Influence of Radiology Report Format on Reading Time and Comprehension

Abstract

This study examined whether radiology report format influences reading time and comprehension of information. Three reports were reformatted to conventional free text, structured text organized by organ system, and hierarchical structured text organized by clinical significance. Five attending radiologists, five radiology residents, five internal medicine attendings, and five internal medicine residents read the reports and answered a series of questions about them. Reading was timed and participants reported reading preferences. For reading time, there was no significant effect for format, but there was for attending versus resident, and radiology versus internal medicine. For percent correct scores, there was no significant effect for report format or for attending versus resident, but there was for radiology versus internal medicine with the radiologists scoring better overall. Report format does not appear to impact viewing time or percent correct answers, but there are differences in both for specialty and level of experience. There were also differences between the four groups of participants with respect to what they focus on in a radiology report and how they read reports (skim versus read in detail). There may not be a “one-size-fits-all” radiology report format as individual preferences differ widely.

Appendices

Appendix 1. Three Report Formats for UPJ Example

Report #1 = Conventional Free Text

CT abdomen and pelvis without contrast

Clinical indication: Abdominal pain

Technique: Axial images were performed through the abdomen and pelvis without intravenous contrast administration.

Comparison Studies: None

Findings:

There is elevation of the right hemidiaphragm with COPD and chronic granulomatous disease.

Post-surgical changes of cholecystectomy identified.

The liver, pancreas, spleen, and adrenals are normal.

Multiple hypo/hyperdense nodules are present within both kidneys, which are poorly evaluated in the absence of contrast. The largest hyperdense nodule measures 3.6 cm and is located within the midlateral right kidney. Additional post-contrast CT imaging is recommended.

Punctuate non-obstructing bilateral renal are identified. There is marked left hydronephrosis in a pattern of UPJ stenosis.

There is normal caliber of vascular structures and bowel with abundant stool.

The prostate is enlarged with a Foley catheter in the decompressed bladder.

A 1.9-cm sclerotic lesion is present within the left acetabular roof suggesting a benign bone island. Multilevel lumbar degenerative changes are identified.

Impression:

Multiple renal abnormalities as described above, which would warrant further evaluation with post-contrast CT.

Report Format #2 = Hierarchical Structured Text (Organized by Clinical Significance)

CT abdomen and pelvis without contrast

Clinical indication: Abdominal pain

Technique: Axial images were performed through the abdomen and pelvis without intravenous contrast administration.

Comparison Studies: None

Positive Findings:

• 1. Hydronephrosis (Left)

Clinical significance: High

Follow-up recommendations: CT with contrast

Severity: Marked

Diagnosis: UPJ stenosis

• 2. Nodular lesions

Clinical significance: Uncertain

Follow-up recommendations: CT with contrast

Anatomic location: Renal, bilateral

Size: 3.6 cm (largest lesion right mid pole)

Diagnosis: ? Cysts

• 3. Calculi

Clinical significance: Moderate

Anatomic location: Bilateral kidneys

Size: Punctate

• 4. Prostate enlargement

Clinical significance: Low

• 5. Bone island

Clinical significance: Low

Anatomic location: Left acetabular roof

Size: 1.9 cm

• 6. COPD and chronic granulomatous disease

Clinical significance: Low

• 7. Osteoarthritis

Clinical significance: Low

Anatomic location: lumbar spine

Normal Anatomy:

Liver, pancreas, spleen, adrenals, blood vessels, lymphatics, biliary ducts, bladder, stomach, small bowel, and colon.

Procedures: Cholecystectomy and indwelling Foley catheter.

Report Format #3 = Structured Text (Organized by Organ System)

CT abdomen and pelvis without contrast

Clinical indication: Abdominal pain

Technique: Axial images were performed through the abdomen and pelvis without intravenous contrast administration.

Comparison Studies: None

Findings:

Lung Base:

Elevation of the right hemidiaphragm with COPD and chronic granulomatous disease

Gastrointestinal:

Normal caliber of stomach, small bowel, and colon.

Large quantity of stool present.

Genitourinary:

Marked left hydronephrosis, in pattern of UPJ stenosis.

Multiple bilateral punctuate renal calculi.

Multiple nodular lesions (hypo and hyperdense) both kidneys, largest 3.6 cm lateral mid pole right kidney. Recommend post-contrast CT.

Normal appearance of the adrenal glands.

Foley catheter in the decompressed bladder.

Enlarged prostate gland.

Biliary:

Status post cholecystectomy.

Liver, pancreas, and biliary ducts are normal.

Cardiovascular:

Patency with normal caliber of major arterial and venous structures

Lymphatic:

Spleen normal, no pathologically enlarged lymph nodes.

Musculoskeletal:

1.9 cm sclerotic lesion in the left acetabular roof? benign bone island.

Degenerative changes in the lumbar spine.

Impression:

• 1. Marked left hydronephrosis ? UPJ stenosis, post-contrast CT recommended.

• 2. Bilateral punctuate renal calculi and hypo/hyperdense nodules.

Appendix 2. Example of the Questions Asked after the Reports Were Read (UPJ Example)

Please circle true (T) or false (F) for each of the following questions regarding the report you just read.

• 1. The principle pathology described was left UPJ stenosis of moderate severity. (T) (F)

• 2. The largest nodular lesion was localized within the right kidney and measured 3.6 c (T) (F)

• 3. Urologic consultation was recommended. (T) (F)

• 4. A 1.9-cm bone island within the right acetabular roof was reported. (T) (F)

• 5. No pathology was reported within the inferior thorax. (T) (F)

• 6. The gall bladder is normal. (T) (F)

• 7. The liver is normal. (T) (F)

• 8. No catheter was reported. (T) (F)

• 9. The clinical indication for the study was flank pain. (T) (F)

• 10. No historical imaging study was available for comparison. (T) (F)