Quality of the Written Radiology Report: A Review of the Literature

doi:10.1016/j.jacr.2010.03.016

Journal of the American College of Radiology

Volume 7, Issue 8, August 2010, Pages 634-643

https://doi.org/10.1016/j.jacr.2010.03.016 Get rights and content

Purpose

A literature review was carried out, guided by the question, What are the important elements of a high-quality radiology written report?

Methods

Two papers known to the authors were used as a basis for 5 PubMed search strategies. Exclusion criteria were applied to retrieved citations. Reference lists of retrieved citations were scanned for additional relevant papers and exclusion criteria applied to these. Web sites of professional radiology organizations were scanned for guidelines relating to the written radiology report. Retrieved guidelines were appraised using the Appraisal of Guidelines for Research & Evaluation instrument. Methodologies of retrieved papers were not suitable for conventional appraisal, and an evidence table was constructed.

Results

The search strategy identified 25 published papers and 4 guidelines. Published study methodologies included 1 randomized controlled trial; 1 before-and-after study of interventions; 10 observational studies, audits, or analyses; 12 surveys; and 1 narrative review of the literature.

Conclusions

Existing guidelines have a number of weaknesses with regard to scope and purpose, methods of development, stakeholder consultation, and editorial independence and applicability. There is a major gap in published studies relating to testing of interventions to improve report quality using conventional randomized controlled trial methods. Published studies and guidelines generally support report content, including clinical history, examination quality, description of findings, comparison, and diagnosis. Important report attributes include accuracy, clarity, and certainty. There is wide variation in the language used to describe imaging findings and diagnostic certainty. Survey participants strongly preferred reports with structured or itemized formats, but few studies exist regarding the effect of report structure on quality.

Introduction

The written radiology report is the dominant method by which radiologists communicate their interpretations of imaging findings. The quality of the report therefore has a direct impact on the safety and appropriateness of decisions about treatment and further investigations. The written report also may be used in education or research, serve as a legal document, or provide billing information. Several clinical practice guidelines and a number of publications in the radiology literature have considered the style, content, timeliness, and clarity of the written radiology report and how it might be improved. The Royal Australian and New Zealand College of Radiologists, through the Quality Use of Diagnostic Imaging program, carried out a literature review guided by the question, “What are the important elements of a high-quality radiology written report?”

The aims of this literature review were to (1) identify the evidence relating the form and content of the written radiology report to objective or subjective measures of quality (such as clarity, utility, comprehensiveness, and the extent to which the report addresses the key question[s] posed in the clinical notes provided in the referral for imaging); (2) determine significant gaps in the evidence that could be filled by further research, such as a practitioner (provider or referrer) survey; and (3) use the information from the literature review and the subsequent survey to inform the development of guidance for curriculum development and evidence-based clinical practice guideline development regarding the radiology report by the Royal Australian and New Zealand College of Radiologists.

Section snippets

Identification of Professional Standards of Radiology Reports

The Web sites of the ACR, the Royal College of Radiologists, Royal Australian and New Zealand College of Radiologists, the European Society of Radiology, and the Canadian Association of Radiologists were searched for guidelines relating to reporting on March 23, 2009. Common issues addressed by these radiology reporting guidelines were identified, and recommendations of each were summarized.

Systematic Review of the Literature on Standards of Radiology Reports–Data Location and Selection

Two papers, by Sistrom et al [1] and Houssami et al [2], relating to the issue of quality in written

Results

No systematic reviews of this topic were identified.

Discussion

Existing guidelines about the written radiology report do not fully document their objectives, evidence appraisal, or development methodology and do not address implementation issues. Current and future guidelines should be integrated into radiology training programs and continuing professional development.

