What clinicians want from radiology reports

Clinicians want accurate opinions and advice from radiologists that they can understand and use. They want radiologists to be proactive if the exam ordered for a clinical indication is inappropriate or if a different one might be better. They want to be informed of unexpected findings.

And they want to talk -- live or by telephone -- to ask questions and to collaborate with interpreting radiologists about challenging or complex cases. In an era of contemplating how electronic media can be used to improve radiology reports, physicians are requesting "old-fashioned" access to radiologists and straightforward radiology reports, according to an online article published 28 July in Insights into Imaging.

When given the opportunity to make recommendations on how reporting the findings of radiology exams could be improved, almost one-third of respondents (233 physicians) to an Internet survey offered suggestions. A total of 735 physicians from the Flanders region of Belgium and from the Netherlands responded to an Internet survey called "Clinicians' Opinions, Views, and Expectations Concerning the Radiology Report (COVER)."

General practice physicians (35%), internal medicine specialists (6%), and pediatricians (6%) offered the most suggestions, according to lead author Dr. Jan Bosmans of the radiology department of the University of Antwerp and University Hospital Ghent in Belgium, and colleagues. Twenty specialties were represented, and respondents ranged from being very young (26 years) to very old (78 years).

With a nod to the electronic age, clinicians recommended that the push-of-a-button availability of a patient's electronic medical record (EMR) provided no excuse not to review it. They suggested that radiologists and residents should at least have a cursory understanding of the clinical history of the patient so they could be better informed when reviewing complex or challenging diagnostic images.

They wanted information presented in a logical manner, with report contents structured in a familiar format that could be easily read. The European Society of Radiology (ESR) has recommended categories that include clinical referral, technique, findings, conclusion, and advice.

While adoption of structured reports was recommended by some, the use of structured report templates was of concern to others because they could cause too many errors. One clinician even exclaimed, "No computer-generated reports in which just a few words have been changed." Others criticized the errors of inadequately proofread reports generated by speech recognition dictation systems.

Physicians overwhelmingly wanted their clinical question answered. They want to confirm that radiologists were looking for indications of the symptom or condition that sent patients to their department in the first place. They criticized the use of the term "no abnormal findings" without referencing the clinical question, and they lambasted radiologists' use of vague and ambiguous statements.

Differential diagnoses should be presented with probability ratings if a diagnosis cannot be made. If a diagnosis cannot be made because of image quality, the radiology department should take the responsibility of rescheduling the patient to repeat the exam.

Unexpected findings or findings outside the scope of the examination should be highlighted, and critical results should be reported promptly with person-to-person communications. When a radiologist believes that additional exams or follow-up exams in the future should be performed, the report should clearly convey this information with inclusion of a recommended time frame if applicable.

Specialists suggested radiologists should take into consideration who's ordering an exam and tailor the language of a report appropriately, especially to a medical specialist. Abbreviations aren't welcomed because they can cause confusion. Terminology used should be consistent and standardized within the radiology department.

Radiologists should include key images if they are important. Ideally the images will be annotated in some way, just like film markups used to be. Measurements should be included if they are meaningful, and should include standard deviations to put this information in perspective.

Finally, clinicians want to be able to talk to the interpreting radiologist when they need to do so. Just as radiologists complain about clinicians being unavailable to be told about critical results and unexpected findings, the clinicians have the same concern. In spite of the ubiquity of the cellphone and the proliferation of the smartphone, all clinicians, regardless of specialty, don't seem to be as accessible as they used to be.

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