RSNA Collaborates, Sets to Improve Radiology Reporting

CHICAGO - It has been six years since the Radiological Society of North America (RSNA) launched its Reporting Initiative. In that time, radiologists across the country have benefited from the tools it offers, according to the Initiative’s leaders and other industry experts, who revealed its accomplishments to date and discussed what’s yet to come.

“Our goal, in part, was to improve the quality of radiology reports, making it easier for referring physicians, patients, and other radiologists to use and have the information that we can extract from reports,” said Charles Kahn, MD, chair of the RSNA’s Radiology Informatics Committee Structured Reporting Subcommittee. “We wanted to develop a better, more robust system that could go beyond speech and voice recognition and really empower the capture of information as radiology becomes more quantitative.”

Rather than dictating to radiologists and practices exactly how they were to create reports, this initiative was designed to collect a sampling of best practice templates that providers could modify to meet their own needs, he said.

The result is a free template library, available at www.radreport.org, which categorizes templates by subject and RadLex terms and can be adapted to local practices. It currently holds 268 templates and has been accessed for template downloads 1.6 million times. Of the templates, 211 are in English, and most of the remaining ones are available in Turkish or Mandarin Chinese.

What’s New?Open Library: In addition to a library full of downloadable templates, the reporting initiative has launched an “open template” library that allows radiologists to upload their own templates to the site. Viewing and downloading templates is still free to anyone, but RSNA members can upload their own templates. Similar to rating websites, such as Yelp or Zagat, the site allows other members to rate templates on a five star system and leave comments.[[{"type":"media","view_mode":"media_crop","fid":"30375","attributes":{"alt":"RSNA informatics reporting","class":"media-image media-image-right","id":"media_crop_7389442543756","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3192","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

“This allows radiologists to make a note if they find something useful or want to make a suggestion about a piece of information that can be added,” said Kahn, who is also a radiology professor and vice chair at the University of Pennsylvania. “All it takes is your RSNA credentials.”

MRRT: Radiologists often have difficulty moving their reports from one reporting system or department to another. To eliminate that problem, the reporting initiative created the management of radiology reporting template (MRRT).

MRRT makes exchanging and moving radiology reports possible. And, it carries all the metadata – the authors, participating organizations, findings, comparisons, and impressions – with it in the move. RadLex terms also translate over, making the data equally usable in its new location.

The MRRT format, which is expected to take its final form in early 2015, is currently available to RSNA members who upload templates to the open library.

DICOM Supplement 155: To easily integrate the MRRT format into the radiology reporting workflow, the reporting initiative created DICOM Supplement 155. It takes information recorded in the MRRT format and integrates it into an existing electronic health record.

“The key piece of this is what MRRT and DICOM 155 are doing together. They allow structured elements template reporting to be captured, incorporated into the reports we dictate, and integrated into the local electronic medical record,” Kahn said. “That’s a whole reason for doing all of this – getting information to the medical record that can be extracted and used to show the value of the radiologist.”

It’s a way, he said, of linking radiological findings, results, and communications with clinical outcomes.

T-Rex: The reporting initiative is also developing an easy way for radiologists who aren’t comfortable with web programming to create reporting templates. Called T-Rex, this free tool is open-source and lets providers select the elements they want included in their templates, such as headers, text, number, date, time, and specialty.

According to Kahn, T-Rex is still in the testing phase but has been shown to be very effective. It will also be compatible with the MRRT format and will support the seamless transfer of data into the medical record.

Additional CollaborationsAmerican College of Radiology (ACR): Similar to BI-RADS, the ACR has launched its Head Injury Imaging Reporting and Data System (HI-RADS) to standardize reporting and data collection of imaging for patients with traumatic brain injury (TBI). The goal is to create consistent language around TBI that could make it easier to interpret images, reduce errors, improve communication with referring physicians, and boost patient outcomes.

By collaborating with HI-RADS, the reporting initiative hopes to gather enough data and clinical knowledge to create a registry around those examinations, Kahn said.

College of American Pathology (CAP): The CAP has a similar structured reporting system that it recommends as a checklist to support diagnosing multiple types of cancer. A partnership with the RSNA Reporting Initiative will integrate the pathology information around cancer with existing radiology data to provide a greater histological database.

Cancer Care Ontario (CCO): Through this collaboration, the RSNA reporting initiative has designed report templates for lung cancer based on CCO’s existing processes.

European Society of Radiology (ESR): Members of the ESR will serve on the editorial board for the RSNA template library, Kahn said.

Succeeding With Template Reporting
To really make a go of using template reporting, radiologists must have support from their institutional leadership on down, said Curtis Langlotz, MD, PhD, a Stanford University Medical Center radiology and medicine professor.

“It needs to come from the top that we need to do this,” he said. “You’ll have a better quality product, and you must agree on what the format of reporting will be in each section.”

Any structured reporting attempts should also have a formal governance structure, a style guide or checklist for what should be included in the reports, a list of which fields can have a default code, and an audit adherence plan.

Other Impacts
In addition to creating an extensive repository of reporting templates, the RSNA Reporting Initiative, by implementing MRRT, has also created a treasure trove of data that can be easily mined using RadLex terminology, said Marta Heilbrun, MD, a radiologist at the University of Utah Health Care. This data collection allows providers to compare their institution’s findings and reports to others nationwide and inform future discussions around decision support systems.

One dubious outcome is the impact template reporting will have on radiology residents and how they practice.

“Are we making our residents box-checkers? If they don’t say the findings, are they not learning and internalizing what they’re seeing and making that observation something actionable,” she said. “Are we losing that step?”

At the same time, she said, teaching residents with template reporting will help providers identify whether a particular resident has trouble over- or under-diagnosing particular findings.

Ultimately, she said, template reporting will only be successful if it’s presented in a way that’s attractive to the radiologist.

“It’s critical that a template be something that advances radiology and takes care of patients, but it also has to be something that radiologists can use,” Heilbrun said. “The template has to be something that’s useful for us.”