Language barrier: 60% of oncologists routinely confused by radiology reports
Referring physicians are increasingly struggling to understand radiologists’ jargon in written imaging reports, a trio of California physicians wrote in the Journal of the American College of Radiology this week. That lack of communication could result in misguided treatment.
While communication of diagnostic certainty, oncologic measurements and incidental findings are all under the microscope when it comes to uniform radiology reporting, a component vital to oncologic imaging is understanding lesion number, first author Joseph R. England, MD, and co-authors said.
“Radiologists often use qualitative descriptors of number, such as ‘few,’ ‘several,’ ‘multiple’ or ‘numerous’ to give an overall impression of how many lesions a particular organ contains,” England and his colleagues at the USC Keck School of Medicine in Los Angeles wrote. “It is unclear how consistently these words are used by radiologists or how well these words are understood by referring physicians.”
The lack of precision in these lesion measurements will become a growing problem as scientists develop more treatments for multifocal primary or metastatic neoplasms, the authors said. To assess the reality of the situation, they designed and distributed an online survey during the fall of 2017, collecting data from attending physicians and fellows alike in medical oncology, gynecologic oncology, cardiothoracic imaging and abdominal imaging.
Participants were asked in the survey how often they were confused by the number of liver lesions reported by radiologists and then asked to specify a range of lesion numbers they would expect to be present if the radiologist reported them as “few,” “several,” “multiple” or “numerous.” Radiologists’ reads were pulled from the authors’ CT report database at USC.
There was a general consensus as to the hierarchy of descriptors, England and colleagues found—both radiologists and referring physicians saw “numerous” as greater than “multiple,” “several” and “few,” though both groups regarded the last two as similar in nature.
Still, oncologists continuously overestimated what radiologists meant by “few” and “several” in reports, the researchers said. In both cases, radiologists had a smaller number of lesions in mind than what referring physicians assumed. When it came to “multiple,” radiologists tended to interpret a higher number of lesions than oncologists.
“Despite general agreement, the number of lesions expected by oncologists and radiologists for each number descriptor exhibit wide and overlapping ranges, and there are statistically significant differences between oncologist and radiologist expectations for the words ‘few,’ ‘several’ and ‘multiple,’” England and co-authors wrote.
Without a departmental lexicon of commonly understood measurements, physicians could continue to struggle with this problem, the authors said. If a radiology department views that as too daunting a task, the issue could also be alleviated with more descriptive, clearer reporting.
“When reading radiology reports, oncologists at our institution are confused by the reported number of lesions significantly more often than radiologists, with 60 percent of oncologists reporting confusion more than 50 percent of the time,” the researchers said. “We believe the guiding principle in reporting lesion number is that the impression section of the report should convey sufficient information for the referring physician to immediately understand severity or change in disease to consider all appropriate treatment options.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.