Communication emphasis churns up lexicon polemics

Communication for better patient care, the theme of the recent RSNA meeting, begins with the radiology report. The purpose of the report is to communicate exact interpretive insight to referring physicians.

"In the medical, legal, and economic sense, the radiology report is the defining product of all radiologists," said Dr. A.J. Yun of Stanford University at a scientific session Wednesday. "Yet if this communication is the core output of a radiologist's cumulative training and effort, it is surprising how little education and scientific inquiry is focused on the nature of this communication outside the field of mammography."

Yun reported an attempt to ascertain and quantitate variability in the appreciation of probability value of common modifiers used in radiology reports among physicians.

"Without a standardized lexicon, communication among physicians regarding interpretation of images is less than fully efficient," he said.

Yun found significant variability in the appreciation of probability values of common modifiers used in radiology reports.

"Sometimes, what the clinician hears is not what radiologist meant," he said.

In the test, the 11 most commonly used modifiers (including probable, consistent with, consider, likely, suggestive, may represent, no definite evidence) indicating probability of diagnosis in the impression section were identified from 250 consecutive chest x-ray reports filed at Stanford Hospital in June 2002.

Survey subjects included 20 practicing radiologists and 20 practicing clinicians (internists). Each group was divided into two diagnostic categories: congestive heart failure and lung cancer. Then, in each survey, the 11 modifiers were listed next to a proposed diagnosis of either cancer or CHF.

Each doctor was asked to quantify in a percentage number the probability value he or she appreciated when reading the particular modifier along with the particular diagnosis.

Results of the survey suggest that across all doctors and phrases, the modifier used in conjunction with CHF was understood to connote a higher probability than when used in conjunction with lung cancer.

When radiologists were measured against clinicians, it was found that across both diagnoses and all phrases, radiologists interpret each modifier with a sense of higher probability more likely than clinicians.

In other words, when radiologists were giving a cancer diagnosis, they tended to pick more aggressive descriptors than when dealing with a CHF diagnosis, Yun said.