European Radiology (2018) 28:3007–3008 https://doi.org/10.1007/s00330-018-5417-z UROGENITAL Structured reporting of pelvic MRI leads to better treatment planning of uterine leiomyomas 1 1 Evis Sala & Susan Freeman Received: 22 February 2018 / Accepted: 8 March 2018 / Published online: 4 May 2018 The Author(s) 2018 Over the years, the role of the radiologist within the multidis- extract relevant prognostic information from radiology reports ciplinary team has evolved remarkably, with imaging provid- . The clarity of the radiology report is essential to the inte- ing crucial information for patient management. Through gration of imaging, pathology, multi-omics and clinical data close collaboration with referring clinicians, most radiology and provides one of the cornerstones of integrative and per- practices now strive for their radiology reports to provide the sonalized medicine. maximum value for individualized patient care . Therefore, Aiming at enhancing the quality and efficiency of radiolo- the development of structured radiology reports has gained gy reports, the Radiology Society of North America (RSNA) impetus as an essential tool toward delivering personalized and the European Society of Radiology (ESR) have jointly medicine. In fact, structured report templates provide a plat- formed the Template Library Advisory Panel (TLAP) . form for potentially providing clear, concise, consistent and TLAP provides reporting templates that are based on actionable reports that can assist the referring clinician in established data standards and incorporate structured termi- triaging the patient to appropriate treatment . The key to nology such as RSNA RadLex radiology lexicon, as well as adding value to radiology reporting lies in the disease-specific access to tools to create and modify templates. The overall structured reports that are developed by radiologists in collab- goal is to improve the value of the radiology service to patients oration with the clinical management team. However, in the and their treating physicians by providing consistent and data- era of increasing workload, the balance between a succinct, rich reports, which also enable better data analysis for out- generic structured report and a time-consuming disease-spe- comesresearchwhencomparedtonarrativeunstructured cific report is important. reports. In general, structured reporting allows information to be Several studies have analyzed the value of structured more easily extracted and improves communication with cli- reporting, most of them focusing on various oncological ap- nicians. In addition, the use of structured reporting reduces plications [5–7]. Brook and colleagues showed that imple- ambiguous terms and errors due to use of speech recognition mentation of structured reports leads to improvement in stag- systems, typically seen with narrative reports, which could ing and surgical planning in patients with pancreatic cancer lead to misinterpretation and in turn impact patient manage- . Yee and colleagues developed a computed tomography ment . Furthermore, standardized template reporting en- (CT) colonography structured reporting template that led to hances the value of natural language processing and machine improved clarity of interpretation and thus better communica- learning techniques, which have been shown to successfully tion with the referring physicians . In patients with primary rectal cancer, structured rectal magnetic resonance imaging (MRI) reporting templates facilitated surgical planning and This editorial comment refers to the article available at https://doi.org/10. led to higher satisfaction level of referring surgeons compared 1007/s00330-017-5161-9. to narrative reports . Other studies assessed the structured format of the conclusion/impression section of the report as a * Evis Sala email@example.com means to provide better value to the managing team [8, 9]. Introduction of a structured format in the impression section of * Susan Freeman firstname.lastname@example.org a coronary CT angiography report led to an improved agree- ment on the number of significant stenotic vessels . More Department of Radiology, Box 218, Cambridge Biomedical Campus, recently, Wibmer and colleagues  found that the implemen- Cambridge CB2 0QQ, UK tation of a lexicon of diagnostic certainty in prostate MRI 3008 Eur Radiol (2018) 28:3007–3008 Conflict of interest The authors of this manuscript declare no relation- reporting significantly reduced the number of expressions ships with any companies whose products or services may be related to used by radiologists to indicate their levels of diagnostic cer- the subject matter of the article. tainty for presence of extracapsular extension. This is impor- tant as wider adoption of such a lexicon might prevent mis- Statistics and biometry No complex statistical methods were necessary communication and help referring clinicians to reliably incor- for this paper. porate radiologists’ input into clinical decision-making. Informed consent Written informed consent was not required for this The study by Franconeri and colleagues investigated study because this