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Re: The radiology report — Are we getting the message across?
Clinical Radiology 67 (2012) 722e725
Contents lists available at SciVerse ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Correspondence
Re: The radiology report d Are we getting the message across? Sir d We read with interest the article from Wallis and McCoubrie1 in the Journal. As trainees in the Southwest Peninsula Radiology Programme, we would like to put forward a trainee’s perspective of radiology reporting. The radiologist report is a crucial tool in patient care during their treatment journey. In the era of changing clinical practice, there is less tolerance for diagnostic uncertainty and less confidence in clinical findings as suggested by Calman report.2 Clinicians have become more and more reliant on imaging, and there is increasing demand and expectation from patients.3 Writing an appropriate radiology report is a critical task for radiologists, as the report documents the findings of the radiologist and expresses their clinical judgment. It is not only a documentation of findings and diagnosis, but also an important medico-legal document. We all understand that the format and content of our report is a major cause of malpractice litigation against radiologists, if it fails to communicate results effectively. It appears that some people are just too worried about that aspect and they endeavour to sit on the fence, which is not helpful to the clinicians involved in the patient’s management. During radiology training, too little attention is given to structured report writing skills, and trainees have to hone their own skills by learning from the varied methods of different senior colleagues. This lapse is more understandable when we realize that most major radiology textbooks do not adequately address how to compose a useful and informative report. The other issue is that there is no standardized format of writing a radiology report. Every radiology consultant has his or her own personal way of formatting a report; for example, some like it to be concise, whereas others like it to be more descriptive. Due to this non-uniformity lots of radiology trainees, especially in their early years of training, find it confusing and difficult to formulate a radiological report with confidence. A few years into the training, most trainees develop their own style of writing a report; however, they are unaware of the effectiveness and appropriateness of their style.
DOIs of original article: 10.1016/j.crad.2012.01.008, 10.1016/j.crad.2011.11. 018, 10.1016/j.crad.2011.11.019, 10.1016/j.crad.2012.01.006.
The key to a clear and concise radiology report that will provide reliable high-quality communication is a coherent format. The quality of the report should not vary as a result of there being different interpreting radiologists with minimal intra and interobserver variability. This is a key principle in statistical quality control and reduces liability risk because it ensures that important issues are addressed systematically. Using a standard format will significantly improve the ability of the report to communicate effectively. Variations in the report format create confusion for the reader, whereas a consistent format of report assists the reader in understanding the report and its clinical implications.4 As clinical radiologists, it is our duty to play our role in patient care more effectively by writing a sensible, structured, useful, and decisive report.
References 1. Wallis A, McCoubrie P. The radiology report d are we getting the message across? Clin Radiol 2011;66:1015e22. 2. Calman KC. Consultation on report of working group on specialist medical training. London: Department of Health, 1993. 3. Bhargavan M, Kaye A, Forman HP, et al. Workload of radiologists in United States in 2006e2007 and trends since 1991e1992. Radiology 2009;252:458e67. 4. Wilcox JR. The written radiology report. Appl Radiol 2006;35:33e7.
S. Chhatani*, A. Sahu, P. Sankaye Peninsula Radiology Academy, Plymouth, UK * Guarantor and correspondent: S. Chhatani, Peninsula Radiology Academy, Plymouth PL6 5WR, UK. Tel.: þ44 (0) 1752 437437. E-mail address: [email protected] (S. Chhatani) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2012.01.007
Re: The radiology report d Are we getting the message across? Sir d I read the above article1 with great interest. I thought it was excellent and the content will be extremely
DOIs of original article: 10.1016/j.crad.2012.01.007, 10.1016/j.crad.2012. 01.008, 10.1016/j.crad.2011.11.019, 10.1016/j.crad.2012.01.006.
Correspondence / Clinical Radiology 67 (2012) 722e725
useful to me in the work that I do d namely running a postgraduate certificate pathway for CT Head Reporting Radiographers. The authors mentioned in passing that “reporting radiographers and sonographers also receive little, if any, formal training in reporting technique and style”. Oddly, in our experience, the exact opposite is the case. Simply because radiographers have a different medical background from radiologists and lack the developed medico-legal and professional support structure that doctors enjoy, we are obliged to pay close scrutiny to exactly what we write in our reports. This practice is taught formally in the university setting, and developed in practice through the completion of a portfolio of reports, written in close working relationship with a radiological mentor. It is perhaps indicative of our different professional circumstances that radiographers have had to adopt such a meticulous approach from the outset, and it is reassuring to know that we are in agreement with radiologists on the need for clarity and good communication.
References 1. Wallis A, McCoubrie P. The radiology report d are we getting the message across? Clin Radiol 2011;66:1015e22.
D. Allen* Birmingham City University, Birmingham, UK * Tel.: 0121 202 4262. E-mail address: [email protected] (D. Allen) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2011.11.018
Re: The radiology report d Are we getting the message across?
