Report Formats
RheumaView always produces one canonical report first — the validator-confirmed Gold Standard read. Every other format is derived strictly from it: the Standard and Concise clinical formats are condensations at the level of detail the user requests, and the optional analytic addendum is an extension built on the same canonical read. Findings never change between derivations, and all three clinical formats summarize complex longitudinal cases in full. The formats differ in concentration — and in whether they carry an EMR-ready summary and the optional addendum — not in the case complexity they handle.
Shared core — common to all formats
The platform always generates the canonical validated read — Gold Standard (READY+) — first, then derives every other format from it; no derivative can modify, reinterpret, or override it. The read is deterministic: identical input yields identical structured output on re-evaluation. Adequacy is always evaluated; if a study is limited or inadequate, a data-limited statement is surfaced. Whether an adequacy / data-needs block is shown is a setting, not a mandatory section. The three clinical formats correspond to the case-library labels READY+ (Gold), READY (Standard), READY− (Concise) — each more concentrated, not less capable. The EMR-ready summary and the optional research addendum attach to Gold (READY+) only.
Format 01 · READY+ · most complete clinical output
Gold Standard
The reference layer for all other formats. Per-region structured findings carry per-joint / per-level grading, quantified laterality, pattern separation with explicit mimic-control, full prior comparison (including numeric deltas where matched priors exist), an adequacy / data-needs block, and an EMR-ready summary suitable for direct inclusion in the record. Gold is the only tier that carries an EMR-ready summary and the only tier the optional research addendum attaches to.
When to use
- Initial structural assessment
- Disease-modifying therapy decisions
- Multi-region or longitudinal review
- Cases requiring quantitative context
Primary audience
- Radiologists
- Rheumatologists, referring specialists
- Clinical-trial readers
Contains
- Per-region structured findings
- Per-joint / per-level grading
- Quantified laterality · mimic-control
- Prior comparison + numeric deltas
- Adequacy statement (when applicable)
- Impression · EMR-ready summary
Demonstrates
- Descriptor completeness
- Reproducible (deterministic) read
- Full auditability of each finding
- Carries EMR summary + research addendum
Format 02 · READY · concentrated clinical read
Standard
A more concentrated clinical report. The factual core, findings, grading, and comparison are identical in substance to Gold Standard; the differences are concentration (a tighter surface), the absence of an EMR-ready summary, and the absence of the optional research addendum. It handles complex longitudinal cases as fully as Gold — it simply presents them more tightly.
When to use
- Routine follow-up and outpatient workflow
- Complex longitudinal cases, read concentrated
- When no EMR summary or addendum is needed
Primary audience
- Radiologists in routine workflow
- Referring clinicians
Contains
- Per-region structured findings
- Per-joint / per-level grading
- Comparison language (preserved)
- Adequacy statement (when applicable)
- Impression
Differs from Gold
- More concentrated surface
- No EMR-ready summary
- No optional research addendum
- Same findings and case handling
Format 03 · READY− · maximally concentrated
Concise
The most concentrated clinical format: principal structural findings and impression, without the expanded quantitative layer. It still summarizes complex longitudinal cases in full — at maximum concentration. An adequacy statement is surfaced even at minimum depth whenever the study is limited.
When to use
- Rapid triage and pre-read
- Hand-off and consultation summaries
- Maximally concentrated summary of complex cases
Primary audience
- On-call and triage radiologists
- Clinicians needing a brief read
Contains
- Principal structural findings
- Impression
- Adequacy statement (if study limited)
Differs from Standard
- Maximum concentration
- Findings reduced to principal items
- Impression-led
Bilateral knees: minimal tibial-eminence sharpening; tiny left lateral femorotibial marginal spurring, trace lateral irregularity on the right. Femorotibial JSN: medial 0/0, lateral 0–trace 1; trace bilateral patellofemoral spurring (0–trace 1). KL/OARSI ~1 bilaterally. No effusion or destructive erosion on the provided views. Chronic asymmetric proximal fibular cortical remodeling, left greater than right (fusiform thickening, focal cortical buttressing). Versus 2022/2024 priors: ΔJSN 0 · Δosteophytes 0 · ΔKL-OARSI 0/0; fibular remodeling stable.
