While some traditions should be valued and retained, the old standard free-text radiology report might not be one of them. At Brigham and Women's Hospital, a structured reporting template yielded a significant improvement in the quality of MRI reports for the crucial task of staging rectal cancer.
A team led by Dr. V. Anik Sahni found that the percentage of reports deemed to be satisfactory or optimal nearly doubled after the voluntary adoption of structured reports, reaching more than 70%. Furthermore, more than 40% of reports were judged to be optimal after structured reporting was implemented, whereas none were prior to adoption.
The researchers shared their results in an article published in the September issue of the American Journal of Roentgenology.
"Implementing a structured report improved the quality of the reports by containing more of the necessary data," Sahni told AuntMinnie.com.
Moving away from free text
A gradual shift is underway in radiology to move from traditional free-text reports to structured reports, he said.
Prior studies have found that structured reports offer several advantages over free-text reports, such as improved clarity, consistency, and end-user satisfaction; however, the researchers wanted to investigate whether this shift translated into a clinically relevant improvement, Sahni said. In their research project, the researchers assessed whether a structured report improved the quality of MRI reports for rectal cancer staging.
"This is an examination that requires certain data elements to be included in the report to guide further management," he said.
Initially, a consensus of subspecialty-trained abdominal radiologists defined the data elements needed to produce an optimal report:
- Rectal segment location
- Radial location
- Distance from anorectal junction or internal anal sphincter
- Tumor length in cm
- Morphologic features
- T1 signal
- T2 signal
- Diffusion restriction
- Extramural extension
- Shortest distance to circumferential resection margin
- Extramural venous invasion
- Invasion of adjacent organs
- T stage
- N stage
The researchers then measured the inclusion of these 14 data elements in MRI reports for rectal cancer staging, both 12 months before and after a structured reporting template was integrated into the institution's speech recognition system on July 2, 2013. Reports that documented all quality measures were considered to be optimal, while reports that only documented certain quality measures were deemed satisfactory. Reports that lacked documentation of one or more of the satisfactory quality measures were classified as unsatisfactory (AJR, September 2015, Vol. 205:3, pp. 584-588).
A total of 106 MRI reports from 104 patients were included in the study; 52 reports (49.1%) were completed prior to implementation of the structured reporting template. Of the 54 reports that were generated afterward, 43 (79.6%) were produced using the template.
| MRI report quality before and after structured reporting | |||
| Adoption of structured reporting | Satisfactory reports | Optimal reports | Satisfactory + optimal reports |
| Before | 20/52 (38.5%) | 0 | 20/52 (38.5%) |
| After | 16/54 (29.6%) | 22/54 (40.7%) | 38/54 (70.4%) |
The improvement in the total number of reports categorized as satisfactory or optimal was statistically significant (p = 0.001).
Adopting structured reporting led to higher-quality reports that contained more of the necessary data elements used to determine if the patient should receive neoadjuvant chemoradiotherapy or surgery, Sahni said.
On the downside, 30% of reports still remained unsatisfactory. Sahni noted that use of the structured report format was voluntary, and approximately 20% of the reports did not use the template. In addition, radiologists were sometimes reluctant -- even with the structured template -- to comment on certain features such as nodal staging.
"Nodal staging is notoriously difficult to perform in rectal cancer, especially in small nodes where there are false positives and negatives," he said. "For this reason, [the] radiologist may feel uncomfortable committing to a particular nodal staging."
Report quality may be improved by making it mandatory for physicians to use the template and fill in all fields, he said.
In the next phase of the research, it would be useful to investigate end-user satisfaction of structured reports and whether the improved reporting of discrete data elements actually affects patient outcome, Sahni said.
