Medical illustrations in radiologic reports for endometriosis: improving communication with surgeons and patients

Endometriosis is a complex, multicompartmental disease in which accurately conveying the extent of involvement to the surgical team is essential for preoperative planning and patient counseling. In this context, medical illustrations have gained increasing popularity as a valuable complement to traditional radiology reports. These drawings provide a visual summary of imaging findings, which are often lengthy and challenging to interpret in written form alone. By translating complex imaging data into accessible visual representations, illustrations can enhance communication between radiologists and surgeons, ultimately leading to improved surgical outcomes. Surgeons may also use these illustrations during patient consultations to explain the disease’s involvement and the planned surgical approach. They can also be applied to patients conservatively managed to monitor treatment efficacy and clinical evolution. This not only improves patient understanding but also saves valuable time during appointments—time that can instead be dedicated to addressing patient concerns and strengthening the physician–patient relationship. Importantly, in modern, patient-centered care models, individuals are encouraged to take an active role in treatment decisions. By helping patients visualize and better understand their condition, medical illustrations empower them to engage more meaningfully in shared decision-making processes. These visual tools enhance treatment adherence and facilitate a more compassionate and efficient clinical workflow. Clinical relevance statement Endometriosis imaging is complex to communicate due to the multifocal nature of the disease and anatomic distortion. Drawings can complement reports, thereby improving surgical planning and patients’ understanding while also enhancing radiologist engagement. Key Points - Endometriosis imaging reporting can be complex, and illustrations can help convey its extent in imaging for effective surgical planning. - Medical illustrations also offer multiple benefits for patients, surgeons and radiologists. - Multiple tools are currently available to assist with creating drawings, eliminating the need for specific artistic skills. Graphical Abstract

Endometriosis is a common gynecologic condition for which surgical management is frequently an appropriate treatment option [1,2,3]. Achieving successful surgical outcomes (a single, complete and definitive procedure without complications) relies heavily on accurate preoperative disease mapping [4, 5]. Precise identification of lesion location and organ involvement enables appropriate surgical planning, including selection of the surgical team, required instrumentation, estimated operating room time and adequate patient counseling, including possible complications. Because preoperative staging is based on clinical evaluation combined with dedicated imaging, such as ultrasound (US) with bowel preparation and magnetic resonance imaging (MRI), radiologists play a central role in this process [1,2,3, 6]. However, the multifocal nature of endometriosis and its tendency to distort normal pelvic anatomy often make image interpretation and clear multidisciplinary communication of findings challenging in daily practice [7]. Medical illustrations depicting endometriotic involvement have emerged as a valuable tool for conveying imaging findings [2, 8] (Fig. 1), as they provide a unique representation of the disease distribution for each individual. Used to complement traditional reports, they serve as a visual fingerprint, synthesizing complex imaging information in an intuitive visual format. This visual approach may benefit surgeons, patients, and radiologists in different but interconnected ways, as explored throughout this article. This article aims to highlight the advantages of incorporating drawings as a complement to endometriosis imaging reports and provides a practical guide for radiologists interested in starting and refining this practice. Interdisciplinary communication: supporting surgical teams A clear understanding of findings supports surgical planning, allows more accurate estimation of operative complexity and duration, and contributes to optimized hospital resource utilization—an important consideration for women with endometriosis who are often of working age. It also plays a key role in comprehensive preoperative patient counseling [2, 5, 9, 10]. Therefore, efforts have been made to improve multidisciplinary communication by addressing how radiologists describe imaging findings [11], especially in complex conditions such as endometriosis. Structured and compartmentalized reporting has become increasingly relevant in this setting to ensure consistent anatomical assessment. A study by Barbisan et al showed that the use of structured MRI reports for pelvic endometriosis outperformed traditional reports in fully documenting essential disease features and may reduce the gap between experts and less-experienced radiologists [5], and is currently recommended by both the European Society of Urogenital Radiology (ESUR) [8] and the Society of Abdominal Radiology (SAR) consensus statements on endometriosis imaging [12]. Classification systems to help predict surgical difficulty have also been developed. An ideal classification should be used for both imaging specialists and surgeons. To date, there are two imaging-based tools proposed for preoperative evaluation of surgical complexity: the #Enzian classification [13], applicable to both ultrasound and MRI reporting [14], and the Deep Pelvic Endometriosis Index (dPEI) MRI-based scoring system developed by Thomassin-Naggara et al [1]. The dPEI calculator predicts surgical complexity based on imaging findings (Fig. 2) and is publicly available (https://www.dpei-score.org). There is also a study by Abrão et al that used US findings in predicting the laparoscopy complexity defined as the 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Staging, which