Minimal bilateral knee osteoarthritic change (approximately KL/OARSI grade 1), with tiny lateral-compartment and patellofemoral spurring; no effusion or destructive erosion. Chronic asymmetric proximal fibular remodeling, greater on the left, stable. No measurable interval progression versus the 2022/2024 priors.
Minimal bilateral knee osteoarthritis, stable; stable chronic left-greater-than-right proximal fibular remodeling.
Within any clinical format, the report can be configured to the reading task. Customization is an overlay on presentation and reporting policy — it changes what the report surfaces and how, not how the platform derives the read. The validated structural read, the deterministic core, and the canonical generation order are unchanged.
An overlay, not a change to the platform
Customization governs which findings, and how much of them, the report presents. The same input still yields the same validated structured source; the underlying read, its lineage, and the way the platform works are unchanged.
Research / Analytic Addendum
An optional analytic layer built on top of the Gold Standard (READY+) report — it attaches to that tier only. It exposes a broader quantitative view of the dataset than the clinical narrative alone. The clinical report is never modified by the addendum — it is appended as a distinct analytic surface and never merged into the clinical text. Public-facing addendum outputs are neutral-labeled. It is offered at a standard analytic tier and a fuller, expanded research tier.
When to use
- Research datasets and registries
- Clinical-trial readouts
- Longitudinal cohort analysis
- Pharma / CRO endpoint review
Primary audience
- Research radiologists, rheumatologists
- Trial sponsors and CROs
- Imaging scientists, statisticians
The clinical report is the system of record. The analytic addendum extends what can be computed from the same dataset; it does not alter what was clinically stated.
RV-003 is one of the most complex cases in the library — five axial/pelvic regions across radiograph, MRI, and EMG/NCS, with a matched ~4-year prior. Its analytic addendum runs to 22 tables with formulas, cross-modal concordance, and a final synthesis. The first matrix is shown; the rest expands below.
A. Quantitative Radiologic Measures
A1. Region-level structural burden matrix
| Region | Dominant structural findings | Distribution | Severity class | Numeric burden (0–4) |
|---|---|---|---|---|
| Cervical XR · current | Straightening, trace C5/C6 retrolisthesis, C5-C6>C6-C7 disc loss, uncovertebral/posterior spurring, mild bilateral foraminal narrowing | Lower cervical | Mild–moderate focal | 1.5 |
| Thoracic XR · current | T7-T12 disc-endplate degeneration, greatest T10-T11/T11-T12 | Lower thoracic contiguous | Mild–moderate | 1.75 |
| Lumbar XR · current | T12-L2 dominant disc degeneration, vacuum at T12-L1/L1-L2, mild lower lumbar facet arthropathy | Thoracolumbar/upper lumbar predominant | Moderate focal / mild global | 2.0 |
| SI joints XR · prior + current (~4-yr interval) | Inferior iliac-sided > sacral-sided sclerosis, mild inferior cortical irregularity, no definite erosions/ankylosis | Bilateral, left slightly greater | Mild | 1.25 |
| Hips/pelvis XR · current | Minimal acetabular spurring, mild reduced head-neck offset, minimal pubic symphyseal degeneration | Bilateral, left slightly greater offset loss | Minimal–mild | 0.5 |
| Cervical MRI · ~4 yr before current | C4-C5 small central protrusion with mild canal stenosis; C5-C6 mild left foraminal stenosis; C6-C7 small central protrusion with minimal canal stenosis and left foraminal stenosis | Lower cervical | Mild | 1.25 |
