It is clear that for a more widespread move towards structured reporting, it will be necessary to engage all stakeholders, such as information technologists and radiologists across borders. Unfortunately, information on different national implementation strategies for structured reporting is lacking. To get a better overview on the current status of structured reporting in different countries, the members of the ESR’s eHealth and Informatics Subcommittee performed a literature review and informally reached out to several representative radiologists as opinion leaders in their network around the world to collect responses to three key questions:

Are there any reporting templates that have been/are made available on a national level by the national radiology society or subspecialty societies?

Are there any monetary or structural incentives to use structured reporting templates?

Are there cross-institutional applications using structured reporting templates, e.g., for registries or research?

Given the rather informal nature of this approach, there may well be initiatives and/or approaches to structured reporting that the respondents were not aware of. Similarly, all collected responses represent individual views, may only apply to the respective individual’s institution can therefore not be considered exhaustive. Nevertheless, the respondents’ qualitative answers can still provide valuable insights into the usage of structured reporting in different countries while allowing for patterns to be identified to help guide future developments.

EuropeFrance

There are no general national initiatives for structured reporting in radiology, apart from the Women’s Imaging subspecialty society (SIFEM) who recently published report templates for both breast and gynecological imaging, including interventional [12]. However, there are no national incentives (particularly economic) and only individual initiatives of template-based reporting in institutions or in research contexts. An unofficial survey among radiologists of the executive committee of the oncologic imaging subspecialty society showed that all had a template or table used in their institution for RECIST evaluation, but none were cross-institutional. Only in the context of the COVID pandemic was a nationwide structured report proposed; however, the extent of its use was not evaluated at a national level.

Germany

Over the past years, the IT Subcommittee of the German Radiological Society (DRG) has been actively developing reporting templates on a national level and made them available on a dedicated website: www.befundung.drg.de. Currently, 26 report templates are available on the DRG’s website, most of which have been developed in consensus with other DRG subcommittees as well as other relevant scientific societies—e.g., in the case of the report templates for staging of pancreatic cancer, with the respective surgical and oncological societies, or in the case of the report templates for cardiac imaging with the respective cardiological societies [13,14,15]. While there are no monetary incentives to use reporting templates in Germany, the DRG’s reporting templates have recently been included in the national guidelines for diagnosis and treatment of pancreatic cancer, thus highlighting their value on a national level [16]. In contrast to this, respondents stated that despite templates being available and some institutions having bought structured reporting software, reporting in clinical routine is mainly done using free-text dictation—with some institutions being notable exceptions [17]. In research settings, first use-cases of cross-institutional applications using structured reporting are emerging. In the wake of the COVID-pandemic, a state-funded research project connecting all German university hospitals was established in which selected imaging data is collected alongside the corresponding structured reports for which dedicated templates have been developed [18].

Italy

A similar national initiative was established by the Italian Society of Medical and Interventional Radiology, where panels of expert radiologists developed various report templates for dedicated pathologies (including breast cancer, pancreatic cancer, lymphoma, neuroendocrine neoplasms and others) using the Delphi method and included them in the corresponding publications [19,20,21,22,23,24,25,26]. Despite these efforts, the contacted radiologists reported that there were no special incentives for using structured reporting templates and were not aware of cross-institutional applications.

Netherlands

Recently, the mammography section of the Dutch Society for Radiology (NVvR) has started working on a structured reporting template for mammography but has not yet published it. In parallel, other sections of the NVvR are working on standard reports, which do not directly refer to template-based reporting. Similar to other countries, no incentives are in place, and respondents were not aware of any cross-institutional applications of structured reporting.

Spain

The Spanish Radiological Society (SERAM) endorses the use of structured report templates, based on imaging modalities and anatomical parts together with disease-specific structured reports. The society highlights this endorsement by the many different papers on the 2022 annual meeting monograph published in the society’s journal [27]. Also, the Spanish Society for Neuroradiology (SENR) started an initiative to develop structured reporting templates. Currently, a dedicated report template for dementia assessment can be accessed on the SENR’s website [28]. Apart from that, the respondents were not aware of any initiatives on a national level and reported no incentives for the usage of structured report templates.

