Orthopedic Radiology Reports: Is Anyone Reading?

You capture that X-ray, CT, or MRI image for a patient who’s facing an orthopedic procedure, but how confident are you that the surgeon is actually going to read your report?

A new survey conducted by radiologists with orthopedic surgeons in Europe shows they do routinely consult your assessments. But, the results also revealed surgeons have suggestions on what would make the reports more useful.

These results contradict the widely held belief that orthopedic surgeons ignore the radiology report, relying rather on their own experience with image interpretation. A team of investigators from Switzerland, Austria, and England published their findings in a July 20 European Journal of Radiology article.

“Orthopedic surgery is one of the sub-specialties where imaging is ubiquitous. Therefore, it has become common practice of orthopedists to assess radiology images of their patients,” said the team led by Dorothee Harder, from the radiology department at the University Hospital Basel in Switzerland. “It is conceived that the written radiology report is not or only rarely consulted by these experts.”

For their study, a group of six radiologists prepared a 14-question survey, asking orthopedic surgeons if they consult radiology reports, and if so, for what modalities. In addition, the team wanted to know what prompted the review, what stopped surgeons from reading the report, and what they thought would make them more helpful. Overall, 81 surgeons replied.

According to their analysis, they found that the vast majority of surgeons do consult the reports when determining the best course of treatment. Specifically, 86 percent routinely review MRI reports while 67 percent and 43 percent take a look at reports for CT and X-ray, respectively. In some cases, though, surgeons said they would only consult a report if they had personal uncertainty about an image.

The surgeons reported several reasons why they would bypass the report. The following three reasons accounted for 60 percent of responses:

• Lack of time
• Report text is too long
• Duration of report availability is too long

In addition, many surgeons said they did not review the report because, as the surgeon, they wanted to examine the images and personally assess them for patient consultation and surgery planning. Several also deemed themselves to be more experienced than the reporting radiologist or they felt the report lacked technical terms or included false descriptions.

Of the surgeons who consulted the reports, 86 percent said they preferred a radiologist include a specific recommendation in their report. But, that doesn’t mean the surgeon was always in agreement. Most indicated they have had instances where they disagreed with the radiologist’s findings, but only half said they would reach out to the radiologist for a discussion. If they did, 64 percent preferred to do so by phone, and 33 percent would do so via email.

The responding surgeons did offer suggestions for what would make a radiology report more useful and actionable:

• Rapid availability
• Including significant images
• Include more clinical and technical background knowledge

The respondents also called for increased inter-disciplinary communication, as well as consultations with referring providers for equivocal cases.

“The majority of participating orthopedic surgeons would welcome more inter-disciplinary interaction with radiologists,” the team said. “This concerns the discussion of equivocal cases to come to a mutual, sensible conclusion in the appropriate clinical context, as well as information on incidental findings requiring further work-up.”

This improved communication, they said, could lead to dedicated teaching sessions that improve the use of terminology and technical background knowledge in reports.

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