| Cervical MRI · ~2–3 yr before current | C4-C5 posterior disc-osteophyte complex with mild central stenosis; C5-C6 left uncovertebral hypertrophy with mild left foraminal stenosis; C6-C7 posterior disc-osteophyte complex with minimal central stenosis | Lower cervical | Mild | 1.25 |
| Lumbar MRI · current +~1 mo | L5-S1 disc desiccation, minimal broad-based bulge, minimal bilateral foraminal stenosis | Focal L5-S1 | Minimal–mild | 0.75 |
| Pelvic/SI MRI · current +~3 wk | Mild marrow-edema-like signal on both sides of both SI joints, no erosions, no effusion; L5-S1 shallow central protrusion with annular fissure | Bilateral SI + L5-S1 | Mild inflammatory/reactive MRI signal burden | 1.25 |
Show full analytic addendum · 21 more tables
A2. XR disc-space / compartment grading
| Structure | Grade |
|---|---|
| C5-C6 disc space loss | 2/4 |
| C6-C7 disc space loss | 1/4 |
| T7-T8 | 1/4 |
| T8-T9 | 1/4 |
| T9-T10 | 1/4 |
| T10-T11 | 2/4 |
| T11-T12 | 2–3/4 |
| T12-L1 | 2/4 |
| L1-L2 | 2/4 |
| L2-L3 | 1/4 |
| L3-L4 | 1/4 |
| L4-L5 | 0–1/4 |
| L5-S1 | 0–1/4 on XR; minimal bulge/desiccation on MRI |
| SI superior JSN right | 0/4 |
| SI superior JSN left | 0/4 |
| Hip JSN right | 0/4 |
| Hip JSN left | 0/4 |
A3. SI structural scorecard
| Feature | Right | Left | Summary |
|---|---|---|---|
| Inferior iliac-sided sclerosis | 1.0 | 1.25 | Mild, left > right |
| Inferior sacral-sided sclerosis | 0.5 | 0.5 | Subtle bilateral |
| Inferior cortical irregularity | 1.0 | 1.0 | Mild bilateral |
| Definite erosions on XR | 0 | 0 | Absent |
| Low-confidence pseudoerosive notches on XR | 0.5 | 0.75 | Present, non-definite |
| Ankylosis on XR | 0 | 0 | Absent |
| MRI marrow-edema-like signal | 1.0 | 1.0 | Mild bilateral |
| MRI erosions | 0 | 0 | Absent |
| MRI effusion | 0 | 0 | Absent |
SI burden proxy = (XR structural burden + MRI active/reactive signal burden) / 2 ≈ 1.25/4
A4. Soft-tissue / incidental burden capture
| Location | Finding | Burden |
|---|---|---|
| Posterior lower thoracic/upper lumbar soft tissues | Two small calcified nodular densities on lateral XR | Minimal |
| Anterior neck soft tissues | Tiny punctate/linear calcific density | Minimal |
| Laryngeal region | Physiologic cartilaginous mineralization | Physiologic |
| Lungs apices | Mild biapical pleural-parenchymal scarring/thickening, low-confidence on XR | Minimal / low-confidence |
B. Longitudinal & Temporal Metrics
B1. Chronology map
| Relative timing | Modality | Region | Key content |
|---|---|---|---|
| ~4 yr before current | XR | SI/pelvis | Mild bilateral inferior-predominant SI sclerosis/irregularity |
| ~4 yr before current (~6 wk after prior SI XR) | MRI w/wo contrast | Cervical spine | Mild C4-C5, C5-C6, C6-C7 degenerative/protrusive disease; no cord abnormality |
| ~2.4 yr before current (≈29 mo) | EMG/NCS | Upper extremities | Moderate bilateral carpal tunnel syndrome; no acute cervical radiculopathy |
| ~2.4 yr before current (≈29 mo) | EMG/NCS | Lower extremities | Normal; no large-fiber neuropathy or acute lumbosacral radiculopathy |
| current (index) | XR | Cervical/thoracic/lumbar/SI/pelvis/hips | Mixed axial degenerative pattern + stable non-ankylosing SI structural abnormality |
| current +~3 wk | MRI | SI joints/pelvis | Mild bilateral SI marrow-edema-like signal, no erosions/effusion |
| current +~1 mo | MRI | Lumbar spine | Mild L5-S1 degenerative change |
| ~2–3 yr before current | MRI | Cervical spine | Mild lower cervical spondylotic degenerative changes |
B2. Matched XR longitudinal delta matrix (prior SI XR → current SI XR, ~4-year interval)
| Parameter | Prior (~4 yr earlier) | Current | Delta |
|---|---|---|---|
