Skip to main content

The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency

European Archives of Oto-Rhino-Laryngology volume 277, pages 269–276 (2020)Cite this article

Abstract

Purpose

Free text reports (FTR) of head and neck ultrasound studies are currently deployed in most departments. Because of a lack of composition and language, these reports vary greatly in terms of quality and reliability. This may impair the learning process during residency. The purpose of the study was to analyze the longitudinal effects of using structured reports (SR) of head and neck ultrasound studies during residency.

Methods

Attending residents (n = 24) of a tripartite course on head and neck ultrasound, accredited by the German Society for Ultrasound in Medicine (DEGUM), were randomly allocated to pictures of common diseases. Both SRs and FTRs were compiled. All reports were analyzed concerning completeness, acquired time and legibility. Overall user contentment was evaluated by a questionnaire.

Results

SRs achieved significantly higher ratings regarding completeness (95.6% vs. 26.4%, p < 0.001), description of pathologies (72.2% vs. 58.9%, p < 0.001) and legibility (100% vs. 52.4%, p < 0.001) with a very high inter-rater reliability (Fleiss’ kappa 0.9). Reports were finalized significantly faster (99.1 s vs. 115.0 s, p < 0.001) and user contentment was significantly better when using SRs (8.3 vs. 6.3, p < 0.001). In particular, only SRs showed a longitudinally increasing time efficiency (− 20.1 s, p = 0.036) while maintaining consistent completeness ratings.

Conclusions

The use of SRs of head and neck ultrasound studies results in an increased longitudinal time-efficiency while upholding the report quality at the same time. This may indicate an additive learning effect of structured reporting. Superior outcomes in terms of comprehensiveness, legibility and time-efficiency can be observed immediately after implementation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

FTR:

Free text report

SR:

Structured report

ACI:

Internal carotid artery

ACE:

External carotid artery

GPA:

Parotid gland

GSM:

Submandibular gland

VAS:

Visual analog scale

DEGUM:

German Society for Ultrasound in Medicine

PACS:

Picture archiving and communication system

References

  1. Beach KW, Bergelin RO, Leotta DF, Primozich JF, Sevareid PM, Stutzman ET, Zierler RE (2010) Standardized ultrasound evaluation of carotid stenosis for clinical trials: University of Washington Ultrasound Reading Center. Cardiovasc Ultrasound 8:39. https://doi.org/10.1186/1476-7120-8-39

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moshtaghi O, Haidar YM, Mahmoodi A, Tjoa T, Armstrong WB (2017) The Role of In-office ultrasound in the diagnosis of neck masses. Otolaryngol Head Neck Surg 157(1):58–61. https://doi.org/10.1177/0194599817696288

    Article  PubMed  Google Scholar 

  3. Forghani R, Yu E, Levental M, Som PM, Curtin HD (2015) Imaging evaluation of lymphadenopathy and patterns of lymph node spread in head and neck cancer. Expert Rev Anticancer Ther 15(2):207–224. https://doi.org/10.1586/14737140.2015.978862

    CAS  Article  PubMed  Google Scholar 

  4. Bialek EJ, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A (2006) US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls. Radiographics 26(3):745–763. https://doi.org/10.1148/rg.263055024

    Article  PubMed  Google Scholar 

  5. Kunzel J, Bozzato A, Strieth S (2017) Follow-up ultrasound of head and neck cancer. HNO 65(11):939–952. https://doi.org/10.1007/s00106-017-0411-3

    CAS  Article  PubMed  Google Scholar 

  6. Lima PH, Fan B, Berube J, Cerny M, Olivie D, Giard JM, Beauchemin C, Tang A (2019) Cost-utility analysis of imaging for surveillance and diagnosis of hepatocellular carcinoma. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.18.20341

    Article  PubMed  Google Scholar 

  7. Enders J, Zimmermann E, Rief M, Martus P, Klingebiel R, Asbach P, Klessen C, Diederichs G, Wagner M, Teichgraber U, Bengner T, Hamm B, Dewey M (2011) Reduction of claustrophobia with short-bore versus open magnetic resonance imaging: a randomized controlled trial. PLoS ONE 6(8):e23494. https://doi.org/10.1371/journal.pone.0023494

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Wallis A, McCoubrie P (2011) The radiology report—are we getting the message across? Clin Radiol 66(11):1015–1022. https://doi.org/10.1016/j.crad.2011.05.013

    CAS  Article  PubMed  Google Scholar 

  9. Nasrallah HA (2015) Consequences of misdiagnosis: inaccurate treatment and poor patient outcomes in bipolar disorder. J Clin Psychiatry 76(10):e1328. https://doi.org/10.4088/JCP.14016tx2c

    Article  PubMed  Google Scholar 

  10. Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, Studdert DM (2006) Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 145(7):488–496

