Added Value of Selected Images Embedded Into Radiology Reports to Referring Clinicians

Purpose

The aim of this study was to evaluate the added utility of embedding images for findings described in radiology text reports to referring clinicians.

Methods

Thirty-five cases referred for abdominal CT scans in 2007 and 2008 were included. Referring physicians were asked to view text-only reports, followed by the same reports with pertinent images embedded. For each pair of reports, a questionnaire was administered. A 5-point, Likert-type scale was used to assess if the clinical query was satisfactorily answered by the text-only report. A “yes-or-no” question was used to assess whether the report with images answered the clinical query better; a positive answer to this question generated “yes-or-no” queries to examine whether the report with images helped in making a more confident decision on management, whether it reduced time spent in forming the plan, and whether it altered management. The questionnaire asked whether a radiologist would be contacted with queries on reading the text-only report and the report with images.

Results

In 32 of 35 cases, the text-only reports satisfactorily answered the clinical queries. In these 32 cases, the reports with attached images helped in making more confident management decisions and reduced time in planning management. Attached images altered management in 2 cases. Radiologists would have been consulted for clarifications in 21 and 10 cases on reading the text-only reports and the reports with embedded images, respectively.

Conclusions

Providing relevant images with reports saves time, increases physicians' confidence in deciding treatment plans, and can alter management.

Introduction

The radiology report is intended to provide timely, relevant, and informative description and interpretation of an imaging study, and it attempts to answer the specific question for which the study was performed. The imaging examination report provides an important means of communication between the radiologist and the other physicians rendering care and is often the only form of communication between the radiologist and the referring physician, especially in the increasingly common practice of teleradiology [1]. As radiology reports become permanent parts of patients' medical records, constituting important legal documents when there is contention, radiologists have an obligation to convey the interpretation of imaging procedures in a manner most useful to ordering physicians.

Several studies to assess referring physicians' preferences as to the form and content of radiology reports [2, 3, 4, 5, 6] have identified areas for improvement. This recognition has led to increasing structure, evolving from the traditional narrative prose to reports with separate paragraphs for “procedure,” “findings,” and “summary” and, more recently, to itemized reporting with subheadings for each anatomic area depicted.

Suggestions for improving communications with referring clinicians by the creation of multimedia reports have been made before [7, 8, 9, 10, 11]. This idea even predates the widespread deployment of PACS [7, 8, 9, 10]. The advances in image distribution technology, especially image distribution using Web servers and applets, has made radiology data readily available throughout hospital systems as part of patients' electronic medical records. However, the abundance of imaging data generated during thin-section multidetector CT and MRI, sometimes with >1,000 images in each study, can make the task of reviewing images cumbersome and ultimately unrewarding for clinicians. Some radiologists routinely indicate series and image numbers of key images in their reports. This approach still requires that busy clinicians access the studies from appropriate servers and depends on concordance of the image numbers across platforms. Unfortunately, with Web-based image distribution systems, image and series numbers may not coincide with image numbers on PACS workstations.

It has been suggested that providing referring physicians with selected images embedded in text reports over the Web could improve and support the information contained in the reports [12]. To study this next step in evolution of the radiology report, we undertook this study to measure the utility to referring physicians of radiology reports with attached, relevant images of the abnormal findings.