5 reasons general practitioners lack confidence when reading neuroradiology reports

Approximately 10 percent of general practitioners (GPs) are not confident at all when reading neuroradiology reports, according to a new study published by Clinical Radiology.

“Since the introduction of direct access for MRI of the brain, GPs are facing neuroradiological reports that they must comprehend and action,” wrote author D. Saunders, department of neuroradiology at England’s Leeds Teaching Hospitals, and colleagues. “Previously, this task fell to the hospital specialist that had requested the study. Any uncertainty by the GP as to the meaning of the report could have a negative impact on patient care.”

Saunders et al. surveyed 100 GPs from the UK for the study. After reading five neuroradiology reports, participants were asked to use a five-point Likert scale to describe how confident they were that (1) they understood the text of the reports, (2) they could interpret and explain the overall meaning of the reports and (3) they could explain the significance of the report and put together a management plan.

While approximately 10 percent of GPs said they were not confident at all about any of those questions, fewer than one-third were entirely confident.

These are five specific aspects of neuroradiology reports that can cause problems for GPs:

1. Anatomical terminology: Specific anatomical terms that challenged GPs were: centrum semiovale, ganglionic region, juxtacortical white matter, corona radiata and cingulate gyrus. 

“The anatomical references are generally not useful,” one respondent noted in their survey.

2. Pathological terminology: Specific pathological terms that challenged GPs were: Gliosis, haemosiderin staining, cavernoma and arachnoid cyst.

One respondent said they needed Google to feel confident enough to speak with the theoretical patient.I don't understand this but I get the gist i.e. this is not serious,” another respondent said.

3. Radiological terminology: “T2 white matter hyperintensities” and terms related to susceptibility-weighted imaging gave GPs issues when they were reading over their five neuroradiology reports.

“Enhancement?” asked one respondent. “Do you mean bright areas?”

4. Significance of the findings: “GPs repeatedly called for an explanation to be included in the radiological report that stated the significance of the finding,” Saunders and colleagues wrote. “They also called for the significance to be complemented by a management plan.”

5. Specific recommendations: GPs want a “clear conclusion” to each report that includes an action plan and “a statement on the urgency of this action.” Respondents also requested fewer details and acronyms.

So what does this tell us about how radiology reports should be written moving forward?

“This research reiterates a call for structured reporting, especially for scans requested by GPs,” the authors wrote. “Respondents eluded to the importance of a report containing the clinical request. Previous studies have suggested that this inspires GPs with confidence, as it implies that the radiologist has read and interpreted the question”

Though the respondents were all from the U.K., the authors did note that specialists working throughout the world should consider thse issues when crafting reports.

“GPs want a clear conclusion and action plan,” they concluded. “This is a pertinent to all radiologists and should be instilled in radiology training.”