Improving Radiological Communication Through Synoptic Reporting

Clear, precise communication is critical to every stage of healthcare delivery. From the patient consulting with their primary care physician, to ordering tests and imaging, to creating medical reports and interpreting results and ultimately delivering the information to patients, ensuring information is accurately transmitted across care teams is integral to achieving the best possible outcomes for all involved. Clear, precise communication is particularly important when it comes to radiology, which occupies a critical role in cancer care [1]. Radiology reports and diagnoses are relied on by care teams for screening and prevention, and to determine treatment regimens and their impact. Without clear, accurate interpretations to draw upon, it can be difficult for care teams to decide on the best possible treatment plan for patients. Diagnoses that are as accurate, precise and definitive as possible are essential.

Communications Problems Facing Radiology

Unfortunately, radiological reports don’t always meet these standards, sometimes relying on qualifying terminology and what has been called “obfuscating jargon” by some [2]. The problem ultimately comes down to how people understand the meanings and definitions of words, and the fact that no two definitions or understandings are ever exactly the same. In communications, this phenomenon is known as plurality, and means “…there are always multiple interpretations of any situation, and that no one person can control those interpretations” [3].

In fact, the problem of qualifying terminology being used in radiological reports has even inspired some to investigate its effect. In 2013, the Massachusetts General Hospital conducted an investigation into the use of qualifying terminology in radiological reports. Their findings showed a surprising disconnect between radiologists’ use of some phrases and the ordering physicians’ interpretation of them. Phrases used by the radiologists meant to convey an explicit diagnosis weren’t interpreted as such by physicians, potentially leading to confusion, wasted additional testing, and in worst cases, possible misdiagnosis [4].

Take, for example, an often-used phrase: “Cannot exclude malignancy.” To a radiologist who has already listed potential diagnoses, this may just be a matter of protecting against legal liability, another important and relevant concern for radiologists in a litigious culture. Unfortunately, such phrasing doesn’t do anything to alleviate the fear and anxiety of the patient who went for the test, likely for exactly the purpose of excluding cancer as a cause of their symptoms.

It can be difficult for anyone to fully agree on the meaning of any given word at any given time in any given context. But when you’re dealing with radiology, particularly cancer care, clarity is even more important. While mixed language definitions may cause confusion anywhere, it can be downright deadly in a medical scenario.

The Changing Nature of Radiology Reporting

Of course, radiological reports are written for a highly-trained audience, the requesting physician, and not the patient, who likely wouldn’t be able to fully comprehend the implications of a radiological report. And rightly so. Nonetheless, there’s an increasing desire on the part of patients to be more involved in their medical care, and the recent explosion of online patient portals providing patients with immediate access to their medical records has empowered many of them to review their radiology reports on their own.

As a result, there’s been a movement in radiology in recent years towards straight-forward language and avoiding qualifying terminology [2]. The Journal of the American College of Radiologists promotes the use of simplified, clear language use in a regular feature column, while the College itself has created standardized reporting systems, including the BI-RADS (Breast Imaging Reporting and Data System), as well as the elective reporting and data systems for colon, liver, lung and thyroid imaging. The Radiological Society of North America has also created a library of downloadable synoptic templates developed that help standardize reporting formats and improve accuracy and clarity of communication.

How Structured (Synoptic) Reporting Can Help

The movement towards structured reporting is likely fueled by multiple factors, physician satisfaction with reports being a primary one. For example, a 2011 study conducted by Dr. Lawrence Shwartz and a team from the Memorial Sloan-Kettering Cancer Center discovered that “…physicians displayed significantly greater satisfaction with the content and clarity of structured reports than with the content and clarity of conventional reports. Since satisfaction with the content and clarity of conventional reporting was high, the fact that a significant improvement could be achieved with structured reporting is remarkable” [5]. In addition, structured reports have consistently been shown to be more complete and accurate than traditional text-based narrative reports, and by removing the need for transcription, can improve report turnaround time and reduce costs [6-8].

References

[1] Sipek, S. Knowing the Importance of Communication Between Radiologists, Physicians and Patients. Health Imaging. 2016.

[2] Mulcahy, N. Jargon Muddies Radiology Reports, Including About Cancers. Medscape. 2017.

[3] Walker, Robyn. Strategic Management Communication. Mason: Cengage Learning, 2011. Print.

[4] Gunn, Andrew J. et al. Recent Measures to Improve Radiology Reporting: Perspectives from Primary Care Physicians. Journal of the American College of Radiology 2013;10(2) , 122 – 127

[5] Schwartz, L.H., Panicek, D.M., et al. Improving Communication of Diagnostic Radiology Findings through Structured Reporting. Radiology 2011 260:1174-181 

[6] McLeod, R.S., Kirsh, R. What impact has the introduction of synoptic reporting for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists? Archives of Pathology & Lab Medicine 2011;135(11):1471–5.

[7] Maniarf, R.L., Hochman, D.J., et al. Documentation of quality of care data for colon cancer surgery: comparison of synoptic and dictated operative reports. Annals of Surgical Oncology 2014;21(11):3592–7

[8] Donahoe L, Bennett S, et al. Completeness of dictated operative reports in breast cancer–the case for synoptic reporting. Journal of Surgical Oncology 2012;106(1):79–83.