This presentation discusses structured radiology reports, including their history, variations, data on effectiveness, and managing change. It notes that structured reports were first introduced in 1922 to standardize terminology. While structured reports have benefits like standardized follow-up, studies found referring clinicians preferred detailed structure more than radiologists. Data showed structured reports still contained errors in 37% of cases, though some error types were reduced. Effective change management requires understanding resistance, engaging stakeholders, leadership buy-in, and an informatics team.

1. Structured Reports in
Radiology
“Promise, Potential, and
Problems”
Matt Hawkins, MD
Assistant Professor – Emory University SOM

2. • History/context of structured
reports
• Variations of structured reports
• Data
• Change management
OUTLINE

3. • History/context of structured
reports
• Variations of structured reports
• Data
• Change management
OUTLINE

4. • Structured reports first introduced
by Preston M. Hickey, MD
• 1922
• “The ARRS should recommend a
standardized nomenclature to be
used in writing roentgenological
reports.”
HISTORY

5. • Structured reports first introduced
by Preston M. Hickey, MD
• 1922
• “The ARRS should recommend a
standardized nomenclature to be
used in writing roentgenological
reports.”
HISTORY

6. • RADLEX introduced in 2006
HISTORY

7. • Keys to radiology report
CONTEXT
CLARITY
CORRECTNESS
CONFIDENCE
CONCISE
COMPLETENESS
CONSISTENCY
Reiner et al. JACR 2007; 4:313-319.

8. • Keys to radiology report
CONTEXT
COMMUNICATION
CONSULTATION
Reiner et al. JACR 2007; 4:313-319.

9. • Strengths of Structure
• Eliminates ambiguity
• Creates mineable data
• Auto-population of data
• Standardized follow-up
• Billing/compliance
CONTEXT
Reiner et al. JACR 2007; 4:313-319.

10. CONTEXT

11. CONTEXT

12. • What do we prefer?
CONTEXT
Naik et al. AJR 2001; 176:591-598.

13. • What do we prefer?
CONTEXT
86% of referring clinicians preferred
detailed structure
Naik et al. AJR 2001; 176:591-598.

14. • What do we prefer?
CONTEXT
56% of radiologists preferred
detailed structure
Naik et al. AJR 2001; 176:591-598.

15. • History/context of structured
reports
• Variations of structured reports
• Data
• Change management
OUTLINE

16. • “Structured” has different meanings
• Pure structure
• Structured template; no structured
content
• Structured “normals”
• Hybrid
VARIATIONS

17. • “Structured” has different meanings
• Purely structured reports have
been ridiculed
• Johnson et al – free-text reports had
greater clarity approx. 80% of the
time
VARIATIONS
Johnson et al. JACR 2010;7:501-506.

18. • “Structured” has different meanings
VARIATIONS

19. VARIATIONS

20. • History/context of structured
reports
• Variations of structured reports
• Data
• Change management
OUTLINE

21. • Structure is great, but does it fix
everything?
DATA on STRUCTURE

22. DATA on STRUCTURE
60% of reports have errors
(1.73 errors per report)

23. DATA on STRUCTURE
36% of reports have non-
grammatical errors

24. DATA on STRUCTURE
0.02 errors per dictated word

25. DATA on STRUCTURE
Missense errors = 12% of all
errors (0.21 per report)

26. DATA on STRUCTURE
Omission errors = 10.1% of all
errors

27. DATA on STRUCTURE
Omission errors that change
the meaning of a sentence =
1.2% of all errors

28. DATA on STRUCTURE

29. DATA on STRUCTURE
26% of reports contained non-
grammatical errors (p=0.024)

30. DATA on STRUCTURE
Missense omission errors:
3.5%  1.2% (p=0.0175)

31. DATA on STRUCTURE
Comission errors:
3.9%  0.8% (p=0.0007)

32. DATA on STRUCTURE
37% of reports STILL had
errors

33. • History/context of structured
reports
• Variations of structured reports
• Data
• Change management
OUTLINE

34. Change Management

35. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informaticists early

36. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informaticists early

37. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informaticists early

38. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informaticists early

39. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informaticists early

40. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informaticists early

41. Change Management
• Understand resistance to change
• Span boundaries
• Engage key stakeholders
• Get leadership buy-in
• Establish consensus
• Define the project improvement team
• Engage informatics team early

42. Change Management

43. Matt Hawkins, MD
@MattHawkinsMD
matt.hawkins@emory.edu