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标准化放射报告的进展:全面综述。

Advancements in Standardizing Radiological Reports: A Comprehensive Review.

机构信息

Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.

Department of Radiology, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.

出版信息

Medicina (Kaunas). 2023 Sep 17;59(9):1679. doi: 10.3390/medicina59091679.

Abstract

Standardized radiological reports stimulate debate in the medical imaging field. This review paper explores the advantages and challenges of standardized reporting. Standardized reporting can offer improved clarity and efficiency of communication among radiologists and the multidisciplinary team. However, challenges include limited flexibility, initially increased time and effort, and potential user experience issues. The efforts toward standardization are examined, encompassing the establishment of reporting templates, use of common imaging lexicons, and integration of clinical decision support tools. Recent technological advancements, including multimedia-enhanced reporting and AI-driven solutions, are discussed for their potential to improve the standardization process. Organizations such as the ACR, ESUR, RSNA, and ESR have developed standardized reporting systems, templates, and platforms to promote uniformity and collaboration. However, challenges remain in terms of workflow adjustments, language and format variability, and the need for validation. The review concludes by presenting a set of ten essential rules for creating standardized radiology reports, emphasizing clarity, consistency, and adherence to structured formats.

摘要

标准化的放射学报告在医学影像学领域引发了讨论。本文探讨了标准化报告的优点和挑战。标准化报告可以提高放射科医生和多学科团队之间沟通的清晰度和效率。然而,挑战包括有限的灵活性、最初增加的时间和精力,以及潜在的用户体验问题。本文还探讨了标准化的努力,包括报告模板的建立、使用通用影像学词汇表以及整合临床决策支持工具。最近的技术进步,包括多媒体增强报告和人工智能驱动的解决方案,因其在改善标准化过程方面的潜力而被讨论。ACR、ESUR、RSNA 和 ESR 等组织已经开发了标准化报告系统、模板和平台,以促进一致性和协作。然而,在工作流程调整、语言和格式多样性以及验证需求方面仍存在挑战。本文最后提出了创建标准化放射学报告的十条基本规则,强调了清晰度、一致性和对结构化格式的遵守。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f41c/10535385/8a85fa6097ba/medicina-59-01679-g001.jpg

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