White Paper - Increasing the value of Radiology through advanced reporting

Increasing the value of Radiology through advanced reporting The tangible product of a radiologist’s work is the radiology report, a central part of patient management that is subject to ever-expanding quality requirements. The multi-modality software syngo.via features a reporting module that enables standardized structured reports with expanded multimedia. These can often be prepared faster than conventional reports and exported in various formats for other information systems, opening up opportunities for improved treatment, new pathways for radiology research and increasing referrer satisfaction. White Paper Requirements for radiology reporting are increasing References 1 The radiology report is the radiologist’s calling card. It bears witness to his or Sistrom CL, Langlotz CP (2005) A frame- work for improving radiology reporting. J Am her expertise and experience, influences treatment decisions, and forms the Coll Radiol 2:159-67 basis for compensation.1,2 2 Phillips CD, Hillman BJ (2001) Coding and reimbursement issues for the radiologist. Meanwhile, reporting practices in radiology are changing. Above all, a trend Radiology 220:7-11 toward structured reporting is gaining more ground. While radiologists have 3 Morgan TA, Helibrun ME, Kahn CE Jr (2014) traditionally drafted their findings as free text, structured reports use preset Reporting initiative of the Radiological templates with defined terminology and incorporated guidelines to report Society of North America: progress and new directions. Radiology 273:642-5 specific findings and recommendations (e. g. BiRADS, PiRADS, LungRADS, etc.) 4 to present the interpretation of an imaging study as clearly and transparently as Kahn CE Jr, Heilbrun ME, Applegate KE (2013) From guidelines to practice: how possible for human readers, but also to make them easy for computer systems reporting templates promote the use of to interpret, in order to fill searchable data bases. radiology practice guidelines. J Am Coll Radiol 10:268-73 Until now, this process was not commonly used except in mammography, but it is playing an ever-greater role in other fields, such as cardiac imaging. This trend is being driven by several international initiatives – not least in order to improve the general quality of reporting and adapt it to modern medical requirements and workflows.3,4 SIEMENS Healthineers . siemens-healthineers.de Living up to referring doctors’ needs Studies demonstrate the advantages of this new reporting “Radiologists traditio- style. For instance, CT findings can often be commu- nicated more clearly to referring physicians using nally spend two-thirds structured reports.5,6 Many referring doctors also of their working hours appreciate it when reports include selected images preparing reports. and summarizing charts on important measured values, along with written information. Reports For complex cardiac with such multimedia additions can remove the tests, using syngo.via need for follow-up inquiries, speed up treatment planning, and increase clinicians’ confidence in the reduces this time spent findings.7,8 by at least half.” “As radiologists, we have to provide structured data in Dr. Tobias Heye, order to adequately meet the needs of today’s medical Cardiac and Thoracic Diagnostics, Basel University Hospital (Switzerland) practice,” confirms Dr. Tobias Heye, Acting Director of the Department of Cardiac and Thoracic Diagnostics at Basel University Hospital in Switzerland. “Structured reporting is a step in the direction of valuebased radiology.” In a survey of no less than 400 Swiss private and hospital physicians, Heye’s team recently showed that referring doctors preferred structured and image re- ports over other forms of reporting that are less easy to interpret, and see them as an aid in their day-to-day work and their communication with patients.9 syngo.via bridges image reading and reporting Since 2014, Heye and his colleagues have used the reporting module of multi- modality software syngo.via to prepare radiology reports for all cardiac CT and cardiac MRI scans. Typical procedures include calcium scoring, CT-angiographic analysis of coronary stenoses, and MRI tests of cardiac function and volumes. What is unique about syngo.via is that, through smart automation, the program largely erases the conventional distinction between image reading and report preparation. References 5 Schwartz LH, Panicek DM, Berk AR, et al. (2011) Improving communication of diag- “The strength of the system is that the report is already being generated in nostic radiology findings through structured the background during the diagnosis,” Heye remarks. For example, measure- reporting. Radiology 260:174-81 ments that the physician takes on the monitor during the image analysis are 6 Ghoshhajra BB, Lee AM, Ferencik M, et transferred automatically to the report, and marked-up images are added in. al. (2013) Interpreting the interpretations: Moreover, digital templates geared to the specific test are available, in which all the use of structured reporting improves referring clinicians’ comprehension of the important parameters of analysis can be entered using drop-down lists. In coronary CT angiography reports. J Am Coll the syngo.via General Engine, these templates can also be customized – say, in Radiol 10:432-8 order to link findings and diagnoses with billing codes specific to the clinic for 7 yer VR, Hahn PF, Blaszkowsky LS, et al. further data processing. (2010) Added value of selected images embedded into radiology reports to referring clinicians. J Am Coll Radiol 7:205-10 Speed up and standardize your workflows 8 Radiologists sometimes complain that structured reporting is more time consu- Sadigh G, Hertweck T, Kao C, et al. (2015) Traditional text-only versus multime- ming than writing up findings freely.10 However, when a smart computer system dia-enhanced radiology reporting: referring is used, the exact opposite can be true. “Radiologists traditionally spend two- physicians’ perceptions of value. J Am Coll Radiol 12:519-24 thirds of their working hours preparing reports,” Heye estimates. “For complex 9 cardiac tests, using syngo.via reduces this time spent by at least half.” Heye T, Gysin V, Boll D, Merkle EM (2016) Structured reporting: using the voice of the customer method to settle an ongoing In addition, the software provides an opportunity to guide the image analy- debate