Radiology Reporting in an Academic Children’s Hospital: What Referring Physicians Think

Abstract & Commentary

Synopsis: A survey of referring pediatricians as to their expectations and use of radiology reports indicates that residents are less confident in their interpretation of images, that the most important content of a report is the response to the question posed in the referral, and that clarity was the most highly regarded nondiagnostic characteristic.

Source: Gunderman R, et al. Pediatr Radiol 2000;30:307-314.

Gunderman and colleagues conducted a survey of referring physicians (181 responses) regarding their needs and assessments of radiology reports they received. Rating a number of parameters for importance, the value of radiology rated good-excellent, but there were a broad range of responses as to whether the report changed decisions made in patient care. A rating of content characteristics of radiology reports rated most highly response to the specific question posed in the referral. Other desirable characteristics of the report were 1) correlation with the results of other imaging examinations; 2) the radiologist’s opinion regarding the most likely diagnosis; 3) the radiologist’s differential diagnosis; and 4) reference to the limitations of the examination. The least highly rated content characteristic was the radiologist’s recommendations in light of the examination.

When rating the importance of nondiagnostic characteristics of radiology reports, most highly rated was clarity, followed by timeliness, ease of accessing images, responsiveness, completeness, and conciseness.

Differences between attending physicians and resident physicians were mainly in their assessments of how well they were able to interpret radiology studies. The mean response for residents was 2.9 (1 low, 5 high) and the mean response for attendings was 3.4. There was also a difference between generalist and specialist pediatricians in their assessments of their ability to interpret imaging studies. General pediatricians rated themselves 3.0 and specialists rated themselves 3.5. Generalists estimated a higher percentage in which the information in the report changed healthcare management decisions and the generalists were less likely to view the images than were specialists. Specialists rely on the typed report less than generalists.

There was a strong positive relationship between the number of studies respondents order per week and the percentage of cases in which they view the images. The number of studies ordered per week is negatively related to the percentage of cases in which respondents read the radiology report. Similarly, there is a strong inverse relationship between the number of studies ordered per week and respondents’ assessments of the frequency with which the radiology report changes health care management decisions.

Comment Beverly P. Wood, MD, MSC

As images are more rapidly and widely available and as reports are generated to accompany images dispersed for viewing, the report increasingly is the way the radiologist is known to the referring physician. Knowing the needs and expectations of the referring physicians is a big step in validating the usefulness of radiology reports.

Gunderman et al asked questions about the key elements that radiology reports should include, how often referring clinicians read radiology reports, and how often radiology reports change the way patients are cared for. They asked the value of radiology.

Other questions that could be addressed are how radiology departments could improve their reports, what is bad about reports, and what is most frequently omitted that referring physicians expect to see. Do physicians read the whole report?

Overall, this is a good step in evaluating the use and usefulness of reports from one institution. Although radiologists spend large amounts of time performing studies and formulating differential diagnoses, they spend much less time and effort considering how to communicate results to other physicians. A consideration in training of residents should include communication of results of imaging studies to referring physicians. More rapid preparation of reports so that they can accompany image dispersal makes this form of communication an even stronger focus for our consultation skills.