The value of structured radiology reports to categorize intracranial metastases following radiation therapy

Abstract

Purpose: Radiology descriptions of intracranial metastases following radiotherapy are often imprecise. This study sought to improve such reports by creating and disseminating a structured template that encourages discrete categorization of intracranial lesions.

Methods: Following initiation of the structured template, a retrospective review assessed patients with intracranial metastases that underwent radiotherapy, comparing 'pre-template' with 'post-template' reports. A total of 139 patients were included; 94 patients (67.6%) were imaged pre-template, 45 (32.4%) post-template. Reports were assessed for discrete versus non-specific descriptions of lesions: '(presumed) new metastases', 'treated metastases', and 'indeterminate lesions'. Non-specific language was subdivided based on the type of lesion(s) described: e.g. 'stable enhancing foci' was deemed a non-specific description of 'treated metastases'.

Results: Non-specific descriptions of lesions were used in 25/94 reports (26.6%) pre-template, and eight reports (17.8%) post-template. No significant difference was found in the frequency of inappropriate/ambiguous descriptions of intracranial lesions following template initiation (P = 0.52). However, only 27/45 (60.0%) of the reports in the post-template time period used the structured report; the other reports were written as free prose. Of the reports that did use the structured template, the authors used significantly less ambiguous language structured template (P = 0.02).

Conclusion: When utilized, a structured report template resulted in decreased non-specific descriptions and improved discrete characterization of intracranial metastases in patients treated with radiation. However, the frequency of non-specific language usage before and after template initiation was unchanged, probably due to poor compliance with template utilization.

Keywords: Intracranial metastases; radiation therapy; structured report; structured template.

Figure 1.

Comparison of reports before (‘pre-template’) and after (‘post-template’) the dissemination and initiation of the structured report template within the radiology department. No significant difference was noted in the overall use of ambiguous language before and after template initiation (P = 0.52). A significantly greater proportion of reports included descriptions of leptomeningeal involvement as a pertinent positive or negative and included history of prior radiotherapy within the report (P < 0.0001 and P = 0.0005, respectively).

Figure 2.

Comparison of reports following the initiation of the template, subdivided based on radiologists’ use of the structured template or use of the unstructured/free prose template. Reports written using the structured template had significantly less use of ambiguous language (P = 0.02), although no difference was noted specifically between descriptions of ‘treated metastases’ or ‘indeterminate lesions’ (P = 0.31 and P = 0.06, respectively).