Radiology reports are central to diagnostic accuracy and clinical decision-making, particularly in neuroradiology. With two primary formats—free-text and structured—each offering distinct advantages and limitations, understanding user preferences can inform better report design. Despite the critical role of these documents, no consensus or guidelines currently exist on the optimal reporting format in neuroradiology. A recent multispecialty survey in Ontario aimed to characterise these preferences, exploring satisfaction levels and perceived effectiveness among various physician groups. The findings provide valuable insights into how reporting practices can evolve to meet clinical needs more effectively.
Reporting Habits and Satisfaction Levels
The survey included 87 valid responses from radiologists and physicians across multiple specialties. While most respondents were satisfied or neutral regarding current neuroradiology reports, underlying concerns surfaced when asked to elaborate. Notably, over a third of physicians indicated they read the full report only when abnormalities were noted in the impressions section, suggesting limited engagement with report bodies. Neurologists were significantly more likely to read entire reports consistently, contrasting with radiologists, who often focused solely on the impression.
Clarity and consistency were identified as ongoing challenges. Both radiologists and referring physicians cited variability in report quality and difficulty locating relevant clinical information. The structure and phrasing of reports were also questioned, with some respondents criticising the ambiguous language and failure to address the specific referral questions. Although most physicians found report section lengths appropriate, radiologists were more likely to consider them overly long. Capitalised headers, impression summaries and annotated images were widely appreciated across the board, while opinions were more divided regarding the inclusion of radiologist contact information.
Structured vs Free-Text Preferences Across Studies
When presented with both structured and free-text versions of seven neuroradiology reports, participants overwhelmingly favoured structured formats. This preference was consistent across all specialties and report types. Structured reports were particularly preferred for CTA Head and Neck studies, likely due to the need for clear, rapid access to critical findings in stroke cases. However, preferences were more mixed for MRI Brain Glioma and MRI of the Sella, indicating that complex cases may still benefit from the narrative flexibility of free-text reporting.
Must Read: Transforming Radiology Reporting with Large Language Models
Ease of locating information emerged as the dominant reason for preferring structured reports. Respondents also appreciated the time-saving and comprehensive nature of structured formats. Conversely, supporters of free-text reports valued their brevity and the absence of unnecessary sections. These findings suggest that structured reports are most effective when clarity and standardisation are paramount, while free-text formats may be better suited for nuanced or atypical cases that require contextual explanation.
Opportunities for Improvement and Standardisation
The study identified several avenues for enhancing radiology reporting. One recurring theme was the need to improve comprehensiveness without overwhelming the reader. Clinical interpretation, particularly the inclusion of differential diagnoses and clear definitions of vague terms, was highlighted as essential. Respondents expressed frustration with reports that used radiology jargon or failed to distinguish between pathological and incidental findings.
Standardisation was another key area of interest. Many clinicians and radiologists supported a shift toward uniform report templates, noting that inconsistency within and across institutions hampered efficiency. While structured reporting can address this issue, some respondents warned against over-standardisation, which could fragment complex cases and obscure the narrative flow. Balancing structured clarity with contextual depth remains a challenge, especially in reports covering multiple anatomical regions or uncertain findings.
There was also emphasis on tailoring reports to address the clinical question posed in the referral. Respondents noted that standardised reports sometimes neglected this element, reducing their clinical utility. Ensuring that reports directly respond to the referring physician’s inquiry could enhance communication and improve patient outcomes. Furthermore, keeping reports concise and focused on abnormal findings was recommended to minimise the risk of critical information being overlooked.
The survey results point to a strong physician preference for structured neuroradiology reports due to their clarity, consistency and efficiency. While free-text reports offer flexibility and brevity, structured formats better support information retrieval and standardisation. However, achieving optimal reporting requires more than choosing one format over another. It involves balancing clarity with clinical relevance and standardisation with flexibility. Institutions must also address variations in practice, report content and physician expectations. By aligning report design with user needs and clinical demands, the neuroradiology community can enhance communication and improve the overall quality of patient care.
Source: Canadian Association of Radiologists Journal
Image Credit: Freepik
