Ultrasound Reporting Automation: 3 Features Improve Efficiency and Achieve Level 3 Automation
As we enter 2026, Radiology departments face a compounding operational crisis: a 5% annual increase [MarketsandMarkets] in imaging volume paired with a 2.83% fee schedule reduction [CMS]. This article examines the three features to achieve full Automation (Level 3 Automation) and restore focus to clinical practice by eliminating wasteful mechanics of report creation.
As a Radiologist, if you read any amount of ultrasound, this article discusses the latest advances in ultrasound reporting software to significantly improve reporting efficiency. I have previously written on this topic, so feel free to review my articles on the Underutilization of Automation and Improved Productivity with Ultrasound Worksheets.
Key Points
Some have taken the first step in reporting automation—automatic measurement transfer.
Most do not realize there is an equally large opportunity in:
- Conditional Text Generation
- Automatic Fetching Prior Measurements and Calculations
- Integrated Clinical Decision Support
Embracing Reporting Automation
Ultrasound is a unique modality that relies on sonographers for image acquisition, measurements, and preliminary impressions. Current workflows require duplicative efforts by sonographers and Radiologists to generate reports. A minority of Radiology departments have implemented basic automation, such as transferring ultrasound DICOM SR data to Powerscribe or other Radiology Reporting software [Underutilization of Automation]. I believe automation efforts lag because structured reporting initiatives are slow—the initial effort to gain consensus is large, and there is resistance to change.
Recent Imorgon Medical research found that 50% of findings in a Radiology report come from qualitative data rather than measurement data [Qualitative research article]. The implication is that more than automating measurement transfer is needed to improve reporting efficiency significantly. This article summarizes three features that maximize the ROI on any reporting automation effort.
1. Conditional Text Generation is next-level Ultrasound Reporting Software
Efficient ultrasound reporting requires the rapid translation of a sonographer’s findings, recorded on a worksheet, into a finding or impression statement in a Radiologist’s report. Many Radiologists are familiar with structured reporting templates that prepopulate default/normal findings. However, when findings deviate significantly from normal, a Radiologist returns to more traditional dictation. Because 50% of findings are qualitative, traditional measurement transfer is insufficient. Conditional Text Generation converts sonographer observations directly into Nuance PowerScribe or Fluency narratives without additional manual transcription.
The following example of lower-extremity venous anatomy is simple yet powerful:.
- First, recreating this efficiency would be difficult without conditional text.
- Second, sonographers’ observations will not be challenged, as they are the only ones who have scanned the patient.
In this example, the radiologist’s role is to ensure that the clinical questions are addressed. The productivity improvement is beyond argument.
Lower Extremity Venous Report Template
Video 1 depicts an Imorgon Report Accelerator ultrasound worksheet with automated text generation. This example displays text for transfer. The following list highlights some of the productivity and quality improvement features:
- The green “findings” and “impressions” are similar to the default text in a Radiology template. A single selection adds the right-side findings and impressions.
- Selecting a non-occlusive femoral vein thrombus automatically updates both Findings and Impressions. The findings maintain the details of the exam, and the impression notes a deviation and summarizes the remainder.
The image below illustrates how mapping sonographer worksheet inputs are entered into Powerscribe.
Conditional Text Generation goes beyond assigning work to another person.
It enables the person closest to the patient to generate preliminary report findings with a few selections.
2. Automatic Prior Measurements and Calculations (Cognitive Load Reduction)
Illustration 2 shows an ultrasound thyroid template that automatically retrieves prior DICOM SR measurements. There were four follow-ups over the past years. Ellipsoid volume and interval difference calculations are automatic. Judging by the measurement variation, previous measurements were only referenced after new measurements were taken.
This simple example illustrates the everyday reporting opportunity of prefetching priors and automatic calculations to enhance report quality, reduce reporting time, and minimize diagnostic errors. Notice that conditional text generation is based on interval growth.
Thyroid Ultrasound Worksheet with Prior Measurements
Everyone hates the ‘looking up’ part for priors.
By prefetching prior DICOM SR measurements and performing calculations, Imorgon reduces the cognitive load and eliminates common dictation errors.
3. Integrated Clinical Decision Support (Governance)
ACR TI-RADS™ and O-RADS™ (ACR TI-RADS) integrations are not just calculators; they are governance tools. Integrated CDS ensures every report meets the Enterprise Standard, reducing biopsy rates by up to 53% while maintaining a 97.8% NPV (Grani et al.). Non-integrated tools fail because:
- Separate apps or web pages lack integration into the exam and sonographer worksheets
- Incomplete guidance implementation
- Results need manual transcription as results are not integrated into PowerScribe or Fluency
Ideal clinical decision support includes worksheet integration, encompasses the entire clinical guideline, and automatically updates report documentation based on inputs.
Clinical Decision Support – TI-RADS
Video 2 illustrates the features of a modern ultrasound reporting system with an integrated clinical decision support system such as TI-RADS. Note the features:
- Automatically collapsing sections make unnecessarily long and complicated ultrasound worksheets accessible. The thyroid worksheet only shows measured nodules even though the worksheet template supports three nodules per lobe. Furthermore, cystic and spongiform compositions hide unnecessary further characterizations to simplify the worksheet.
- TI-RADS guidelines are more fully implemented than other web implementations. A solid/mixed composition selection opens the remaining TI-RADS options. Additionally, echogenicity, taller-than-wide, and margins are exclusive radio buttons while allowing multiple echogenic foci selections.
- Interval growth and small-sized cases are integrated into the tool.
- No additional transcribing step is necessary, as each selection updates impression and findings statements.
- TI-RADS grading, size, and text generation automate findings and boilerplate recommendations.
- All of this information is transferred directly into PowerScribe or Fluency.
It is easy to imagine improved departmental workflow when all the integrated clinical decision support system features are combined.
With these features, it is easy to visualize productivity improvements.
A key question is whether automation will increase or decrease in the coming years.
Conclusion: Ultrasound Reporting Software Automates Radiology Reports
Reporting automation becomes necessary as Radiology faces continued reimbursement cuts and increased volumes. Ultrasound reporting software can now dramatically improve reporting efficiency in every Radiology department. Embracing this change will enable you to leverage the efficiency improvements that improve your life. The ultrasound reporting software features described are the beginning of automation features we will see in the coming years.
Andy Milkowski
Andy Milkowski