Connecting images to radiologist findings in the form of an interactive multimedia radiology report has become a valuable capability for radiologists and the referring physicians they serve.
Recognizing interoperability standards as the key to successful interactive multimedia reporting (IMR), this special edition two-part series presents perspectives and selected analyses from IMR initiatives.
Although the traditional plain text-only radiology report has proved difficult to supplant, technology advances, and the growing evidence of IMR's utility and value may finally be the key to unlock widespread clinical adoption.
Connecting images to radiologist findings in the form of an interactive multimedia radiology report has become a valuable capability for radiologists and the referring physicians they serve.
Recognizing interoperability standards as the key to successful interactive multimedia reporting (IMR), this special edition two-part series presents perspectives and selected analyses from IMR initiatives.
Although the traditional plain text-only radiology report has proved difficult to supplant, technology advances, and the growing evidence of IMR's utility and value may finally be the key to unlock widespread clinical adoption.
Modern document formats such as rich text, HTML, and XML support more advanced multimedia features than traditional reporting techniques, including the use of formatted text, interactive elements such as hypertext and other links, and the insertion of tables, charts, and the scan images themselves.
Advanced radiology reports level up the standard of care, according to those who use them.
Cree Gaskin, MD, University of Virginia, UVA Health. Gaskin is a professor of radiology and orthopedic surgery, interim chair of radiology, and chief medical imaging information officer.
In the U.S., two institutions are among those who pioneered IMR and have the most experience with advanced reporting: the U.S. National Institutes of Health (NIH) Clinical Center and the University of Virginia (UVA).
At the University of Virginia (UVA) and UVA Health -- one of a few landmark IMR projects in the U.S. -- utilization of advanced reporting is being tracked across the institution. While UVA's initiative dates back to 2015, major milestones were reported by 2019 and continue beyond, according to IMR lead radiologist Cree Gaskin, MD, who highlighted that interactive multimedia reports have been most common for CT (ranging from 14% to 67% by subspecialty), MRI (ranging from 22% to 80% by subspecialty), and PET-CT (64%).
Referring providers are commonly electing to use interactive elements placed in the report by radiologists to facilitate review and understanding of key findings, noted Gaskin, a professor of radiology and orthopedic surgery, interim chair of radiology, and chief medical imaging information officer.
"Rates vary by modality but longitudinal growth in the adoption rate is evident," he told AuntMinnie, adding that the initiative is designed for a better patient experience as much as physicians. Gaskin will be presenting new findings at the 2026 Society for Imaging Informatics in Medicine (SIIM) meeting in Pittsburgh (See Part 2 of this series for more details.)
Instant image-to-findings connections
Over the years, Gaskin and his team have highlighted IMR in practice.
For a radiologist reading a complicated lumbar spinal MRI study, a simple voice command of “insert priors” will automatically insert brief descriptions of the prior studies into the comparison field of the report, while also hyperlinking these descriptions to the previous studies themselves. This can save reporting time and reduces risk for transcription error.
In the case of a meniscal tear on MRI or lung nodule on chest CT, for example, the radiologist can draw an arrow pointing at the tear, or insert the value of the lung nodule measurement including the series and image number. In each example, the annotation serves as an automatic bookmark that can be referenced by the reporting application.
Seth Berkowitz, MD
Beth Israel Deaconess interventional radiologist and clinical informaticist
Ultimately, IMR systems are designed to create radiology reports that transcend traditional static text in meaningful ways.
IMR bridges the gap between what medical imaging shows and what it actually means along an individual patient's course of care, according to Seth Berokowitz, MD, an interventional radiologist (IR), clinical informaticist, and medical director of radiology informatics at Beth Israel Deaconess Medical Center in New England. Berkowitz has also built and implemented IMR.
Definition of interactive multimedia report (IMR)
"[IMR] is a radiology report that contains both text and structured content, including hyperlinks, especially hyperlinks to images, embedded images, and other formatting that may include, tables or rich-text formatting," said Berkowitz to define the concept. "What we're proposing beyond that initial definition is a report that's according to our IMR IHE profile."
Berkowitz has been a long-time champion of interactive multimedia radiology reporting. As an IR, he spends a lot of time reading other radiologists' reports as part of planning IR procedures. He is also among those most familiar with a key component, the Integrating the Healthcare Enterprise (IHE) IMR profile, the birthplace of IMR in the sense of a preferable technical framework.
The IHE IMR profile was released in 2024 for experimental implementation, feedback, and quality improvements.
