Sree Harsha Tirumani MBBS, MD, Presenter: Nothing to Disclose

John Gerard Ryan MD, Abstract Co-Author: Nothing to Disclose

Structured reporting does not improve the accuracy of ultrasonography reports in abdominal imaging.

The purpose of this research project was to determine the best way to communicate the results of  ultrasonography to its customers, patients and physicians. Two methods of generating radiology reports are in vogue: conventional free flow reporting, where the radiologist has his/her own format without a definite order, and structured pattern where the report is standardized and is subdivided into specific sections using templates. We investigated prospectively the following, with respect to abdominal ultrasound reporting: Whether structured reports have better accuracy than non-structured reports while reporting the ultrasonography findings in abdominal imaging.  

We evaluated about 100 abdominal ultrasound reports dictated in structured fashion using standard templates between October and December 2010 at The Ottawa Hospital using voice recognition software. All these reports were redictated by body imaging fellows in a non-structured free style dictation, blinded to the original structured report. Both these reports were then compared for qualitative and quantitative differences. Qualitative parameters assessed include accuracy, completeness, conciseness and clarity. Quantitative parameters assessed include number of positive findings reported or missed and number of pertinent  negatives reported. Each parameter was scored on a likert-type scale of 0-5. Statistical tests applied were Wilcoxon signed rank test.

Both structured and non-structured reports fared well in quantitative analysis. There was no statistical difference in degree of reporting of positive or negative findings. All the quantitative parameters were  better in non-structured reports meaning non-structured reports are more accurate, clear, concise and complete. But statistically significant difference was noted only with respect to accuracy (p=0.023).  Our study found that use of structured reports does not significantly affect the quality of ultrasound reports and may  indeed be conter-productive due to decreased accuracy. Template reporting tends to be over constraining and time inefficient.    

Tirumani, S, Ryan, J, Structured vs Nonstructured Reporting: Does Structured Reporting Increase the Accuracy of Ultrasonography Reports in Abdominal Imaging.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005458.html