Abstract
Purpose
Free text reports (FTR) of head and neck ultrasound studies are currently deployed in most departments. Because of a lack of composition and language, these reports vary greatly in terms of quality and reliability. This may impair the learning process during residency. The purpose of the study was to analyze the longitudinal effects of using structured reports (SR) of head and neck ultrasound studies during residency.
Methods
Attending residents (n = 24) of a tripartite course on head and neck ultrasound, accredited by the German Society for Ultrasound in Medicine (DEGUM), were randomly allocated to pictures of common diseases. Both SRs and FTRs were compiled. All reports were analyzed concerning completeness, acquired time and legibility. Overall user contentment was evaluated by a questionnaire.
Results
SRs achieved significantly higher ratings regarding completeness (95.6% vs. 26.4%, p < 0.001), description of pathologies (72.2% vs. 58.9%, p < 0.001) and legibility (100% vs. 52.4%, p < 0.001) with a very high inter-rater reliability (Fleiss’ kappa 0.9). Reports were finalized significantly faster (99.1 s vs. 115.0 s, p < 0.001) and user contentment was significantly better when using SRs (8.3 vs. 6.3, p < 0.001). In particular, only SRs showed a longitudinally increasing time efficiency (− 20.1 s, p = 0.036) while maintaining consistent completeness ratings.
Conclusions
The use of SRs of head and neck ultrasound studies results in an increased longitudinal time-efficiency while upholding the report quality at the same time. This may indicate an additive learning effect of structured reporting. Superior outcomes in terms of comprehensiveness, legibility and time-efficiency can be observed immediately after implementation.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Background
Ultrasound of the head and neck is the diagnostic modality of choice for a wide variety of routine and emergency patients in otorhinolaryngology [1,2,3,4,5]. Potential reasons for this development may include the high availability, the absence of potential harm due to radiation, the applicability for claustrophobic patients as well as a high cost–benefit calculation [6, 7]. Whereas mode and manner of the examination is taught widely throughout medical school and residency, high quality reporting remains a major challenge. This stands in sharp contrast to the high and yet rising importance of the report and its respective content. Consequently, insufficient report quality may cause misunderstandings between the referring and examining physician which may result in inadequate clinical decision making with potential medical and legal issues [8,9,10].
Structured reporting has proven to be a promising approach to standardize report content and improve overall report quality of several diagnostic modalities, including head and neck ultrasound [11,12,13,14,15,16,17]. Additionally, referring and examining physician generally favor structured reports (SR) over free text reports (FTR) because of the standardized approach and use of recommended terminology [18,19,20,21,22]. Since head and neck ultrasound is a key element in tumor follow-up and planning of operations, comprehensive and understandable reports are indispensable [21]. Additionally, inexperienced residents may profit from using SRs because relevant anatomical structures are pointed out to the examiner and the recommended terminology is also offered. This may result in more complete and comprehensive composed reports during the learning process [3, 13].
While clinical studies were able to demonstrate a superior report quality of SRs of head and neck ultrasound in the context of routine outpatient treatment and medical school training, there are no data concerning its impact on the longitudinal learning process during residency [14, 15]. It remains elusive at what point in time structured reporting should be implemented during training and how this affects the individual learning curve.
Therefore, the present study’s objective was to analyze the effects of using SRs of head and neck ultrasound studies on the longitudinal learning curve over the course of residency. As previously described, we hypothesized that training effects are characterized by obtaining new expertise and capacities that ultimately influence attitudes, decisions and actions [15, 23]. By monitoring the report quality of participating residents’ report quality over the course of a year, the additive training effect of each report type may be illuminated. Besides, we examined the user contentment of participating residents regarding each type of report.
Methods
Study design
In total, 24 residents of different training levels who participated in our 2018 tripartite course on head and neck ultrasound, accredited by the German Society for Ultrasound in Medicine (DEGUM), agreed to participate in this trial. All participants were trained to create FTRs ahead of the course in their daily work routine. The individual level of experience with regard to ultrasound diagnostic was evaluated prior to inclusion by individual self-assessment using a five-point scale (0: insufficiently experienced, 5: very experienced, see Table 1).
