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. 2019 Mar 27;19(1):25.
doi: 10.1186/s12880-019-0325-5.

Structured reporting of head and neck ultrasound examinations

Benjamin P Ernst  1 , Mohamed Hodeib  2 , Sebastian Strieth  2 , Julian Künzel  2 , Fabian Bischof  2 , Berit Hackenberg  2 , Tilmann Huppertz  2 , Veronika Weber  2 , Katharina Bahr  2 , Jonas Eckrich  2 , Jan Hagemann  2 , Matthias Engelbarts  2 , Matthias F Froelich  3 , Philipp Solbach  4 , Richard Linke  5 , Christoph Matthias  2 , Wieland H Sommer  3 , Sven Becker  2
Affiliations

Structured reporting of head and neck ultrasound examinations

Benjamin P Ernst et al. BMC Med Imaging. .

Abstract

Background: Reports of head and neck ultrasound examinations are frequently written by hand as free texts. Naturally, quality and structure of free text reports is variable, depending on the examiner's individual level of experience. Aim of the present study was to compare the quality of free text reports (FTR) and structured reports (SR) of head and neck ultrasound examinations.

Methods: Both standard FTRs and SRs of head and neck ultrasound examinations of 43 patients were acquired by nine independent examiners with comparable levels of experience. A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion, and readability by four independent raters with different specializations (Paired Wilcoxon test, 95% CI) and inter-rater reliability was assessed (Fleiss' kappa). A questionnaire was used to compare FTRs vs. SRs with respect to user satisfaction (Mann-Whitney U test, 95% CI).

Results: By comparison, completeness scores of SRs were significantly higher than FTRs' completeness scores (94.4% vs. 45.6%, p < 0.001), and pathologies were described in more detail (91.1% vs. 54.5%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 47.1%, p < 0.001). The mean time to complete a report, however, was significantly higher in SRs (176.5 vs. 107.3 s, p < 0.001). SRs achieved significantly higher user satisfaction ratings (VAS 8.87 vs. 1.41, p < 0.001) and a very high inter-rater reliability (Fleiss' kappa 0.92).

Conclusions: As compared to FTRs, SRs of head and neck ultrasound examinations are more comprehensive and easier to understand. On the balance, the additional time needed for completing a SR is negligible. Also, SRs yield high inter-rater reliability and may be used for high-quality scientific data analyses.

Keywords: Head and neck Cancer; Lymphadenopathy; Salivary gland diseases; Structured reporting; Ultrasonography.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained by the Institutional Review Board (Ethik-Kommission der Landesärztekammer Rheinland-Pfalz. Reference number: 2018–13,225). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Oral and written patient information was given by the examining physician. Written informed consent was obtained prior to the examination.

Consent for publication

Not applicable

Competing interests

Wieland H Sommer is the founder of the company Smart Reporting GmbH that hosts an online platform for structured reporting. Matthias F Froelich is an employee of Smart Reporting GmbH. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This manuscript is part of a medical doctoral thesis presented by Mohamed Hodeib at the University Mainz Medical School.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Screenshot of the decision-tree within the reporting software. Shown is an exemplary report of a lymph node pathology. On the left side, the examiner can select the corresponding neck level, number and size of affected lymph nodes as well as pathological feature such as hilus sign, perfusion pattern and assessment of dignity while the template generates full semantic sentences on the right side
Fig. 2
Fig. 2
Results of report analysis. Reports were evaluated by four independent internal and external raters of different specialties. Structured reports (SR) yield significantly higher completeness rates in describing cervical lymph nodes, salivary glands and major neck vessels than free text reports (FTR) resulting in a significantly increased overall completeness (a). Additionally, level of detail, readability and overall report quality was significantly improved when using SRs (b). Time needed to complete the report was significantly shorter when using FTRs (c). Results are presented as mean with standard deviation. * p < 0.05
Fig. 3
Fig. 3
Visual analog scale (VAS) of questionnaire findings. User contentment of the nine participating examiners was evaluated using a questionnaire. VAS (10: Complete agreement, 0: Complete disagreement) shows that structured reports (SR, right side, blue bars) are regarded as practicable (question 1), useful (question 2), to improve report-quality (question 3), to be time-efficient, to have a good time-wise economy (question 4), that additional time needed may be justified (question 5), that inexperienced physicians learning ultrasound examinations (question 6) and reporting (question 7) benefit from SR, that usability by intuition (question 8) and clearness of arrangement are substantial (question 9) when compared to free text reports (FTR, left side, red bars). * p < 0.05
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