Emergency Teleradiology: Reporting Standards & Quality Assurance

1. Carl Aschkenasi, MD
Emergency Teleradiology:
Reporting Standards & Quality Assurance

2. Reporting Standards & Quality Assurance
1. You cannot standardize descriptions of individual humans.
2. I’m not a robot.
3. I’m a professional who expresses himself.
4. Not all cases fit a mold.
5. I use standard language already.
Barriers to implementation
“When I use a word,” Humpty Dumpty said
in a rather scornful tone, “it means just
what I choose it to mean – neither more or
less.”

3. Reporting Standards & Quality Assurance
1. You can’t assure quality.
2. It’s a never-ending process.
Barriers to implementation

4. Reporting Standards
Quality Assurance
IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE
ORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY

5. exophytic, enhancing mass likely
Where in the study?
Image/series number?
…image 43/189 of the cor
recons….”
Size matters
Units
Caliper placement
Dimensions Appropriate terms
Lesion
Structure
Cyst
Tumor
Phlegmon
Process
Infiltrate
Goober
Certainty
Adapted from: The radiology report: A guide to thoughtful communication for radiologists and other medical professionals 2015, Curtis P Langlotz MD PhD
“On the post-contrast images, a 1-cm is present in the anterior upper pole
of the left kidney.”
Accurate anatomy
Descriptors
vs.
Action!

6. What’s normal?
Unremarkable
Essentially/relatively/fairly normal
No radiologic evidence of disease
Within normal limits
No significant abnormality
Age-appropriate
Negative for trauma

7. I see nothing wrong in the foot.
Adapted from: The radiology report: A guide to thoughtful communication for radiologists and other medical professionals 2015, Curtis P Langlotz MD PhD
OR
The foot is normal.
How would you report this?
What’s normal?

8. Acad Radiol. 2003 Jun;10(6):685-8. Khorasani R1, Bates DW, Teeger S, Rothschild JM, Adams DF, Seltzer SE.
What’s certainty?
?

9. …cannot be excluded.
Host abdominal wall
What’s certainty?

10. Severity
Adapted from: The radiology report: A guide to thoughtful communication for radiologists and other medical professionals 2015, Curtis P Langlotz MD PhD
Kijowski R1, Blankenbaker D, Stanton P, Fine J, De Smet A. Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint.
AJR Am J Roentgenol. 2006 Sep;187(3):794-9

11. Mild/mod/severely limited by respiratory motion
Exam is limited by nonstandard positioning
Normal given small lung volumes
Pulsation/beam hardening
Ectopic disclaimer
Subtle stroke disclaimer
Disclaimers

12. The organ recital – “Yes, I looked.”
“Yes, I am thinking.”
What clinicians want to see: “No ICH, shift, or mass effect”
Billing/coding purposes
Pertinent negatives

13. C spine for
radicular
pain
C spine for
trauma
Chest
radiograph
PE chest CT
C7-T1 Moderate
posterior disk
bulge
Body
Impression
Body ? ?Body
C7-T1 Minimal
posterior disk
bulge
Body No No No
Acute C7
fracture
Body
Impression
Body
Impression
Body
Impression
Body
Impression
Cardiomegaly NA NA Body
Impression
Body
+/- impression
Aortic calfication No No Body Body
Finding
Exam
Relevance

14. Sistrom CL, et al. Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology. 2009 Nov;253(2):453-61
Grieve FM, Plumb AA, Khan SH. Radiology reporting: a general practitioner's perspective. Br J Radiol. 2010 Jan;83(985):17-22.
The majority of PCPs want radiologists’ recommendations.
12% of radiology reports recommend follow-up imaging.
Recommendations
Reporting Standards & Quality Assurance

15. Signal-to-noise ratio model
Reporting Standards & Quality Assurance

16. Reporting Standards & Quality Assurance
Recommend clinical correlation.
Recommend follow-up.
Too small to characterize…. NOT an adjective.
Prominent
Markedly
Bilaterally
Irregular
Significant

17. Reporting Standards
Quality Assurance
www.radreport.org
open.radreport.org

18. For the clinician:
Consistent & clear
Logical format and organization
Standard terminology
Benefits of standardization

19. Benefits of standardization
For the radiologist:
Checklist
Memory aid for various diagnoses e.g., splenic v. patency in pancreatitis
Computer searchable for research, QA
National Radiology Data Registry
ACR appropriateness criteria
Consistent PACS tagging
Radiologic decision support tools

20. Benefits of standardization
For the patient:
Critical value communication (JCHAO)
Medical society guidelines (ACR, ACOG, ASTS, AOA)
Physician Quality Reporting System compliance (CMS)

21. Benefits of standardization

22. Benefits of standardization

31. We can’t:
Set the technical parameters
Prevent/manage procedure complications
….or technical failures at a client facility
Easily get follow-up (although we try)
Get access to EHR/RIS
IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE
IDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTIO
We can:
Track turnaround time
Track CV/Call return time
Track case volume/productivity
Measure accuracy c/w peers
Demonstrate gen-leading reporting

32. Thanks!