RSNA Reporting Committee Plan

Laying the Groundwork for a Library of Best-Practice Radiology Report Templates

Curtis P. Langlotz, MD, PhD, Chair
Charles E. Kahn, Jr, MD, MS, Co-Chair

The mission of the RSNA Reporting Committee is to improve radiology reporting practices by creating clear and consistent report templates that contain reusable structured data. The primary goal of the RSNA Reporting Committee will be to create a library of standardized radiology report templates based on RadLex and other standard terminologies. These report templates will represent best-practices that can be adapted and adopted based on local practice patterns. The report template library will serve as a starting point for practices wishing to improve their reporting practices by standardizing the format, content, and structure of their reports. Such a report template library will be valuable to clinical radiologists, whether they use conventional dictation and transcription, automated speech recognition, or other reporting tools.

Committee Activities in 2008

During the first year, the RSNA Reporting Committee will perform pilot studies and lay the technical and organizational groundwork for a consensus process that can be rapidly scaled over the ensuing two years.

The following tasks will be accomplished in 2008:

1. Propose a standard format for structured radiology reports. The committee will convene a Structured Reporting Technical Task Force that will survey existing report formats, including HL7 Clinical Document Architecture (CDA), DICOM Structured Reporting (DICOM-SR), cancer Biomedical Informatics Grid (caBIG) Annotation and Image Markup (AIM) format. Special attention will be paid to the representation of quantitative measures, such as the Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) criteria for measuring lesions. From these formats, the technical task force will propose a standard format and presentation for structured radiology reports.
2. Convene a Workshop on the Structured Radiology Report. A structured reporting workshop will bring together approximately 60 individuals with specific interests in radiology reporting. (See attached draft agenda.) The workshop will serve several purposes:
   1. Radiology subspecialty organizations will be invited to participate in the RSNA reporting effort and to describe any ongoing related efforts.
   2. Other medical specialties with active structured reporting efforts, such as pathology and cardiology, will offer lessons learned, and will be invited to contribute to our process.
   3. Technical experts will discuss the strengths and weaknesses of report format standards, and devise a way to combine or harmonize these formats.
   4. Clinical radiologists will consider the most important clinical scenarios and use cases for which structured report templates are needed.
   5. At the conclusion of the meeting, a white paper will summarize the conclusions of the workshop. The manuscript will be modeled after a similar manuscript recently published in the American Journal of Nuclear Cardiology. (See attached.)
3. Conduct a pilot focused on an important clinical reporting issue. Before scaling up the consensus process for developing standard report templates, we would like to develop a successful and repeatable methodology based on experiences with a single committee. For example, the reporting of equivocal pulmonary nodules is an important reporting issue for thoracic radiologists. Musculoskeletal radiologists might focus on the reporting of knee MRI exams when ligamentous injury is suspected. This pilot effort will test consensus methods and technical formats to assure they are sufficiently robust when scaled up.
4. Develop standard report elements for notification of critical test results. The RSNA Reporting Committee will support the RSNA Continuous Quality Improvement Initiative (CQII) Committee in the development of standard reporting methods to support the notification of critical test results. These methods will enable the auditing of notification practices to satisfy regulatory requirements, such as those of the Joint Commission.

Deliverables

1. An agreed standard format for structured radiology reports
2. A tested consensus process for developing structured radiology reports
3. Best-practices report templates for at least one important clinical problem
4. Standard report templates for notification of critical test results

Plans for 2009

Based on experience with the pilot efforts in 2008, the project will be scaled up to include all radiology subspecialty areas. A committee process similar to the RadLex term development process will be used to develop best-practice report templates in each area. To begin the process, subspecialty committees will select a few key clinical scenarios in their areas of expertise. We expect this scaled up process to conclude by RSNA 2010. At the conclusion, standard report templates will be available for the majority of reports created by radiologists.

Report templates for these clinical scenarios will be developed from actual de-identified clinical reports or templates submitted by practicing radiologists. Submitted reports will embody what the author believes is an exemplary format and content of a report for a given clinical imaging scenario. The submission and editing of reports will be an interactive and participatory electronic process. Reports for each clinical area will be discussed and integrated by the subspecialty committees into consensus best-practice reports available for download from an RSNA-hosted site in several standard formats, including text. To support this effort, RSNA will develop software tools for web-based authoring, display, and distribution of the structured reports in the library.