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Radiology reporting paper just published in Radiographics
Radiology reporting receives very little attention in the literature, and has very few guidelines or advice out there. And yet, it’s the most important way that Radiologists communicate with other specialities!
Radiographics just published “How to create a great radiology report” which I wrote with an international team of rads in an attempt to compile the best resource we could for residents and practicing rads to tune-up their reporting. I hope you find it helpful as you develop your reporting style!
[link]https://pubs.rsna.org/doi/10.1148/rg.2020200020[/link]
[link=https://twitter.com/MP_Hartung/status/1311735706696511488]https://twitter.com/MP_Ha…us/1311735706696511488[/link] -
46 Replies
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Agree with most of your recommendations, but good luck getting people entrenched in their 10 point impressions and full prose reports to change.
If I’m going to nitpick, “enlarged liver masses” in table 1 is kind of meaningless. I’d say enlarging or increased or something
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Does it discourage the use of infiltrate?
Impression: No infiltrate.
Impression. Subtle infiltrate in the left lung base.-
lol infiltrate…
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I didn’t get into the weeds with specific terms like “infiltrate”, but basically no –
The impression should state the meaning of the findings and give a diagnosis or differential diagnosis.
“Infiltrate” is a finding (perhaps a questionable one at that!), and too murky to leave standing alone for the ordering provider to figure out what you mean.
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Thanks for your comments. Well, there is always the new generation of radiologists that can be influenced 😉
The point with saying “enlarged, enlarging, growing, increased” etc is not to get caught up on which one or tense you prefer, but rather to point out how silly something like this sounds when you can replace it with only one word:
“There has been interval increase in size of the liver metastases” vs.
“Growth of liver metastases”
The key point is to use natural sentence structure like you would in person or on the phone so that the message is as clear as possible, rather than these often unnatural, rambly constructs that have become unique to radiology-speak over the years.
Thanks again-
Full of pet peeves.
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This is a good article. Im going to re-read this. These are a few points I would like to makethere is a huge pressure on radiologist right now from everyonefrom referring clinicians to malpractice insurers to government agencies for us to spend more time on incidental findings, interpretation and follow-upand particularly saying what and when for every incidental finding. This can be so frustrating because we really are presented with limited information and we feel the fire to make some type of interpretation/recommendation when we really dont knowthis is a huge problem. Spending extra time and lost RVUs on exams that have incidental findings and are not conclusive What we see in our radiology crystal ball is usually hazy. We often need to recommend follow up because we dont know or cannot come to a final diagnosis and want/need more information, not because we are greedy and want more money from an additional scan. I think a lot of people dont understand or get this.
As far as infiltrateit seems these days its as an equivocal and acceptable as consolidation so just go with it.-
To me, consolidation is more specific and definae as alveoli filled with water blood pus etc. Doesn’t include the interstitium or atelectasis. I guess “infiltrate” is a more generic umbrella term for abnormal lung? Personally have never used it
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I personally think (to use a term I picked up from Donald Altman from Miami Children’s Hospital back in the day) when someone states a nonspecific FINDING and then repeats it as the IMPRESSION (ie, “opacity in the left lung”), it is “chicken sh#t radiology”. I clearly remember him instructing residents to “say what you think it is, otherwise you are no help”. Plus, it was great to hear a 75 year old mentor say something so hilariously crude.
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Long winded non committal cover your ass reports are the problem. Who cares otherwise?
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Quote from Drrad123
Long winded non committal cover your ass reports are the problem. Who cares otherwise?
Would think this is true; but we get very few complaints about such reports in our practice, and we have one radiologist who is out of control with hedges.
So it bothers us, but not many clinicians, at least not enough to complain.
It amazes me.
In fact, I used to monitor our reports, and make global critiques toward improvement. To no avail. And then I realized, most people don’t give a sheet.
I will say that VR and templates have improved the quality of reporting for many. I know that will annoy some; but it’s true.-
^^ I am sure it bothers the referrers, its just that you may not be getting the complaints or second look requests. Perhaps the complaints are going elsewhere and cause damage.
