A report that contains common reporting headings (e.g. “Indication; Findings; Impression, etc), subheadings within the Findings section, and a standardized lexicon is a _________ structured report.

1. Tier 1
2. Tier 2
3. Tier 3*
4. Tier 4

• Structured reporting in radiology can be defined with a three-tiered approach.
• Tier 1 reports contain common headings, such as “Clinical Indication,” “Technique,” “Findings,” “Impression,”“Recommendation.”
• Tier 2 reports contain pre-defined subheadings in the Findings section, for instance based upon discrete anatomic structures.
• Tier 3 reports containing the aforementioned structure, but additionally employing standardized language or lexicon.

An advantage of structured reporting is that it prompts radiologists to continue inspecting anatomic regions on the images whether or not the radiologist has already made a pertinent diagnosis.  In so doing, structured reporting mitigates against:

1. Anchoring bias
2. Alliterative bias
3. Satisfaction of search bias*
4. Framing bias

• Satisfaction of search bias is the tendency by radiologists to terminate their search for abnormalities once they identify an initial finding that potentially explains the patient’s clinical presentation.  Structured reporting mitigates against this tendency by prompting radiologists to continue searching all pertinent anatomic regions, regardless of whether a finding was already identified.
• Anchoring bias is reflects the undue influence that an initial impression or clinical judgment has on the evaluation of subsequently collected information. This is also known as the “primacy” effect.
• Alliterative bias commonly occurs while interpreting an imaging study with a prior comparison study that was interpreted by a colleague. Reading the colleague’s report can influence how a radiologist interprets the follow-up imaging study. This is the so-called “copy and paste” error.
• Framing bias results from a tendency to be influenced by how a question is asked or how a problem is presented. For radiologists, framing bias commonly results from the influence that the clinical history has on image interpretation

“Contextual reporting” is a form of structured reporting where:

1. The report template is tailored to the clinical indication or diagnosis in question*
2. Each report subheading includes pre-populated drop-down menus
3. Free-text reporting is always permitted
4. Date and time of report creation are incorporated into the report

• Contextual reporting is a form of structured reporting where the report structure and content are tailored to the clinical indication or diagnosis in question.
• Example:  For reporting an abdominal CT in a patient with newly diagnosed pancreatic cancer, a structured report that contains prompts directly relevant to the staging, managements, and prognosis of the cancer (e.g. tumor location, size, biliary involvement, vascular encasement, adenopathy, etc) is a form on contextual reporting.

A potential pitfall of structured reporting is:

1. Increases syntactic errors in reports
2. Reduces reimbursement by rigid documentation of imaging technique and findings
3. Reduces radiologist “dwell time” on the images by increasing their focus on filling out the report template*
4. Promotes “satisfaction of search”tendency among radiologists

• If radiologists increasingly focus on filling out and adhering to a structured report template rather than viewing the images, there might be an overall decrease in radiologist “dwell time” on the images.   In other words, radiologists may spend less time viewing the images, and more time viewing the report template.
• Structured reporting, especially those utilizing drop-down menu items with pre-filled standard lexicon, can reduce the incidence of typographical or speech recognition errors.
• Structured reporting helps ensure completeness in documentation of technique and findings, thus optimizing reimbursement for the department.
• Structured reporting may help to reduce satisfaction of search errors.

When implementing structured reporting templates, it is recommended to:

1. Use financial incentives to encourage adherence with structured reporting
2. Create reporting templates that prioritize efficiency and reimbursement
3. Tailor templates to specific clinical presentations or diagnoses*
4. Develop report templates among a select group of subspecialist radiologists

• Tailoring templates to specific clinical presentations and diagnoses (i.e. “contextual reporting”) improves the clinical impact and pertinence of the radiology report, and helps ensure that clinically relevant information is communicated in a clear and predictable fashion to the ordering provider.
• We do not advocate creating structured report templates based on prioritizing efficiency/reimbursement.
• Financial incentives should not be used to encourage adherence to structures reporting.
• Structured reporting templates should be developed in consultation with all radiologists affected by implementation of the template, not simply a select group of radiologists or“leadership.”