Radiology Reporting: Current Practices and an Introduction to Patient-Centered Opportunities for Improvement.

OBJECTIVE: As health care evolves, the radiology report must also change to satisfy referring physician and patient expectations. Knowledge of the issues and controversies regarding a patient-centered approach to reporting practices is important. This article will aid the radiologist in this endeavor by summarizing key facets of radiology reporting, including current reporting standards and emerging patient-centered concepts in report language, formatting, and delivery. CONCLUSION: Future efforts to improve radiology reporting practices need to account for the needs of an increasingly heterogeneous audience that includes patients. Radiologists must exploit information technologies to craft and deliver meaningful patient-centered reports. A modern radiology report will be a powerful, flexible document that strengthens the connection between the radiologist and the patient.

JOURNAL CLUB: Structured Feedback From Patients on Actual Radiology Reports: A Novel Approach to Improve Reporting Practices.

OBJECTIVE: Patient perceptions of radiology reports are largely unknown. The objective of the present study is to describe our experience receiving structured feedback from patients on actual radiology reports as a means of improving reporting practices. MATERIALS AND METHODS: Eight reports (two for radiographs, two for ultrasound images, two for CT scans, and two for MR images) were randomly selected from our system for review. For each report, patients were asked to rate their level of comprehension, identify any problems in the report, and, in the free-text portion of the feedback form, indicate any questions about the report that they may have. Potentially confounding factors were also examined. RESULTS: A total of 104 patients (46 men and 58 women) participated in the study (for a total of 832 evaluations). The median score for report comprehension was 2.5 (on a scale of 1-5), with the most common problems affecting comprehension identified as "unclear or technical language" (mentioned in 59.6% of evaluations) and the report being "too long" (mentioned in 10.2% of evaluations). A request for an explanation of the report in lay terms (noted in 20.1% of evaluations) was the most common request mentioned in the free-text portion of the feedback form. An inverse relationship existed between report length and patient comprehension (p < 0.001). Patients who had prior experience with their own radiology reports indicated having greater comprehension than did patients with no prior experience (p = 0.003). No correlation between the educational status and report comprehension of the patients was identified (p = 0.488). CONCLUSION: Radiology reports are not well understood by patients, who identify technical language and the long length of reports as the most common problems affecting their comprehension. Longer reports tend to be less well understood.

Differing Interpretations of Report Terminology Between Primary Care Physicians and Radiologists.

PURPOSE: The lexicons of the radiologist and the referring physician may not be synonymous, which could cause confusion with radiology reporting. To further explore this possibility, we surveyed radiologists and primary care physicians (PCPs) regarding their respective interpretations of report terminology. METHODS: A survey was distributed to radiologists and PCPs through an internal listserv. Respondents were asked to provide an interpretation of the statistical likelihood of the presence of metastatic disease based upon the terminology used within a hypothetical radiology report. Ten common modifying terms were evaluated. Potential responses for the statistical likelihoods included 0%-25%, 26%-50%, 51%-75%, 76%-99%, and 100%. Differences between the groups were evaluated using either a χ2 test or Fisher exact test, as appropriate. RESULTS: The phrases "diagnostic for metastatic disease" and "represents metastatic disease" were selected by a high percentage of both groups as conferring a 100% likelihood of "true metastatic disease." The phrases "cannot exclude metastatic disease" and "may represent metastatic disease" were selected by a high proportion of both groups as conferring a 0% likelihood of "true metastatic disease." Radiologists assigned a higher statistical likelihood to the terms "diagnostic for metastatic disease" (P = .016), "represents metastatic disease" (P = .004), "suspicious for metastatic disease" (P = .04), "consistent with metastatic disease" (P < .0001), and "compatible with metastatic disease" (P = .003). CONCLUSION: A qualitative agreement among radiologists and PCPs exists concerning the significance of the evaluated terminology, although radiologists assigned a higher statistical likelihood than PCPs for several phrases.

Creating a Patient-Centered Radiology Practice Through the Establishment of a Diagnostic Radiology Consultation Clinic.