Participating residents received training on how to use our department’s standard FTR template and were randomly allocated to pictures of various frequent diseases of the neck in each course. The pictures were sampled at our outpatient-department ahead of the course and selected in an increasing order of complexity (see Table 2). Therefore, the individual learning process was reflected in order to prevent a ceiling effect. Subsequently, each participant created FTRs and SRs of the assigned pathology and completed a user contentment questionnaire at each course.
Sample size calculation
The amount of reports needed was computed based on the anticipated effect size when comparing the quota of each report type with a completeness of 80% or higher [24]. We figured that using FTRs would result in a ratio of 40% very high completeness appraisals, considering prior publications [14, 15]. Additionally, we estimated that using SRs results in an increase of very high completeness ratings to 80%. The power was set to 80% with a significance level of α = 0.05. Consequently, the minimum number of reports required within this trial was computed to be n = 44 (22 reports of each type).
FTR and SR
In this study, our standard form used in our department was utilized to create FTRs. As previously published, an online-based platform (Smart Reporting GmbH, Munich, Germany, https://smart-reporting.com) was utilized to create a specialized structured reporting template for head and neck ultrasound studies [14, 15]. The structured reporting template incorporates the current recommendations of the DEGUM with regard to anatomical structures and terminology and addresses a maximum variety of pathologies consistently in every report (see Fig. 1).
Report evaluation
Anonymized reports were assessed by two board-certified otorhinolaryngologists independently regarding their completeness with respect to lymph nodes, major salivary glands and blood vessels, accuracy concerning pathological features and terminology. In order to standardize the assessment, an evaluation form was incorporated and reports were categorized as insufficient (0–20% overall report quality), poor (20–40%), moderate (40–60%), high (60–80%) and very high (80–100%) as previously described [14, 15]. Moreover, legibility of each report type was subjectively valued utilizing a five-point scale as previously described [14, 15]. Time spent on reporting was document during report generation. User contentment was inquired by using a questionnaire utilizing a ten-point visual analogue scale as previously published.
Statistical analysis
Data are reported as mean ± standard deviation (SD). To compare report evaluations and questionnaire findings, Wilcoxon signed-rank test for paired nominal data was applied. Additional possible correlations were evaluated using linear regression analysis and inter-rater reliability was tested by Fleiss’ kappa [25]. A p-value of less than 0.05 was defined as statistically significant. All statistical tests were performed utilizing SigmaPlot 12 (Systat Software, Inc., San Jose, CA, USA).
Results
Report analysis
In total, 144 anonymized reports (72 SRs and FTRs each) were derived from all three course parts. Report evaluation revealed that using a SR template lead to a significantly increased comprehensiveness in all categories (95.6% vs. 26.4%, p < 0.001). To be more precise, structured reporting produced higher completeness ratings in terms of reported lymph node levels (92.3% vs. 17.3%, p < 0.001), major blood vessels (98.8% vs. 15.5%, p < 0.001) and salivary glands (97.8% vs. 59.3%, p < 0.001). Additionally, pathologies were reported significantly more accurate and detailed using structured reporting (72.3% vs. 58.9%, p < 0.001). Average duration to finalize the report was also significantly shorter in SRs (99.1 s vs. 115.0 s, p < 0.001). SRs were significantly better readable (100% vs. 52.4%, p < 0.001) than FTRs. Consequently, overall report quality was significantly better in SRs in comparison to FTRs (91.8% vs. 35.1%, p < 0.001) with a positive correlation between high-quality reports with structured reporting (91.7% vs. 6.0%, p < 0.001). More details of the report analysis are given in Fig. 2.
In a next step, the participants’ individual longitudinal learning progress throughout the three course parts was evaluated. For SRs, data analysis showed a progressive time efficiency in course II (− 16.1 s, p = 0.072) which continued and reached significance level in course III (− 20.1 s, p = 0.036) when compared to baseline. This effect was not observed in FTRs which showed constant time requirements in courses II (− 1.1 s, p = 0.463) and III (− 0.48 s, p = 0.479). Moreover, FTRs revealed a significant absolute decrease in overall report quality in course II (− 15.8%, p = 0.009) as well as in course III (− 10.7%, p = 0.04) when compared to baseline. This significant decrease in overall report quality was not observed in SRs, neither in course II (− 2.2%, p = 0.09) nor in course III (− 6.2%, p = 0.084). More details concerning the report progress analysis can be found in Fig. 3.
Additionally, only structured reporting produced a very high inter-rater reliability with a Fleiss’ kappa of 0.9.
