Purpose
A key component of response evaluation in oncologic imaging is the comparison with previous examinations. The radiologic imaging that is performed before starting chemotherapy is referred to as the baseline study. After several cycles of chemotherapy, the imaging with the lowest tumour burden is the nadir examination. For reliable response evaluation, radiologists should compare the current study with the baseline study, and if applicable the nadir study. According to Response Evaluation Criteria in Solid Tumors (RECIST), comparison can encompass one up to five lesions. Finding the correct study, the proper series, and the right lesion is prone to errors and time-consuming. 
The PACS integrated reporting system allows the application of hyperlinks in radiology reports. The intended usage of this system is to enable referring clinicians to find specific radiology findings by selecting hyperlinks in radiology reports. Radiologists can also make use of the hyperlinks in radiology reports of previous examinations. Hyperlinks improve concordance on target lesion selection. Even though the availability of the functionality of hyperlinks in PACS integrated reporting, its application in daily-practise by radiologists has not been systematically assessed.
Our purpose is to demonstrate a practical strategy for accurate and efficient oncologic CT evaluation using hyperlinks in radiology reports and assess the usage of hyperlinks among radiologists.

Methods
In previous work, we describe an improved workflow for response evaluation in oncologic imaging. Elements of that project are applying structured reporting based on the RECIST criteria, sub-specialisation of radiologists and an operating agreement among radiologists (Eur Radiol. 2018 Oct;28(10):4274-4280. doi: 10.1007/s00330-018-5427-x ).
In this study, we describe a specific part of this workflow regarding looking up lesions in previous examinations for comparative purposes. We parallel the conventional and hyperlink-enhanced approach by demonstrating a schematic representation and performing a simulation study.
We assessed the usage of hyperlinks by a survey among radiologists and by checking radiology reports of oncology CT's in the periods 27 June-27 September 2016 and 27 June- 27 September 2020.

Results
Figure 1 demonstrates an example of a structured report with hyperlinks.
Figure 2 provides a schematic representation of the conventional workflow and the hyperlink assisted workflow. 
Table 1 demonstrates a simulation of the estimated time in seconds needed for radiologists to perform the task of finding and comparing with previous studies. Radiologists can achieve up to a fivefold timesaving for looking up previous lesions by using hyperlinks.
The response rate of the survey was 86% (12/14). The results indicated that 92% of radiologists are familiar with hyperlinks in radiology reports, 83% are making hyperlinks in their reports, 83% use hyperlinks to identify previous examinations, and 92% use hyperlinks in multidisciplinary team meetings. At a 5 point scale ranging from not useful to very useful, nine radiologists (75%) provided the highest score(figure 3).  
The percentages of oncology CT reports containing hyperlinks in the three month periods in 2016 and 2020 were 80% (99) and 86% (85) respectively (p = 0.013).

Conclusion
Usage of hyperlinks in PACS integrated reporting contributes to accurate and efficient radiology reporting in oncologic imaging. 
Radiologist value the functionality of hyperlinks as high.

Hyperlinks in radiology reports: improved efficiency in comparing current with previous examinations in oncologic imaging and high user satisfaction.

The new EuSoMII Annual Meeting 2020 is a very nice live format with hosts and moderators in live video streaming  plus speakers connected remotely from Europe and US. The Program includes a morning session with Didactic Lectures and the possibility to do an examination at the end. A great afternoon session will follow: 2 great European speakers  and a Joint Session with our US partner  SIIM (Society for Imaging Informatics in Medicine). [Visit the Event Page](https://www.eusomii.org/events/eusomii-annual-meeting-2020/https://www.eusomii.org/events/eusomii-annual-meeting-2020/#:~:text=The%20new%20EuSoMII%20Annual%20Meeting,an%20examination%20at%20the%20end.)

[Introduction of the speakers](https://drive.google.com/file/d/12c7ObMM72HgA6TYZ1j8NWTqCcHumXurG/view?usp=sharing)

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