Structured reporting is emerging as a key element of optimising radiology’s contribution to patient outcomes and ensuring the value of radiologists’ work. It is being developed and supported by many national and international radiology societies, based on the recognised need to use uniform language and structure to accurately describe radiology findings. Standardisation of report structures ensures that all relevant areas are addressed. Standardisation of terminology prevents ambiguity in reports and facilitates comparability of reports. The use of key data elements and quantified parameters in structured reports (“radiomics”) permits automatic functions (e.g. TNM staging), potential integration with other clinical parameters (e.g. laboratory results), data sharing (e.g. registries, biobanks) and data mining for research, teaching and other purposes. This article outlines the requirements for a successful structured reporting strategy (definition of content and structure, standard terminologies, tools and protocols). A potential implementation strategy is outlined. Moving from conventional prose reports to structured reporting is endorsed as a positive development, and must be an international effort, with international design and adoption of structured reporting templates that can be translated and adapted in local environments as needed. Industry involvement is key to success, based on international data standards and guidelines.Key Points• Standardisation of radiology report structure ensures completeness and comparability of reports.• Use of standardised language in reports minimises ambiguity.• Structured reporting facilitates automatic functions, integration with other clinical parameters and data sharing.• International and inter-society cooperation is key to developing successful structured report templates.• Integration with industry providers of radiology-reporting software is also crucial.

Existing quantitative imaging biomarkers (QIBs) are associated with known biological tissue characteristics and follow a well-understood path of technical, biological and clinical validation before incorporation into clinical trials. In radiomics, novel data-driven processes extract numerous visually imperceptible statistical features from the imaging data with no a priori assumptions on their correlation with biological processes. The selection of relevant features (radiomic signature) and incorporation into clinical trials therefore requires additional considerations to ensure meaningful imaging endpoints. Also, the number of radiomic features tested means that power calculations would result in sample sizes impossible to achieve within clinical trials. This article examines how the process of standardising and validating data-driven imaging biomarkers differs from those based on biological associations. Radiomic signatures are best developed initially on datasets that represent diversity of acquisition protocols as well as diversity of disease and of normal findings, rather than within clinical trials with standardised and optimised protocols as this would risk the selection of radiomic features being linked to the imaging process rather than the pathology. Normalisation through discretisation and feature harmonisation are essential pre-processing steps. Biological correlation may be performed after the technical and clinical validity of a radiomic signature is established, but is not mandatory. Feature selection may be part of discovery within a radiomics-specific trial or represent exploratory endpoints within an established trial; a previously validated radiomic signature may even be used as a primary/secondary endpoint, particularly if associations are demonstrated with specific biological processes and pathways being targeted within clinical trials. Key Points • Data-driven processes like radiomics risk false discoveries due to high-dimensionality of the dataset compared to sample size, making adequate diversity of the data, cross-validation and external validation essential to mitigate the risks of spurious associations and overfitting. • Use of radiomic signatures within clinical trials requires multistep standardisation of image acquisition, image analysis and data mining processes. • Biological correlation may be established after clinical validation but is not mandatory.

Objectives To gather information from radiological departments in Europe about the organization and practice of interventional radiology (IR). Methods The European Society of Radiology (ESR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) developed an online survey with questions that addressed the organization of IR within radiology departments. The survey was sent to 1180 addresses of department heads throughout Europe. Results There were 98 answers (response rate 8.3%) from many European nations, reflecting the situation of IR in Europe. Conclusions Five points of action can be suggested based on the survey results. There is a need to assure 24-h service of IR in all radiological departments; networking can be the solution in case staffing problems arise. To attract students, IR needs to be recognized early as a possible career option. Although IR is included in the ESR Curriculum for Undergraduate Radiological Education, this is not the case everywhere, and it must be. There is a “gender issue” in IR since the majority of specialists are male. The lack of role models is probably the main reason why women do not pursue an interventional career. It is, therefore, necessary to increase the number of women in faculty and chair positions to provide a well-balanced leadership team. The field of radiology should work towards recognition of the full clinical role of IR, making efforts to also take into account the “administrative” responsibility throughout the entire process of care for each patient treated by interventional radiologists. Additionally, those radiologists who perform only diagnostic tasks must take an active role in IR. When a situation is encountered which could be amenable to therapy with IR, the radiological report should suggest this form of therapy and the patient should be referred to colleagues in IR.

The European Society of Radiology

The European Society of Radiology (ESR) considers the use of evidence-based referral guidelines in clinical practice essential to ensure the appropriate utilisation of medical imaging for patients. Since 2014, the ESR has been working with the American College of Radiology (ACR) to develop referral guidelines for Europe, based on the ACR Appropriateness Criteria (AC) and appropriate use criteria developed by the ACR Rapid Response Committee. This paper sets out the methodology used by the ESR's Referral Guidelines Subcommittee to adapt the ACR criteria for use in the European clinical decision support (CDS) platform ESR iGuide. The ESR adheres to the ACR's original methodology as far as applicable, and has established additional methodological guidance for its experts, establishing several key principles: Any changes to existing recommendations, and any additional guidelines, should be based on evidence as far as possible Expert opinion, judgement, European practice standards, should only function as a supplement when necessary Appropriateness recommendations should give no consideration to national or institutional circumstances, costs, or availability of equipment. The cooperation between the ACR and ESR on appropriate use criteria and imaging referral guidelines provides added value to both societies as European studies and guidelines from European subspecialty societies of radiology are fed into the process and the exchange of views among the experts makes the guideline development and review process more robust. The ESR's aim is to ensure referrers and patients benefit from the best possible guidance for appropriate imaging.