is an editorial without any study subjects. the clarity and impact of structured reporting, in comparison to narrative reporting, on treatment planning for patients with Ethical approval Institutional review board approval was not required uterine leiomyomas. The most important and novel aspect of because this is an editorial without any study subjects. the study design is that the structured reporting template was Open Access This article is distributed under the terms of the Creative developed by diagnostic radiologists in collaboration with in- Commons Attribution 4.0 International License (http:// terventional radiologists and gynecologists. The reports were creativecommons.org/licenses/by/4.0/), which permits unrestricted use, assessed both objectively and subjectively by the same multi- distribution, and reproduction in any medium, provided you give appro- priate credit to the original author(s) and the source, provide a link to the disciplinary team; this is another major strength of the study Creative Commons license, and indicate if changes were made. design, as patient management decisions in clinical practice are made by multidisciplinary teams. This is key to successful implementation and acceptance of such reports by the man- References agement team and ultimately impacts individual patient care. The authors also found that structured reports described the 1. Schwartz LH, Panicek DM, Berk AR, Li Y, Hricak H (2011) key features of uterine leiomyomas and provided sufficient Improving communication of diagnostic radiology findings information to enable treatment planning more frequently, through structured reporting. Radiology 260:174–181 when compared to narrative reports. More importantly, struc- 2. Anderson TJT, Lu N, Brook OR (2017) Disease-specific report tured reports were more helpful for surgical planning and eas- templates for your practice. J Am Coll Radiol 14:1055–1057 ier to understand by gynecologists compared to narrative 3. Chen P-H, Zafar H, Galperin-Aizenberg M, Cook T (2017) Integrating natural language processing and machine learning algo- reports. rithms to categorize oncologic response in radiology reports. J Digit Template reporting improves the consistency of radiology Imaging. https://doi.org/10.1007/s10278-017-0027-x reports and assures a terminology accepted by everyone in- 4. Chen JY, Sippel Schmidt TM, Carr CD, Kahn CE Jr (2017) volved in patient care. Selection of the clinically important Enabling the next-generation radiology report: description of two new system standards. Radiographics 37:2106–2112 features that determine patient management and treatment se- 5. Brook OR, Brook A, Vollmer CM, Kent TS, Sanchez N, Pedrosa I lection is crucial and best done in consultation with the clinical (2015) Structured reporting of multiphasic CT for pancreatic can- management team. In fact, the study by Franconeri and col- cer: potential effect on staging and surgical planning. Radiology leagues  proves that structured reports developed in con- 274:464–472 sultation with treating gynecologists and interventional radiol- 6. Yee J, Chang KJ, Dachman AH et al (2016) The added value of the CT colonography reporting and data system. J Am Coll Radiol 13: ogists reduce the number of missing key features, are easier to 931–935 understand and more likely to contain sufficient information 7. Nörenberg D, Sommer WH, Thasler W et al (2017) Structured for procedural planning in patients with uterine leiomyomas. reporting of rectal magnetic resonance imaging in suspected prima- One could argue that in the era of proliferation of multidisci- ry rectal cancer: potential benefits for surgical planning and inter- disciplinary communication. Invest Radiol 52:232–239 plinary team meetings (MDTs), they will provide the best plat- 8. Ghoshhajra BB, Lee AM, Ferencik M et al (2013) Interpreting the form to discuss overall a patient’s clinical and imaging infor- interpretations: the use of structured reporting improves referring mation. However, MDTs are increasingly time-consuming and clinicians’ comprehension of coronary CT angiography reports. J usually focused on patients on oncology pathways. Therefore, Am Coll Radiol 10:432–438 the use of disease-specific structured reporting for both onco- 9. Wibmer A, Vargas AH, Sosa R, Zheng J, Moskowitz C, Hricak H (2014) Value of a standardized lexicon for reporting levels of diag- logical and non-oncological applications might reduce the nostic certainty in prostate MRI. AJR Am J Roentgenol 203: number of patients discussed at MDTs. Consequently, this will W651–W657 allow more time for adequate discussion of complicated cases 10. Franconeri A, Fang J, Carney B et al (2017) Structured vs narrative as well providing a better educational forum. reporting of pelvic MRI for fibroids: clarity and impact on treatment planning. Eur Radiol. https://doi.org/10.1007/s00330-017-5161-9 Funding The authors state that this work has not received any funding. Compliance with ethical standards Guarantor The scientific guarantor of this publication is Evis Sala.
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Published: May 4, 2018