Original article
Clinical practice management
Effect of Template Reporting of Brain MRIs for Multiple Sclerosis on Report Thoroughness and Neurologist-Rated Quality: Results of a Prospective Quality Improvement Project

https://doi.org/10.1016/j.jacr.2016.09.037Get rights and content

Abstract

Purpose

To assess the impact of structured reporting templates on the objective and subjective quality of radiology reports for brain MRIs in patients with multiple sclerosis (MS).

Methods

A HIPAA-compliant prospective quality improvement initiative was undertaken to develop and implement a 12-item structured reporting template for brain MRI examinations in patients with known or suspected MS based on published guidelines. Reports created 1 year before implementing the template served as the baseline. A random sample of 10 template and 10 non-template reports was sent to five neurologists outside the study institution with MS expertise, who reviewed the reports for comprehensiveness and quality. The number of MS-relevant elements in template and non-template reports were compared with unpaired t tests. Proportions were compared with χ2 and Fisher exact tests.

Results

There were 63 reports in the pre-template period and 93 reports in the post-template period. Use of the template increased over time in the post-template period (P = .04). All 12 MS-relevant findings were addressed more often and with less variability in template reports: (11.1 ± 0.7 findings versus 5.8 ± 2.2 findings in non-template reports, P < .001). Neurologists were more likely to give the template reports the highest positive rating (56% [107/190] versus 28% [56/199], P < .001) and less likely to give the template reports a lower rating (7% [13/190] versus 15% [29/199], P = .01) compared with the non-template reports.

Conclusion

Template reporting of brain MRI examinations increases the rate at which MS-relevant findings are included in the report. Standardized reports are preferred by neurologists with MS expertise.

Introduction

Structured radiology report templates have been explored as a method to organize the information contained in a radiology report to improve report quality. Templates provide an inherent “checklist” that prevents omission of important data and displays information in a consistent manner [1]. When created in collaboration with referring physicians, report templates can educate and remind radiologists which imaging data are most relevant for management in specific patient populations [2] and guide radiologist practice patterns. Prior research into structured reporting of radiology information has demonstrated that templates are preferred by referring physicians in a number of settings 3, 4, 5, 6, 7 and improve the comprehensiveness of radiology reports 8, 9. Templates have been created through collaborations between radiology and clinical specialty societies in targeted disease states, such as rectal [10] and pancreatic [2] adenocarcinoma. However, not all evidence has been positive: Johnson et al [11] noted a paradoxical decrease in report accuracy and thoroughness with resident use of a brain MRI template for patients with a clinical suspicion of stroke.

One area in neuroradiology that may benefit from structured reporting is multiple sclerosis (MS), a chronic neurologic disease that comprises a large volume of neuroimaging in which longitudinal MRI assessments are recommended and commonly performed in clinical practice [12]. MRI is a critical clinical tool for the diagnosis of MS in many settings. The presence of T2-weighted (T2w) /fluid-attenuated inversion recovery (FLAIR) white matter hyperintensities and, in particular, gadolinium-enhancing lesions or lesions with certain spatial distributions (eg, periventricular, juxtacortical, below the tentorium cerebelli) [13] can help establish the diagnosis of MS. The updated 2010 guidelines from the International Panel on Diagnosis of MS (ie, the updated McDonald Criteria) newly permit the use of one MRI scan without comparison imaging to support the diagnosis of MS if it contains both contrast-enhancing (active) and quiescent (remote) lesions that are separated spatially [14]. In addition to diagnosis, imaging is used to determine the need for and type of medications, which can prevent the development of new lesions and alter the long-term course of this disease [15]. Owing to the primary role of imaging in the diagnosis and management of MS, the 2015 guidelines by the Magnetic Resonance Imaging in MS (MAGNIMS) network has advocated for structured reporting to ensure inclusion of critical report elements [16].

This prospective quality improvement initiative was conducted to improve the real and perceived quality of radiology reports on brain MRIs in patients with MS.

Section snippets

Methods

The institutional review board considered this quality improvement initiative to be “not regulated” on the basis of its goal of assessing and immediately improving health system quality. All medical records were handled in a HIPAA-compliant fashion.

Results

The structured template was used for 71% (66/93) of the reports in the post-template period. Use of the template in the post-template period increased over time between the first and fourth quarters after its introduction (P = .04) (Fig. 1). Nearly all (97% [152/156]) reports had a comparison contrast-enhanced brain MRI available when created.

Discussion

We found that brain MRI reports that used a template designed for comprehensive and accurate reporting of findings relevant to MS contained significantly more details relevant to MS management compared with non-template reports (11.1 ± 0.7 findings versus 5.8 ± 2.2 findings, P < .001), was preferred by neurologists with expertise in MS management, and was integrated effectively into clinical practice over a 1-year period. These findings are consistent with the results of studies investigating

Take-Home Points

  • Brain MRI reports using a template for MS contained significantly more details relevant to MS management compared with non-template reports.

  • Template brain MRI reports for MS were far less likely to omit discussion of critical aspects of MS reporting, such as the presence or absence of enhancing lesions.

  • Brain MRI reports using a template for MS were rated as higher quality and more comprehensive than non-template reports by neurologists.

  • The objective and neurologist-perceived improvements in

Acknowledgments

Thank you to Dr Christopher Bever, Department of Neurology, University of Maryland Medical School and Chief of the Neurology Service at the VA Medical Center in Baltimore, for his assistance in data collection; and to Vanessa Allen, Department of Radiology, University of Michigan, for assistance with preparing illustrations for publication.

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    Matthew S. Davenport receives royalties from Wolters-Klewer for book publications, and is a paid consultant to the FDA and National Cancer Institute. Olaf Stuve serves on the editorial boards of JAMA Neurology, Multiple Sclerosis Journal, and Therapeutic Advances in Neurological Disorders; has served on data monitoring committees for Pfizer and TG Therapeutics without monetary compensation; collaborated with Medscape on educational initiatives; has advised Genzyme; has participated in a Teva-sponsored meeting; currently receives grant support from Teva Pharmaceuticals and Opexa Therapeutics; and is funded by a Merit Review grant (federal award document number [FAIN] I01BX001674) from the US Department of Veterans Affairs, Biomedical Laboratory Research and Development. Jeffrey A. Cohen reports personal fees from Genentech, personal fees from Genzyme, personal fees from Novartis, personal fees from Receptos, and personal fees from Teva, outside the submitted work. The other authors have no conflicts of interest related to the material discussed in this article.

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