User contentment
Overall, the user contentment questionnaire showed that all interviewed participating residents significantly favored structured reporting (8.3 vs. 6.3, p < 0.001). In detail, using SRs was thought to generate a predominant report quality (8.7 vs. 5.2, p = 0.005) and to be supportive for residents learning to report head and neck ultrasound studies (8.5 vs. 6.9, p = 0.017). All other questions revealed a tendency towards a preference for SRs without reaching significance level (see Fig. 4).
Discussion
Over the course of the last few decades ultrasound studies of the head and neck have evolved to the gold standard in the diagnostic workup of a great variety of pathologies in otorhinolaryngology [1,2,3,4,5]. Despite its great importance for clinical practice and decision-making, there is almost no training in reporting in most departments [8]. The report of any imaging technique represents the essence of the examination since it transmits its content and conclusion. Additionally, it is the baseline for follow-up examinations which are frequently carried out in head and neck oncology [5, 26]. The head and neck region is comprised of a multitude of delicate structures within a rather small space. This makes their three-dimensional topography more complicated to interpret, which effects the reporting of any imaging technique [27]. Therefore, the implementation of structured reporting tools has the potential to overcome these challenges [14, 15].
Structural report content, terminology as well as important anatomical structures and their mutual relevance may be incomprehensible to inexperienced physicians because of a general lack of report training. Structured reporting has been promoted to challenge these troubles by multiple societies and publications. It has the capability to lead inexperienced examiners through the process of examination and reporting and by proposing important anatomical structures and their reciprocal orientation along with appropriate language to specify [28].
Our analysis revealed that using SRs leads to a significantly higher report completeness, a more detailed description of pathologies and a better report legibility resulting in a higher overall report quality. Besides, average time to create a report was significantly shorter for SRs. Evaluation of user contentment revealed a significant overall preference for SRs with a focus on improvement of report quality and support in report training. These results are in accordance with previous publications that studied the impact of structured reporting on a variety of imaging techniques, including head and neck ultrasound [12, 14, 15, 18,19,20,21, 24].
Moreover, SRs have been shown to reduce grammatical or orthographical mistakes for inexperienced and especially non-native residents the era of globalization and rural depopulation with an increasing need for telemedical consulting [29, 30]. Additionally, SRs have been associated with a reduced number of missed pathologies, a higher diagnostic accuracy and an improved intra- and interrater reliability as underlined by our results [13, 16, 19, 31].
It remains unclear to what extent structured reporting supports the learning process of diagnostic modalities [28]. Previous publications from our study group have pointed out a positive influence of structured reporting on report quality and time efficiency during medical school [15]. It is yet unknown if inexperienced examiners, whether medical students or residents, will benefit from an early implementation of this technology or if a fundamental knowledge, which is indispensable for free text reporting, is also favorable ahead of implementation. Additionally, it is unclear if these positive effects are attributed only to the implementation or if this development progresses longitudinally over time. The latter would most likely indicate a sustainable additive educational effect of structured reporting. As far as we know, there have not been any longitudinal studies concerning the impact of structured reporting on potential training effects. Our data provide evidence for the first time that improvement of report quality is not exclusively caused by the implementation of a SR template itself. Participating residents created superior reports in terms of quality and time efficiency using structured reporting already at the time of implementation which is in line with other recent studies [14, 15, 20]. Consequently, the implementation itself constitutes a benefit in report quality for trainees of the diagnostic modality. This conflicts with the hypothesis or earlier publications that the introduction of structured reporting results in an initial decrease of time efficiency [32]. In contrast to the latest SR technologies, the use of first-generation SR templates has been proven to be insufficiently intuitive which resulted in an initial impairment of workflow [33].
As stated before, the initial loss in time efficiency in other studies may not be solely attributed to the introduction of structured reporting into clinical practice [32]. A more decisive factor seems to be that most physicians have received training in free text reporting over the past decades.
Whether this instant improvement in report quality and workflow may be compensated over time due to the ceiling effect of the individual learning curve using both modalities is of central importance within the characterization of the learning effect of structured reporting. The longitudinal analysis revealed a progressive time efficiency using SRs in course II which was even more pronounced in course III. In contrast, no improvement in time efficiency was observed using FTRs, neither in course II nor in course III. Additionally, the overall report quality of FTRs deteriorated significantly in course II and remained significantly inferior in course III. Even though there was a tendency towards a decline in overall report quality in SRs as well, this trend remained insignificant.
