Digital Radiology Reporting Systems

Radiographs are the output images from any kind of imaging modalities. Reporting is the process of extracting findings and information from these radiographs. The most common way used in the reporting process is called “Transcription”. Transcription process starts when the radiologist records his findings with his voice on a tape, and then sends this tape to another person, the “Stenographer”, who listens to the tape and start writing down the report. Report is then returned back to the radiologist to be signed for approval. In some cases, reports are sent back to the stenographer to be corrected if it contained errors [1, 2].

This method continued to be used till the development of speech recognition applications. Speech recognition applications help the radiologist to write down the radiology report at the time of radiograph observation. But, the output result stills the same, an unstructured text-file. Some research was done to apply natural language processing step to the unstructured text-file to produce a structured form report. Other advanced techniques combine both steps to allow the radiologist build a structured report at the point of observation. That can be done using a pointing device or a touch-screen to select the appropriate points and values from a set containing all possible findings [1, 3].

A study made in Midway Hospital Medical Center, with more than 160,000 structured reports using the digital StructuRad system, was made and demonstrated many advantages of using structured reporting. The study continued for four years, using 12 different imaging modalities. The StructuRad system uses different templates for each modality and for each anatomical site being imaged. Each template holds almost all the possible findings for each specific diagnosis [4].

Results:

The study shows many advantages for using structured reports over the conventional transcription. Advantages listed below are due to eliminating transcription process: 1. Reduces the cost. 2. Reduces the turnaround time. 3. Saves the time needed for both correcting errors and coding [StructuRad’s templates do both ICD-9 and CPT necessary coding]. 4. Reduce manual transcription errors.

Even of these advantages, structured reporting have some disadvantages. First, it reduces the radiologist efficiency during the training period until they become familiar with this system. Radiology lexicon is the second challenge in the development of standardized structuring process. RSNA took the lead in this field with their RadLex application. RadLex initiative aimed to "create a unified radiology lexicon for indexing teaching files, organizing research databases, and creating point-and-click reporting systems". RadLex had a very significant role in building and updating the radiology lexicon; in 2005 six RadLex committees were held and released more than 7500 terms for radiology lexicon. In 2007, another effort called - RadLex Playbook- with a more six committees held focused on imaging modalities terms related to the device used and exam procedure steps [4, 5, 6].

Comments:

Structured radiology reporting has many advantages that will lead to enhancement in the healthcare quality. Another issue is that structured reports will improve the usability of the EHR increase the ability to use the radiology reports in data mining for research and analysis. We can conclude that we can cope with structured reporting disadvantages in order to achieving a better healthcare quality.

References:

1. Case study: Structured radiology reporting: a 4-year case study of 160,000 reports. Presented at the Integrating the Healthcare Enterprise (IHE) Symposium of the Radiological Society of North America (RSNA) 2001 Annual Meeting November 25 - 30, 2001. Available at: http://www.structuredreporting.com/

2. Digital Imaging and Communications in Medicine (DICOM) - Supplement 101: HL7 Structured Document Object References. Available at: http://xml.coverpages.org/DICOM-sup101PC.pdf

3. Barton F. Branstetter IV. Basics of Imaging Informatics: Part 2. Radiology 2007; 244(1):78–84. Available at: http://radiology.rsnajnls.org/

4. Indrajit IK, Verma BS. DICOM, HL7 and IHE: A basic primer on Healthcare Standards for Radiologists. Indian J Radiol Imaging [serial online] 2007 [cited 2008 Dec 1];17:66-8. Available from: http://www.ijri.org/text.asp?2007/17/2/66/33610

5. Dan Harvey. Structured Reporting — Speeding Clear Results to Referrers. Radiology Today Magazine 2008; Vol 9 No 3 P 16. Available at: http://www.radiologytoday.net/archive/rt02112008p16.shtml

6. Radiological Society of North America; Website: http://www.rsna.org/RadLex/index.cfm

Submitted by (Ayman M. AbulEla Amin)