723
radiograph and, therefore, sometimes all that can be said is that “they appear to be clear”. I also would encourage the use of the word “seen”, which again provides the verb. There is something linguistically quite ugly about stark statements such as “No fractures” or “No abnormality”. It is often very important to express the requirement of clinical correlation, in what is a medical report. This is most definitely not hedging and should be encouraged. The modern, irritating habit of stating “comparison radiograph” and the date at the beginning of a report, especially when no comparison is subsequently made in the report, should be eradicated. It is far better to make a statement in the report along the lines of “in comparison with the examination of.” I do also believe that young radiologists have a tendency to create long reports, not only detailing the clinical details provided, but also elaborating every sequence or part of the examination taken and then listing every finding, including those that are incidental. Many radiologists in the UK now probably do not have English as their first language and perhaps welcome the use of attenuated statements, and it is interesting that the references quoted in this article are largely American. However, I shall always endeavour and encourage the use of correct English and considered thought in radiological reporting.
Reference 1. Wallis A, McCoubrie P. The radiology report d are we getting the message across? Clin Radiol 2011;66:1015e22.
A.J. Thompson* NHS-Grampian, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, UK * Tel.: þ44 1224633804. E-mail address: [email protected] (A.J. Thompson) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2012.01.008
Sir d Wallis and McCoubrie have written an interesting and provocative article.1 As an individual radiologist, I also have strong views on language in radiology reports, but after over 29 years in radiology have come to rather different conclusions from those indicated in this article. A radiology report is an important, professional document. To that end, surely it is important that reports are drafted in decent English and do not appear similar to a list of shorthand notes. In correct English a sentence should contain a verb. This is probably even more important when that verb should be a part of the verb “to be”. Therefore, I would discourage the attenuated statements made in Table 5. In addition, what is described in this article as “hedging” is often considered description of the radiological findings; for example, lungs are not always well visualized on even the best chest
Sir d I enjoyed the article by Wallis and McCoubrie on the radiology report1 and support their suggestion of giving clinicians what they want in the way they want to hear it. What they want is the ‘truth’, but what we have from crosssectional imaging is shades of grey obtained by utilizing certain physical properties of matter manipulated by a complex mathematical algorithm. This version of the ‘truth’ hence has intrinsic uncertainty, and I would argue
DOIs of original article: 10.1016/j.crad.2012.01.007, 10.1016/j.crad.2011.11. 018, 10.1016/j.crad.2011.11.019, 10.1016/j.crad.2012.01.006.
DOIs of original article: 10.1016/j.crad.2012.01.007, 10.1016/j.crad.2012. 01.008, 10.1016/j.crad.2011.11.018, 10.1016/j.crad.2012.01.006.
Re: The radiology report d Are we getting the message across?
Contents lists available at SciVerse ScienceDirect
Clinical Radiology journal homepage: www.clinicalradiologyonline.net
Correspondence
Re: The radiology report d Are we getting the message across? Sir d We read with interest the article from Wallis and McCoubrie1 in the Journal. As trainees in the Southwest Peninsula Radiology Programme, we would like to put forward a trainee’s perspective of radiology reporting. The radiologist report is a crucial tool in patient care during their treatment journey. In the era of changing clinical practice, there is less tolerance for diagnostic uncertainty and less confidence in clinical findings as suggested by Calman report.2 Clinicians have become more and more reliant on imaging, and there is increasing demand and expectation from patients.3 Writing an appropriate radiology report is a critical task for radiologists, as the report documents the findings of the radiologist and expresses their clinical judgment. It is not only a documentation of findings and diagnosis, but also an important medico-legal document. We all understand that the format and content of our report is a major cause of malpractice litigation against radiologists, if it fails to communicate results effectively. It appears that some people are just too worried about that aspect and they endeavour to sit on the fence, which is not helpful to the clinicians involved in the patient’s management. During radiology training, too little attention is given to structured report writing skills, and trainees have to hone their own skills by learning from the varied methods of different senior colleagues. This lapse is more understandable when we realize that most major radiology textbooks do not adequately address how to compose a useful and informative report. The other issue is that there is no standardized format of writing a radiology report. Every radiology consultant has his or her own personal way of formatting a report; for example, some like it to be concise, whereas others like it to be more descriptive. Due to this non-uniformity lots of radiology trainees, especially in their early years of training, find it confusing and difficult to formulate a radiological report with confidence. A few years into the training, most trainees develop their own style of writing a report; however, they are unaware of the effectiveness and appropriateness of their style.
DOIs of original article: 10.1016/j.crad.2012.01.008, 10.1016/j.crad.2011.11. 018, 10.1016/j.crad.2011.11.019, 10.1016/j.crad.2012.01.006.
The key to a clear and concise radiology report that will provide reliable high-quality communication is a coherent format. The quality of the report should not vary as a result of there being different interpreting radiologists with minimal intra and interobserver variability. This is a key principle in statistical quality control and reduces liability risk because it ensures that important issues are addressed systematically. Using a standard format will significantly improve the ability of the report to communicate effectively. Variations in the report format create confusion for the reader, whereas a consistent format of report assists the reader in understanding the report and its clinical implications.4 As clinical radiologists, it is our duty to play our role in patient care more effectively by writing a sensible, structured, useful, and decisive report.