These findings may be explained by the fact that experienced and versed physicians often concentrate on the main problem for which an examination is carried out, while neglecting other less important or unremarkable findings. This may result in a reduced overall completeness. Additionally, the pathologies presented to the participants during the three course parts were chosen to be increasingly complex and difficult to report. Reporting on a complex pathology in a detailed manner is based on experience and is time-consuming. Consequently, a speed-up due to improved routine may be consumed by more dedicated and detailed reporting. Therefore, the increase in complexity may have outweighed the individual learning curve, resulting in a decrease in report quality and time efficiency. This was most evident in the FTR group in course II in which a substantial decline in report quality was observed. The decline was partially compensated by the individual learning progress between courses II and III but remained significantly inferior to baseline values.
The early introduction and the consequent application of structured reporting resulted in a continuing increase in time efficiency while upholding the report quality at the same time. Both factors are promoted by the pre-defined structure and redundancy of the report. Also, clickable decision-trees prevent physicians from neglecting additional findings by repeated querying. All of these factors facilitate an efficient workflow and therefore cause the significant preference for SRs in this study. Continued improvement of report quality and facilitation of training may be resort to the struggle most diagnostic departments face with queries because of incomplete and ambiguous reports [32].
Finally, participating residents uniformly stated that the use of SRs offers an increase in report quality and supports the learning process and its continued improvement over time. Whether these factors lead to an improved quality of diagnostic and therapeutic services resulting in an improved patient outcome has to be evaluated by future studies. Nonetheless, studies have shown that structured reporting greatly facilitates the compliance with clinical guidelines and therefore with evidence-based medicine [28].
Conclusions
In conclusion, SRs should be considered as the report type of choice for head and neck ultrasound studies during residency. Early implementation of structured reporting results in an increased longitudinal time-efficiency while upholding the report quality at the same time. Superior outcomes in terms of comprehensiveness, legibility and time-efficiency can be observed immediately after implementation. Progressive time efficiency and maintained report quality over time may suggest a sustainable learning effect due to the use of SRs which reflects an improved workflow. These superior findings are substantiated by the fact that residents significantly favor SRs. Therefore, we recommend that structured reporting of head and neck ultrasound studies should be implemented early on during residency.
Abbreviations
- FTR:
-
Free text report
- SR:
-
Structured report
- ACI:
-
Internal carotid artery
- ACE:
-
External carotid artery
- GPA:
-
Parotid gland
- GSM:
-
Submandibular gland
- VAS:
-
Visual analog scale
- DEGUM:
-
German Society for Ultrasound in Medicine
- PACS:
-
Picture archiving and communication system
References
Beach KW, Bergelin RO, Leotta DF, Primozich JF, Sevareid PM, Stutzman ET, Zierler RE (2010) Standardized ultrasound evaluation of carotid stenosis for clinical trials: University of Washington Ultrasound Reading Center. Cardiovasc Ultrasound 8:39. https://doi.org/10.1186/1476-7120-8-39
Moshtaghi O, Haidar YM, Mahmoodi A, Tjoa T, Armstrong WB (2017) The Role of In-office ultrasound in the diagnosis of neck masses. Otolaryngol Head Neck Surg 157(1):58–61. https://doi.org/10.1177/0194599817696288
Forghani R, Yu E, Levental M, Som PM, Curtin HD (2015) Imaging evaluation of lymphadenopathy and patterns of lymph node spread in head and neck cancer. Expert Rev Anticancer Ther 15(2):207–224. https://doi.org/10.1586/14737140.2015.978862
Bialek EJ, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A (2006) US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls. Radiographics 26(3):745–763. https://doi.org/10.1148/rg.263055024
