Although structured reporting is in widespread use throughout radiology, there are many who still prefer using a free text, or narrative, format.
O'Connor
Yousem
Informatics experts debated the merits and drawbacks of each approach in the Controversy Session: "Radiology Report Substance, Structure and Style-Who's Right?"
"One thing everyone can agree on is that accurate, timely and high-quality radiology reports are critical to ensuring optimal patient care," said Stephen O'Connor, MD, a radiologist at the Baystate Medical Center and Children's Hospital, Springfield, MA. "The debate lies in whether using a structured or narrative approach is the best method for achieving this."
Dr. O'Connor, who moderated the sessions, says that while both approaches have their advantages and disadvantages, he is on Team Standard. "Although I have been a strong advocate of structured reporting for most of my career, I am well aware that some of my very best colleagues prefer the purely narrative style of reporting," he added.
Structured Reporting: The End of Creativity?
One of those experts is David Yousem, MD, MBA, a radiologist at the Johns Hopkins University School of Medicine, Baltimore, MD. "Most radiologists view their reports as a reflection of themselves, often using certain phrases that denote their level of assuredness and style," he said. "For some, taking away that creativity may lead to decreased satisfaction at work."
Flanders
Ganeshan
However, according to Adam Flanders, MD, a radiologist at the Thomas Jefferson University Hospital, Philadelphia, structured reporting does not necessarily mean the end of creativity. "Structured reporting can mean different things to different radiologists," he explained.
For example, although in some instances imposing structure means using controlled vocabularies or listed responses without explanation, it can also mean that a report's content appears in the same order for everyone, with the actual information remaining in free text format.
"This approach has tremendous advantages because it allows the reader to become familiar with the structure, thus making it easier to read and comprehend," Dr. Flanders said. "Clinicians overwhelmingly prefer to have reports constructed in this fashion."
Dhakshina Ganeshan, MD, a radiologist at the University of Texas MD Anderson Cancer Center, Houston, tends to agree.
"Sure, a well-crafted narrative report has its own charm and may work well in many instances, but the significant variability in narrative styles amongst radiologists can pose problems," Dr. Ganeshan said.
"From that viewpoint, a well-crafted structured radiology report is excellent as it removes any potential misunderstanding that may arise due to variability in the language used in narrative reports."
One Template Does Not Fit All
Regardless of format, Dr. Flanders argues that using a structured approach provides a more consistent method for recording and communicating relevant imaging information to clinicians and downstream systems. "The bottom line is that structured systems provide a level of consistency that ultimately improves the quality of care," he said.
Dr. Yousem takes issue with this point. "I don't believe that structured reports are the solution for interpretation errors," he said. "Perceptual and cognitive errors are much more likely to be the source of error than the mere format of a report."
So, what is the verdict?
"In the end, it seems likely that a hybrid model proposed by Dr. Flanders will prevail, but there is no question that one template does not meet all clinical needs," Dr. O'Connor continued.
For More Information
View the RSNA 2020 session Radiology Report Substance, Structure and Style—Who's Right? — SPSC20 at RSNA2020.RSNA.org.
