Solid structure: Radiography reports more effective with templates

Structured radiology reports are more complete and more effective than free text reports, according to a study published in the December issue of the American Journal of Roentgenology.

The study was conducted by Peter A. Marcovici, MD, of the UCSF Benioff Children’s Hospital in San Francisco, and George A. Taylor, MD, of Boston’s Children’s Hospital.

The authors noted that in some areas of imaging, like mammography, standardized reporting have been shown to increase quality, and these practices have been recently proposed for radiography.

“The goal of this study was to compare unstructured and structured chest radiograph reports in terms of their completeness and effectiveness,” Marcovici and Taylor wrote.

To establish the effectiveness of standardized reporting, radiology trainees at Boston Children’s Hospital were given one-hour lectures quarterly and then provided with a chest radiograph reporting templates. For each trainee, five randomly selected radiograph reports generated before their educational intervention and five randomly selected structured chest radiograph reports generated after the educational intervention were exported. These were scored by four blind pediatric physicians who rated the reports on a 5-point Likert scale that analyzed two features: completeness and effectiveness.

A total of 120 (60 structured and 60 unstructured) reports were rated.

The mean completeness score for structured reports was 4.42 (out of five) while the unstructured reports rated 3.99. The mean effectiveness scores for structures and unstructured reports were 4.11 (out of five) and 3.85, respectively.

“These results are notable, given the relatively high scores achieved by the unstructured reports; structured reports showed improvement over and above already high-scoring unstructured reports,” the authors wrote.

The authors conceded that the higher completeness scores may have been related to the “checklist effect” from using the structured template—it was more likely with the structured report that every relevant feature was analyzed and commented on.

“It is also possible that the raters scored the structured reports as more complete because of a preference for the itemized presentation; bulleted information is easier to digest than paragraph form,” Marcovici and Taylor wrote.

The authors noted structured reporting could positively impact patient care through improved communication of radiological results and the use of structured reports may also improve quality by promoting a more systematic review at the time of report creation.

“The use of structured reporting could contribute to more than just radiology quality improvement,” Marcovici and Taylor wrote.  “In fact, heretofore unknown trends in diseases; correlations among radiographic, clinical, and laboratory data; and other relational explorations could be mined from ever-growing data if these data are gathered in an organized and consistent manner.”