Utilizing a Digital Multi-Language Patient Questionnaire for Diagnostic Imaging Examinations

  • Nick N. MaizlinEmail author
  • Nina P. Singh
  • Sat Somers


In diagnostic imaging (DI) practice, patient questionnaires allow clinical staff to gather medical history information directly from patients. However, language barriers can prevent patients from completing the questionnaires and may endanger patient safety if the patient fails to indicate critical medical information. Interpreters are commonly employed to help patients convey important medical details; however, there are limits to their practical utilization. Thus, the purpose of this study was to evaluate the feasibility and practicality of a digital multi-language questionnaire designed to help overcome the language barriers between patients and clinical staff. The standard English-language questionnaire for bone mineral density (BMD) examinations was used in this study. It was translated into several languages and presented in an electronic form to patients in a language most suitable for them. The completed questionnaires, along with the patient responses, were automatically converted into English, allowing them to be reviewed by DI staff through a radiological information system (RIS) and picture archiving and communication system (PACS). Patients and clinical staff commented on the comfort of using the translated questionnaires. The modified Wald method was used to establish the confidence interval. The results showed that all patients and clinical staff were comfortable using the translated questionnaires. Ultimately, in this study we have developed a digital multi-language questionnaire for BMD examinations which can be converted into different languages and be stored in RIS and PACS. To the best of our knowledge, this approach had not been applied or tested elsewhere.


