Embedding selected images into radiology reports may save time and improve communication between radiologists and clinicians, according to a study published in the March issue of the Journal of the American College of Radiology. In rare cases, the attached images can even affect patient management.
In a retrospective comparison of text-only reports to reports with embedded images, a research team from Massachusetts General Hospital (MGH) of Boston found that clinicians overwhelmingly preferred the added information available from the images. While the participating clinicians in the study found text-only reports to be satisfactory in 91.4% of the cases, they also felt that their clinical questions were better answered by reports with embedded images.
"The results of our study indicate that although clinicians' queries are satisfactorily answered by the current itemized reports, providing additional images conveys useful additional information," wrote a research team led by Dr. Veena Iyer. "It may enable referring clinicians to formulate management plans more rapidly and with increased confidence" (JACR, March 2010, Vol. 7:3, pp. 205-210).
To evaluate the utility of images embedded in radiology reports, the MGH team selected 35 abdominal-pelvic CT cases from two prior years. Of the 35, 21 were chosen from a cohort of cases referred by a staff gastrointestinal medical oncologist and 14 were selected from cases referred by a staff gastrointestinal surgeon.
For each exam, selected images were exported from MGH's Impax PACS (Agfa HealthCare, Greenville, SC) in a JPEG format and appended to the text report. As a result, two pairs of radiology reports were created for all 35 cases: a text-only report and the same report with embedded images.
After first reviewing the clinical notes in which they had first requested the imaging studies, the oncologist and surgeon were asked to review the text-only report. The readers filled out a questionnaire before examining the report with embedded images. They then completed a second questionnaire.
Of the 35 cases, 32 (91.4%) text-only reports were judged by the participants to provide satisfactory information. The readers did not agree or disagree that the reports provided satisfactory information in the other three cases.
The participants also believed that the reports with embedded images answered their clinical questions better than the text-only reports in 32 cases (91.4%).
"In all of these 32 cases, the reports with the images helped the participants make more confident decisions while formulating management plans and also saved time taken to formulate the plan (95% [confidence interval], 89.11%-99.99%)," the authors wrote.
Management plans were modified after viewing the attached images in two (6.3%) of the cases. Both of these changes were made by the surgeon, according to the researchers.
"In one case, the surgeon would have performed dissection of an enlarged lymph node shown in the image attached to the report but would not have dissected this node after reading its description in the text-only report; in the second case, the surgeon would have ordered an additional imaging study after viewing attached images," the authors wrote.
In both of these cases, the surgeon had visited the radiology department to review the reports with the radiologist.
When asked to rate whether the embedded images were the most important features in the reports, the participants strongly agreed in seven cases, agreed in 21 cases, neither agreed nor disagreed in one case, and disagreed in six cases, according to the authors. They also said they were pleased to have the convenience of receiving images with the reports in all cases.
The participants would have consulted radiologists in 21 of the cases after reviewing the text-only reports. However, that number dropped to 10 after examining the reports with embedded images.
"Technological advances to support the creation of reports with attached subsamples of images should be pursued, as they are viewed favorably by referring clinicians," the authors concluded.
By Erik L. Ridley
AuntMinnie.com staff writer
March 1, 2010
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