A Plea for Better Imaging Reports

A prominent radiation oncologist gave a shout-out to structured EHR data during a keynote session at RSNA 2014, as part of a plea for better communication among radiologists, referring physicians, and patients.


A prominent radiation oncologist gave a shout-out to structured EHR data during a keynote session at RSNA 2014, as part of a plea for better communication among radiologists, referring physicians, and patients.

"The electronic medical record gives us an opportunity to think creatively about how to make our reports more readable," said Lawrence Marks, M.D., chair of clinical research at the University of North Carolina School of Medicine. "Maybe the reports could start to look like a checklist, with a supplemental narrative."

He exhorted attendees to make use of the American College of Radiology's BI-RADS (Breast Imaging-Reporting and Data System) assessment categories--a structured method of describing a patient's risk of breast cancer.  "I'm a big fan of the BI-RADS system," he said, because it makes the information easier to digest. He also recommended incorporating images directly into the report, with points of interest highlighted, and accenting significant findings with color to make them easier to read.

Marks scolded vendors who deliver radiology reports--or any information for that matter--in all capital letters, which are intrinsically difficult to read and make it easy to miss crucial pieces of information, like numbers. He showed an example of such a report, confessing that he had misinterpreted it by mistaking a period for a comma.

Clarity of communication is important among physicians, but will become even more important as patients gain access to their radiology reports. "The communication issue is going to become critical," Marks said.

Most of Marks's talk dealt with oncologists' over-reliance on modern imaging data in determining how much tissue to remove and whether to follow up with radiation and chemotherapy. Because the images appear more precise, he said, surgeons are comfortable using narrower margins, but more targeted surgeries often miss tiny cancer growths that imaging modalities don't pick up. As a result, mortality rates for some cancers go up when the latest imaging technologies and techniques are used. He showed a picture of termite-damaged wood, pointing out that while the termites aren't visible in the picture, they are almost certainly there somewhere, causing more damage.

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