also offers an automated calculator capable of generating both the score and a corresponding illustrative drawing [15]. Similar to structured reports and preoperative classifications, visual representations can be used as an effective tool to organize and communicate imaging findings in a 3D perspective. Several information that may impact the surgical strategy can be effectively conveyed through drawings (Fig. 3). For instance, in cases of bowel involvement, factors such as the distance from the anal verge, the degree of circumferential involvement, the number of bowel lesions and the longitudinal extent of the lesion influence the decision between shaving, discoid excision, or segmental resection [3, 16] (Fig. 4a). In the anterior compartment, measurements such as the distance between ureteral and bladder lesions and the ureterovesical junction, infiltration of the bladder wall, as well as the presence or absence of ureteric obstruction, can guide the choice between end-to-end anastomosis and ureteric reimplantation [3] (Fig. 4b). Lesions in the posterior vaginal fornix also require detailed information including extent and distance from the anal verge, considering lower lesions may require a deeper, subperitoneal dissection for complete resection (Fig. 4c) [17]. The importance of clearly communicating the involvement of non-gynecologic structures by endometriosis—such as the bladder, ureters, bowel, nerves, and diaphragm (Fig. 4d)—also relies on the fact that they require surgical planning that involves coordination with urologic, colorectal, neuropelvic, or thoracic surgeons, as well as the use of specific surgical tools and materials [1, 2, 18]. To enhance the understanding and practical application of an illustrative map, it is essential to align it with the perspective used in surgical procedures. This alignment is crucial because the surgical view is mirrored compared to that of a radiologist. Specifically, what appears on the surgeon’s right side will correspond to the radiologist’s left. By considering this difference in perspectives, users can effectively interpret and utilize the map in a medical context. Besides, a single, well-designed drawing can often condense pages of descriptive reporting into a clear and intuitive visual summary, sometimes even integrating findings from both TVUS and MRI in a unified report. Although these imaging modalities differ, they are complementary, and illustrations help unify this information, offering the surgeon a cohesive understanding of the overall disease burden (Fig. 5a–f). Importantly, although these imaging studies are typically requested to map endometriosis, other concomitant findings relevant to the clinical management of the disease—such as leiomyomas, adenomyosis, adhesions, and ovarian findings including the antral follicle count—can also be depicted in the illustrations. Many of these findings are common and may coexist with endometriosis. Incorporating them into the drawings allows for a more comprehensive and individualized depiction of the patient’s female pelvis, encompassing both endometriotic lesions and associated conditions (Fig. 6a, b). Over time, both radiologists and referring physicians can become familiar with these visual conventions, which may enhance long-term communication by allowing for quicker interpretation and shared understanding of findings (Fig. 7). Patient communication In the setting of patient-centered care, patients are increasingly engaged in shared decision-making, shifting away from a traditionally passive role in treatment decisions dictated solely by physicians [8]. For this collaborative approach to be effective, patients must understand both their condition and available therapeutic options. Notably, patients are more likely to adhere to recommended treatments when they understand their disease [19]. However, the lack of access to clear, understandable information is one of the most frequently reported sources of dissatisfaction among patients with endometriosis [8]. Drawings offer practical advantages during consultations by helping individuals better understand their condition and the proposed management strategies. Visual information enhances comprehension and acceptance, promotes patient engagement, and facilitates shared decision-making. Many surgeons use hand-drawn sketches during consultations to convey the nature and extent of the disease [20]. Incorporating standardized illustrations into radiology reports can reduce consultation time otherwise spent creating explanatory drawings, allowing surgeons to focus on addressing patient concerns, providing emotional support, and facilitating information processing. It also empowers minimally invasive gynecologic surgeons (MIGS) and reproductive surgeons to provide clear and effective preoperative counseling regarding surgical techniques, associated risks, and realistic expectations, ultimately strengthening the patient-physician relationship. Furthermore, radiologists themselves can act as a bridge between patients and surgeons. Although radiologists are often perceived as distant from direct patient care, studies have shown that direct communication between patients and radiologists after an initial image review can significantly improve the quality, clarity, and structure of radiology reports [21]. In this context, illustrations may provide a simpler, more appropriate vocabulary, thereby supporting patient understanding and enabling them to revisit and reflect on the information after the consultation. Overall, they can play a meaningful role in alleviating the burden on those living with endometriosis, which is especially relevant given the central role of imaging in endometriosis management. Radiology services have a significant impact on the patient’s clinical journey, and satisfaction with this process is closely linked to psychological well-being and treatment outcomes [22]. Moreover, when patients perceive that their physician is making a genuine effort to help them understand their condition, such as by using visual representations, this