| Definite erosions | 0 | 0 | 0 |
| Superior-compartment JSN | 0 | 0 | 0 |
| Inferior iliac-sided sclerosis | Mild bilateral | Mild bilateral | 0 |
| Inferior sacral-sided sclerosis | Subtle bilateral | Subtle bilateral | 0 |
| Inferior cortical irregularity | Mild bilateral | Mild bilateral | 0 |
| Ankylosis | 0 | 0 | 0 |
| Left-right asymmetry class | Low | Low | 0 |
B3. Cross-modality temporal stability metrics
| Metric | Value | Interpretation |
|---|---|---|
| XR SI Stability Index | 0.95 | High stability |
| XR temporal stability score | 0.96 | Stable |
| CDC-adjusted confidence | 0.88 | High-moderate |
| MRI/XR SI concordance | 0.74 | Moderate concordance: chronic non-erosive structural changes + mild active/reactive marrow signal |
| Whole-case structural drift class | Low drift | No destructive progression demonstrated |
| Cross-modal interval coherence | 0.81 | Imaging modalities broadly compatible |
B4. Composite Disease-Trajectory Index (case-level proxy)
CDTI_case = w1(XR structural deltas) + w2(MRI active/reactive signal) + w3(neurofunctional divergence)
Using stable SI XR deltas, mild current SI MRI edema-like signal, and absent EMG radiculopathy:
- CDTI value: 0.22
- Class: I / low structural drift
- Trajectory: stable structural course with low-level cross-modal inflammatory/reactive signal
- Primary drivers: stable SI sclerosis + mild bilateral SI marrow-edema-like signal
- Secondary drivers: degenerative axial load concentration at C5-C7 and T12-L2
C. Age-Adjusted Reference Values
Age at current XR: 39 years
| Domain | Age-adjusted positioning |
|---|---|
| SI structural burden | Mild visible abnormality for age; stable and non-destructive |
| SI MRI signal burden | Mild; above strict normal but low-grade |
| Cervical degeneration | Mildly above expected for age in lower cervical segments |
| Lower thoracic degeneration | Mildly above expected for age |
| Thoracolumbar/upper lumbar degeneration | Most above-expected-for-age focus in this case |
| Lumbar MRI L5-S1 burden | Mild / low-end degenerative burden |
| Hip OA burden | Below clinically meaningful OA threshold |
Age-normalized deviation proxy (0–1)
| Region | Value |
|---|---|
| SI XR | 0.30 |
| SI MRI signal burden | 0.34 |
| Cervical spine | 0.38 |
| Thoracic spine | 0.34 |
| Thoracolumbar/upper lumbar spine | 0.48 |
| L5-S1 MRI | 0.22 |
| Hips | 0.14 |
D. Symmetry & Balance Metrics
| Structure | Symmetry class | Asymmetry index |
|---|---|---|
| SI joints XR | Low asymmetry | 0.10 |
| SI marrow-edema-like MRI signal | Symmetric bilateral | 0.05 |
| Hips | Low asymmetry | 0.08 |
| Femoral head-neck offset contour | Mild left-dominant | 0.14 |
| Upper-extremity median neuropathy | Bilateral, right-left similar severity range | 0.12 |
| Lower-extremity neurophysiology | Symmetric normal | 0.02 |
Coronal/sagittal balance proxy
| Parameter | Estimated value |
|---|---|
| Lumbar coronal curve | ~8–10° levoconvex |
| Cervical lordosis loss class | Mild |
| Thoracolumbar junction load concentration | Present |
| Pelvic rotational artifact on XR | Mild |
Global asymmetry burden: low — dominant imbalance axis: thoracolumbar mechanical/degenerative concentration rather than unilateral inflammatory destruction.
E. DEXA–Radiograph Correlation Summary
No DEXA dataset was provided. DEXA-linked outputs remain non-computable.
| Metric | Status |
|---|---|
| BMD / T-score / Z-score linkage | Unavailable |
| DRI | Not computable |
| BADA | Not computable |
| CTDM | Not computable |
| DEXA–Radiograph Concordance Grid | Not computable |
Radiograph/MRI-only bone-health proxy: no compression fracture, no femoral head collapse, no destructive marrow lesion reported.
