Structured for Success: The RSNA Radiology Reporting Initiative

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 - Puzzle

To understand why the future of radiology is in reporting that is both structured and template-based, look to the earliest days of the profession.

One day in 1896, William James Morton, MD, of the New York Post-Graduate Medical School and Hospital took fountain pen to paper and scrawled:

“The X ray shows plainly that there is no stone of an appreciable size in the kidney. I only got the negative today and could not therefore report earlier. The picture is not so strong as I would like, but it is strong enough to differentiate the parts.”

“So you had workflow problems, and a little bit of a hedge, even in 1896. Some things never change,” Curtis P. Langlotz, MD, PhD, professor of radiology and biomedical informatics at Stanford, quips.

Langlotz was one of three presenters of a talk titled, “The RSNA Reporting Initiative: Developing a Library of Best Practices Radiology Report Templates,” at the annual meeting of the Radiological Society of North America on Dec. 2 in Chicago. Specifically, the session presented tools and resources that the initiative makes available to radiologists who want to tap into RSNA’s growing library of best–practice-based report templates.

Langlotz: The actionable narrative

“Even though we use a lot of fancy technology, speech recognition and so on, fundamentally what we produce is a narrative,” Langlotz says. “That really has not changed much.” Nonetheless, reporting methods are going to have to continue to evolve to keep up with changing payment models, Imaging 3.0 and all of the other change drivers in healthcare, he adds.

In the current environment, structured reporting, the method of verbally characterizing diagnostic images in a way that combines a fixed format with consistent organization and standard language—ideally one that incorporates checklists and produces reports that are readable to machines as well as humans—is gaining disciples.

The RSNA Radiology Reporting Initiative got off the ground in 2007, when the ACR invited leaders of radiology subspecialty organizations to a summit on reporting. A consensus emerged: Structured reporting is an optimal method of creating reports—as long as tools exist to generate structured reports just as fast as narrative ones have been created through the years.

Attendees of that ACR summit also agreed, Langlotz says, that one of the best ways to achieve this is to combine structured reporting elements with voice-to-text software that incorporates macros, the one- or two-word prompts that automatically populate a given text field with full sentences or paragraphs frequently spoken in radiology reporting. “There was then this notion that radiology professional organizations should create a repository of exemplary reports,” Langlotz says. “That’s what this RSNA report library is intended to provide.”

Today, RSNA’s best-practices template library—online for free and unrestricted use at—offers radiologists select, macros-based templates largely created by experts, subspecialty radiology societies and leading radiology departments. It also links to an open template library ( in which radiologists can share their own templates and critique others’ templates using comments and a starred rating system à la Amazon and Yelp.

“Over the past couple of years we have worked on standards that enable templates to be exchanged from libraries and exchanged between systems [and sites],” Langlotz says. “These are raising the bar for the vendors and giving us more capabilities in our reporting systems.”

A new IHE reporting protocol

Langlotz described a new reporting protocol to facilitate such template exchanges by defining templates using an HTML5-based, Internet-friendly format. Called Management of Radiology Report Templates (MRRT), the protocol was developed by Integrating the Healthcare Enterprise (IHE) in 2013 and will soon be the standard profile of the RSNA template library. “This is something that you should consider having a conversation with your reporting vendor about,” Langlotz says. “It will make for a better report and, in fact, make the radiologist even more productive.” (See sidebar)

“To close with an elevator story for the RSNA template library and for structured reporting, what are the benefits?” Langlotz asks, and then rattles off a few. “They can help a practice that wants to get started with structured reporting agree on a consistent format using standard headings and sections. They can help you create reports your