about the future of radiology repor- ting. Abstract submitted to the 2016 annual sis itself more and more (guided reading). For instance, for the standardized meeting of the Radiological Society of North measurements required in selecting a prosthetic heart valve, one could imagine America (preprint) giving specific measurement instructions in a guided process via the software 10 Weiss DL, Langlotz CP (2008) Structured and then preparing reports automatically with guaranteed quality. reporting: patient care enhancement or pro- ductivity nightmare? Radiology 249:739-47 In countries like China, where there are great differences in radiological ex- pertise between urban and peripheral clinics, these kinds of opportunities for standardization are now attracting a lot of interest. Integrating results into information systems syngo.via also facilitates the radiological evaluation of treatment results in oncology. In this case, RECIST (Response Evaluation Criteria in Solid Tumors) criteria are usually applied. The principle behind this is to measure the sizes of select tumor foci multiple times in the course of treatment and incorporate the results into treatment decisions. “With syngo.via, we can automatically compare these measurements with pre- vious results and generate easily understandable trend charts with a few mouse clicks,” explains Dr. Philipp Lust, a radiologist at Klinikum Wels-Grieskirchen in Austria. This is possible because syngo.via has a pattern recognition algorithm that detects identical anatomical structures on different scans (see White Paper on ‘Enhanced image reading with ALPHA technology). Lust and his colleagues are using the reporting module of syngo.via to electronically transfer RECIST measurements of oncology study patients to the hospital information system through an HL7 interface. This could soon “Using the same become a routine clinical practice, says Lust. “Using software to do all the the same software to do all the measurements and compare them with prior scans, and then measurements and output the report as a multimedia document – compare them with this is where the future lies.” prior scans, and then Leveraging reports for better care output the report as a and radiological research multimedia document Generally speaking, the wide range of options this is where the – for exporting data from syngo.via allows for bet- ter integration of reporting into more advanced future lies.” patient management. For instance, when nodules are discovered by chance in a lung CT, the report, Dr. Philipp Lust, Institute for Radiology I, which encodes this finding so that a receiving infor- Klinikum Wels-Grieskirchen (Austria) mation systems can unambiguously interpret it, could be linked to appointment scheduling software, and the patient could be invited to come in for a follow-up scan. It is a known fact that these kinds of incidental findings are otherwise frequently overlooked in everyday clinical practice.11 Radiology research would also be very likely to benefit from structured data preparation. Pilot projects are already underway to test whether data mining methods can be used in a pile of reports to filter out, for example, correla- tions between the volume of certain brain structures and clinical-neurological deficits. In this way, structured reporting goes well beyond good radiology documentation, and gains a scientific value in its own right. References 11 Blagev DP, Lloyd JF, Conner K, et al. (2014) Follow-up of incidental pulmonary nodules and the radiology report. J Am Coll Radiol 11:378-83 Ways to use syngo.via for reporting BASEL UNIVERSITY HOSPITAL, CLEVELAND CLINIC, USA system through an HL7 interface. A unique SWITZERLAND Radiologists at the Cleveland Clinic use advantage of syngo.via is that the software Radiologists in the Department of Cardiac syngo.via for standardized and structured makes an automatic comparison to previous and Thoracic Diagnostics prepare multimedia diagnosis of cardiac scans. Results are tests, and generates precise case-progression reports for all cardiac CT and MRI scans using transferred to Nuance PowerScribe 360 and information for each patient and presents syngo.via. For structured reporting, they use integrated into electronic patient files as rich it in easy-to-understand charts. Electronic templates customized for their clinic, which media PDFs. Benefits include the avoidance of data export eliminates the need for paper are stored in the software. dictation errors, output of concise and multi- documentation and avoids calculation and media-enhanced reports, and better support transmission errors. CITY GENERAL HOSPITAL, for treatment decisions. STOKE-ON-TRENT, UK ST TERESA’S HOSPITAL, HONG KONG At City General Hospital, CT scans of the KLINIKUM WELS-GRIESKIRCHEN, AUSTRIA Radiologists here use syngo.via in CT imaging colon are diagnosed with syngo.via. In At Klinikum Wels-Grieskirchen, the treat- of coronary arteries and for calcium scoring. three-quarters of the workflows, the system is ment result measurements for oncology In about 70 percent of cases, a structured then used to produce a radiology report. study patients (according to RECIST criteria) report is generated directly from the software. are transferred to the hospital information Courtesy of University of Erlangen, Erlangen, Germany; UMM, Mannheim, Germany; and Cardioangiologisches Centrum Bethanien, Frankfurt, Germany. On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and are subject to change without prior notice. Some of the features and products described herein may not be available in the United States. The information in this document con- tains general technical descriptions of specifications and options as well as standard and optional features that do not always have to be present in individual cases. Siemens reserves the right to modify the design, packag- ing, specifications and options described herein without prior notice. Please contact your local Siemens sales representative for the most current information. Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when repro- duced. The statements contained herein are based on the actual experience of data on file to support these claims. However, these statements do not suggest or constitute a warranty that all product experiences will yield similar results. Results may vary based on the particular circumstances of individual sites and users. 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