Kunzel J, Bozzato A, Strieth S (2017) Follow-up ultrasound of head and neck cancer. HNO 65(11):939–952. https://doi.org/10.1007/s00106-017-0411-3
Lima PH, Fan B, Berube J, Cerny M, Olivie D, Giard JM, Beauchemin C, Tang A (2019) Cost-utility analysis of imaging for surveillance and diagnosis of hepatocellular carcinoma. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.18.20341
Enders J, Zimmermann E, Rief M, Martus P, Klingebiel R, Asbach P, Klessen C, Diederichs G, Wagner M, Teichgraber U, Bengner T, Hamm B, Dewey M (2011) Reduction of claustrophobia with short-bore versus open magnetic resonance imaging: a randomized controlled trial. PLoS ONE 6(8):e23494. https://doi.org/10.1371/journal.pone.0023494
Wallis A, McCoubrie P (2011) The radiology report—are we getting the message across? Clin Radiol 66(11):1015–1022. https://doi.org/10.1016/j.crad.2011.05.013
Nasrallah HA (2015) Consequences of misdiagnosis: inaccurate treatment and poor patient outcomes in bipolar disorder. J Clin Psychiatry 76(10):e1328. https://doi.org/10.4088/JCP.14016tx2c
Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, Studdert DM (2006) Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 145(7):488–496
Morgan TA, Helibrun ME, Kahn CE Jr (2014) Reporting initiative of the Radiological Society of North America: progress and new directions. Radiology 273(3):642–645. https://doi.org/10.1148/radiol.14141227
Schoppe F, Sommer WH, Schmidutz F, Pforringer D, Armbruster M, Paprottka KJ, Plum JLV, Sabel BO, Meinel FG, Sommer NN (2018) Structured reporting of x-rays for atraumatic shoulder pain: advantages over free text? BMC Med Imaging 18(1):20. https://doi.org/10.1186/s12880-018-0262-8
European Society of R (2018) ESR paper on structured reporting in radiology. Insights Imaging 9(1):1–7. https://doi.org/10.1007/s13244-017-0588-8
Ernst BP, Hodeib M, Strieth S, Kunzel J, Bischof F, Hackenberg B, Huppertz T, Weber V, Bahr K, Eckrich J, Hagemann J, Engelbarts M, Froelich MF, Solbach P, Linke R, Matthias C, Sommer WH, Becker S (2019) Structured reporting of head and neck ultrasound examinations. BMC Med Imaging 19(1):25. https://doi.org/10.1186/s12880-019-0325-5
Ernst BP, Katzer F, Kunzel J, Hodeib M, Strieth S, Eckrich J, Tattermusch A, Froelich MF, Matthias C, Sommer WH, Becker S (2019) Impact of structured reporting on developing head and neck ultrasound skills. BMC Med Educ 19(1):102. https://doi.org/10.1186/s12909-019-1538-6
Tuncyurek O, Garces-Descovich A, Jaramillo-Cardoso A, Duran EE, Cataldo TE, Poylin VY, Gomez SF, Cabrera AM, Hegazi T, Beker K, Mortele KJ (2018) Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning. Abdom Radiol (NY) 44(3):811–820. https://doi.org/10.1007/s00261-018-1858-8
Park SB, Kim MJ, Ko Y, Sim JY, Kim HJ, Lee KH, s (2019) Structured S preference survey of 594 referring physicians, surgeons, and radiologists from 20 hospitals. Korean J Radiol 20(2):246–255. https://doi.org/10.3348/kjr.2018.0109
Gassenmaier S, Armbruster M, Haasters F, Helfen T, Henzler T, Alibek S, Pforringer D, Sommer WH, Sommer NN (2017) Structured reporting of MRI of the shoulder—improvement of report quality? Eur Radiol 27(10):4110–4119. https://doi.org/10.1007/s00330-017-4778-z
Norenberg D, Sommer WH, Thasler W, D'Haese J, Rentsch M, Kolben T, Schreyer A, Rist C, Reiser M, Armbruster M (2017) Structured reporting of rectal magnetic resonance imaging in suspected primary rectal cancer: potential benefits for surgical planning and interdisciplinary communication. Invest Radiol 52(4):232–239. https://doi.org/10.1097/RLI.0000000000000336
Sabel BO, Plum JL, Kneidinger N, Leuschner G, Koletzko L, Raziorrouh B, Schinner R, Kunz WG, Schoeppe F, Thierfelder KM, Sommer WH, Meinel FG (2017) Structured reporting of CT examinations in acute pulmonary embolism. J Cardiovasc Comput Tomogr 11(3):188–195. https://doi.org/10.1016/j.jcct.2017.02.008
Schoeppe F, Sommer WH, Haack M, Havel M, Rheinwald M, Wechtenbruch J, Fischer MR, Meinel FG, Sabel BO, Sommer NN (2018) Structured reports of videofluoroscopic swallowing studies have the potential to improve overall report quality compared to free text reports. Eur Radiol 28(1):308–315. https://doi.org/10.1007/s00330-017-4971-0
