Structured Radiology Reporting: Best Practices and Templates

The radiology report is the product of the radiologist's work. It is often the only thing the referring clinician reads. Yet traditional free-text reports vary widely in structure, vocabulary and completeness from one radiologist to the next, and sometimes from one day to the next. Structured reporting aims to fix this without turning reports into checkbox forms. Here is what the main professional bodies recommend and how to put it into practice.

What structured reporting means

Structured reporting is not one thing. It usually combines three levels:

1. A consistent layout. The same headings in the same order: clinical information, technique, comparison, findings, impression.
2. Organized content. Within the findings, a predefined sequence of organs or items, so nothing is skipped.
3. Standardized language and coded data. A controlled vocabulary such as RadLex and, where relevant, classification systems that produce data a computer can use.

The European Society of Radiology (ESR) set out the case in a 2018 paper in Insights into Imaging. It describes structured reporting as a key element in improving radiology's value to patients. A standardized structure helps ensure that all relevant areas are addressed. Standard terminology reduces ambiguity and makes reports easier to compare over time. Structured data can also support automated functions, such as cancer staging.

The main resources

RSNA RadReport and the joint template library

The Radiological Society of North America (RSNA) built a public library of reporting templates at radreport.org. It covers common examinations across modalities and subspecialties. Since 2013, the RSNA and the ESR have worked together on these templates through a joint Template Library Advisory Panel (TLAP). The aim is to review templates, adapt them for international use and translate them into other languages.

IHE MRRT

Integrating the Healthcare Enterprise (IHE) developed the Management of Radiology Report Templates (MRRT) profile in 2013. MRRT defines a standard format for exchanging templates between systems, so a template written once can be loaded into different reporting software. The profile was integrated into the IHE radiology technical framework in early 2022.

Disease-specific systems

Classification systems for specific organs and findings (the "-RADS" family, such as BI-RADS for breast imaging) already combine structured content with standardized conclusions and management categories. They show how structure can directly support clinical decisions.

Why adoption is still slow

Despite this, structured reporting is not yet routine in many departments. The ESR's 2023 update in Insights into Imaging noted that it has still not been widely adopted in clinical practice, even though referring physicians often prefer structured reports. It also pointed to a lack of cross-institutional use of templates and of incentives to use them.

Radiologists cite familiar reasons:

• Templates that are too rigid for complex or unexpected findings.
• The feeling of filling in a form instead of thinking about the images.
• Reporting software that makes navigating templates slower than free dictation.
• Templates that do not exist in the reporting language, or that do not fit local practice.

Best practices for implementing templates

Start with high-volume, high-value examinations

Begin with examinations where completeness matters and reports are repetitive: chest CT for nodules, oncology staging and follow-up, prostate or liver MRI, and examinations with an established -RADS system. Early wins build acceptance.

Keep a free-text escape

A good template guides without constraining. Leave room for narrative descriptions of complex findings and unexpected results. The impression section in particular should remain a reasoned synthesis, not an automatic list.

Use "pertinent normals" deliberately

Pre-filled normal statements save time but carry a risk. If the radiologist forgets to change a pre-filled normal, the report can contradict the images. Keep defaults short, and review every pre-filled sentence before signing.

Agree locally, then adapt international templates

Adapt RadReport or ESR templates with your referring clinicians. Surgeons, oncologists and emergency physicians know which items they actually use. Translate terms carefully when reporting in French or Arabic, and keep the coded vocabulary behind the scenes.

Make templates fast to drive

Structure should not cost speed. Voice commands to jump between sections, insert macros and accept normal blocks let radiologists keep their eyes on the images. Reporting software that supports template exchange formats such as MRRT makes maintenance easier.

Measure

Audit a sample of reports before and after adoption: completeness of key items, clarity of the impression, turnaround time and clinician feedback.

Key takeaways

• Structured reporting combines a consistent layout, organized content and standardized language.
• RSNA RadReport templates, reviewed jointly with the ESR, are a free starting point.
• IHE MRRT allows templates to move between reporting systems.
• Start with high-volume examinations, keep free-text options and review every pre-filled normal.
• Combine templates with voice navigation so structure does not slow reporting.

Frequently asked questions

What is structured reporting in radiology?

It is reporting with a consistent layout, a predefined sequence of findings and standardized terminology, often based on templates, to make reports complete and comparable.

Where can I find free radiology report templates?

The RSNA template library at radreport.org offers free templates, developed and reviewed with the European Society of Radiology through a joint advisory panel.

Does structured reporting slow radiologists down?

It can if the software is poorly designed. Voice navigation, macros and well-designed templates help keep reporting speed.

Sources

1. Insights into Imaging — ESR paper on structured reporting in radiology (2018)
2. Insights into Imaging — ESR paper on structured reporting in radiology, update 2023
3. IHE Wiki — How RadLex, radreport.org, RTE, MRRT, CDA and XDS work together (white paper)
4. Radiology Business — Structured for success: the RSNA radiology reporting initiative

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General information, checked at the publication date; it is neither medical nor legal advice.