Nothing worse then getting a follow up on one of these verbal diarrhea radiologists with pages of nothing or, worse overcalls.
They cause more havoc then misses. The damage they do to patients, our field, and their colleagues is very high.
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Quote from Drrad123
^^ I am sure it bothers the referrers, its just that you may not be getting the complaints or second look requests. Perhaps the complaints are going elsewhere and cause damage.
Nothing worse then getting a follow up on one of these verbal diarrhea radiologists with pages of nothing or, worse overcalls.
They cause more havoc then misses. The damage they do to patients, our field, and their colleagues is very high.
I want to believe you, but I just don’t think it is as bad as you say [as far as complaints]. I spend a lot of my time perfecting my reports; for what? Secret admirers? Because not much feedback, either way.
Look at all the crap in the EMR, everyone is used to informational trash. We are all numb. -
^^ no feedback is what you want.
Negative feedback may not come your way. Your colleagues may hear it, chief, or worse admin.
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Are Drrad123 and drad123 different people?
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I’ve been the chief, president etc. Still thought as such by many. And nada.
Listen, I get the frustration, and I groan every time I read such reports, but the negative repercussions have been minimal; at least in our practice. -
Great discussion and comments.
I do think a very helpful guiding principle in much of medicine and certainly in rad reporting is the “Golden rule” –
[i]Create the sort of thoughtful, thorough, and responsible reports that you would want for the care of a close friend, family member, or even yourself.[/i]
I agree with those who said feedback often does not come our way – in my experience it does not.
The fact is that WE are the standard bearers of radiology and reporting. WE are responsible for upholding and promoting high standards and we should not be looking to complaints to help us to know what to do. Imagine if other specialties approached excellence in this way (surgery, pathology)…
FYI there are more practical points in a video summary that I created for the Radiopaedia virtual conference last spring during quarantine, currently featured as free on their website –
[link=https://radiopaedia.org/courses/featured-video?lang=gb]https://radiopaedia.org/c…featured-video?lang=gb[/link] -
The negative feedback exists, daily, and generally goes to rads that generate useful concise accurate reports. The negative feedback virtually never goes directly to the rads that generate the less useful reports. Dont kid yourself that referrers are not talking about and bemoaning the quality of our reports, and dont convince yourself that an unhelpful report doesnt have sustained clinical untoward effect. Many do. Too many.
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[/quote]
[i] Look at all the crap in the EMR, everyone is used to informational trash. We are all numb. [/i]
[/quote]
So true, the EMR is full of garbage. I think negative repercussion are minimal for garbage reports. I do think clinicians recognize those who have targeted, relevant, concise reports, esp. specialists. Good do get recognized, but don’t expect compliments to flow your way. Mediocre and kind of bad get lumped in with the rest of nonsense in the medical record and medical system and are just more of the same blah… -
Quote from dr77767
[i] Look at all the crap in the EMR, everyone is used to informational trash. We are all numb. [/i]
So true, the EMR is full of garbage. I think negative repercussion are minimal for garbage reports. I do think clinicians recognize those who have targeted, relevant, concise reports, esp. specialists. Good do get recognized, but don’t expect compliments to flow your way. Mediocre and kind of bad get lumped in with the rest of nonsense in the medical record and medical system and are just more of the same blah…
A z-dogg says “It’s just a glorified bill platform … with some patient stuff tacked on”
[link]https://youtu.be/xB_tSFJsjsw[/link]
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(To the authors … thanks. I have a lecture I give on Radiology Reporting and Communication … I will be updating it and incorporating parts of the paper) -
[link=https://www.amazon.com/Radiology-Report-Communication-Radiologists-Professionals/dp/1515174085/ref=sr_1_1?dchild=1&keywords=radiology+report&qid=1602160700&sr=8-1]https://www.amazon.com/Ra…=1602160700&sr=8-1[/link]
has anyone read this?
