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The Management of Radiology Report Templates (MRRT) Profile Curtis P. Langlotz, MD, PhD Professor and Vice Chair for Informatics Department of Radiology, University of Pennsylvania Chair, RSNA Structured Reporting Committee

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Radiology Reporting: Standardization Proprietary format Limited capabilities Isolated systems Duplicated work Vendor A System Vendor B System Vendor C System Expert consensus Standard format Rich functionality XML encoding Template capabilities Template interchange Report encoding Term mapping Customer A Macros Customer B Macros Customer C Macros RSNA Radiology Report Template Library Year 1-2 Standards Development: IHE DICOM WG8 Year 3-4

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Radiologist Work Flow Goal 1.Radiologist needs a template 2.Browses template library 3.Fills shopping cart with templates 4.Downloads template file to vendor system 5.Edits templates in vendor system if needed 6.Creates standard reports 7.Migrates easily to new system when needed Library RSNA

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RSNA Report Template Library http://www.radreport.org

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Radiology Reporting Process Overall metaphor is a text editor with an insertion point User may use templates to create a report User has ultimate control over the content All or part of a template can be deleted Addition of content is allowed Multiple reporting modes Fill in the blanks Serial assembly Nested/hybrid

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MRRT Profile: New Reporting Features Field typestext, menu, number, date, time Tables Auto-populate fieldspull from RIS or modality Selection list fieldchoose phrase from menu Field behavior on signing: prohibit, alert, silent Template nesting Annotate template using standard terms, facilitating decision support, etc. Parent-child relationships between templates

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MRRT Template Structure HTML5 file format elements for attribute-value data, using Dublin Core when applicable element for XML-like coded content Coded Content (XML) linked to Body using same mechanism as HL7 CDA Optional CSS style information (HTML5) Text and fields, with HTML5 custom attributes

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MRRT Template Fields in HTML5 Field Type HTML5 Element HTML5 Attribute HTML5 Attribute Value Text inputtypetext, textarea Numeric inputtypenumber Selection List selectmultiplesingle, multiple Date inputtypedate Time inputtypetime

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MRRT Profile: Other Supported HTML5 Elements HTML5 TagDescription Hyperlink to a web resource specified by the href attribute Line break Emphasized text, often in italics Image List item Ordered list Paragraph Short quotation Groups inline text and other elements Important text, often bold Subscripted text Superscripted text Defines a table Table cell Header cell in a table Table row Stylistically different text, often underlined Unordered list

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MRRT: Other Key Design Decisions HTML5 is a representation formalism, not a prescription for how to render a report Basic coded content onlylists of terms Simple merge fields only Optional RESTful query mechanism No inheritance among templates

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MRRT Sample Template

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RSNA Reporting Vendor Forum 2012 Participants Agfa Clickview GE Karos Health Medken M*Modal Nuance Siemens Toshiba

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Curtis P. Langlotz, MD, PhD Professor and Vice Chair for Informatics Department of Radiology, University of Pennsylvania Chair, RSNA Structured Reporting Committee Thank You