TORONTO - The use of structured reports in radiology will allow the uncomplicated retrieval of pertinent information for referring physicians, opening up many potential applications, according to a talk at the Medical Imaging Informatics and Teleradiology (MIIT) conference.
"The great value is being able to extract information from these [structured] reports," said Dr. Charles Kahn Jr., professor of radiology and chief of the division of informatics at the Medical College of Wisconsin, and also vice chairman of RSNA's Structured Reporting Subcommittee. "I think that is what will enable clinical and translational research."
Information available in structured radiology reports could potentially be accessed and included in clinical trials in the future, Kahn noted. Moreover, the information could be used to support monitoring for quality improvement, reduce errors of omission, and improve patient safety.
Kahn stressed that structured reports can be tailored to an institution's specific needs. RSNA's initiative to encourage the use of structured reports in radiology, attached to the use of RadLex, the association's sponsored reference ontology that now contains more than 34,000 radiology terms, is a form of best practice and is not a standard that is being imposed on radiologists, he said.
"The goal is to capture information in a consistent way and display it in an organized fashion," Kahn said. "RadLex terminology is a way to enforce consistency. The report has RadLex as a backbone to give it some structure and make it work."
Key features of a structured report include modularity, such as the use of section headings and templates for consistent ordering of observations, and controlled vocabulary, designed for consistent use of words and phrases, explained Kahn. A structured report could contain the clinical indication, imaging technique, comparison, observations, and impression, noted Kahn, adding that one of the goals of structured reports is to accelerate the reporting process.
In one study, subjects surveyed indicated a preference for itemized, structured reports over free-text reports (American Journal of Roentgenology, September 2005, Vol. 185:3, pp. 804-812). Another analysis found that referring clinicians surveyed favor the use of template-based reports (85%), but radiologists did not express the same enthusiasm for template-based radiology reports (55%) (Insights into Imaging, October 2011, Vol. 2:5, pp. 577-584).
Still another investigation found a statistically significant difference in content satisfaction and clarity satisfaction between structured and conventional reports that favored structured reports (Radiology, July 2011, Vol. 260:1, pp. 174-181).
"If the information is available in a more structured format, it becomes relatively easy to look for the fields in which the information is found," said Kahn. "Other people are mining information from it."
Structured reports would particularly benefit referring physicians in the field of oncology where the information could be applied over time, noted Kahn. He envisions that structured reports could pull information from sources such as DICOM Structured Reporting, avoiding the need for transcription of information and possible error. Ultimately, the content of a structured radiology report would flow to a patient's electronic medical record, he added.
"The report is not just a collection of text," he said. "We can create image-rich reports and include other kinds of information like decision-support resources and knowledge resources that could be brought to bear and be part of the report."
The adaptable nature of structured radiology reports and the abundance of templates for various clinical scenarios would permit institutions to develop and adopt structured reports that suit their particular needs, he said. Because these will be in XML format, they will be interoperable, Kahn added.
"I think these things can come together naturally in local communities," Kahn said, giving the example of a hospital adopting a particular template for abdominal CT radiology reports.
It's at the discretion of the radiologist or an institution to use templates to generate structured reports. The decision can be made to ignore the template and stick to using free text in radiology reports, he said.
Radiologists are encouraged to regard radiology reports as a tool that other clinicians can use in their scope of practice, Kahn said.
"Heretofore, when we thought of radiology reporting, we thought about what it does for us," he said. "The problem is that someone had to read it."
