# Enhancing Radiology Reporting Standards: A Two-Cycle Audit Based on the Royal College of Radiologists (RCR) 2018 Guidelines in a Tertiary Gastroenterology and Hepatology Center in Iraq

## TL;DR

This study improved radiology report quality at an Iraqi hospital by implementing training and structured reporting, aligning with international standards.

## Contribution

A two-cycle audit and targeted interventions significantly enhanced radiology reporting standards in a tertiary hospital in Iraq.

## Key findings

- Actionable reporting improved from 95% to 100% after interventions.
- Advice for next steps increased from 13% to 100%.
- Differential diagnoses in reports rose from 11% to 94%.

## Abstract

Background

High-quality radiology reports are crucial for informing clinical decisions and ensuring patient safety, particularly in a tertiary center like Basra Gastroenterology and Hepatology Hospital (BGHH), Iraq. However, at our institution, many reports lacked key elements such as actionable recommendations, provisional diagnoses, and differential diagnoses, which are essential for clinician-focused reporting. To address these deficiencies, we conducted a two-cycle audit, benchmarking our practice against the 2018 Royal College of Radiologists (RCR) “Standards for Interpretation and Reporting of Imaging Investigations".

Objective

This audit aims to assess whether radiological reports produced at BGHH adhered to the 2018 RCR standards for actionable reporting and to evaluate whether targeted interventions could improve compliance.

Methodology

A two-cycle clinical audit was conducted. During the first cycle in January 2025, 100 radiology reports were randomly selected and analyzed against RCR standards. After identifying key gaps, four targeted interventions were introduced, including departmental training and a structured reporting format. In the second cycle (March-April 2025), another 100 reports were reviewed to evaluate the impact of these changes.

Results

After implementing the interventions, we observed a marked improvement in report quality and compliance with RCR standards. Actionable reporting reached 100%, compared to 95% in the initial cycle (p < 0.05), eliminating any reports lacking clear clinical direction. The presence of advice for next steps, a critical component of actionable reporting, improved dramatically from 13% to 100%, ensuring all reports offered guidance for further management. Furthermore, the presence of differential diagnoses rose from 11% to 94% (p < 0.05), reflecting enhanced clinical reasoning within reports. These improvements demonstrate the effectiveness of structured training and standardized templates in elevating the consistency and clinical utility of radiology reporting.

Conclusion

This audit shows that implementing simple, focused changes led to measurable improvements in the clarity, structure, and clinical usefulness of radiology reports at BGHH. These findings show that even low-cost interventions can enhance report quality and align practice with international standards, ultimately supporting better clinical decision-making. This audit also provides a practical template that could be replicated across other hospitals in Iraq to promote nationwide improvement in radiology reporting.