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Quote from Picasso01
This is a good article. Im going to re-read this. These are a few points I would like to makethere is a huge pressure on radiologist right now from everyonefrom referring clinicians to malpractice insurers to government agencies for us to spend more time on incidental findings, interpretation and follow-upand particularly saying what and when for every incidental finding. This can be so frustrating because we really are presented with limited information and we feel the fire to make some type of interpretation/recommendation when we really dont knowthis is a huge problem. Spending extra time and lost RVUs on exams that have incidental findings and are not conclusive What we see in our radiology crystal ball is usually hazy. We often need to recommend follow up because we dont know or cannot come to a final diagnosis and want/need more information, not because we are greedy and want more money from an additional scan. I think a lot of people dont understand or get this.
As far as infiltrateit seems these days its as an equivocal and acceptable as consolidation so just go with it.Agree with this… which is why i have almost entirely quit even commenting on renal cysts (unless specifically done for complex renal cyst eval, etc). Seems like easy way out of all the BS.
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Your dictating for your referrers not some author sitting in academia. No one cares how smart your are or if you dictate according to terms in radiology textbooks. White spot on x ray with differential or infiltrate may be ok.
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Great article and video! Well done. Older and younger rads could all benefit from adopting these strategies.
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Everyone on this message board produces concise reports just like the article says to do.
And everybody on this message board is in the costs 25th percentile for accuracy and quality reports.
And everyone on this board is in the top 25th percentile for production
Just ask them. -
Everyone on this message board produces concise reports just like the article says to do.
And everybody on this message board is in the top 25th percentile for accuracy and quality of reports.
And everyone on this board is in the top 25th percentile for production.
Just ask them. -
Nothing really wrong with infiltrate. Its a descriptive term. I avoid using it, but it is really no better or worse than opacity or consolidation.
Everyone on this message board produces concise reports just like the article says to do.
And everybody on this message board is in the top 25th percentile for accuracy and quality of reports.
And everyone on this board is in the top 25th percentile for production.
Just ask them.-
Actually, Aunt Minnie may self select to motivated, quality Radiologists to a certain extent.
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Nice and insightful comments everyone.
The book in the amazon link is a great read and one of the sources that I cited in the paper – it takes time but there is a lot of very interesting and insightful information. Under the Radiopaedia video link I list my 5 most helpful sources and his book is included ([link=https://radiopaedia.org/courses/featured-video?lang=gb). ]https://radiopaedia.org/c…-video?lang=gb). [/link]
Regarding the comments about “infiltrate” or not, and other similar words, I think it’s missing the bigger point. You can call it whatever you want in the findings, and even if it is an inaccurate term to an extent it matters much, much less than what you say in the impression. The impression is reserved for providing a clear diagnosis or differential diagnosis that everyone with an appropriate medical degree can understand, and that is where I draw the line and say “don’t bring in vague terms or technical language that only mean something to you or other radiologists” (shop talk). Honestly the biggest offender is MRI signal characteristics – nobody has any idea what you are talking about, and you should avoid using any in the impression (Figure 2 in the paper)
Regarding the comment on feedback – I agree they have opinions on our reports, but at least in my experience we rarely hear from them. We did a survey of our ED and oncology about their satisfaction with rad reporting and had some very interesting and helpful responses. It is a bit of Pandora’s box to ask a lot of wishlist or “are you happy with” questions because it does carry and implication that you are willing to do whatever they ask, and often that is just not true or possible. However, giving such a survey does help you to see patterns and open up the door of communication.-
^The impression is reserved for providing a clear diagnosis or differential diagnosis that everyone with an appropriate medical degree can understand.
Disagree. Report should be targeted to referring specialty that not everyone with medical degree will understand. Neurorads need not dumb down their reports so any primary care doc can understand, same for msk.
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Quote from fushibob
^The impression is reserved for providing a clear diagnosis or differential diagnosis that everyone with an appropriate medical degree can understand.
Disagree. Report should be targeted to referring specialty that not everyone with medical degree will understand. Neurorads need not dumb down their reports so any primary care doc can understand, same for msk.
