ECR Today 2011 daily news from europe’s leading imaging congress SUNDAY, MARCH 6, 2011 News report Obesity epidemic Ultrasound advances INSIDE from ESR meets puts focus on fatty in the technical TODAY Brazil session liver disease exhibition halls See page 5 See page 9 See page 17 Hot topic of radiological reports draws in the crowds at ECR By Mélisande Rouger and Erik Ridley get the radiologist on. That they failed to generate a report that incited, if you like, the appropriate Abnormal reporting is common, and is the princi- action in a timely fashion.” pal cause of lawsuits against radiologists. As they search for the best way to protect themselves, radi- The balance of the report has to be between brevity ologists have been left wondering what form their and completeness, uniformity and individualism, reports should take. Experts echoed these concerns portability and data-protection, advice and pro- in a dedicated, jam-packed session on Saturday at scription, universality and priority. ECR, addressing an issue that strikes at the very heart of their profession. The report should rather be brief, except in com- plex cases or in the case of significant findings. In The radiological report goes right to the essence a nutshell, it should be as long as necessary, but of being a radiologist. It demonstrates the radiolo- some cases, such as aneurysms, may require it to gists’ added value, embodies their duty of care to go beyond the basics. “Referrers want clarity and the patient, and defines their standard of care. As meaningfulness,” he said. such, careful attention should be paid to this vital Jane Adam from London, United Kingdom. Leo Lawler from Dublin, Ireland. task, according to a panel of experts. Lawler encouraged authors to keep their own style, to use the universal scientific acronyms alone and “A report should be an epiphany; it should be and it should make equal sense there as it does and the key words would have a universality about to avoid enumerations or word bytes. something you pick up and get an immediate where you are,” he said. them,” said Lawler. intuitive grasp of what the person is trying to As for the choice between free text and structure, Opening Ceremony say,” said Dr. Leo Lawler of the Mater Miseri- Technological advances should be reflected in As for their content, reports should be very concise, he was straightforward. “With modern software, we cordiae University Hospital in Dublin, Ireland. reports, he continued. The ability to image both clear, complete, and consistent and reproducible. cannot have both,” he said. Headlines are necessary “And in my opinion … if a clinician doesn’t read form and function of the body should prompt a They should also lack any ambiguity, he said. but it doesn’t mean that everything should be struc- a very well-constructed report, the radiologist re-think of the way reports are being written. How- tured. BI-RADS has served as a standard up to now. has failed in some way. But equally when he has ever, the reality is quite different. Reports should demonstrate the radiologist’s decided that there’s no longer a value to reading insight into clinical care, be accurate, and convey Finally, he advised caution when writing recom- our reports then somehow we have fallen short “We are now intervening in ways we have never the message in a meaningful way, Lawler said. mendations. “When advising additional imaging, of the mark.” done before. Our reports have to reflect that kind remember the example of the dog chasing the car. of complexity. Too often you read reports on proce- “It must be decisive and, if properly worded, should He may be running to get it but what does he get Writing an effective radiology report requires close dures in which you realise radiologists have no idea elicit the appropriate response,” he said. once he gets there?” he said. Clearly, debates on this attention to be paid to the three major pillars of about interventional procedures. They simply can’t hot topic are only starting. reporting: structure, content, and functionality, keep up; most of us can’t,” he said. Negligent reports often demonstrate good vision Lawler said. and descriptive techniques, but fail to go to the next Dr. Jane Adam, consultant radiologist at St. The report should be electronic and able to be step of forming an opinion. George̓s Hospital in London and session modera- The report structure should be dynamic and able embedded into other systems such as HIS and RIS, tor, acknowledged the high number of participants. to change over time, he said. Reports should also he said. It should also be effective by being very “It is a report that tends to distance itself from a “I think we should continue this session next year, be portable. readable, and universal. clinical issue and it’s a report that fails to prompt probably in a bigger room. We should also make it the appropriate action in a timely