Analytical performance of aPROMISE: automated anatomic contextualization, detection, and quantification of [18F]DCFPyL (PSMA) imaging for standardized reporting.

PURPOSE: The application of automated image analyses could improve and facilitate standardization and consistency of quantification in [18F]DCFPyL (PSMA) PET/CT scans. In the current study, we analytically validated aPROMISE, a software as a medical device that segments organs in low-dose CT images with deep learning, and subsequently detects and quantifies potential pathological lesions in PSMA PET/CT. METHODS: To evaluate the deep learning algorithm, the automated segmentations of the low-dose CT component of PSMA PET/CT scans from 20 patients were compared to manual segmentations. Dice scores were used to quantify the similarities between the automated and manual segmentations. Next, the automated quantification of tracer uptake in the reference organs and detection and pre-segmentation of potential lesions were evaluated in 339 patients with prostate cancer, who were all enrolled in the phase II/III OSPREY study. Three nuclear medicine physicians performed the retrospective independent reads of OSPREY images with aPROMISE. Quantitative consistency was assessed by the pairwise Pearson correlations and standard deviation between the readers and aPROMISE. The sensitivity of detection and pre-segmentation of potential lesions was evaluated by determining the percent of manually selected abnormal lesions that were automatically detected by aPROMISE. RESULTS: The Dice scores for bone segmentations ranged from 0.88 to 0.95. The Dice scores of the PSMA PET/CT reference organs, thoracic aorta and liver, were 0.89 and 0.97, respectively. Dice scores of other visceral organs, including prostate, were observed to be above 0.79. The Pearson correlation for blood pool reference was higher between any manual reader and aPROMISE, than between any pair of manual readers. The standard deviations of reference organ uptake across all patients as determined by aPROMISE (SD = 0.21 blood pool and SD = 1.16 liver) were lower compared to those of the manual readers. Finally, the sensitivity of aPROMISE detection and pre-segmentation was 91.5% for regional lymph nodes, 90.6% for all lymph nodes, and 86.7% for bone in metastatic patients. CONCLUSION: In this analytical study, we demonstrated the segmentation accuracy of the deep learning algorithm, the consistency in quantitative assessment across multiple readers, and the high sensitivity in detecting potential lesions. The study provides a foundational framework for clinical evaluation of aPROMISE in standardized reporting of PSMA PET/CT.

Pulmonary CTA Reporting: AJR Expert Panel Narrative Review.

Pulmonary CTA is a ubiquitous study interpreted by radiologists with different levels of experience in a variety of practice settings. Pulmonary embolism (PE) can range from an incidental and clinically insignificant finding to a clinically significant thrombus that can be managed on an outpatient basis to a potentially fatal condition requiring immediate medical or invasive management. Accordingly, a clear and concise pulmonary CTA report should effectively communicate the most pertinent findings to help the treating medical team diagnose or exclude PE and provide information to guide appropriate management. In this Expert Panel Narrative Review, we discuss the purpose of the radiology report for pulmonary CTA, the optimal report format, and the relevant findings that need to be addressed and their clinical significance.

IUGA report on reporting urodynamics in women.

INTRODUCTION AND AIM: Urodynamics (UDS) is the current gold standard investigation for explaining pathology in lower urinary tract dysfunction. The role of UDS is to answer a urodynamic question based on reproducing the patient's symptoms. Despite the introduction of several standardization documents on terminology and methodology for performing UDS and the standard of equipment required, there remains no standardization on how to report and therefore how to interpret UDS findings. The lack of guidance in this specific area may undermine the value of this extremely important tool in the patient evaluation. The aim of this article is to propose a standardized proforma and checklist for the reporting of UDS studies; the main text discusses the rationale for the proforma. METHODS: This document underwent four rounds of review by the working group and external review by Andrew Gammie. Between each round the document was re-circulated for comment and the comments collated and then reviewed for adoption or rejection based on consensus prior to the document going for further external review. The comments of the external review were then collated and again circulated for consideration prior to adoption based on consensus and the paper put out to review by an IUGA committee public consultation prior to being submitted for publication. RESULTS: This article sets out the rationale for a standardized proforma for reporting female UDS. CONCLUSION: This document gives a standardized approach to reporting of UDS. The importance of this is based on UDS being part of a process and not an isolated event. Standardized reporting, like the WHO checklist, gives a framework to ensure that the test has been ordered appropriately and that the final report refers to the indication rather than merely the observations. As such, a standardized report has a better chance of being interpreted appropriately for the woman's symptoms.

The effect of clinical pharmacists' intervention in adverse drug reaction reporting: a retrospective analysis with a 9-year interrupted time series.

