Quality - three concepts for radiology reports / by Timothy Myers

Introduction

Quality is something we put into each interpretation and each report.

Radiologists who put a lot of time and careful thought into rendering their interpretations are many times not taking that same level of care in presenting those thoughts.

Regardless of how carefully we review the images or how difficult a diagnosis we make, if we do not then put that information into an actionable format by creating a document that is understandable, the patient and the clinician will not benefit from our thoughts or reasoning.

 

Three concepts to adhere to:

  1. Relevance
  2. Simplicity
  3. Brevity

Relevance

Everything we say should have some meaning for the clinician. Pertinent positive findings as well as pertinent negatives need to be stated and discussed as needed. Many times it is the negative that is most important as the clinician tries to evaluate the patient. We frequently do not know what is causing the symptoms be we can definitively say what is NOT causing the symptoms.

Example: Not describing a right ovarian cyst on a CT may lead to a patient immediately having an unnecessary ultrasound to continue to followup right lower quadrant pain where the CT is otherwise normal.  The ultrasound is not necessary in this case. The CT answers the clinical question of, "Why is this female patient without an elevated white count having right lower quadrant pain ?", with a potential etiology for the patient's condition.

Simplicity

If something can be said simply in a declarative sentence, it should be said that way.

Example: An impression that says, “There do not appear to be areas of consolidation or infiltrate.”, does not have the same meaning or carry the same weight with the clinician as, “There is no evidence of pneumonia.”, in a patient with a cough and a fever.

Brevity

We need to be appropriately brief.

Example: A report that says, “Nonspecific abdomen.”, tells the clinician nothing and leaves them with a patient that has symptoms and no help is received from the interpretation provided. 

I used to argue with a staff radiologist who hated this type of interpretation for an abdomen series. He would say that every film or study was specific in varying degrees, even though it may be limited in its essence e.g. a plain film vs. a CT, as to what it may tell us.

A ‘nonspecific bowel gas pattern’ on a film does tell us there are no dilated bowel loops, there is no significant accumulation of stool and there is no overtly obstructive pattern. With these findings we know there is a differential that can still include ileus or enteritis depending on the exact picture before us and the clinical findings.

Appropriately brief should be determined by the examination and the need to help the clinician know what we see, not by the radiologist who simply says something that allows them to move on to the next study. When we say "nonspecific" what we mean is, there is no evidence of obstruction or other potentially specific diagnosis.  When the clinician hears "nonspecific" they are left with doubt as to what may or may not be seen on the images and what clues there may be as to the etiology of the patient's symptoms.

summary - Quality is our value added input to patient care.

Quality is not accuracy.  Quality is our value added input to patient care.  It includes accuracy but accuracy alone does not help the clinician.  If we are to remain relevant in the patient care chain, we must maintain the highest quality reporting and interpretations.  We must tell the clinicians not just what we see but also what we think.  And, we have to include information that will help them most easily determine an etiology for the patient's problems or symptoms so that treatment can begin promptly with the lowest cost and the highest likelihood of success.