At its core, the profile specifies how a diagnostic report with interactive multimedia content can be reliably encoded, communicated, and presented. Ideally, IMR should create the ultimate structured report, but vendors must adopt it, Berkowitz told AuntMinnie.
"Ideally, you'd have this capability to report on any type of study," Berkowitz said. "Maybe a simple normal chest radiograph doesn't need an interactive multimedia report, but obviously a complex oncology follow-up would benefit."
NIH clinical trialist James Gulley, MD, PhD
Medical oncologist James Gulley, MD, PhD, a clinical trialist at the NIH Clinical Center in Bethesda, MD, told AuntMinnie that adopting interactive multimedia reporting has both streamlined the way medical oncologists work with radiologists and simplified the clinical trials process.
"Interactive multimedia reporting has dramatically improved the efficiency of reviewing CT scans or MRIs of patient tumors," Gulley said. "It's made communication clearer and cleaner. It's made the radiologists happy to give us what we want. We just want to get to what is required by our protocol, and the radiologists don't have time to read our protocol."
Physician communication
Gulley noted that IMR creates an opportunity to manage a higher volume of reviews. "And it's allowed us to do that much more quickly in real-time with the patient right there," he added.
At any given time, about 200 National Cancer Institute (NCI) clinical trials are in progress at the NIH Clinical Center, according to Gulley.
"Interactive multimedia reporting has dramatically improved the efficiency of reviewing CT scans or MRIs of patient tumors. It's made communication clearer and cleaner. It's made the radiologists happy to give us what we want. We just want to get to what is required by our protocol, and the radiologists don't have time to read our protocol."
— NIH clinical trialist James Gulley, MD, PhD
During an average year, about 1,000 patients are part of interventional trials that include CT, PET, and MRI imaging and other nuclear scans. With the clinical center's IMR reports, the medical oncologist and radiologist peer talk begins sooner.
"You can have everything right at your fingertips rather than having to go and find a radiologist and then compare it with your notes," Gulley explained.
Les Folio, DO
James A. Haley's Veterans' Administration Hospital radiologist and imaging informatics section chief
The NIH was one of the first clinical centers to implement IMR in the U.S. -- in 2015. Les Folio, DO, who now serves as imaging informatics section chief in radiology services at James A. Haley's Veterans' Administration Hospital in Tampa, FL, led the development.
IMR implementation has become invaluable in cancer management, Folio told AuntMinnie.
"Any measurement or annotation made in the image data immediately populated the report, saving the radiologist from having to say it and visually crosscheck it," Folio said. "Better yet, the report takes oncologists directly to the image on that series without having to hunt through thousands of slices to the measured lesion."
Early on, IMR adoption was strongest with the National Cancer Institute (NCI), according to Folio. Radiologists immediately utilized prior hyperlinked reports during interpretation, he said.
More important than radiologists' efficiency -- and oncologist efficiency indirectly -- are improved concordance with target lesions (select lesions that determine the efficacy of the treatment quantitatively), Folio added. Because oncologists determine therapeutic response (usually by RECIST), then it behooves radiologists to take more ownership of the measurements and their direct relation with the images, he noted.
IMR as a standard of care
"My whole career has been trying to figure out why we're not using interactive multimedia reporting more as a standard of care, because it's not a new idea," Berkowitz said.
Trailblazers like Folio and Gaskin have created effective custom systems for their institutions, he explained, noting that some vendors have exceptional implementations as well. Regardless, IMR requires a deep integration between image viewing and reporting.
"There are vendors where that's all in one system," Berkowitz said. "My hope is that we can do this in a vendor-neutral and interoperable way so that this content can be done anywhere, regardless of your tech stack. Places that are doing this love it, and we've documented in many studies that both providers and radiologists really benefit from these tools."
Adhering to the IHE profile standards lowers the barrier for all vendors and ultimately for physician groups, Berkowitz emphasized. Is this an AI conversation? Yes and no. Although there can be many report variations, the ubiquity of AI in radiology workflows means it is destined to have a place in IMR, according to Berkowitz.
"If you can read the text and then see the image that references those findings, it's a lot easier for us to understand, okay, here's what the prior radiologist thought, here's what my resident thought, here's what the AI thought," Berkowitz continued. "But we really believe that [IMR] is the way we should be communicating."
In Part 2 of this series, we'll share details of a forthcoming IMR-in-practice survey that begins to quantify time savings (perceived) and bring more perspectives on what you need to know about implementing an interactive multimedia radiology reporting system.