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.

Real-time PACS-integrated longitudinal brain metastasis tracking tool provides comprehensive assessment of treatment response to radiosurgery

“…Structured reports have been previously evaluated in the field of neuro-oncology and have been found to reduce nonspecific descriptions of brain lesions in patients with brain metastases to help detect all intracranial pathologies, and reproducibly document findings. 3 , 4 In our study comparing the free-text radiologist impressions with the structured output provided by the LTT, we found inconsistencies regarding the growth of lesions. In one striking case with multiple metastases, a lesion increased in size from 14 to 19 mm in LD, a change that was clearly shown in the treatment response curve and even recorded by the radiologist in the report but was left out from the impression of the radiology report.…”

“… 2 These also contribute to the generation of unclear and nonspecific radiological reports, which are at odds with the need of clinicians to precisely define the behavior of individual lesions for treatment planning purposes. 3 In addition, this shifts the responsibility of tumor treatment response assessment to neuro-oncologists, who may not have ready access to measurement tools needed to generate treatment response curves of tumors. Furthermore, objective and efficient communication between radiologists and clinicians is hampered by the free-text method of report writing, the current standard for reporting treatment responses.…”