Your point of disagreement was implied by the use of “appropriate” -
I work at neuro and ortho specialty hospitals.
I have never had a doc complain about a report or impression that was too short.
Brevity and clarity not only helps the clinician, but speeds workflow and decreases errors.
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Quote from spongiform
I work at neuro and ortho specialty hospitals.
I have never had a doc complain about a report or impression that was too short.
Brevity and clarity not only helps the clinician, but speeds workflow and decreases errors.Actually, oncologists will complain about short reports.
As far as long reports, we have some rads who I personally can’t figure out what they are saying. They speak in legalistic tongues. It’s amazing; if I were a referrer, I would request they NOT interpret my patients; but not a peep.
I do appreciate the attempt by the author to address this; as it is important to me. But I must say, I get discouraged by the variability and lack of interest in reporting by many. -
Quote from spongiform
I have never had a doc complain about a report or [b]impression [/b]that was too short.
Quote from boomer
Actually, oncologists will complain about short[b] reports.[/b]
Two different things.
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Just to add my $0.01 in since it was brought up. Long ago when I trained under the late great Robert G. Fraser, MD (of Fraser and Pare fame), we were prohibited from using the term “infiltrate.” The justification was that it was a pathologic term that could rarely be determined by a radiograph (x-ray or CT). When the etiology was unknown, the descriptive term of “opacity” was preferred hopefully further classified by airspace or interstitial location. Sorry, did not mean to derail, but…
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The never ending radiology debate.
In training, infiltrate was verboten.
Radioopacification was preferred, but opacification or opacity accepted.
As years went by, I was able to actually utter the “I” word.
Now it just flows off the tongue so sweetly. I just can’t resist…-
Was taught to use opacity, and that infiltrate is bad. They’re exactly the same in my mind, some white crap in the lungs that you’re not sure what it is. The only thing that bothers me is when I see “RLL infiltrate” in the impression when theres a dense consolidation and the hx is cough and fever. Just call it what it is. Otherwise on the ICU board, I use opacity/infiltrate all the time. No one cares. I doubt anyone reads those reports anyway.
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I use infiltrate and will never give it up.
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In my experience, the clinician uses the world infiltrate just as much if not more than the radiologist. “R/O infiltrate”, etc. It is pretty much implicit that opacity = infiltrate.
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ol’ timer here and still practicing after 40 years-
One of the grandfather’s of Radiology – Ben Felson, used that word in his authoritative textbook (required reading for the old ABR Board exam in Louisville) [i][b]Principle’s of Chest Roentgenology.[/b][/i] That was before CT scanning though.
[i][b]
[/b][/i]Board review courses in the 80’s and 90’s used that word and so did the expert lecturers including numerous world renown ones in Chest [i]Roentgenology[/i] (NOW CALLED RADIOLOGY).
Incidentally – RADIOLOGY is also probably an antiquated term and should probably be Medical/Diagnostic Imaging? (doesn’t seem that anyone is complaining though)
I use INFILTRATE everyday and still teach residents, and medical students; everybody including young/old attendings and clinicians completely understand it and it’s meaning. Also use OPACITY interchangeably as well.
Maybe it is regional?
[i][b]
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In France we love the french version of infiltrate : “inffiltrat ” “infiltrat alveolo-interstitiel ” ……………………….
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^^ curious how your work conditions are in France? Here in the states we read as fast we can for as long as possible and are held to a standard of perfection. We are being taken over by corporations.
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Quote from Drrad123
^^ curious how your work conditions are in France? Here in the states we read as fast we can for as long as possible and are held to a standard of perfection. We are being taken over by corporations.
In France we work on one shift at time , for example when you are on MRI in the afternoon , you read only MRI . Our dicatting desk is the MRI suit behind the technologists ( let say you read up to 17 or 18 scans ) -
ROFLOL.
Sorry didnt mean to hi jack this thread to discuss infiltrate. It was meant as a joke. -
slightly switching gears, but apparently per billing service they very much dislike consistent with, or likely.
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What would they prefer?
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