Published studies consist mainly of surveys or observational report audits and analyses. There is a major gap in published studies relating to testing of interventions to improve report

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Cited by (37)

Learning from the research process: An advanced practitioner reporting radiographer reflective narrative
2022, Journal of Medical Imaging and Radiation Sciences
Citation Excerpt :
Over and above the complications for my research secondary to this equivocality, the frequency of these ambiguous terms was an important consideration for my own practice. Whilst acknowledging that uncertainty is sometimes necessary, overuse of hedging should be avoided [47] and risks compromise of appropriate decision-making on patient treatment and further investigations [52]. Wallis and McCoubrie [47] suggest that where equivocation is necessary, adopting the first person adds ‘a personal touch and demonstrates thought’.
Research is one of the recognized four pillars of advanced practice. This reflective narrative outlines the radiographer author's critical thoughts throughout the completion of the research modules for an MSc in Clinical reporting. The journey is followed from formative stages through to completion. Skills are developed in determining a research subject, literature searching, navigating ethics, conducting research and dissemination. Throughout the process, as well as producing a published piece of research, the learning contributes to the remaining three pillars of advanced practice (Leadership, Clinical practice and Education), ultimately improving service to the patient.
La recherche est l'un des quatre piliers reconnus de la pratique avancée. Ce récit réflexif décrit les pensées critiques de l'auteur, radiographe, tout au long de l'achèvement des modules de recherche pour un MSc en rapport clinique. Le parcours est suivi depuis les étapes formatives jusqu'à l'achèvement. Les compétences sont développées dans la détermination d'un sujet de recherche, la recherche documentaire, la navigation dans l'éthique, la conduite de la recherche et la diffusion. Tout au long du processus, outre la production d'un document de recherche publié, l'apprentissage contribue aux trois autres piliers de la pratique avancée (leadership, pratique clinique et éducation), améliorant ainsi le service au patient.
What does the orthopaedic surgeon want in the radiology report?
2021, Journal of Clinical Orthopaedics and Trauma
Citation Excerpt :
The report represents a formal documentation of the results for the referring clinician. Despite this era being one of digital technological advancements and Picture Archiving and Communication Systems (PACs), written Radiology reports remain the primary method of communication between the referring clinician and the radiologist in several countries.8–10 Radiology reports should highlight the clinical importance of any imaging findings in an informative way, answering the clinical query to help direct patient care.11
Complementary imaging is crucial in the diagnosis and management of the spectrum of Musculoskeletal (MSK) pathologies. Like in all medical specialities, its role in trauma and orthopaedic conditions has evolved. A radiology report following an imaging study should provide an accurate, timely interpretation of images and be presented in a format that allows formal analysis or clarification of a patient's diagnostic dilemma. It is essential that it is descriptive enough to allow clinico-pathological correlation to a patient's condition. A high-quality report follows clinical governance processes, provides clinical feedback, and when appropriate, incorporates advice regarding differential diagnosis or further investigation/management that can be undertaken, permitting the attending clinician to formulate a suitable treatment plan for their patient.
In this narrative we explore common radiological investigations and reporting information in trauma and orthopaedic conditions, which would be useful to the attending surgeon.
Computed Tomography for Abdominal Pain: Do Radiology Reports Answer the Clinical Question?
2021, Academic Radiology
To assess whether abdominopelvic computed tomography (CT) radiology reports directly address a cause for pain when pain is included in the scan indication.
Four hundred and ninety-five random abdominopelvic CT reports containing “pain” in the indication were retrospectively reviewed. The position of pain descriptors within the indication, the presence of an oncology-related indication in addition to pain and whether a cause for pain was addressed in the impression were recorded. Linguistic analysis of indication and impression sections was performed. Comparisons between reports that addressed pain and those that did not were conducted using Chi-square, Fisher exact, and two-tailed t-tests.
A cause for pain was addressed in 454 of 495 (91.7%) report impressions. Indications with both oncology-related and pain-related descriptors were less likely to have pain directly addressed (χ² (1, N = 495) = 16.4, p < .001). There was no significant association between where pain appeared within the indication and whether pain was addressed (χ² (1, N = 495) = 3.2, p = .07). Whether an impression conveyed a normal result did not influence if pain was addressed (p = .49). Impression word count and complexity were higher in the addressed group compared to the not addressed group (word count 66.6 vs. 51.9, p= .02, Composite grade level 30.1 vs. 25.3, p= .02).