Armbruster M, Gassenmaier S, Haack M, Reiter M, Norenberg D, Henzler T, Sommer NN, Sommer WH, Braun F (2018) Structured reporting in petrous bone MRI examinations: impact on report completeness and quality. Int J Comput Assist Radiol Surg 13(12):1971–1980. https://doi.org/10.1007/s11548-018-1828-1
Thomas KD, Muga HE (2014) Handbook of research on pedagogical innovations for sustainable development. Information Science Reference (an imprint of IGI Global) 10.4018/978-1-4666-5856-1
Sahni VA, Silveira PC, Sainani NI, Khorasani R (2015) Impact of a structured report template on the quality of mri reports for rectal cancer staging. AJR Am J Roentgenol 205(3):584–588. https://doi.org/10.2214/AJR.14.14053
Fleiss JL, Cohen J (1973) The equivalence of weighted Kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Measur 33:613–619
Kunzel J, Strieth S, Wirth G, Bozzato A (2018) Ultrasound in the re-staging of cervical metastases after chemoradiotherapy for head and neck cancer. Ultraschall Med 39(6):659–666. https://doi.org/10.1055/a-0573-0908
Bock A, Modabber A, Holzle F, Prescher A, Classen-Linke I (2019) Improvement of anatomical knowledge and surgical skills in head and neck region—an interdisciplinary hands-on course for clinical students. Ann Anat. https://doi.org/10.1016/j.aanat.2019.03.011
Kahn CE Jr, Heilbrun ME, Applegate KE (2013) From guidelines to practice: how reporting templates promote the use of radiology practice guidelines. J Am Coll Radiol 10(4):268–273. https://doi.org/10.1016/j.jacr.2012.09.025
Ranschaert ER, Binkhuysen FH (2013) European Teleradiology now and in the future: results of an online survey. Insights Imaging 4(1):93–102. https://doi.org/10.1007/s13244-012-0210-z
Matsumoto M, Koike S, Kashima S, Awai K (2015) Geographic distribution of radiologists and utilization of teleradiology in japan: a longitudinal analysis based on national census data. PLoS ONE 10(9):e0139723. https://doi.org/10.1371/journal.pone.0139723
Lin E, Powell DK, Kagetsu NJ (2014) Efficacy of a checklist-style structured radiology reporting template in reducing resident misses on cervical spine computed tomography examinations. J Digit Imaging 27(5):588–593. https://doi.org/10.1007/s10278-014-9703-2
Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI (2016) The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. Virchows Arch 468(6):639–649. https://doi.org/10.1007/s00428-016-1935-8
Marcovici P, Blume-Marcovici A (2013) Intuition versus rational thinking: psychological challenges in radiology and a potential solution. J Am Coll Radiol 10(1):25–29. https://doi.org/10.1016/j.jacr.2012.06.029
Acknowledgements
The authors thank Ben Braun for language editing. Additionally, the authors thank the attendees of the 2018 Mainz DEGUM-accredited course on head and neck ultrasound for their participation in this study.
Funding
This research project did not receive any funding.
Author information
Authors and Affiliations
Contributions
BPE and SB contributed to the conception and design of the project and to data collection, analysis and interpretation, and wrote the initial draft of the manuscript. SS, FK, MH, JE, KB, TR, JK, MFF; CM and WHS contributed to the conception and design of the project, as well as the analysis and interpretation. All authors conducted critical revisions of the manuscript, gave final approval to the submitted paper and agreed to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Conflict of interest
Wieland H. Sommer is the founder of the company Smart Reporting GmbH, which hosts an online platform for structured reporting. Matthias F. Froelich is an employee of Smart Reporting GmbH. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This manuscript is part of a medical doctoral thesis presented by Fabian Katzer at the University Mainz Medical School.
Ethical approval on research involving human participants
Ethics approval was obtained by the Institutional Review Board (Ethik-Kommission der Landesärztekammer Rheinland-Pfalz. Reference No: 2018-13225). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ernst, B.P., Strieth, S., Katzer, F. et al. The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency. Eur Arch Otorhinolaryngol 277, 269–276 (2020). https://doi.org/10.1007/s00405-019-05679-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-019-05679-z