    Article  Google Scholar 

  11. Morgan TA, Helibrun ME, Kahn CE Jr (2014) Reporting initiative of the Radiological Society of North America: progress and new directions. Radiology 273(3):642–645. https://doi.org/10.1148/radiol.14141227

    Article  PubMed  Google Scholar 

  12. Schoppe F, Sommer WH, Schmidutz F, Pforringer D, Armbruster M, Paprottka KJ, Plum JLV, Sabel BO, Meinel FG, Sommer NN (2018) Structured reporting of x-rays for atraumatic shoulder pain: advantages over free text? BMC Med Imaging 18(1):20. https://doi.org/10.1186/s12880-018-0262-8

    Article  PubMed  PubMed Central  Google Scholar 

  13. European Society of R (2018) ESR paper on structured reporting in radiology. Insights Imaging 9(1):1–7. https://doi.org/10.1007/s13244-017-0588-8

    Article  Google Scholar 

  14. Ernst BP, Hodeib M, Strieth S, Kunzel J, Bischof F, Hackenberg B, Huppertz T, Weber V, Bahr K, Eckrich J, Hagemann J, Engelbarts M, Froelich MF, Solbach P, Linke R, Matthias C, Sommer WH, Becker S (2019) Structured reporting of head and neck ultrasound examinations. BMC Med Imaging 19(1):25. https://doi.org/10.1186/s12880-019-0325-5

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ernst BP, Katzer F, Kunzel J, Hodeib M, Strieth S, Eckrich J, Tattermusch A, Froelich MF, Matthias C, Sommer WH, Becker S (2019) Impact of structured reporting on developing head and neck ultrasound skills. BMC Med Educ 19(1):102. https://doi.org/10.1186/s12909-019-1538-6

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tuncyurek O, Garces-Descovich A, Jaramillo-Cardoso A, Duran EE, Cataldo TE, Poylin VY, Gomez SF, Cabrera AM, Hegazi T, Beker K, Mortele KJ (2018) Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning. Abdom Radiol (NY) 44(3):811–820. https://doi.org/10.1007/s00261-018-1858-8

    Article  Google Scholar 

  17. Park SB, Kim MJ, Ko Y, Sim JY, Kim HJ, Lee KH, s (2019) Structured S preference survey of 594 referring physicians, surgeons, and radiologists from 20 hospitals. Korean J Radiol 20(2):246–255. https://doi.org/10.3348/kjr.2018.0109

    Article  PubMed  Google Scholar 

  18. Gassenmaier S, Armbruster M, Haasters F, Helfen T, Henzler T, Alibek S, Pforringer D, Sommer WH, Sommer NN (2017) Structured reporting of MRI of the shoulder—improvement of report quality? Eur Radiol 27(10):4110–4119. https://doi.org/10.1007/s00330-017-4778-z

    Article  PubMed  Google Scholar 

  19. Norenberg D, Sommer WH, Thasler W, D'Haese J, Rentsch M, Kolben T, Schreyer A, Rist C, Reiser M, Armbruster M (2017) Structured reporting of rectal magnetic resonance imaging in suspected primary rectal cancer: potential benefits for surgical planning and interdisciplinary communication. Invest Radiol 52(4):232–239. https://doi.org/10.1097/RLI.0000000000000336

    Article  PubMed  Google Scholar 

  20. Sabel BO, Plum JL, Kneidinger N, Leuschner G, Koletzko L, Raziorrouh B, Schinner R, Kunz WG, Schoeppe F, Thierfelder KM, Sommer WH, Meinel FG (2017) Structured reporting of CT examinations in acute pulmonary embolism. J Cardiovasc Comput Tomogr 11(3):188–195. https://doi.org/10.1016/j.jcct.2017.02.008

    Article  PubMed  Google Scholar 

  21. Schoeppe F, Sommer WH, Haack M, Havel M, Rheinwald M, Wechtenbruch J, Fischer MR, Meinel FG, Sabel BO, Sommer NN (2018) Structured reports of videofluoroscopic swallowing studies have the potential to improve overall report quality compared to free text reports. Eur Radiol 28(1):308–315. https://doi.org/10.1007/s00330-017-4971-0

    Article  PubMed  Google Scholar 

  22. Armbruster M, Gassenmaier S, Haack M, Reiter M, Norenberg D, Henzler T, Sommer NN, Sommer WH, Braun F (2018) Structured reporting in petrous bone MRI examinations: impact on report completeness and quality. Int J Comput Assist Radiol Surg 13(12):1971–1980. https://doi.org/10.1007/s11548-018-1828-1

    Article  PubMed  Google Scholar 

  23. Thomas KD, Muga HE (2014) Handbook of research on pedagogical innovations for sustainable development. Information Science Reference (an imprint of IGI Global) 10.4018/978-1-4666-5856-1