BACKGROUND: In China, 85.4% of adverse drug reactions (ADRs) are spontaneously reported by healthcare facilities. As a result, many ADRs are not reported due to lack of mandatory reporting requirements. As healthcare professionals, clinical pharmacists (CPhs) serve as a bridge between clinical work and medication and ensure rational drug use. In China, A team of CPhs implemented an intervention for ADRs reporting, with the goal of improving the number of ADRs reports, the number of unreported ADRs, and the standardized reporting rate. METHODS: On June 01, 2015, a team of CPhs implemented an intervention for ADRs reporting at a Grade A, Class 3 hospital in China. The drug review catalogue (DRC) was used to screen physician orders for having visible symptoms of ADRs across departments, pooled the ADRs, and submitted them to the Center for Advanced Drug Monitoring (CNCAM). We retrospectively analysed the effect of a CPhs ADRs reporting intervention on the number of clinical ADRs reports, the number of unreported ADRs, and the standardized reporting rate over a 9-year period by interrupted time series (ITS). The method was implemented at the hospital on June 1, 2015, and a segmented regression model was used to analyse the data from January 1, 2010, to December 31, 2019. RESULTS: After the CPhs ADRs reporting intervention, the number of inpatient ADRs reports submitted to the CNCAM immediately increased by approximately 63 (62.658, P < 0.01) and then decreased by approximately 1 (0.701, P = 0.000151 < 0.01) per month afterward; the number of unreported ADRs was immediately reduced by approximately 44 (44.091, P < 0.01) and remained largely unchanged over time (P > 0.05); the standardized ADRs reporting rate per month immediately increased by 63.634% (P < 0.01) and remained largely unchanged over time (P > 0.05). CONCLUSION: The CPhs ADRs reporting intervention had an immediate effect on improving ADRs reporting, which highlights the severity of ADRs underreporting in Chinese hospitals. The method is practical and should be used more widely in clinical practice. For example, the method can adjust and establish a DRC catalog that meets the actual situation of the implementing hospital based on the hospital's drug use habits and has the characteristics of good adaptability. However, it does have some limitations; for example, it may be difficult to detect early ADRs without visible symptoms.

Are We Speaking the Same Language? Communicating Diagnostic Probability in the Radiology Report.

OBJECTIVE. The purpose of this study was to evaluate the level of agreement in diagnostic probability for selected phrases among radiologists and emergency medicine (EM) physicians. MATERIALS AND METHODS. A survey was distributed to the radiologists and EM physicians at our academic institution. Respondents selected the degree of diagnostic probability they believe was conveyed by 18 commonly used phrases chosen from studies in the radiology literature. Potential responses for the degree of diagnostic probability were < 10%, ≈ 25%, ≈ 50%, ≈ 75%, and > 90%. RESULTS. Seventy-eight percent (28/36) of EM residents and 56% (14/25) of EM attending physicians (combined fellows and attending physicians) completed the survey; 83% (15/18) of radiology residents and 81% (17/21) of radiology attending physicians completed the survey. There was a high degree of shared understanding for most phrases between the departments except for the phrase "compatible with," which was associated with a higher degree of diagnostic probability by radiologists than by EM physicians (p = .02). Although no term was significantly more specific than any other within the ≈ 50% category or below, "most likely" and "diagnostic of" were significantly more specific than other terms in the ≈ 75% and > 90% categories, respectively. CONCLUSION. The results of this study show a high degree of shared understanding between radiologists and EM physicians for most of the phrases (17/18) in the survey. The only phrase that showed a significant difference was "compatible with." These results can be used to generate diagnostic probability groups with suggested phrases that can be used when creating radiology reports, thereby improving communication with the emergency department.

Pediatric appendiceal ultrasound: maintaining accuracy, increasing determinacy and improving clinical outcomes following the introduction of a standardized reporting template.

