title: Radiology Reports With Hyperlinks Improve Target Lesion Selection and Measurement Concordance in Cancer Trials.
abstract: OBJECTIVE
  Radiology reports often lack the measurements of target lesions that are needed for oncology clinical trials. When available, the measurements in the radiology reports often do not match those in the records used to calculate therapeutic response. This study assessed the clinical value of hyperlinked tumor measurements in multimedia-enhanced radiology reports in the PACS and the inclusion of a radiologist assistant in the process of assessing tumor burden.
  
  
  METHODS
  We assessed 489 target lesions in 232 CT examinations of 71 patients with metastatic genitourinary cancer enrolled in two therapeutic trials. We analyzed target lesion selection and measurement concordance between oncology records (used to calculate therapeutic response) and two types of radiology reports in the PACS: multimedia-enhanced radiology reports and text-only reports. For statistical tests, we used the Wilcoxon signed rank, Wilcoxon rank sum test, and Fisher method to combine p values from the paired and unpaired results. The Fisher exact test was used to compare overall measurement concordance.
  
  
  RESULTS
  Concordance on target lesion selection was greater for multimedia-enhanced radiology reports (78%) than the text-only reports (52%) (p = 0.0050). There was also improved overall measurement concordance with the multimedia-enhanced radiology reports (68%) compared with the text-only reports (38%) (p < 0.0001).
  
  
  CONCLUSIONS
  Compared with text-only reports, hyperlinked multimedia-enhanced radiology reports improved concordance of target lesion selection and measurement with the measurements used to calculate therapeutic response.
authors.affiliation: 1 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD 20892.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Machado
authors.affiliation: 2 Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Apolo
authors.affiliation: 3 Biostatistics and Data Management Section, Office of the Clinical Director, National Cancer Institute, Rockville, MD.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.affiliation: 1 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD 20892.
authors.forename: Les R
authors.initials: LR
authors.lastname: Folio
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods*; D057225:Data Mining / Q000379:methods; D004282:Documentation / Q000706:statistics & numerical data; D006801:Humans; D008498:Medical Record Linkage / Q000379:methods*; D009323:Natural Language Processing; D011873:Radiology Information Systems / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D066066:Response Evaluation Criteria in Solid Tumors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014565:Urogenital Neoplasms / Q000175:diagnosis* / Q000628:therapy*
keywords: Response Evaluation Criteria in Solid Tumors (RECIST) 1.1; hyperlinks; multimedia; radiology reports; tumor assessment