Surprising Improved Productivity with Ultrasound Worksheets

Introduction

Radiologists face various challenges, including the need for greater efficiency and quality in reporting. The implementation of structured reporting is widely recognized as a means to improve communication and enhance satisfaction for both referring clinicians and radiologists [1]. However, due to the current shortage of radiologists and the increasing volume of imaging studies, there is a pressing need, as described by BenWhite [2], for “mass efficiency gains.” In this article, I discuss the importance of both measurement transfer and electronic ultrasound worksheets in ultrasound reporting software to achieve these efficiency gains. It is essential to understand that measurement transfer alone is not sufficient to meet the required efficiency gains.    

Transferring Measurements and DICOM SR 

DICOM Structured Reporting (DICOM SR) provides a standardized format for transferring measurements, allowing applications like Imorgon to receive measurements from different ultrasound vendors and accurately incorporate them into reporting packages [3]. This approach enables radiologists to focus on image interpretation rather than transcribing numbers, thereby reducing dictation time and minimizing errors. Several publications highlight successful implementations of measurement transfer in their institutions, showcasing its benefits and widespread acceptance [4] [5]. Dr. Steve Horii went a step further and estimated the impact of measurement transfer on radiologist reporting time, revealing median reductions of up to 40% for measurement-intensive exams [6]. 

Ultrasound Worksheets in Modern Ultrasound Reporting Automation

While some institutions exclusively focus on transferring ultrasound measurements, incorporating electronic worksheets alongside measurement transfer offers numerous advantages.

• Reduced likelihood of omitting key observations, resulting in fewer questions and report creation delays [7].
• Ultrasound worksheet templates serve as checklists for sonographers, enhancing the quality and consistency of observations during exams. A study conducted by Nordin et al. demonstrated the effectiveness of checklists in reducing imaging costs for ultrasound screening of suspected appendicitis in pediatric patients [8]. Over time, there was a significant decrease in the percentage of patients requiring CT scans, resulting in cost savings and reduced radiation exposure.
• Other studies implemented quality improvement processes and observed a decrease in unsupported ultrasound findings [9].  

The benefits of ultrasound worksheets apply to all institutions. However, it’s important to note that there are particularly significant advantages for young or new sonographers, travelers, or after-hours scanning.

Ultrasound Worksheets Not Just Secondary Captures

It is essential to note that the electronic ultrasound worksheets discussed in this article go beyond scanned paper worksheets stored as pictures (secondary captures) in the PACS system for radiologists to dictate their reports. Modern ultrasound reporting software provides web-based forms as solutions. These forms enable the automatic transfer of consistent, structured sonographer findings into specific fields within a Radiology report.

New Imorgon Research 

Imorgon investigated various imaging and academic centers to examine the implementation of measurement transfer, sonographer worksheets, and structured reporting. The study focused on the most common exams conducted at hospitals and imaging centers, including Complete Abdominal, Pelvic, and Thyroid exams. Surprisingly, the findings revealed that approximately 50% of the input fields in radiology reports originated from electronic worksheets, while the remaining 50% were derived from ultrasound system measurements. Notably, there was no discernible difference observed between academic and imaging centers.

The first figure depicts that sites tend to have an equal number of measurements and worksheet inputs for a given exam.  

The second graph plots the difference between the number of measurement fields and worksheet fields at a site. It demonstrates that sites engaged in significant measurements also tend to gather a substantial number of worksheet inputs. Hence, irrespective of the total quantity of data collected by the sites, both measurements and worksheet data play an equally crucial role.

It is important to note that this investigation did not encompass measurement-intensive Doppler or OB exams, nor non-measurement DVT studies. As a result, results may vary among institutions. Nevertheless, it is reasonable to conclude that sonographer observations from worksheets significantly contribute to the generation of Radiology reports. [10]. 

Summary on Ultrasound Worksheets and Ultrasound Reporting Software

Structured reporting is being implemented to enhance the quality and effectiveness of radiology reporting. However, many sites fail to realize the productivity and quality benefits that come from embracing both measurement transfer and electronic worksheets. It is crucial to understand that significant improvements in reporting productivity necessitate the incorporation of both measurement transfer and electronic worksheets. By doing so, radiologists can unlock the potential for “mass efficiency gains” and optimize their reporting processes, thereby benefiting patients, referring clinicians, and their own sanity.  

Thank you for reading my blog and please leave a comment below. Before you go, could I ask for a favor? I am collecting data on reporting automation and would appreciate your experiences in a 3-question survey.

– Andy

1. Schwartz LH, Panicek DM, Berk AR, Li Y, Hricak H. Improving communication of diagnostic radiology findings through structured reporting. Radiology. 2011 Jul;260(1):174-81. doi: 10.1148/radiol.11101913
2. The Radiologist Shortage is Here | Ben White [Website Blog]
3. Imorgon Report Accelerator [Webpage]
4. Scheinfeld MH, Kaplun O, Simmons NA, Sterman J, Goldberg-Stein S. Implementing a Software Solution Across Multiple Ultrasound Vendors to Auto-fill Reports with Measurement Values. Curr Probl Diagn Radiol. 2019;48(3):216-219. doi:10.1067/j.cpradiol.2018.09.002
5. Hangiandreou, N., Stekel, S., Tradup, D. Comprehensive Clinical Implementation of DICOM Structured Reporting Across a Radiology Ultrasound Practice: Lessons Learned - Journal of the American College of Radiology. 2016. https://doi.org/10.1016/j.jacr.2016.09.046
6. Horii, S. (Article)
7. Doyon, V., Tuomi, S., King, C. Best Practice in Standardized Ultrasound Reporting. The Canadian Journal of Medical Sonography. Vol. 13 No. 1 (2022) (jsonocan.com)
8. Nordin, A., Sales, S., Nielson, J., Adler, B., Bates, D., Kenney, B. Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs. Journal of Surgical Research. 2018;222:77-83. doi.org/10.1016/j.jss.2017.07.002
9. Schenone, M., Ziebarth, S., Duncan, J., Stokes, L., Hernandez, A. Effects of a proposed quality improvement process in the proportion of the reported ultrasound findings unsupported by stored images. The Journal of Maternal-Fetal & Neonatal Medicine. 2019. 32:14, 2328-2331, DOI: 10.1080/14767058.2018.1432587
10. Imorgon Reporting Automation Investigation across multiple imaging and academic centers (unpublished data)