BACKGROUND: Pediatric patients who underwent appendiceal US and received an equivocal interpretation had poorer clinical outcomes and higher medical costs compared to those to whom a definitive interpretation was given, either positive or negative. In an effort to reduce equivocal interpretations, we educated our group on the importance of increasing determinacy and encouraged the use of a reporting template with a definitive impression. OBJECTIVE: We hypothesized that educational sessions and implementation of an optional reporting template with only a definitive impression would reduce equivocal reporting and improve clinical outcomes without negatively impacting US diagnostic performance. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients <18 years old at Mayo Clinic Rochester whose initial evaluation for acute appendicitis was a US in the 3-year period following educational sessions and template implementation. All studies were interpreted by board-certified fellowship-trained pediatric radiologists. We performed statistical analysis to compare the pre- and post-implementation cohorts. RESULTS: Following intervention, the rate of equivocal US interpretations was reduced from 23.7% to 9.3% (P<0.001). For studies with a definitive interpretation, measures of diagnostic performance of appendiceal US were similar for the pre- and post-implementation groups. US performance parameters were independent of appendiceal visualization. Follow-up CT utilization decreased from 18.7% to 8.9% (P<0.001). The negative laparotomy rate resulting from false-positive US interpretations remained low (6.8% vs. 5.0%, P=0.31). CONCLUSION: Following education sessions and implementation of an appendiceal US reporting template encouraging definitive reporting, equivocation was reduced, excellent diagnostic performance was maintained, follow-up CT utilization was reduced, and a low negative laparotomy rate was preserved.

Editorial on "Head-to-Head Comparison of PI-RADS Version 2 and 2.1 in Transition Zone Lesions for Detection of Prostate Cancer".

LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 1 J. Magn. Reson. Imaging 2020;52:587-588.

A study of the description of exercise programs evaluated in randomized controlled trials involving people with fibromyalgia using different reporting tools, and validity of the tools related to pain relief.

RATIONALE:: Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other. OBJECTIVES:: This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool. METHOD/RESULTS:: Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen's kappa value, ranging from -0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680-0.908) among the reporting tools were shown. CONCLUSION:: Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.

The state of structured reporting: the nuance of standardized language.

Radiology reports are the principal form of communication with the referring provider. Unfortunately, they can be a form of communication riddled with errors and inscrutable statements burying the intended meaning, failing to achieve the main task for which it was made: communicating key imaging findings as they pertain to the clinical question being posed. Structured reporting is a multifaceted and modular solution to problematic reports, with variable iterations and benefits. Structured reports have been adapted across departments and even national societies, with standardized format, content and language. Newer developments include contextual reporting and common data elements. Herein, we discuss the various forms and levels of structured reporting and the latest advancements, as well as the general acceptance within radiology. We also discuss some areas for improvement as the practice of structured reporting matures.

Improving the Quality of MRI Reports of Preoperative Patients With Rectal Cancer: Effect of National Guidelines and Structured Reporting.

OBJECTIVE: Since the implementation of new guidelines for rectal cancer in The Netherlands in April 2014, clinical stage as seen at preoperative MRI indicates whether neoadjuvant therapy is necessary before rectal cancer surgery. Therefore, the importance of correct MRI interpretation has increased. The aim of this study was to evaluate the completeness of MRI reports of rectal cancer and the effect of implementation of the new guidelines and standardized reporting on the completeness of these reports. MATERIALS AND METHODS: Data were collected from all patients who consecutively underwent rectal cancer surgery at one hospital between January 2011 and July 2017. Data were extracted from electronic patient records. RESULTS: The study included 492 MRI examinations. Before implementation of the new guidelines, a median of 4 of 10 items (interquartile range [IQR], 3-6 items) were described in each MRI report. After implementation of the new guidelines, the number of items described improved significantly (median, 7 items; IQR, 6-8 items; p < 0.001). Implementation of a standardized report led to further significant improvement (median, 9 items; IQR, 9-10 items; p < 0.001). The items scored most frequently were distance between the tumor and the anal verge (85.6%) and length of the tumor (87.6%). The items scored least were presence or absence of extramural venous invasion (21.1%) and morphologic features of the tumor (24.6%). CONCLUSION: Implementation of a standardized protocol and a standardized reporting system for MRI in preoperative staging of rectal cancer results in a more complete MRI report.

Web-Based Tool for Standardized Reporting of Thyroid Ultrasound Studies.

OBJECTIVE: Our objective was to create a user-friendly synoptically driven web-based tool for radiologists to report thyroid ultrasound studies and thereby improve the quality, completeness, and recommendations of reports. CONCLUSION: The tool, developed using JavaScript and PHP (hypertext preprocessor), provides radiologists with a way to generate complete thyroid ultrasound reports and automatically categorize thyroid nodules of varying suspicion. Future work will focus on integration with the radiology information system for seamless reporting and the development of a prospective database.

Assessment of the content reporting for therapeutic exercise interventions among existing randomized controlled trials on knee osteoarthritis.

