Contextual structured report template library published for neuroradiology

Adoption of electronic structured report templates has been a slow process for radiologists, similar to the adoption and utilization of speech recognition dictation systems. Progress has been made, but implementation in radiology departments in North America and in Europe has not met the expectations of the technology’s enthusiasts.

The 2009 initiative by the Radiological Society of North America (RSNA) to create a free library of downloadable best-practice report templates prepared by over 100 experts in their fields has inspired radiologists to develop additional best-practice content templates. Neuroradiologists at Kaiser Permanente Medical Center Santa Clara, CA have added a library of 50 contextual neuroradiology reports to the public domain, described in the August issue of the ANJR American Journal of Neuroradiology.

Contextual structured reports are specifically related to a disease or examination indication. Contextual templates are individually tailored to the diagnosis, ensure that all pertinent points are addressed in a checklist fashion, and educate trainees by providing a systematic approach for clinical interpretation. They represent a new type of structured report that is disease- or symptom-specific. The templates contain pick lists to permit different options for the radiologist to choose from, and are also flexible, allowing free-text dictation within the appropriate contextual fields.

One of the main drawbacks of existing structured reporting is that the templates are modality-based and are usually organized by a litany of organs with little meaningful content, lead author Mark D. Mamlouk, MD, told Applied Radiology. He said that this was one reason some radiologists don’t use them.

Led by Dr. Mamlouk, a committee recruited the subspecialty regional leaders of neuroradiology within the brain, neurovascular, head/neck, spine imaging, and pediatric neuroradiology among the 50 neuroradiologists working in the Kaiser Permanente Northern California network. The committee developed template content for common exam indications and diseases within neuroradiology, working with subject matter clinician experts.

The team then mapped the templates to procedural codes in its radiology information system (RIS), but added the capability of permitting more complex associations between the procedures and the templates. They explained that the mapping enables a template to automatically load in the reporting software when an exam is opened for interpretation.

In an anonymous survey, 83% of the neurologists, neurosurgeons, radiation oncologists, and otolaryngologists who received the reports preferred the contextual structured reports compared to traditionally prepared ones. Ninety-five percent thought the pertinent findings and impression were easy to understand. Radiologists were slightly less enthusiastic, with only 65% in favor of their use and with 24% being neutral. But among the radiologists who endorsed structured reporting, 80% thought the contextual templates made reporting more thorough and relevant for complex entities, and 71% thought they increased the efficiency of reporting.

As one example illustrating the benefits of contextual reporting, a preoperative sinus computed tomography (CT) contextual template ensures the radiologist comment on important sinonasal ariants that are vital to surgical planning. The authors said the contextual template permits this discussion, as it is difficult to remember all sinonasal variants in a free-text dictation. They also mentioned that they created a concise imaging guide of all the described sinonasal variants to aid in reporting, which was accessible via a hyperlink in the dictation software.

The 50 neuroradiology contextual structured report templates which are compatible with Radiator and Nuance Powerscribe 360 (versions 3.5 and 4.0) may be freely accessed at:


  1. Mamlouk MD, Chang PC, Saket RR. Contextual radiology reporting: A new approach to neuroradiology structured templates. AJNR Am J Neuroradiol. 2018;39(8):1406-1414.
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