound reporting and the most important was identified to be the lack of standardisation when producing these reports. There is a resistance to change from some radiologists preferring the free writing style, making any attempt to computerise the processing of these reports difficult. This paper explores the possibility of using Rhetorical Structure Theory (RST) together with a domain ontology to transform free-form ultrasound reports into a structured form. It discusses a new approach in segmenting and identifying rhetorical relations that are more applicable to ultrasound reports from classical RST relations. The approach was evaluated on a sample ultrasound reports where the system’s parsing was compared to the manual parsing performed by experts. The results show that discourse parsing using RST in ultrasound reports can be performed effectively using the support of a domain ontology. The results also demonstrate that the transformation of free-form ultrasound reports into a structured form can be performed with the support of RST relations identified and the domain ontology.
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The aim was to evaluate the effect of structured reporting of computed tomography angiography (CTA) runoff studies on clarity, completeness, clinical relevance, usefulness of the radiology reports, further testing, and therapy in patients with known or suspected peripheral arterial disease.
Conventional reports (CRs) and structured reports (SRs) were generated for 52 patients who had been examined with a CTA runoff examination of the lower extremities. The sample size was based on power calculations with a power of 95% and a significance level of .007 (adjusted for multiple testing). CRs were dictated in a free text form; SRs contained a consistent ordering of observations with standardised subheadings. CRs were compared with SRs. Two vascular medicine specialists and two vascular surgeons rated the reports regarding their satisfaction with clarity, completeness, clinical relevance, and usefulness as well as overall satisfaction. Additionally, they made hypothetical decisions on further testing and therapy. Median ratings were compared using the Wilcoxon signed rank test and generalised linear mixed effects models.
SRs received higher ratings for satisfaction with clarity (median rating 9.0 vs. 7.0, p < .0001) and completeness (median rating 9.0 vs. 7.5, p < .0001) and were judged to be of greater clinical relevance (median rating 9.0 vs. 8.0, p < .0001) and usefulness (median rating 9.0 vs. 8.0, p < .0001). Overall satisfaction was also higher for SRs (median rating 9.0 vs. 7.0, p < .0001) than CRs. There were no significant differences in further testing or therapy.
Referring clinicians perceive SRs of CTA runoff examinations of the lower extremities as offering superior clarity, completeness, clinical relevance, and usefulness than CRs. Structured reporting does not appear to alter further testing or therapy in patients with known or suspected peripheral arterial disease.
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To compare effect of free-text versus structured reporting of IR procedures on report quality and report coding and value.
In this retrospective study, 432 common consecutive free-text IR reports created during 4 months (from September 2013 to December 2013) before implementation of structured reporting (February 2014) and 415 structured IR reports created after implementation (from September 2014 to December 2014) were reviewed to assess ease of use and compliance with reporting requirements for regulatory requirements and coding. IR staff and trainees and referring physicians to IR were surveyed on procedure report attributes, such as detail, quality, and clarity.
Structured reporting increased compliance with reporting fluoroscopy time, radiation dose, and contrast administration compared with free-text reports (402/432 [93.1%] vs 251/415 [60.5%], P < .001; 402/432 [93.1%] vs 242/415 [58.3%], P < .001; and 395/432 [91.4%] vs 257/415 [61.9%], P < .001). Structured reporting decreased addendum requests for insufficient documentation from 43% (121/435 [28%] to 50/415 [12%], P = .01). Most IR physicians found structured reports to require less time to complete (21/26 [81%]), to be easier to complete (23/26 [89%]), and to have a similar or higher level of detail (19/26 [73%]) compared with free-text reports. Referring physicians were more satisfied with structured reports compared with free-text reports (6.9/10 vs 5.6/10, P = .03).
Structured IR reporting compared with free-text reporting improves compliance with radiation dose and contrast reporting, reporting and coding efficiency, and satisfaction among IR and referring physicians.

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Survey of hospital clinicians' preferences regarding the format of radiology reports

Aim

Materials and methods

Results

Conclusion

Introduction

Section snippets

Materials and methods

Demographics

Satisfaction rates

Discussion

Lancet

J Am Coll Radiol

J Am Coll Radiol

The radiological report: what is useful for the referring physician?

Can Assoc Radiol J

Radiology reports: how much descriptive detail is enough?

AJR Am J Roentgenol

Radiology reports: examining radiologist and clinician preferences regarding style and content

AJR Am J Roentgenol