Purpose/Rationale: Physical exercise interventions for the management of knee osteoarthritis are well known to be effective and accessible forms of rehabilitation and symptom management. However, without adequate reporting of these interventions, accurate replication and clinical use is negatively impacted. OBJECTIVES: The main objective of this article was to assess content reporting using The Consensus on Exercise Reporting Template list and 2016 American College of Sports Medicine guidelines among moderate- to high-quality exercise interventions randomized controlled trials (total score of ≥6/10 on the PEDro scale) involving individuals with knee osteoarthritis. RESULTS: The Consensus on Exercise Reporting Template mean total score for all 47 included randomized controlled trials was 4.42 out of 19, demonstrating generally low quality of reporting. The Consensus on Exercise Reporting Template list and the 2016 American College of Sports Medicine guidelines scores were moderately correlated (based on 95% confidence interval, intraclass correlation coefficient = 0.508) for aerobic interventions only. CONCLUSION: The content analysis of exercise interventions in knee osteoarthritis demonstrated low scores for moderate- to high-quality trials. Improved standardized reporting is recommended to ensure knowledge transfer and replication of effective exercise programs for individuals with knee osteoarthritis.

Emergency medicine summary code for reporting CT scan results: implementation and survey results.

PURPOSE: The purpose of the study was to assess the emergency department (ED) providers' interest and satisfaction with ED CT result reporting before and after the implementation of a standardized summary code for all CT scan reporting. MATERIALS AND METHODS: A summary code was provided at the end of all CTs ordered through the ED from August to October of 2016. A retrospective review was completed on all studies performed during this period. A pre- and post-survey was given to both ED and radiology providers. RESULTS: A total of 3980 CT scans excluding CTAs were ordered with 2240 CTs dedicated to the head and neck, 1685 CTs dedicated to the torso, and 55 CTs dedicated to the extremities. Approximately 74% CT scans were contrast enhanced. Of the 3980 ED CT examination ordered, 69% had a summary code assigned to it. Fifteen percent of the coded CTs had a critical or diagnostic positive result. CONCLUSIONS: The introduction of an ED CT summary code did not show a definitive improvement in communication. However, the ED providers are in consensus that radiology reports are crucial their patients' management. There is slightly increased satisfaction with the providers with less than 5 years of experience with the ED CT codes compared to more seasoned providers. The implementation of a user-friendly summary code may allow better analysis of results, practice improvement, and quality measurements in the future.

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop.

Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes.

Differences in Perceptions Among Radiologists, Referring Physicians, and Patients Regarding Language for Incidental Findings Reporting.

OBJECTIVE: The purpose of this article is to compare radiologists', referring physicians', and patients' interpretations of expressions within radiology reports to describe findings of likely low clinical significance. SUBJECTS AND METHODS: Surveys were completed by abdominal radiologists (n = 13), physicians referring patients for abdominal CT (n = 59), and outpatients awaiting imaging (n = 51) at a large urban academic medical center. Surveys presented 10 expressions for describing an incidental 5-mm liver lesion and asked respondents to select from a list of choices their perceived likelihood that the lesion represented malignancy. Radiologists and referrers were asked supplemental questions. RESULTS: Compared with radiologists' concern, referrers' and patients' concerns were higher for four and seven of the 10 expressions. Only the expression "benign cyst" was associated with no concern in all groups; "most likely a cyst" and "too small to characterize" were associated with median levels of concern of 0% for radiologists, > 0% to 1% for referrers, and > 2% to 5% for patients. Expressions containing the phrase "not excluded" had the highest concern in all groups. Referrers' likelihood of ordering follow-up imaging varied widely for the expressions (e.g., "benign cyst," 2%; "cyst," 22%; "most likely a cyst," 46%; "most likely a cyst, although tumor not excluded," 75%). Overall, the preferred phrase for a 5-mm liver lesion with benign features in normal-risk patients was "cyst" among radiologists and "benign cyst" among referrers. Seventy-six percent of referring physicians thought that radiology reports should indicate whether follow-up imaging is recommended for such lesions. CONCLUSION: Ambiguity in radiologists' language for incidental low-risk findings may contribute to increased patient anxiety and follow-up testing, warranting greater radiologist attention and potentially new practice or reporting strategies.

Key Intervention Characteristics in e-Health: Steps Towards Standardized Communication.