Diagnostic imaging Multi-language patient questionnaire 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Doshi AM, Huang C, Ginocchio L, Shanbhogue K, Rosenkrantz AB: Impact of patient questionnaires on completeness of clinical information and identification of causes of pain during outpatient abdominopelvic CT interpretation. Abdom Radiol (NY). 42(12):2946–2950, 2017CrossRefGoogle Scholar
  2. 2.
    Markert DJ, Haney PJ, Allman RM: Effect of computerized requisition of radiology examinations on the transmission of clinical information. Acad Radiol. 4(2):154–156, 1997CrossRefGoogle Scholar
  3. 3.
    Brodman K, Erdmann, Jr AJ et al.: The Cornell medical index: a adjunct to medical interview. J Am Med Assoc 140(6):530–534, 1949CrossRefGoogle Scholar
  4. 4.
    Spector TD, Edwards AC, Thompson PW: Use of a risk factor and dietary calcium questionnaire in predicting bone density and subsequent bone loss at the menopause. Ann Rheum Dis. 51(11):1252–1253, 1992CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Shellock FG, Kanal E: Guidelines and recommendations for MR imaging safety and patient management. III. Questionnaire for screening patients before MR procedures. The SMRI Safety Committee. J Magn Reson Imaging 4(5):749–751, 1994CrossRefGoogle Scholar
  7. 7.
    Zähringer C, Potthast S, Tyndall AJ, Bongartz G, Hohmann J: Serum creatinine measurements: evaluation of a questionnaire according to the ESUR guidelines. Acta Radiol. 56(5):628–634, 2015CrossRefGoogle Scholar
  8. 8.
    Morcos SK, Bellin MF, Thomsen HS, Almén T, Aspelin P, Heinz-Peer G, Jakobsen JA, Liss P, Oyen R, Stacul F, van der Molen AJ, Webb JA: Reducing the risk of iodine-based and MRI contrast media administration: recommendation for a questionnaire at the time of booking. Contrast Media Safety Committee of European Society of Urogenital Radiology. Eur J Radiol. 66(2):225–229, 2008. CrossRefGoogle Scholar
  9. 9.
    Fatahi N, Krupic F: Factors beyond the language barrier in providing health care to immigrant patients. Med Arch. 70(1):61–65, 2016CrossRefGoogle Scholar
  10. 10.
    Hamai T, Nagata A, Nishikawa H: The need for medical interpreters: a questionnaire survey of municipal hospitals in Japan. Nihon Koshu Eisei Zasshi. 64(11):672–683, 2017Google Scholar
  11. 11.
    Blay N, Ioannou S, Seremetkoska M, Morris J, Holters G, Thomas V, Bronwyn E: Healthcare interpreter utilisation: analysis of health administrative data. BMC Health Serv Res. 18(1):348, 2018CrossRefGoogle Scholar
  12. 12.
    Sayed-Hassan RM, Bashour HN: The reliability of the Arabic version of Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS). BMC Res Notes. 6:138, 2013CrossRefGoogle Scholar
  13. 13.
    Cantarelli FB, Szejnfeld VL, Oliveira LM, Ciconelli RM, Ferraz MB: Quality of life in patients with osteoporosis fractures: cultural adaptation, reliability and validity of the Osteoporosis Assessment Questionnaire. Clin Exp Rheumatol 17(5):547–551, 1999Google Scholar
  14. 14.
    Zhang YP, Wei HH, Wang W, Xia RY, Zhou XL, Porr C, Lammi M: Cross-cultural adaptation and validation of the Osteoporosis Assessment Questionnaire Shortversion (OPAQ-SV) for Chinese osteoporotic fracture females. Clin Rheumatol. 35(4):1003–1010, 2016CrossRefGoogle Scholar
  15. 15.
    Henze T, von Mackensen S, Lehrieder G, Zettl UK, Pfiffner C, Flachenecker P: Linguistic and psychometric validation of the MSSS-88 questionnaire for patients with multiple sclerosis and spasticity in Germany. Health Qual Life Outcomes. 12(1):119, 2014CrossRefGoogle Scholar
  16. 16.
    Vascellari A, Spennacchio P, Combi A, Grassi A, Patella S, Bisicchia S, Canata GL, Zaffagnini S: Cross-cultural adaptation and multi-centric validation of the Italian version of the Achilles Tendon Total Rupture Score (ATRS). Knee Surg Sports Traumatol Arthrosc. 26(3):854–861, 2018CrossRefGoogle Scholar
  17. 17.
    Lee JS, Shin JK, Son SM, An SJ, Kang SS: Validation of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26) in Korean population. Rheumatol Int. 34(7):919–927, 2014CrossRefGoogle Scholar
  18. 18.
    Yilmaz F, Sahin F, Dogu B, Ozmaden A, Kuran B: Reliability and validity of the Turkish version of the mini Osteoporosis Quality of Life Questionnaire. J Back Musculoskelet Rehabil. 25(2):89–94, 2012CrossRefGoogle Scholar
  19. 19.
    Robinson TJ, DuVall SL, Wiggins, 3rd RH: Creation and storage of standards-based pre-scanning patient questionnaires in PACS as DICOM objects. J Digit Imaging. 24(5):823–827, 2011 OctCrossRefGoogle Scholar
  20. 20.
    Collen MF, Cutler JL, Siegelaub AB, Cella RL: Reliability of a self-administered medical questionnaire. Arch Intern Med. 123(6):664–681, 1969CrossRefGoogle Scholar
  21. 21.
    Hall GH: Experiences with outpatient medical questionnaires. Br Med J. 1(5791):42–45, 1972CrossRefGoogle Scholar
  22. 22.
    Boissonnault WG, Badke MB: Collecting health history information: the accuracy of a patient self-administered questionnaire in an orthopedic outpatient setting. Phys Ther. 85(6):531–543, 2005Google Scholar
  23. 23.
    Johnson SH, Shapiro GM: Use of a medical history questionnaire in a rural, educationally disadvantaged population. J Fam Pract. 4(1):147–148, 1977 No abstract availableGoogle Scholar
  24. 24.
    Gilkison CR, Fenton MV, Lester JW: Getting the story straight: evaluating the test-retest reliability of a university health history questionnaire. J Am Coll Health. 40:247–252, 1992CrossRefGoogle Scholar
  25. 25.
    Abramson JH: The Cornell Medical Index as an epidemiological tool. Am J Public Health Nations Health. 56:287–298, 1966CrossRefGoogle Scholar
  26. 26.
    Pecoraro RE, Inui TS, Chen MS, Plorde DK, Heller JL: Validity and reliability of a self-administered health history questionnaire. Public Health Rep. 94:231–238, 1979Google Scholar
  27. 27.
    Siminoski K, Leslie WD, Frame H, Hodsman A, Josse RG, Khan A, Lentle BC, Levesque J, Lyons DJ, Tarulli G, Brown JP: Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment. J Clin Densitom. 10(2):120–123, 2007CrossRefGoogle Scholar
  28. 28.
    Lim LS, Hoeksema LJ, Sherin K; ACPM Prevention Practice Committee. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med. 2009;36(4):366–375. doi:
  29. 29.
  30. 30.
  31. 31.
    CMS. ICD-9-CM coding for diagnostic tests. https://www.cms. gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/AB01144.pdf. Last accessed 1 Dec 2018
  32. 32. Last accessed 1 Dec 2018
  33. 33. Last accessed 1 Dec 2018

Copyright information

© Society for Imaging Informatics in Medicine 2019

Authors and Affiliations

  1. 1.Arts and Science Program (NNM) and Department of Radiology (NPS, SS)McMaster UniversityHamiltonCanada

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