Structured Reporting

For Medical Students

What It Shows

A structured report follows a fixed set of headings rather than free prose, so the same facts appear in the same order for every study. 5.1.1 covers why imaging matters.

On the pages of this chapter the six template headings are read as questions about the report rather than about an image: what the report shows, how it is produced, what a good one looks like, what a poor one looks like, how good reporting is, and where reports mislead. 5.1.7 covers evidence-based imaging.

It matters because the report is the only part of the study most referrers read, so what the template omits is effectively absent. 5.1.2 covers clinical examination versus imaging.

How It Is Acquired

Start from the clinical question in the request, because that is what the report has to answer. 5.1.3 covers choosing the correct investigation.

State the technique: the sequences acquired, the planes, and anything that limited them. 5.5.1 covers the standard protocol.

Work through the structures in a fixed order, so an omission shows up as a missing heading rather than hiding in prose. 5.5.9 covers the ligaments.

Record the relevant negatives, since a question is answered only when the alternative has been excluded. 5.1.6 covers imaging pitfalls.

Finish with a conclusion that answers the question in the words the referrer used. 4.1.8 covers the examination documentation.

What Normal Looks Like

A technique paragraph that says what was acquired and what was not. 5.5.1 covers the standard protocol.

A findings section organised by structure, each one stated as present, absent or not assessable. 5.5.8 covers the menisci.

Measurements given with the convention used to make them. 5.16.4 covers the TT-TG measurement.

A conclusion short enough to be read in full and specific enough to act on. 5.20.8 covers common reporting errors.

What Abnormal Looks Like

A report that describes the images and never returns to the question. 5.1.3 covers choosing the correct investigation.

A findings list with no negatives, so a structure's absence from the text could mean normal or unexamined. 5.1.6 covers imaging pitfalls.

A conclusion that repeats the findings rather than interpreting them. 5.20.8 covers common reporting errors.

A measurement with no convention attached to it. 5.16.4 covers the TT-TG measurement.

Hedging language that hands the decision back to the referrer. 4.1.6 covers the examination in the era of MRI.

MRCS Level

How It Is Acquired

In a viva the expected answer treats the report as an instrument with a user.

The expected points are the clinical question, the technique, the fixed order, the relevant negatives, and a conclusion that decides something.

Say that the quality of the request sets a ceiling on the quality of the report. 5.1.3 covers choosing the correct investigation.

Say that a structured report can be audited where free prose cannot. 5.1.7 covers evidence-based imaging.

Say that the same template is what makes two studies comparable over time. 5.20.7 covers reporting the post-operative knee.

What Normal Looks Like

The reasoning expected is that a report serves a reader who will not look at the images, so completeness and ordering do work that prose cannot. 4.1.8 covers the examination documentation.

Relevant negatives are the part most often dropped and the part a surgeon leans on hardest, because an operation is planned around what is not there. 5.17.2 covers the meniscal repair.

A fixed order lets a reader find one structure without reading the whole report, which is how reports are used in a clinic. 5.5.9 covers the ligaments.

Naming the convention behind a measurement is what makes the number portable between departments. 5.16.4 covers the TT-TG measurement.

How Good It Is

Structured reporting is the best available way to make reports complete and does nothing for the judgement inside them.

Its best contribution is completeness and comparability, both of which free text achieves by luck. 5.1.7 covers evidence-based imaging.

It is limited by the fact that a template can be filled in without thought, so a complete report can still be wrong. 5.20.8 covers common reporting errors.

No figures appear for accuracy on this page, under decision 028, and no reader agreement statistics appear either: those are published quantities from particular reader panels and this environment cannot check them.

FRCS Level

How Good It Is

At decision level a report either constrains the operative plan or it does not, and most reports do not. 5.1.2 covers clinical examination versus imaging.

A report naming the pattern, the location and the extent constrains the plan. 5.20.2 covers reporting meniscal tears.

A report naming the structure alone leaves the plan where it was. 5.20.8 covers common reporting errors.

The surgeon reviews the images regardless, so the report's value lies in directing that review rather than replacing it. 4.1.6 covers the examination in the era of MRI.

A conclusion that commits is what allows a disagreement between the report and the images to be noticed at all. 5.1.6 covers imaging pitfalls.

Where It Misleads

The commonest error is reading completeness as accuracy. 5.20.8 covers common reporting errors.

A populated template reads as a thorough study even when the sequences acquired could not support the findings. 5.5.1 covers the standard protocol.

Text copied from a previous report carries forward a finding that has since changed. 5.20.7 covers reporting the post-operative knee.

Standard phrases acquire local meanings, so one department's wording is read as the national one. 5.21.1 covers the meniscal imaging literature.

A long findings section with a short conclusion reads as a careful report when it may be an undecided one. 4.1.6 covers the examination in the era of MRI.

Fellowship Level

Where It Misleads

At fellowship level the report in front of you was written in another department, to another template, for another question. 5.1.3 covers choosing the correct investigation.

The words have no shared definition between departments, so the same appearance yields different reports and the referrer cannot tell which. 5.21.1 covers the meniscal imaging literature.

A report generated automatically is complete by construction and carries no record of what the model could not assess. 5.18.8 covers artificial intelligence in imaging.

Serial comparison across departments compares templates as much as it compares knees. 5.20.6 covers reporting osteoarthritis.

Re-reporting a study from elsewhere is a clinical act and belongs in the notes as one. 4.1.8 covers the examination documentation.

The useful report states the question, the technique and its limits, the findings with their negatives, the measurements with their conventions, and a conclusion that commits. 5.20.8 covers common reporting errors.