title: Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology.
abstract: OBJECTIVE
  More than 75 million Americans have less than adequate health literacy skills according to the National Center for Education Statistics. Readability scores are used as a measure of how well populations read and understand patient education materials. The purpose of this study was to assess the readability of Web sites dedicated to patient education for radiologic spine imaging and interventions.
  
  
  METHODS
  Eleven search terms relevant to radiologic spine imaging were searched on the public Internet, and the top 10 links for each term were collected and analyzed to determine readability scores by using 10 well-validated quantitative readability assessments from patient-centered education Web sites. The search terms included the following: x-ray spine, CT spine, MR imaging spine, lumbar puncture, kyphoplasty, vertebroplasty, discogram, myelogram, cervical spine, thoracic spine, and lumbar spine.
  
  
  RESULTS
  Collectively, the 110 articles were written at an 11.3 grade level (grade range, 7.1-16.9). None of the articles were written at the American Medical Association and National Institutes of Health recommended 3rd-to-7th grade reading levels. The vertebroplasty articles were written at a statistically significant (P< .05) more advanced level than the articles for x-ray spine, CT spine, and MR imaging spine.
  
  
  CONCLUSIONS
  Increasing use of the Internet to obtain health information has made it imperative that on-line patient education be written for easy comprehension by the average American. However, given the discordance between readability scores of the articles and the American Medical Association and National Institutes of Health recommended guidelines, it is likely that many patients do not fully benefit from these resources.
authors.affiliation: From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania david.hansberry@jefferson.edu.
authors.forename: D R
authors.identifier: http://orcid.org/0000-0003-2338-0766
authors.initials: DR
authors.lastname: Hansberry
authors.affiliation: Department of Radiation Oncology (A.L.D., A.V.P.), University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: A L
authors.identifier: http://orcid.org/0000-0002-2477-9608
authors.initials: AL
authors.lastname: Donovan
authors.affiliation: Department of Radiation Oncology (A.L.D., A.V.P.), University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: A V
authors.identifier: http://orcid.org/0000-0002-9928-2911
authors.initials: AV
authors.lastname: Prabhu
authors.affiliation: Department of Neurological Surgery (N.A.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: N
authors.identifier: http://orcid.org/0000-0003-0256-3897
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-5113-2228
authors.initials: M
authors.lastname: Cox
authors.affiliation: From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: A E
authors.identifier: http://orcid.org/0000-0002-4679-0787
authors.initials: AE
authors.lastname: Flanders
mesh_terms: D003142:Communication; D032882:Comprehension; D004522:Educational Status; D006266:Health Education; D057220:Health Literacy; D006801:Humans; D020407:Internet; D008279:Magnetic Resonance Imaging; D009493:Neurosurgery; D010361:Patients; D010817:Physician-Patient Relations; D000072177:Radiologists; D011932:Reading; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed