Impact of a standardized reporting format on the quality of MRI reports for rectal cancer staging

Abstract

Background and aims: Besides providing a surgical roadmap, rectal MRI plays a major role in treatment planning. We recently started using a structured template for reporting rectal cancer via MRI. We study the impact of using this template at our hospital in terms of number of essential imaging parameters described in the reports as compared to the pre-template free-text reports.

Methods: A structured rectal MRI reporting template was created in consensus with members of the colorectal tumour board and was introduced in the department, which included 14 essential parameters to be mentioned in the reports. We conducted a retrospective analysis of rectal MRI reports of 100 cases with histologically proven rectal cancer, comprising 50 consecutive free-text reports before the template was introduced and 50 consecutive structured reports after its introduction, checking for the presence or absence of inclusion of the 14 parameters. An anonymous online feedback survey was conducted as well after the introduction of the template for the members of the colorectal tumour board.

Results: Overall, the total number of parameters reported increased from a median value of 10 (range 6-13) to 14 (range 12-14). The common unreported parameters prior to template introduction included T staging, presence or absence of restricted diffusion, anterior peritoneal reflection (APR) involvement, and presence or absence of extramural vascular invasion; these were reported in 16%, 22%, 30% and 50% respectively. These improved to 98-100% reporting after template introduction. Maximum improvement was in T staging (16% to 98%) (P < 0.0001), restricted diffusion on DWI (from 22% to 100%) (P < 0.0001) and APR involvement (from 30% to 100%) (P < 0.0001). The most common unreported parameter after template introduction was the "tumoral T2 signal intensity" (unreported in 4% cases). The results of the survey were as follows: 100% felt a decreased need to talk to the radiologist to clarify the report, 81.8% felt an improvement in the quality of reporting as compared to free style reports, and 91% felt that the new template is easier to interpret.

Conclusion: The introduction of a structured template for rectal cancer significantly improved the quality of rectal MRI reports, along with the satisfaction of referring providers.

Keywords: Cancer; rectal; reporting; structured; template.

Figure 1

Measurement of length of tumor involving the anal canal and lower rectum on sagittal T2-weighted image

Figure 2

Measurement of distance of upper rectal tumor from anal verge on sagittal T2-weighted image

Figure 3

Circumferential rectal wall thickening showing diffusion restriction on diffusion weighted imaging

Figure 4

Depth of extra-serosal extension on axial T2-weighted image (measured by the orange colored line shown in the image)

Figure 5

Involvement of mesorectal fascia from 8 to 9 o' clock position on axial T2-weighted image as shown by the yellow arrows (Circumferential resection margin status- positive)

Figure 6

Oblique coronal T2-weighted image showing extramural vascular invasion as shown by the yellow arrowheads

Figure 7

Number of quality parameters mentioned in the report before and after the implementation of the template

Figure 8

Responses to the anonymous online survey conducted for the members of the colorectal tumor board after introduction of dedicated rectal MRI template