By Erik L. Ridley, AuntMinnie staff writer

February 13, 2019 -- ORLANDO, FL - Interactive multimedia radiology reports -- with additional help from artificial intelligence (AI) -- can improve reporting clarity and save time for clinicians and fellow radiologists, according to presentations on Tuesday at the Healthcare Information and Management Systems Society (HIMSS) annual meeting.

These reports, which can include hyperlinks to key images, tables, graphics, and styled text, can also be valuable for engaging patients and for educating medical students, residents, and others, according to Dr. Cree Gaskin of the University of Virginia (UVA) Health System and Dr. Les Folio of the U.S. National Institutes of Health (NIH) Clinical Center.

"Interactive multimedia reports increase the value of imaging care delivery," said Gaskin, a professor of radiology in the UVA Health System.

Traditional radiology reports

Radiology has changed dramatically in recent years, but the imaging report -- the primary means by which diagnostic radiologists provide patient care -- has, for the most part, changed very little and remains in plain-text prose, Gaskin said.

In radiology, plain-text reports are often used to ensure compatibility across information systems from different vendors. However, modern document formats such as rich text, HTML, and XML can support more advanced multimedia features, including the use of formatted text, interactive elements like hypertext and other links, and the insertion of tables, charts, and images, Gaskin said.

These capabilities can be very useful for busy referring physicians, he said.

"A picture is worth a thousand words," Gaskin said. "As a group in radiology, we need to move into getting images in our reports. They help [us] communicate better."

Multimedia radiology reports can be created now with features such as formatted text, annotated key images, and even a radiologist photo for increased visibility. But will radiologists take the time to add images and other multimedia elements to their reports? Only if it's quick and easy, he said.

By integrating the viewing and reporting systems into one combined application, image-related information from the viewer can be more rapidly and easily integrated into the report, according to Gaskin. Radiologists can select key images and easily import them into the report.

In addition, prior studies can be automatically imported for comparison and hyperlinked in the report. Measurements and image/series numbers can also be automatically imported from the viewer into the report with hyperlinks.

UVA and the NIH Clinical Center have collaborated with Carestream Health on interactive multimedia software that performs many of these functions. The software also features AI-powered, context-aware tools based on the anatomy that is being assessed.

Benefits for clinicians, radiologists

Multimedia radiology reports with hyperlinks require minimal additional time for radiologists to create and make the reports interactive -- improving clarity and saving time for referring providers, trainees, and patients, Gaskin said. At UVA, radiologists are also readily adopting these interactive reports, particularly for advanced imaging modalities.

The combined viewing and reporting application can also enable lesion tracking and summarization by automatically populating the report with measurements and graphics. Current and prior studies are anatomically registered on the fly and presented using multiplanar reformatting (MPR). The same lesion(s) are automatically segmented in the current study.

Referring physicians appreciate seeing tables and graphs automatically generated by a lesion tracking tool in the PACS to show lesion trends over time, Gaskin said. A variety of AI-based imaging analytics tools can also be used to assist interpretation.

In addition to including hyperlinks to key images, these reports can also include links to email, the radiologist's resume, a way to rate the report, prior exams, and medical references. For patients, hyperlinks could be included to content geared for them, such as RadiologyInfo.org.

Formatting issue

While these interactive multimedia reports can be created now, Gaskin noted that sharing them can be challenging if the receiving information systems, such as the electronic health record (EHR) software, are optimized for plain text. At UVA, clinicians can get one-click access to the full multimedia report as a PDF through the EHR.

The goal, though, is to put interactive multimedia reports directly in line in the EHR, and UVA is testing this now with vendors, Gaskin said. UVA is also testing patient portal integration.

Interactive multimedia radiology reports are ready for prime time, according to Gaskin. UVA has experienced technical success in creating these "rich" reports and distributing them to referring providers.

"We've been doing it for years," he said. "We have solid, sustained adoption by our radiologists and there is no reason this can't be reproduced [at other institutions]."

In part 2 of this article, we'll cover the NIH Clinical Center's experience with interactive multimedia radiology reports.


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