PURPOSE: This paper reports expert opinion on e-health intervention characteristics that enable effective communication of characteristics across the diverse field of e-health interventions. The paper presents a visualization tool to support communication of the defining characteristics. METHODS: An initial list of e-health intervention characteristics was developed through an iterative process of item generation and discussion among the 12 authors. The list was distributed to 123 experts in the field, who were emailed an invitation to assess and rank the items. Participants were asked to evaluate these characteristics in three separate ways. RESULTS: A total of 50 responses were received for a response rate of 40.7%. Six respondents who reported having little or no expertise in e-health research were removed from the dataset. Our results suggest that 10 specific intervention characteristics were consistently supported as of central importance by the panel of 44 e-intervention experts. The weight and perceived relevance of individual items differed between experts; oftentimes, this difference is a result of the individual theoretical perspective and/or behavioral target of interest. CONCLUSIONS: The first iteration of the visualization of salient characteristics represents an ambitious effort to develop a tool that will support communication of the defining characteristics for e-health interventions aimed to assist e-health developers and researchers to communicate the key characteristics of their interventions in a standardized manner that facilitates dialog.

A novel reporting system to improve accuracy in appendicitis imaging.

OBJECTIVE: The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy. MATERIALS AND METHODS: We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC. RESULTS: The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs < 6 mm]; p = 0.002), periappendiceal fat stranding (OR = 8.9; p < 0.001), and appendiceal mucosal hyperenhancement (OR = 8.7; p < 0.001). Of 35 patients whose initial clinical findings were reported as indeterminate, 28 (80%) had appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001). CONCLUSION: Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way.

Improvement in diagnostic accuracy of ultrasound of the pediatric appendix through the use of equivocal interpretive categories.

OBJECTIVE: The purpose of this article is to evaluate the diagnostic performance of ultrasound of the pediatric appendix using standardized structured reports that incorporate equivocal interpretive categories. MATERIALS AND METHODS: Standardized structured appendix ultrasound reports using a five-category interpretive scheme were reviewed. Interpretive categories were positive, intermediate likelihood, or negative when the appendix was visualized, and secondary signs or no secondary signs when the appendix was not visualized. Interpretations were compared with clinical and pathologic follow-up. Diagnostic accuracy was compared with the accuracy of a simulated binary interpretive scheme based on the same data. RESULTS: One thousand three hundred fifty-seven examinations were included, with appendicitis present in 16.9% (230/1357) of cases. The appendix was visualized in 47.2% (641/1357) of cases, with interpretations as follows: positive, 27.5% (176/641); intermediate likelihood, 9.7% (62/641); and normal, 62.9% (403/641). The appendicitis rate in each group was 92.6% (163/176), 25.8% (16/62), and 0.5% (2/403), respectively. The appendix was not visualized in 52.8% (716/1357) of cases, with secondary findings identified in 8.5% (61/716) and no secondary findings in 91.5% (655/716) of cases. The appendicitis rate was 39.3% (24/61) and 3.8% (25/655) in these groups, respectively. Appendicitis was present in 32.5% of equivocal (intermediate likelihood and not visualized, secondary findings) cases and 2.6% of negative (normal and not visualized, no secondary findings) cases. Diagnostic accuracy of a five-category scheme was 96.8% versus 94.1% for a binary scheme. CONCLUSION: Appendix ultrasound examinations interpreted according to a scheme that incorporates equivocal categories better convey diagnostic certainty and increase diagnostic accuracy compared with a binary interpretive scheme.

Value of a standardized lexicon for reporting levels of diagnostic certainty in prostate MRI.

OBJECTIVE: The purpose of this study was to evaluate the usefulness and diagnostic performance of a 5-point standardized diagnostic certainty lexicon for reporting the likelihood of extracapsular extension (ECE) of prostate cancer on routine staging prostate MRI. MATERIALS AND METHODS: This study was a retrospective analysis of routine clinical prostate MRI reports before (254 patients) and after (211 patients) the implementation of a 5-point diagnostic certainty lexicon. Whole-mount step-section pathology of the radical prostatectomy specimens served as the reference standard. The terms used to express diagnostic certainty regarding ECE on standard-of-care MRI and the presence of ECE on pathology were compared between the two periods. ROC analysis was used to evaluate the diagnostic accuracy of the 5-point certainty lexicon for detecting ECE. RESULTS: Before the implementation of the certainty lexicon, radiologists used 38 different terms to express the levels of certainty regarding the presence of ECE on MRI. Afterward, they adhered to the lexicon's predefined 5-point terminology in 85.3% of cases. The 5-point certainty lexicon used on MRI reports had an AUC of 0.852 for diagnosing ECE. CONCLUSION: The implementation of a lexicon of diagnostic certainty dramatically reduced the number of expressions used by radiologists to indicate their levels of diagnostic certainty. The accuracy of the certainty lexicon for diagnosing ECE on standard-of-care prostate MRI is similar to previously reported accuracy values for the diagnosis of ECE by MRI. Thus, the use of such a lexicon might prevent miscommunication and help referring clinicians reliably incorporate radiologists' assessments into clinical decision making.