Redefining the imaging report in 2018: ‘Radiologists can and must do better'

Granting radiology patients access to online patient portals is growing transparency in the field, Atlanta radiologist Nadja Kadom, MD, and colleagues have reported in the Journal of the American College of Radiology—but a lack of health literacy across the country is compromising the success of such an idea.

Plainly, Kadom et al. said, though radiology reports might be more accessible to laypeople now, they were originally intended for medically trained readers.

“They frequently contain jargon and technical terminology that render them uninterpretable by patients, who increasingly have access to their reports through patient portals,” the authors wrote in JACR. “Although perceived by some radiologists as sufficiently patient-centered, mere portal access neglects issues of readability and comprehension, appraisal and application.”

Kadom and her team at Emory University School of Medicine reviewed 55,575 radiology reports from their institution, noting readability based on five widely accepted scoring algorithms. While guidelines have historically recommended reports be written at a fourth- to sixth-grade reading level, the researchers found that at their practice, readability was more around a twelfth-grade level.

“Our analysis confirmed what we expected,” the authors wrote. “Not a single modality or subspecialty division met recommended patient readability guidelines.”

According to the reports, which were all graded on Flesch-Kincaid, FORCAST, Gunning fog and SMOG readability scales, neuroimaging studies were the least readable, while mammography saw the highest readability levels. 

But taking the ten-dollar syntax down a notch probably wouldn’t fix anything, Kadom and co-authors said, since medical professionals do rely on speciality-specific lexicons of terms and synonyms that are appropriate to use in radiology reporting.

“Although improving patients’ understanding of radiology reports is a very important goal, initiatives to improve the readability levels of radiology reports could result in unintended consequences,” the researchers wrote. “In contrast to patients, provider and payer stakeholders, such as radiologists, referring physicians and insurers, typically seek nuanced granularity for imaging comparison purposes, clinical decision-making and insurance coverage.”

Replacing the medical vocabulary with simplicity could decrease both accuracy and understanding in these cases, Kadom et al. said.

The group wrote that multimedia-enhanced reporting, like linking technical terms and diagrams in online text, could help, as could something as simple as adding a text module to radiology reports detailing findings and outcomes in simpler terms for patients.

“In our opinion, to become truly patient-centered, radiologists must move beyond traditional ‘business-as-usual’ report generation and find new ways to help patients access, comprehend, appraise and apply the valuable information contained within our reports,” Kadom and colleagues wrote. “Radiologists can and must do better.”