Quality is now the name of the game in radiology, and according to a recent case study published in the Journal of the American College of Radiology, one way to increase the overall quality of patient care is standardizing templates to be used for all breast MRI reports.

Lead author Dorothy A. Sippo, MD, MPH, of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital in Boston, and colleagues compared the breast MRI reports of 12 different specialists at the same imaging center and noticed a significant problem: They were all done differently.

“Significant variability of content, format and specific descriptive language was noted among individual reports,” the authors wrote. “Potential contributing factors include reporting by 12 breast imaging attendings working with 36 different trainee radiologists.”

If reports were completed using standardized templates, Sippo et al. thought, it could instantly improve the quality of those reports. So that’s exactly what they tried to do.

Developing a new standard

The authors reviewed a random sample of 100 contrast-enhanced breast MRI reports interpreted by 12 different attending breast imagers. Certain things were missing more than half of the time, they noticed, including examination indication, enhancing lesion type and lesion enhancement. Also, background parenchymal enhancement (BPE) was being reported just 60 percent of the time.

Templates were then created with special attention being paid to these problem areas.

“The templates were developed to describe clinical context, imaging examination parameters, imaging findings and final assessment,” the authors wrote. “A basic normal report template was created with structured fields where specific information was to be entered. These fields contained text to prompt the radiologist to use BI-RADS lexicon–based terminology.”

It was a learning process. Trainees were asked to use the templates and then provide feedback during monthly meetings. What was helpful? What wasn’t working? This was all taken into account, and improvements were made where necessary.

The final templates were then launched. To test their value, Sippo and colleagues compared 100 contrast-enhanced breast MRI reports from before the templates were introduced with 100 contrast-enhanced breast MRI reports from after.

“From each of these two time periods, the 100 reports were reviewed by a board-certified diagnostic radiologist doing fellowship training in breast imaging,” the authors wrote. “Each report was manually reviewed for a clear statement of (1) examination indication type (screening, follow-up, diagnostic workup or monitoring of therapy response), (2) BPE (minimal, mild, moderate or marked), (3) lesion type (focus, mass or non-mass enhancement), and (4) lesion enhancement kinetics (initial rise and delayed phase). Lesion type and kinetics had to be specified using BI-RADS lexicon terminology for this information to be deemed clearly stated in the report.”

The final verdict

Sippo et al. found their new templates made a clear impact on breast MRI report quality.

The percentage of reports that included examination indication jumped from 31 percent before the templates were standardized to 88 percent after. BPE increased from 60 percent to 100 percent. Enhancing lesion type went from more than 46 percent to 83 percent.

“Our study shows that the use of standardized templates for structured reporting of breast MRI examinations can improve quality by increasing report completeness and consistency,” the authors wrote.