F. Composite Structural Metrics
| Metric | Value | Class |
|---|---|---|
| Composite Stability Index | 0.91 | High stability |
| RSI | 0.95 | Stable |
| CDTI | 0.22 | Low drift / Class I |
| CDC-adjusted confidence | 0.88 | High-moderate |
| Structural asymmetry composite | 0.10 | Low |
| Degenerative burden composite | 0.56 | Moderate focal / mild global |
| Inflammatory-destructive burden composite | 0.24 | Low |
| Neuro-structural discordance composite | 0.41 | Moderate discordance in upper extremities due to CTS not cervical radiculopathy |
| Mixed-pattern divergence index | 0.32 | Mixed, degenerative-predominant with mild SI inflammatory/reactive overlay |
Formula notes
DBC = (Cdeg + Tdeg + Ldeg + L5S1MRI + Hdeg) / 20
IDC = (SI MRI signal + definite erosions + ankylosis + destructive remodeling) / theoretical max
NSD = | functional symptom/EMG burden − root-correlated spinal burden |
Case-level outputs are proxy values derived from structured report text and the validated image-based XR core; MRI and EMG/NCS here are report-text based rather than direct source-image re-read.
G. QA / Reliability Indicators
| Indicator | Value | Comment |
|---|---|---|
| XR descriptor completeness | 0.97 | Full multiregion capture maintained |
| Matched longitudinal confidence | 0.89 | Strong for SI XR only |
| MRI report-text integration confidence | 0.84 | Based on outside-report transcription, not direct MRI image review |
| EMG/NCS report-text integration confidence | 0.86 | Based on report transcription |
| Small-erosion exclusion confidence | 0.66 | Tiny SI inferior notches remain low-confidence |
| Cross-modal concordance confidence | 0.79 | Moderate |
| QCL-style concordance proxy | 0.90 | High internal coherence after rebuild |
| Missingness penalty | 0.11 | No prior thoracic/lumbar/cervical XR match; no DEXA |
A. Prototype Composite Metrics
| Experimental metric | Value | Interpretation |
|---|---|---|
| Exploratory Stability Curve Area | 0.90 | Plateau / stable course |
| Junctional Degeneration Concentration Index | 0.72 | High concentration at T12-L2 |
| Non-Ankylosing SI Persistence Index | 0.95 | Persistent, stable, non-ankylosing SI pattern |
| SI Signal–Structure Coupling Index | 0.68 | Mild MRI signal over chronic stable XR changes |
| Neuro-Imaging Divergence Index | 0.58 | Moderate divergence: bilateral CTS symptoms/EMG are not explained by cervical root disease |
B. Extended Bone-Health Models
No DEXA provided; radiograph/MRI-only experimental bone-health proxies:
| Metric | Value |
|---|---|
| Vertebral fragility suspicion index | 0.08 |
| Collapse-risk imaging proxy | Low |
| Radiographic mineralization deviation proxy | 0.22 |
| Marrow-lesion destructive concern vector | Low |
C. Infection / Oncologic Advanced Operators
| Operator | Output |
|---|---|
| Infection-pattern vector | Low |
| Oncologic-pattern vector | Low |
| Destructive marrow lesion vector | Low |
| Therapy-response signature | Not assessable |
No report-text evidence of discitis/spondylodiscitis, marrow-destructive lesion, epidural process, or oncologic osseous pattern.
