Explaining radiology reports to patients in the modern practice
Communication is a key component of success, but perhaps never more so than in the health care professions. When you communicate clearly with your patients, you have a much greater chance to connect, educate, gain their trust, and thus achieve better patient compliance to treatment. And one of the best ways to communicate clearly with a patient is through a radiology report.
The important point to remember is that there are two major components to a radiology report. First is the interpretation of the study, which involves the identification and recognition of the salient findings and using them to arrive at a diagnosis or a differential diagnosis (in other words, a suggested pathway for further investigation). The second component is the equally important element of communicating those findings and conclusions clearly, usefully and unequivocally in a report. Mastering one component does not necessarily mean success in the other.1
Patients place a high value on procedural correctness and clear communication with their radiologist or the chiropractor as the de facto clinician in ordering and reading X-ray images. Patients want and need information provided that outlines the procedures being ordered, an explanation of the results, and a personal consultation regarding the findings.
A lack of or incomplete communication is often found to be a cause of dissatisfaction among patients and could suggest a means of improving patient outcomes as measured by Value-Based Health Care metrics.
The 6 + 1 radiology ‘C’s’
There are six “C’s” of effective communication in a modern practice, and these six lead to an important seventh we will begin to outline. These six “C’s” are attributed to Armas in his study2 of the qualities of a good radiology report:
Clarity
Traditionally, radiology reports comprise text only, using just words to describe and communicate the meaning of the images. Research has proven that people process and retain information visually much more effectively than through words alone.
In short, words are processed sequentially in the short-term memory and images are incorporated directly into the long-term memory. It has only been in recent years that researchers have shown that incorporating key images into written radiology reports has proven effective.3,4
Correct
Accuracy in your report is critical for building patient trust and treatment compliance. A 2017 study found that in a review of 378 radiology reports “originating from a single department in a single 24-hour period, found that 90 reports contained errors. Seven errors were considered significant and nine were ‘very significant.’”
The study also found that mistakes were more frequent in reports involving more complex studies and the “error rate correlated with the length of the report (longer reports contained a higher rate of errors per page).”5
A great way to maintain the accuracy of your reports is using software technology. Radiology reports have evolved in recent years to include both the X-ray images and schematics or charts to help point out analysis in a visual manner, as studies have shown it is an effective educational tool and beneficial to the patient, according to the Journal of Digital Imaging.
Confidence level
One way to display your confidence level is to adopt the standardized language and structure applied to the reports, which has increased in popularity. In 2007, the American College of Radiology (ACR) Intersociety Conference concluded a few points related to this standardized language and structure. First is that structured reporting tools in no way impeded productivity. As such, a digital report template with stored macros of appropriate terminology is beneficial to the report creation.
Second, the radiology professional organizations should “create a repository of exemplary reports based on standard vocabulary.” 6 Again, having a set of macros in your software repository for faster generation and avoidance of word selection errors and misinterpretations can result when using technology designed specifically for chiropractors needing biomechanical descriptors.
Concise
It is also important to keep things brief, yet specific. Consider following this outline when composing your radiology report:
- Heading, including patient demographics of age, dates of image acquisition and clinic info
- Comparison (if applicable)
- Clinical history (if applicable)
- Technique
- Findings
- Impression
- Recommendations
A great resource for various templates is RadReport.org, a website housing a free library of templates based on best practices. For spine radiographic utilization and analysis the best website is RadEvidence.org, which contains more than 400 articles related to the use of X-rays in practice, safety, and a chiropractic survey with the opinions of more than 3,500 DCs on the use of radiographic procedures in the chiropractic practice.
Complete
Perhaps the best way to explain the importance of creating a complete report is summarized in the following study published just last year:
“However, there are certain key principles to reporting the imaging findings, impression, and recommendations that serve as a guide and promote careful consideration about how reports are understood. The findings section should emphasize short, informative, and factual observations while avoiding inappropriate interpretation, excessive use of terms of perception, and redundancy. The impression is the thoughtful synthesis of the meaning of the findings leading to a diagnosis, a differential diagnosis, and management recommendations.
“Creating a clear and impactful impression allows a doctor to provide the highest level of clinical care and direction but takes time and effort beyond simply restating the findings. The impression should use language that is understandable, memorable, and actionable. Reporting skills require ongoing attention and must adapt to the evolving practice patterns and communication styles in chiropractic.” 7
Consistent
Consistency in format and word choice are also extremely important. You certainly do not want to confuse your patients or other health care practitioners who may be reading the report.
A great resource to follow is the guidance as defined by the American College of Radiology Practice Guideline for Communication. They advise including elements such as patient identifiers, imaging procedure descriptions, clinical indications, imaging findings and summary information. This is another reason that having a template and macros in your technology makes the report generation fast, customized and accurate.
A macro is a predetermined sentence or phrase that can be reused in multiple cases and selected from a repository or software system used to create the radiology report. The doctor can select the appropriate and applicable macro for the findings or recommendation section as a stand-alone macro or tweak that macro for the current patient, which saves time and helps with accuracy and consistency.
Radiology report success: Communication
And each of these six “C’s” comes together to comprise the most important of them all: communication.
Using technology to help generate those radiology reports and inserting images of the radiographs directly into the report with biomechanical annotations and measurements helps to visually communicate to the patient what is happening with their spine in terms they can understand as opposed to just words on a page.
Having the ability to create these educational moments more quickly with the use of digital X-ray software technology allows the doctor to save time, provides a more professional presentation to the patient, and ultimately achieves greater patient satisfaction. This all leads to better care plan compliance, more referrals, and a gold standard reputation in the local community.
STEVEN KRAUS, DC, FIACN, DIBCN, FASA, FICC, is an accomplished practitioner, author and business owner. He is a past chairman of the Iowa Board of Chiropractic Examiners, a past president of the Iowa Chiropractic Society, and has served on numerous national association committees and boards regulating chiropractic. Graduating from Palmer College of Chiropractic, Davenport, Iowa, in 1988, he has owned 18 chiropractic practices including an interdisciplinary practice; launched a consultancy firm that coordinated the sale of over 400 different health care clinics nationwide; and has been the CEO and owner of two separate technology companies including Biokinemetrics Inc., manufacturing digital X-ray hardware, and the software ChiroSight, a digital X-ray solutions company. He can be reached at skraus@biokinemetrics.com.
