By Charles Bankhead

The use of voice recognition technology has increased the amount of time required to prepare radiology reports and has not helped shorten reports, a study from Massachusetts General Hospital indicates.

An evaluation of radiology reports prepared for 200 routine plain-film radiographs and ultrasound images showed that voice recognition required 37% more time on the part of a radiologist to dictate and revise a report. Despite the additional time spent revising and correcting reports, the average report length did not decrease, compared to reports prepared by use of a conventional dictation system.

"Previous studies have shown that voice recognition improves the time required to make reports available to referring physicians, which makes the trade-off in radiologist time worthwhile," said Dr. Amit Mehta, a radiologist at Massachusetts General and Harvard Medical School.

When MGH implemented the voice recognition system four years ago, the technology was known to increase dictation time by two- or three-fold, Mehta said. Healthcare systems have been under pressure to adopt new technology to increase service while decreasing costs, however. Voice recognition provided one answer to that pressure.

Mehta reported findings on 200 consecutive imaging studies performed over a four-day period at an MGH satellite outpatient clinic. Most of the images were plain film, with a few ultrasound studies included. Radiologists first dictated reports using the IBM MedSpeak voice recognition system.

The same 200 studies were reintroduced into the workflow a month later, under the assumption that the radiologists would not recall their original reports. The radiologists then dictated reports for each study using the conventional dictation system. A majority of the studies proved to be normal, which is associated with reduced dictation time, Mehta said.

The time required to dictate a report using voice recognition averaged 44.3 seconds, compared to 28 seconds with the legacy dictation system, an increase of 36.8%.

"It takes radiologists longer to prepare reports with voice recognition, and our volume of studies has increased substantially. Yet, most radiologists are still able to leave work at the usual time," Mehta said. "We wanted to see if we could find an explanation for how radiologists compensated for the extra time spent on reports."

Working on the hypothesis that voice recognition had changed the way radiologists prepare reports, Mehta and his associates evaluated the length of the 200 reports prepared by the voice recognition and legacy dictation systems. They found that the report length averaged 36 words with both systems. Accuracy also was comparable.

The composition of the reports differed between systems, however. With the legacy system, the body averaged 27 words and the impression nine words. In contrast, the body of the report was shorter with voice recognition (21 words) and the impression was longer (15 words).

"Our hypothesis is that the difference has to do with dictation continuity," Mehta said. "With the MedSpeak system, if you are able to talk continuously, the accuracy is much better than if you are constantly stopping and then continuing to speak. When radiologists dictate the body of a report, they often are looking at the exam and start and stop talking frequently as they look at the film. By the time they reach the end of the body, they have usually formulated what they want to say in the impression, so speech is more continuous."

Future studies of the voice recognition system will focus on effects on patient care, Mehta said. In particular, he and his associates will try to determine whether certain types of information might be omitted to accommodate voice recognition. As an example, he cited numbers associated with measurements, which often cause problems for the system.

"I think voice technology will continue to improve, leading to better accuracy and efficiency," Mehta said. "Other advances, such as incorporating voice recognition into the PACS systems, also should lead to increased efficiency."

Watching the world of radiology walk by is a time-honored RSNA activity.