Sweden

Efforts to developing structured report templates have been coordinated between the Swedish Society of Radiology and the Swedish Colorectal Cancer Registry and as a result a dedicated structured report template was introduced [29]. As in other countries, no specific incentive is in place, and therefore—even for rectal cancer where a template is available—the majority of radiological reports are composed using free-text dictation.

Switzerland

While respondents were not aware of specific incentives for structured reporting in Switzerland, some institutions already implemented structured reporting in some form into their reporting workflows. The Swiss Society of Radiology (SGR/SSR) set up a working group on structured reporting to further coordinate the efforts on a national level and provide templates for download in all Swiss working languages [30]. Currently, reporting templates for a variety of examinations and clinical indications are available for download on their website—mostly in the form of word files with specific subheadings to better organize findings.

Outside EuropeUnited States of America

While the RSNA’s reporting initiative [31] has been one of the first coordinated efforts to facilitate the adoption of structured reporting, the RSNA’s templates (www.radreport.org) are not widely used. Respondents stated that this is mainly due to vendors showing little interest in adopting interoperable standards such as IHE MRRT [8]. In contrast, on a departmental level, various structured reporting templates are used, mainly for cross-sectional imaging and interventional procedures [32]. In cases of departments spanning over multiple sites, e.g., multiple hospitals and outpatient centers, report templates are distributed across the enterprise. While on a national level the use of structured reporting templates is not monetarily incentivized per se, its usage has some advantages for institutions. In some cases where billing is tied to report completeness (e.g., to bill for a “complete abdomen ultrasound” explicit mentions of the inferior vena cava and the aorta must be included) or participation in quality improvement programs (e.g., requiring reporting of specific metrics or report items in breast and lung cancer) is mandatory, structured reporting helps ensure the necessary information are included in the radiologists’ final reports. Similarly, structured reporting can be used to facilitate data collection for registries, e.g., the American College of Radiology’s National Radiology Data Registry [33]. Interestingly, pathology departments are using structured reporting templates, too, and through its usage can receive credit towards their accreditation status.

United Kingdom

Given the RSNA’s templates’ availability, the need for a national initiative to develop structured reporting templates in the United Kingdom may always have been somewhat limited. Consequently, the respondents stated that there is no separate national initiative for structured reporting in the UK. Much as in other countries, it was stated that the usage of reporting templates is very variable and mostly a personal choice—only in very few instances are there individual departmental policies promoting their usage. The National Health Service does not require structured reporting to be used and does not provide any dedicated incentives. The respondents were not aware of any cross-institutional applications where structured reporting templates were used to facilitate data collection and exchange.

Turkey, Israel, and India

None of the contacted radiologists were aware of national initiatives regarding structured reporting in their respective countries, and neither are incentives offered nor are there any mandates in place. An initiative to promote structured reporting started in 2018 by the Turkish Ministry of Health and the Turkish Society of Radiology was not able to reach consensus for proposing reporting templates and ultimately only proposed report formats. Consequently, no reporting templates are available on a national level and reporting is done using free-text dictation. On a departmental level, some individual radiologists use reporting templates, e.g., for cardiac imaging, but this does not extend to cross-institutional applications.

Asia–Pacific

In a recently published position statement, the Asian Oceanian Society of Radiology (AOSR) recognizes the value of reporting templates and advocates that templates be individualized to accommodate heterogeneous access to resources within the diverse group of Asia Oceanian countries [34]. To further promote the usage of structured reporting templates, the AOSR aims to develop a platform (ASTeR—AOSR Structured Template Reporting) to host downloadable report templates that are reviewed and endorsed by the relevant subspecialty societies. The Asian Society for Abdominal Radiology is currently reviewing templates for rectal, liver, and prostate imaging which shall be published in a variety of working languages to reflect the diverse nationalities that make up the AOSR member societies.