Intersociety Conference Urges Adoption of Structured Reports

Aside from referrers’ clear-cut preference for structured reports, radiologists have added cause to adopt the use of structured reporting. At its annual meeting last summer, the 2007 Intersociety Conference urged the adoption of structured reports, according to an article by N. Reed Dunnick, MD, and Curtis P. Langlotz, MD, in the May 2008 issue of the Journal of the American College of Radiology. Because the reports are organized into sections that are consistent and that use standardized language, they are more easily mined for key information that is increasingly necessary to document quality metrics linked to pay-for-performance programs, the authors wrote. While there are a few structured reporting systems for radiology on the market, radiologists can make progress toward satisfying referrers’ preference for structured reports by using the standard macros available in most speech-recognition programs. The conference participants also supported the continued use of free text, which enables radiologists to expand on findings. There remains, however, the challenge of creating those macros, and the conference participants urged the creation of best-practices structured reports using a standard radiology lexicon across all reports for examinations, interventions, and radiation oncology. The conference suggested that professional societies take the lead in developing these best-practices reports, enlisting subspecialists and referring physicians to develop the report templates. The reports could then be adapted for local conditions. Communication of results was also addressed by the conference, which urged enhanced communications for findings:

• for which urgent intervention is required;
• not anticipated by the patient’s presentation; or
• In a final report, when they are significantly different from the preliminary interpretation.

The conference also noted that radiologists should be aware that some patients, particularly those who are knowledgeable about their conditions, will access their reports and should have the opportunity to discuss findings with the radiologist. The participants supported the use of one or two key images embedded in the report, with arrows marking relevant findings and comparisons with previous studies, as a real value to referring physicians and their patients. The use of annotated images is enabled by the DICOM Key Object Selection object. The authors warned radiologists, however, to resist saying, “See image,” rather than describing the findings. “The temptation must be avoided, because part of the value of radiologists is lost if the findings are not described and their significance analyzed,” they wrote. Because structured reporting represents such a dramatic paradigm shift for radiologists, the conference participants predicted sustained resistance to the transition. They also noted, however, that once the transition begins, radiologists will find it impossible to turn back due to the enhanced value of annotated images perceived by referring physicians and their patients.