Radiologists at our institution consistently addressed a cause for pain on abdominopelvic CTs when pain was in the indication. However, oncology patients who also had an indication of pain were less likely to have a cause for pain addressed. Impression complexity was high for all reports, though higher in those where pain was addressed.
Best Reporting Practices for Multipart CT Scans: A Pilot Evaluation and Construction of the Optimal Analysis Methodology
2019, Journal of the American College of Radiology
Citation Excerpt :
Importantly, the instrument combined numeric Likert-type items with narrative responses, the results of which not only built a more cohesive understanding of the stakeholder perspectives but also supported the numeric question validity. Additionally, the reporting preferences found in this instrument mirror prior findings [19-22], lending support to the instrument’s validity with respect to external data and suggesting generalizability. This limited, two-center, multispecialty pilot survey found that both radiologists and nonradiologists held similar opinions favoring single-radiologist reads of multipart CT scans of the chest, abdomen, and pelvis, with some opinions not far from neutral.
Communication failure between radiologists and referring physicians contributes to a substantial portion of medical errors. With a rising number of complex imaging orders and subspecialization among radiologists, the best method of reporting those results has yet to be evaluated. The aim of this study was to create, validate, and pilot a survey to reveal best practices for communication of radiologic findings, specifically addressing multipart CT scans of the chest, abdomen, and pelvis.
A survey consisting of Likert-type and narrative response items was created, tested, and validated. It was then administered to physicians of five specialties (including radiology) at an urban quaternary care academic center and an affiliated community hospital.
The pilot survey results revealed that there was a small preference among both radiologists and referring physicians to have a single radiologist read in a single report for a multipart CT scan, rather than multiple subspecialist radiologists and reports. The findings were supported by narrative response explanations as well and demonstrate the importance of a rapid, clear, and cohesive image interpretation, despite the growing trend of radiology subspecialization. The results of the survey also confirmed its validity through an assessment with Messick’s five sources of validity evidence.
The survey’s validity indicates its generalizability to a future national survey to physicians of multiple specialties to further identify the preference of physicians on reporting of complex radiologic studies, in the setting of increased radiologic subspecialization.
Variation in the length and structure of reports written by reporting radiographers: A retrospective study
2018, Radiography
The literature suggests that there is variation in various features of the written radiology report for a range of body areas and imaging modalities. The retrospective study presented here aims to determine if similar variation is demonstrated in a group of 5 reporting radiographers in a UK NHS Trust.
Full reports for 1530 knee radiographic examinations performed from accident and emergency referrals were extracted for a 12-month period from a Radiology Information System (RIS) into Excel. Copied into Word, the word count function was used for each report and the number of words and characters (without spaces) was returned into Excel. Average word count and word length per report, by radiographer, were calculated for the following sections of the report: report title, main body and signature. SPSS was used to perform inferential statistical analysis.
A wide range in the maximum and minimum average report lengths (60.88 v 17.83 words) was demonstrated. Statistically significant differences (p < 0.05) were seen between all but one pair-wise comparison (Rad 2 v Rad 4; p = 0.98) for the overall report length; for the length of the findings section, four pair-wise comparisons did not reach significance. Average word length demonstrated less variation. 4 out of 5 radiographers always included a report title; 3 out of 5 never included a report signature. There was a strong negative correlation between experience and report length.
Variation in report structure and length, as well as word length, was seen, comparable to studies of radiologist reports. Further research is required to investigate the drivers of this variation, and determine if there is any clinical significance.
Institutional Pressure to Reduce Report Turnaround Time Is Damaging the Educational Mission
2017, Journal of the American College of Radiology

View all citing articles on Scopus

: Dr Pool was funded by the Quality Use of Diagnostic Imaging program from November 2008 until December 2009.

View full text

Original articleQuality of the Written Radiology Report: A Review of the Literature

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Identification of Professional Standards of Radiology Reports

Systematic Review of the Literature on Standards of Radiology Reports–Data Location and Selection

Results

Discussion

J Am Coll Radiol

Breast

J Vasc Interv Radiol

Acad Radiol

Eur J Radiol

Acad Radiol

Clin Radiol

Acad Radiol

Clin Radiol

J Am Coll Radiol

Acad Radiol

Acad Radiol

J Am Coll Radiol

Appraisal of Guidelines Research and Evaluation (AGREE) Instrument

ACR practice guideline for communication of diagnostic imaging findings

CAR standard for communication in diagnostic radiology

Standards for the reporting and interpretation of imaging investigations

Original article
Quality of the Written Radiology Report: A Review of the Literature