fashion,” he said. more interactive, for instance by equipping the room “You should be able to take a report from one insti- “If you took it to a different continent and if it was “And the literature unfortunately is replete with with keypads to let the public participate during the tution or one part of the hospital to another part deciphered, the report would make a lot of sense medico-legal cases where this is the angle they lectures. It is such an important topic,” she said. myESR.org How can I achieve high-quality outcomes at the lowest possible dose? Combined Applications to Reduce Exposure (CARE) help you to reduce radiation dose with excellent diagnostic and interventional outcomes. Life is precious. Protecting it from radiation is our concern. That’s why, as an innovation leader in dose reduction, Siemens has long applied a comprehensive approach to all areas of diagnostic and interventional imaging. The Siemens CARE standard brings together a wide variety of advanced technologies and applications to meet the needs of patients and physicians. This allows for appropriate radiation dose while maintaining excellent outcomes for diagnosis and interventions. Life is precious – take CARE. For more information, visit www.siemens.com/low-dose Answers for life. A91IM-30-A3-7600 Sunday, March 5, 2011 HIGHLIGHTS ECR TODAY 2011 3 To err is human, to learn from that error is vital By Frances Rylands-Monk Mistakes that have an impact on patient manage- ment often stem from problems of perception, and lack of background clinical information is frequently due to communication issues, delegates heard at yesterday’s Special Focus Session. Good judgement comes from experience, but expe- rience comes from bad judgement, speakers agreed, while emphasising that radiologists can arm them- selves against potential pitfalls with methods to identify and minimise danger areas. When errors do slip through the net, doctors should retrospec- tively use them for education to avoid the same mistake happening again. Keeping personal and institutional records, as well as holding regular error meetings with obligatory attendance, is one way to learn. Alan Freeman from Cambridge, United Kingdom. Cornelia Schaefer-Prokop from Amsterdam, Netherlands. Lorenzo Derchi from Genoa, Italy. “The surroundings must allow for critical appraisal explanation for the ‘left renal colic’. As the patient hurry was always a mistake. If adequate time could showed the disappearance of the ‘tumour’. He con- and constructive debate, not dispute. Reviews are was still in pain, surgery was performed, which not be allocated, doctors should refuse to read ima- cluded that it was probably chewing gum! an obligatory quality control tool to show where we found an ovarian serous cystadenoma complicated ges, as he learnt personally. need improvement and where we are good,” said by torsion. While perception and individual bias can impede Dr. Cornelia Schaefer-Prokop, chest radiologist at One particular case Freeman recounted to dele- objective reporting, technical reasons can hamper Amsterdam University Hospital and Amersfoort “Complications from torsion are associated with gates was of an 88-year old woman who had pre- diagnosis in ultrasound, specifically of upper pole Medical Centre, The Netherlands. ovarian masses in 50 to 81% of cases. So why did sented with acute abdominal pain. The case came tumours, according to Derchi. Sagittal and axial we miss the diagnosis?” Derchi asked delegates. to him late in the afternoon when a trusted colle- views of the upper pole cannot provide a good Although the ideal environment of blamelessness “First because the symptoms ‘suggested renal colic’, ague wanted to discuss what he was certain was means of evaluation, without coronal planes. Psy- and education might sometimes seem combative, the renal and extra-renal ultrasound findings were bowel ischaemia in an otherwise healthy patient. chological ‘satisfaction of search’ syndrome may anonymising cases would help to reassure radio- normal and because the cyst was considered inci- At around 16:30 Freeman suggested a CT, in which also jeopardise diagnosis. logists about the non-punitive motives for holding dental.” he saw nothing to discount ischaemia. Coronal and such reviews. In the panel discussion one delegate sagittal views seemed to show one major vessel “When reading or performing an examination, volunteered that trust was built to such an extent Other compounding factors were that the radio- supplying her GI tract. As Freeman rushed to catch once you discover a finding that explains symp- in her department’s review sessions that doctors logical considerations were not taken into account his five o’clock lift home the patient was referred to toms, your attention drops and you may miss asso- would recognise case images and admit that they or correlated to the clinical considerations; visible the surgeons.