Physicians prefer itemized reports in an emergency setting

When comparing the three imaging report types used in an emergency setting, both radiologists and referring physicians prefer itemized reports (IR) over basic structured reports (BSR) and point-and-click reports (PCR), according to a survey published in Academic Radiology.

A BSR is the simple, bare-bones imaging report option, and an IR adds to the BSR format by providing more detail. A PCR asks physicians to choose previously determined options from various drop-down menus.

101 total physicians—61 radiologists and 40 referring physicians—responded to the survey. Authored by Rathachai Kaewlai, MD, and colleagues, the inquirey was an attempt to better understand what physicians in more urgent situations want from their imaging reports.

“In emergency setting, timeliness, readability, and accuracy of imaging reports are of the utmost importance for case management,” Kaewlai et al wrote. “Knowing the optimal type of reporting in view of both radiology and referring physicians would be helpful for planning of standardization of reporting pattern in emergency radiology.”

Physicians were asked which report type they preferred in two different scenarios: ultrasound/CT scans and radiography. The results showed that IR was preferred in both instances. When judging overall satisfaction for ultrasound/CT reports on a scale of 1 to 10, physicians gave IR an average score of 8.7. They gave PCR a 7.19 and BSR a 6.05. When judging overall satisfaction for radiography reports on a scale of 1 to 10, physicians gave IR an average score of 8.66. They gave PCR an 8.04 and BSR a 6.

IR was preferred the most and BSR preferred the least almost across the board. The authors explained, however, that this does not mean IR is necessarily light years ahead of PCR.

“Because IR and PCR looked quite similar in view of final reports seen by referring physicians and both were quite comparable in terms of quality, either of them might be used as a standard format in emergency radiology,” Kaewlai et al wrote. “To opt in for one type over another would likely depend on local preference of radiology physicians.”

Physicians were also asked about what kind of information they think belongs in an imaging report. Radiologists and referring physicians seem to be in almost complete agreement over this, responding that history, techniques, comparison study, quality of examination, size of normal organs, recommendation for further imaging, recommendation for non-imaging technique, recommendation from organization and how to communicate results should all be in the report.

However, only 47.5% of radiologists and 32.5% of referring physicians are in favor of including information about the radiation dose. And 41% of radiologists and 55% of referring physicians want recommendations for further treatment to be included.

The authors wrote that the inclusion of radiation dose is an especially controversial subject. Such information is required in California imaging reports, but radiologists are still clearly conflicted overall.

“The jury is still out, given lack of standardized methods for dose calculation, uncertain effect of radiation dose from diagnostic medical imaging, concerns over the effects it may have on patients who may read their own reports and lack of knowledge in radiation dose and cancer risk among physicians,” Kaewlai et al wrote.

The authors were quick to point out that the relative lack of experience of many of the responding physicians may have affected the results.

“The majority of respondents were young trainees,” Kaewlai et al wrote. “Younger generation physicians may be more computer-savvy and resilient to adapt to newer systems. They may also rely more on imaging report than their seniors.”