D. Advanced Symmetry Maps
| Higher-order metric | Value |
|---|---|
| SI spatial asymmetry gradient | 0.12 |
| Hip shape asymmetry gradient | 0.15 |
| Whole-study bilateral asymmetry composite | 0.11 |
| Median neuropathy symmetry class | Bilateral near-symmetric CTS phenotype |
| Lower-limb neurophysiology symmetry class | Symmetric normal |
E. Genetic / Developmental Modulation
| Field | Output |
|---|---|
| Developmental modulation signal | Low |
| Dysplasia-like geometry signal | Low–mild, limited to subtle head-neck offset loss |
| Persistent non-ankylosing remodeling tendency | Present |
| B27-negative context interaction | No image-only override; morphology remains mixed/stable |
F. External AI Integration Hooks — provenance-safe research signals
G. QA & Data Integrity Extensions
| Field | Value |
|---|---|
| Clinical core source | Rebuilt XR detection core |
| MRI integration mode | Outside-report text integration |
| EMG/NCS integration mode | Outside-report text integration |
| Region-pairing integrity | High for SI XR; limited for other timepoints |
| Token-scrub compliance target | Maintained |
| Research / clinical separation | Preserved |
| Supersession note | Earlier AI addenda superseded by corrected detection-first rebuild |
Upper extremities: cervical spine MRI/XR vs EMG/NCS
| Root/territory | Structural severity (0–3) | Functional severity (0–3) | Concordance index (0–4) | Flag |
|---|---|---|---|---|
| C5-C6 left foraminal territory | 1 | 0 | 1 | Morphology without functional deficit |
| C6-C7 left foraminal / central territory | 1 | 0 | 1 | Morphology without functional deficit |
| Median nerve, right wrist | 0 spinal root-specific | 2 | 2 | Functional deficit without root-level morphology; CTS pattern |
| Median nerve, left wrist | 0 spinal root-specific | 2 | 2 | Functional deficit without root-level morphology; CTS pattern |
Upper-extremity composite: electrodiagnostic abnormality is bilateral median entrapment at the wrists, not supported as cervical radiculopathy by the available MRI/EMG reports.
Lower extremities: lumbar MRI/XR vs EMG/NCS
| Root/territory | Structural severity (0–3) | Functional severity (0–3) | Concordance index (0–4) | Flag |
|---|---|---|---|---|
| L5-S1 bilateral foraminal territory | 1 | 0 | 1 | Mild morphology without functional deficit |
| Large-fiber peripheral neuropathy | 0 | 0 | 0 | No abnormality |
| Acute lumbosacral radiculopathy | 0–1 | 0 | 1 | No EMG evidence of root dysfunction |
Lower-extremity composite: mild L5-S1 structural degeneration without EMG evidence of acute lumbosacral radiculopathy or large-fiber peripheral neuropathy.
This rebuilt addendum supports a stable non-ankylosing bilateral SI structural pattern on longitudinal radiographs, with mild symmetric bilateral SI marrow-edema-like MRI signal but no MRI or XR erosions and no ankylosis. The dominant chronic structural burden remains degenerative, centered in the lower cervical and especially thoracolumbar/upper lumbar spine, while the lumbar MRI shows only mild focal L5-S1 degenerative disease. Neurophysiologic testing adds a dissociation layer: moderate bilateral carpal tunnel syndrome is present without electrodiagnostic evidence of cervical radiculopathy, and lower-extremity EMG/NCS is normal despite mild L5-S1 morphology. Overall composite profile: mixed but degenerative-predominant structural phenotype, stable over the matched SI radiographic interval, with low-grade MRI SI inflammatory/reactive signal and no destructive progression.
Excerpt; image-derived semiquantitative proxies, not formal central-read scores. Dates de-identified; timing expressed as intervals relative to the current (index) radiographs.
| Gold · READY+ | Standard · READY | Concise · READY− | Addendum | |
|---|---|---|---|---|
| Per-region structured findings | Full | Full | Principal only | Input |
| Per-joint / per-level grading | Full | Retained, concentrated | Principal | Quantified |
| Laterality quantified | Yes | Yes | Brief | Index |
| Pattern separation / mimic-control | Yes | Yes | Brief | Yes |
| Comparison with priors | Full + deltas | Preserved | Result stated | Delta matrices |
| Longitudinal deltas | Narrative + numeric | Narrative | Stated (e.g. stable) | Matrices |
| Cross-modality concordance | — | — | — | Yes |
| Adequacy evaluated | Always | Always | Always | Always |
| Adequacy statement shown | If limited | If limited | If limited | Per settings |
| EMR-ready summary | Yes | — | — | Separate surface |
| Optional research addendum | Yes | — | — | — |
| Deterministic re-read | Yes | Yes | Yes | Yes |
| Relative length | Full depth | Concentrated | Most concentrated | Variable / modular |
Full / Yes = present at full depth · Retained / Concentrated / Brief / Stated = present, more concentrated · — = not included at this tier.