OBJECTIVE: The purposes of this study were to assess the feasibility of and to create a referral mechanism for a diagnostic radiology consultation clinic. SUBJECTS AND METHODS: A pilot program was instituted with patients from a single primary care clinic over a 3-week period. Patients with findings of common problems at routine imaging, such as atherosclerosis, emphysema, and hepatic steatosis, were eligible to participate. As the patients arrived for their routine primary care visits, office staff informed them of the opportunity to formally meet with a radiologist to review their most recent imaging findings. The office staff of the primary care clinic then contacted the radiologist covering the diagnostic radiology consultation clinic to schedule a consultation. A survey was administered before and after the session. RESULTS: Twenty-two patients participated (88% participation rate). Participants rated the consultation as very helpful (mean, 4.8 on 1-5 scale), and all participants would take the opportunity to review studies with the radiologist again. Significantly more patients preferred the involvement of the radiologist in communicating the results of an imaging examination after the consultation compared with before the consultation (p = 0.001). After the consultation session, patients had significantly improved understanding of a radiologist's role (p = 0.004), and all participants were able to correctly identify the radiologist as a physician who interprets medical images. CONCLUSION: A referral mechanism for a diagnostic radiology consultation clinic can be effectively integrated into the everyday workflow of both the referring physician and the radiologist. The consultations are useful to patients and help to increase their awareness of the role of the radiologist.

Rethinking the role of the radiologist: enhancing visibility through both traditional and nontraditional reporting practices.

The written radiology report is the primary method by which the radiologist communicates examination findings to the referring physician and the patient. Unfortunately, despite recent efforts to improve radiology reporting practices, dissatisfaction with regard to traditional reporting practices continues among referring physicians and patients. Moreover, the current reporting paradigm limits the amount of interaction that radiologists can have with patients and referring physicians. To address these issues, organizational efforts have been made by the Radiological Society of North America and the American College of Radiology to educate the public about the role of the radiologist in patient care, provide resources for individuals to learn more about the practice of radiology, and assist radiologists in creating a more "patient-centered" practice. In addition, individual radiologists may want to consider making adjustments to their reporting practices to improve communication of examination findings and increase patient awareness of the radiologist's role in clinical care. Many opportunities exist for radiologists to make such changes, both within the traditional reporting model (decreasing barriers to communication, educating patients) and with implementation of various nontraditional reporting practices (eg, delivering examination results directly to patients, receiving structured feedback on reports, establishing a diagnostic radiology consultation clinic). The authors provide guidance for radiologists who wish to enhance their visibility in clinical care with use of both traditional and nontraditional reporting practices.

Radiologists' role in the communication of imaging examination results to patients: perceptions and preferences of patients.

OBJECTIVE: It has been suggested that radiology reporting practices would be improved if radiologists were to discuss the results of an examination directly with the patient. The attitudes and preferences of patients with regard to direct communication with the radiologist are not well-defined. The purpose of this study was to survey patients about their preferred method of receiving radiologic results. MATERIALS AND METHODS: An anonymous survey was distributed to adult patients undergoing contrast-enhanced CT or MRI over a 2-week period in June 2013. RESULTS: The response rate was 58.4% (642 responses). For normal examination results, the preferred mode of communication was a telephone call from the ordering physician (34.1%); only 12% of respondents opted for a telephone call from the radiologist, and 2.6% chose a face-to-face meeting with the radiologist. For abnormal test results, the preferred mode of communication was also a telephone call from the ordering physician (49.8%); 14.4% of respondents selected a telephone call from the radiologist, and 8.3% chose a face-to-face meeting with the radiologist. Patients preferred receiving very detailed versions of radiology reports for both normal (46.4%) and abnormal (81.8%) test results. Patients also expressed a desire to have access to at least key images from their examinations. CONCLUSION: Patients prefer receiving both normal and abnormal examination results from the physicians who ordered the examination rather than the radiologist. They also prefer to receive very detailed examination results rather than a brief summary in lay terms.