Jan Bosmans

PURPOSE: To investigate and compare the opinions and expectations regarding the radiology report of radiologists and referring clinicians and to identify trends, discordance, and discontent. MATERIALS AND METHODS: A total of 3884 clinicians and 292 radiologists were invited by e-mail to participate in two internet surveys, COVER (for clinical specialists and general practitioners) and ROVER (for radiologists). Respondents were asked to state their level of agreement with 46 statements according to a Likert scale. Dichotomized results were compared by using the χ(2) statistic. RESULTS: Eight hundred seventy-three completed forms were prepared for analysis, corresponding to a response rate of 21%. Most clinicians declared themselves satisfied with the radiology report. A large majority considered it an indispensable tool and accepted that the radiologist is the best person to interpret the images. Nearly all agreed that they need to provide adequate clinical information and state clearly what clinical question they want to have answered. Itemized reporting was preferred for complex examinations by both the clinicians and the radiologists. A majority in both groups were convinced that learning to report needs to be taught in a structured way. CONCLUSION: The surveys emphasize the role of the radiologist as a well-informed medical imaging specialist; however, some of the preferences of radiologists and clinicians diverge fundamentally from the way radiology is practiced and taught today, and implementing these preferences may have far-reaching consequences.

We report clinical outcomes following transcatheter aortic valve implantation (TAVI), using the CoreValve revalving system (18 Fr transfemoral or subclavian) or the Edwards Sapien valve (22 Fr transfemoral or 24 Fr transapical) as part of a Belgian prospective nonrandomized multicentre registry. All 15 Belgian centres performing TAVI participated to this registry (seven exclusively Edwards Sapien, eight exclusively CoreValve). All consecutive high-risk symptomatic patients with severe aortic stenosis were evaluated by a heart team and screened for eligibility for TAVI. Three hundred and twenty-eight patients underwent TAVI with CoreValve (ns141; eight subclavian and 133 transfemoral) or Edwards Sapien (ns187; 99 transfemoral and 88 transapical) up to April 2010. Procedural success was 97%. Onemonth survival was 88% for the Edwards and 89% for the CoreValve treated patients. One-month mortality was both related to cardiac and non-cardiac reasons. Overall one-year survival was 78% in the CoreValve transfemoral treated patients, 100% in the CoreValve subclavian treated patients, 82% in the Edwards transfemoral treated patients and 63% in the Edwards transapical treated patients. This mid-term mortality was mainly related to age-related, non-cardiac complications.

PURPOSE: To determine why, despite growing evidence that radiologists and referring physicians prefer structured reporting (SR) to free text (FT) reporting, SR has not been widely adopted in most radiology departments. METHODS: A focus group was formed consisting of 11 radiology professionals from eight countries. Eight topics were submitted for discussion. The meeting was videotaped, transcribed, and analyzed according to the principles of qualitative healthcare research. RESULTS: Perceived advantages of SR were facilitation of research, easy comparison, discouragement of ambiguous reports, embedded links to images, highlighting important findings, not having to dictate text nobody will read, and automatic translation of teleradiology reports. Being compelled to report within a rigid frame was judged unacceptable. Personal convictions appeared to have high emotional value. It was felt that other healthcare stakeholders would impose SR without regard to what radiologists thought of it. If the industry were to provide ready-made templates for selected examinations, most radiologists would use them. CONCLUSION: If radiologists can be convinced of the advantages of SR and the risks associated with failing to participate actively in its implementation, they will take a positive stand. The industry should propose technology allowing SR without compromising accuracy, completeness, workflows, and cost-benefit balance. MAIN MESSAGES: Structured reporting offers radiologists opportunities to improve their service to other stakeholders. • If radiologists can be convinced of the advantages of structured reporting, they may become early adopters. • The healthcare industry should propose technology allowing structured reporting. • Structured reporting will fail if it compromises accuracy, completeness, workflows or cost-benefit balance.

Intracranial hemorrhage is an uncommon complication of dural puncture. In most instances, hematomas are subdural; they may be unilateral or bilateral. Rarely are intraparenchymal cerebral hemorrhages related to dural puncture. This report describes a delayed occurrence of bilateral intraparenchymal hemorrhages in a 38-year-old woman 7 days after lumbar myelography with iohexol. A review of the literature is presented.