References 1. Wallis A, McCoubrie P. The radiology report d are we getting the message across? Clin Radiol 2011;66:1015e22. 2. Calman KC. Consultation on report of working group on specialist medical training. London: Department of Health, 1993. 3. Bhargavan M, Kaye A, Forman HP, et al. Workload of radiologists in United States in 2006e2007 and trends since 1991e1992. Radiology 2009;252:458e67. 4. Wilcox JR. The written radiology report. Appl Radiol 2006;35:33e7.
S. Chhatani*, A. Sahu, P. Sankaye Peninsula Radiology Academy, Plymouth, UK * Guarantor and correspondent: S. Chhatani, Peninsula Radiology Academy, Plymouth PL6 5WR, UK. Tel.: þ44 (0) 1752 437437. E-mail address: [email protected] (S. Chhatani) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2012.01.007
Re: The radiology report d Are we getting the message across? Sir d I read the above article1 with great interest. I thought it was excellent and the content will be extremely
DOIs of original article: 10.1016/j.crad.2012.01.007, 10.1016/j.crad.2012. 01.008, 10.1016/j.crad.2011.11.019, 10.1016/j.crad.2012.01.006.
Correspondence / Clinical Radiology 67 (2012) 722e725
useful to me in the work that I do d namely running a postgraduate certificate pathway for CT Head Reporting Radiographers. The authors mentioned in passing that “reporting radiographers and sonographers also receive little, if any, formal training in reporting technique and style”. Oddly, in our experience, the exact opposite is the case. Simply because radiographers have a different medical background from radiologists and lack the developed medico-legal and professional support structure that doctors enjoy, we are obliged to pay close scrutiny to exactly what we write in our reports. This practice is taught formally in the university setting, and developed in practice through the completion of a portfolio of reports, written in close working relationship with a radiological mentor. It is perhaps indicative of our different professional circumstances that radiographers have had to adopt such a meticulous approach from the outset, and it is reassuring to know that we are in agreement with radiologists on the need for clarity and good communication.
References 1. Wallis A, McCoubrie P. The radiology report d are we getting the message across? Clin Radiol 2011;66:1015e22.
D. Allen* Birmingham City University, Birmingham, UK * Tel.: 0121 202 4262. E-mail address: [email protected] (D. Allen) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2011.11.018
Re: The radiology report d Are we getting the message across?
723
radiograph and, therefore, sometimes all that can be said is that “they appear to be clear”. I also would encourage the use of the word “seen”, which again provides the verb. There is something linguistically quite ugly about stark statements such as “No fractures” or “No abnormality”. It is often very important to express the requirement of clinical correlation, in what is a medical report. This is most definitely not hedging and should be encouraged. The modern, irritating habit of stating “comparison radiograph” and the date at the beginning of a report, especially when no comparison is subsequently made in the report, should be eradicated. It is far better to make a statement in the report along the lines of “in comparison with the examination of.” I do also believe that young radiologists have a tendency to create long reports, not only detailing the clinical details provided, but also elaborating every sequence or part of the examination taken and then listing every finding, including those that are incidental. Many radiologists in the UK now probably do not have English as their first language and perhaps welcome the use of attenuated statements, and it is interesting that the references quoted in this article are largely American. However, I shall always endeavour and encourage the use of correct English and considered thought in radiological reporting.
Reference 1. Wallis A, McCoubrie P. The radiology report d are we getting the message across? Clin Radiol 2011;66:1015e22.
A.J. Thompson* NHS-Grampian, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, UK * Tel.: þ44 1224633804. E-mail address: [email protected] (A.J. Thompson) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2012.01.008
Sir d Wallis and McCoubrie have written an interesting and provocative article.1 As an individual radiologist, I also have strong views on language in radiology reports, but after over 29 years in radiology have come to rather different conclusions from those indicated in this article. A radiology report is an important, professional document. To that end, surely it is important that reports are drafted in decent English and do not appear similar to a list of shorthand notes. In correct English a sentence should contain a verb. This is probably even more important when that verb should be a part of the verb “to be”. Therefore, I would discourage the attenuated statements made in Table 5. In addition, what is described in this article as “hedging” is often considered description of the radiological findings; for example, lungs are not always well visualized on even the best chest
Sir d I enjoyed the article by Wallis and McCoubrie on the radiology report1 and support their suggestion of giving clinicians what they want in the way they want to hear it. What they want is the ‘truth’, but what we have from crosssectional imaging is shades of grey obtained by utilizing certain physical properties of matter manipulated by a complex mathematical algorithm. This version of the ‘truth’ hence has intrinsic uncertainty, and I would argue
DOIs of original article: 10.1016/j.crad.2012.01.007, 10.1016/j.crad.2011.11. 018, 10.1016/j.crad.2011.11.019, 10.1016/j.crad.2012.01.006.
DOIs of original article: 10.1016/j.crad.2012.01.007, 10.1016/j.crad.2012. 01.008, 10.1016/j.crad.2011.11.018, 10.1016/j.crad.2012.01.006.
Re: The radiology report d Are we getting the message across?