Improving Patient-Reported Understanding of Radiographic Reports in Spine Surgery Through Implementation of Natural Language Processing: A Randomized Controlled Study

BACKGROUND AND OBJECTIVES: Many spinal imaging reports are written above recommended health literacy levels, limiting patient comprehension at a time when rapid electronic access to radiology results is increasing. We aim to evaluate whether supplemental natural language processing (NLP)–modified radiology reports—within the context of usual patient portal access to the original report—are associated with improved patient-reported perceived understandability compared with standard reports among patients undergoing spine imaging. METHODS: This is a prospective randomized controlled study with limited participant blinding, conducted with 2 spine surgeons affiliated with a single academic medical center in New York City. Participants (18 years or older) undergoing spine imaging at initial surgical consultation were enrolled and were randomized to receive either their original radiology report or a supplemental NLP–modified version. Radiology reports were rewritten using a standardized natural language processing prompt (ChatGPT 4.0) and reviewed for accuracy by study investigators. The primary outcome was survey-based patient-reported perceived understandability. Secondary outcomes included objective readability scores (Flesch-Kincaid Grade Level, Flesch Reading Ease, Simple Measure of Gobbledygook, Gunning-Fog Index). RESULTS: Fifty-two adults were enrolled; 42 (81%) completed the postintervention survey. Among 52 randomized participants (26 women [50%]), NLP–modified reports demonstrated significantly improved objective readability across all indices compared with original reports (Flesch-Kincaid Grade Level, 5.9 ± 1.1 vs 11.0 ± 1.7; Reading Ease, 71.0 ± 10.3 vs 28.2 ± 12.5; Simple Measure of Gobbledygook, 20.1 ± 12.7 vs 23.5 ± 15.7; Gunning-Fog Index, 8.2 ± 1.1 vs 14.3 ± 1.8; all P < .01). Of 42 survey respondents, those receiving supplemental NLP-modified reports reported greater ease of understanding the report language (4.2 ± 1.2 vs 2.6 ± 1.5, mean-difference 95% CI: 0.75-2.53, P < .01, Bonferroni-corrected- P = .02), and less difficulty with medical terms (2.0 ± 1.5 vs 3.6 ± 1.4, mean-difference 95% CI: −2.51 to −0.60, P < .01, Bonferroni-corrected- P = .04). CONCLUSION: Supplemental NLP-modified radiology reports were associated with improved objective readability and higher patient-reported perceived ease of understanding in a spine surgery initial consultation setting. These findings support further investigation of NLP-generated supplemental explanations within supervised clinical workflows.