  24. Sahni VA, Silveira PC, Sainani NI, Khorasani R (2015) Impact of a structured report template on the quality of mri reports for rectal cancer staging. AJR Am J Roentgenol 205(3):584–588. https://doi.org/10.2214/AJR.14.14053

    Article  PubMed  Google Scholar 

  25. Fleiss JL, Cohen J (1973) The equivalence of weighted Kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Measur 33:613–619

    Article  Google Scholar 

  26. Kunzel J, Strieth S, Wirth G, Bozzato A (2018) Ultrasound in the re-staging of cervical metastases after chemoradiotherapy for head and neck cancer. Ultraschall Med 39(6):659–666. https://doi.org/10.1055/a-0573-0908

    Article  PubMed  Google Scholar 

  27. Bock A, Modabber A, Holzle F, Prescher A, Classen-Linke I (2019) Improvement of anatomical knowledge and surgical skills in head and neck region—an interdisciplinary hands-on course for clinical students. Ann Anat. https://doi.org/10.1016/j.aanat.2019.03.011

    Article  PubMed  Google Scholar 

  28. Kahn CE Jr, Heilbrun ME, Applegate KE (2013) From guidelines to practice: how reporting templates promote the use of radiology practice guidelines. J Am Coll Radiol 10(4):268–273. https://doi.org/10.1016/j.jacr.2012.09.025

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ranschaert ER, Binkhuysen FH (2013) European Teleradiology now and in the future: results of an online survey. Insights Imaging 4(1):93–102. https://doi.org/10.1007/s13244-012-0210-z

    CAS  Article  PubMed  Google Scholar 

  30. Matsumoto M, Koike S, Kashima S, Awai K (2015) Geographic distribution of radiologists and utilization of teleradiology in japan: a longitudinal analysis based on national census data. PLoS ONE 10(9):e0139723. https://doi.org/10.1371/journal.pone.0139723

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. Lin E, Powell DK, Kagetsu NJ (2014) Efficacy of a checklist-style structured radiology reporting template in reducing resident misses on cervical spine computed tomography examinations. J Digit Imaging 27(5):588–593. https://doi.org/10.1007/s10278-014-9703-2

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI (2016) The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. Virchows Arch 468(6):639–649. https://doi.org/10.1007/s00428-016-1935-8

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Marcovici P, Blume-Marcovici A (2013) Intuition versus rational thinking: psychological challenges in radiology and a potential solution. J Am Coll Radiol 10(1):25–29. https://doi.org/10.1016/j.jacr.2012.06.029

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Ben Braun for language editing. Additionally, the authors thank the attendees of the 2018 Mainz DEGUM-accredited course on head and neck ultrasound for their participation in this study.

Funding

This research project did not receive any funding.

Author information

Affiliations

  1. Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Benjamin P. Ernst, Sebastian Strieth, Fabian Katzer, Mohamed Hodeib, Jonas Eckrich, Katharina Bahr, Julian Künzel & Christoph Matthias

  2. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Matthias F. Froelich

  3. Department of Radiology, LMU University Hospital, Marchioninistraße 15, 81377, München, Germany

    Wieland H. Sommer

  4. Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen Medical Center, 72076, Tübingen, Germany

    Sven Becker

  5. Division of Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany

    Tobias Rader

Authors
  1. Benjamin P. Ernst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Strieth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabian Katzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Hodeib
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonas Eckrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katharina Bahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tobias Rader
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Julian Künzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Matthias F. Froelich
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Christoph Matthias
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Wieland H. Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sven Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BPE and SB contributed to the conception and design of the project and to data collection, analysis and interpretation, and wrote the initial draft of the manuscript. SS, FK, MH, JE, KB, TR, JK, MFF; CM and WHS contributed to the conception and design of the project, as well as the analysis and interpretation. All authors conducted critical revisions of the manuscript, gave final approval to the submitted paper and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Benjamin P. Ernst.

Ethics declarations

Conflict of interest

Wieland H. Sommer is the founder of the company Smart Reporting GmbH, which hosts an online platform for structured reporting. Matthias F. Froelich is an employee of Smart Reporting GmbH. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This manuscript is part of a medical doctoral thesis presented by Fabian Katzer at the University Mainz Medical School.

Ethical approval on research involving human participants

Ethics approval was obtained by the Institutional Review Board (Ethik-Kommission der Landesärztekammer Rheinland-Pfalz. Reference No: 2018-13225). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ernst, B.P., Strieth, S., Katzer, F. et al. The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency. Eur Arch Otorhinolaryngol 277, 269–276 (2020). https://doi.org/10.1007/s00405-019-05679-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05679-z

Keywords

  • Medical education
  • Ultrasonography
  • Head and neck cancer
  • Workflow
  • Structured reporting