alone can strengthen the physician–patient relationship. This is particularly vital in endometriosis care, where many patients have experienced significant psychological distress after years of having their symptoms overlooked or normalized by healthcare providers [22]. Such experiences can erode trust in the healthcare system, underscoring our responsibility to help rebuild it [19]. In the context of endometriosis, pain invalidation and infertility represent deep emotional wounds for many women [22], and a visual representation of their condition can help validate their experiences by providing a tangible explanation for their symptoms. Being able to ‘put a face’ to a disease they cannot see, only feel, is deeply meaningful, as it transforms an invisible condition into something concrete and understandable. This can also empower patients to share their drawings with others, facilitating understanding and empathy within their personal and professional networks. Nonetheless, medical illustrations can also evoke psychological discomfort, as they expose the inner workings of a disease that has often been a source of profound emotional and physical pain. Accordingly, the creation and even the educational sharing of such drawings must be approached with care and sensitivity, always respecting the patient’s emotional boundaries and privacy. Impacts for radiologists For radiologists, the ability to express imaging findings fosters a more accessible and intuitive common visual language with the referring physician. When drawings address the specific informational needs of referring physicians, they not only enhance the clarity and reliability of the reports but also strengthen the radiologist’s professional credibility. Over time, this practice promotes a collaborative spirit and builds mutual trust across clinical teams. Furthermore, the illustrative map may be seen by the patient as a worthwhile investment in her overall quality of care, enhancing the radiologist’s fundamental place in surgical planning. Actively engaging in visual art has also been shown to stimulate creative thinking, provide new perspectives on clinical scenarios, and strengthen neural connectivity—benefits that may counteract age-related cognitive decline and enhance overall engagement [23, 24]. In parallel, the healthcare community continues to face increasing levels of psychosocial stress and professional burnout, driven by high workloads, emotional strain, and systemic pressures [25]. Creative activities, including visual arts production, have demonstrated potential in mitigating burnout and improving overall well-being among healthcare professionals [24]. However, despite these advantages (Table 1), incorporating drawings into radiology reports can present some challenges. Radiologists may perceive it as an additional task in an already time-constrained workflow, particularly in high-volume practices. There may also be concerns about illustrating uncertain findings, as translating complex or ambiguous imaging data into a visual format may raise anxiety about potential misinterpretation or overcommitment to a diagnosis. Nevertheless, over time, especially in follow-up studies, previously created illustrations can serve as a clear and immediate reference, allowing radiologists to more easily understand what was previously reported than by relying solely on written text. Recent developments in digital tools have begun to address these barriers. Some platforms now allow for semi-automated generation of illustrations based on structured report data or classification input, such as disease location and depth, reducing the manual workload and lowering the threshold for adoption. These tools offer a promising avenue for integrating visual communication into radiologic practice in a time-efficient and standardized manner [18]. Furthermore, in the future, the illustrative map added to a more direct structured report can become a less time-consuming endometriosis report.

of illustration: from traditional to immersive technologies While some healthcare professionals may perceive a lack of artistic training as a barrier to incorporating visual tools into clinical practice, evidence suggests that producing effective medical illustrations is entirely feasible without formal artistic expertise [26]. A range of tools is available to support the creation of medical illustrations, from traditional hand-drawn sketches to professional-grade digital platforms (Fig. 8). Among currently available tools, the Deep Pelvic Endometriosis Index (dPEI) application (previously introduced in this article) is freely accessible on computers and mobile devices, provides automated illustrative outputs based on MRI findings, and has been validated in European consensus recommendations for endometriosis imaging and reporting [8]. Hand-drawn tools are perfect when you need artistic flexibility to replicate subtle findings, like endometriomas or adenomyosis contours. Vector-based tools are ideal for schematic, labeled, and scalable illustrations, and they can be included directly in the report. Radiologists widely use Presentation Software due to its accessibility and ease of use, although it is less refined for producing professional illustrations. Table 2 presents a list of valuable tools for radiologists, categorized by their type of functionality. More recently, artificial intelligence (AI)-assisted tools have expanded the possibilities for generating customized medical visuals. Platforms such as BioRender (BioRender Inc.), Midjourney (Midjourney Inc., San Francisco, CA), and DALL·E (OpenAI) enable the creation of illustrations from text-based prompts, providing accessible solutions for users without formal training in graphic design. These tools reduce the barrier to visual content creation while maintaining an emphasis on anatomical clarity and scientific accuracy. Importantly, the effectiveness of an illustration lies not in its artistic complexity but in its ability to convey key information. Simplified, schematic diagrams often enhance communication and comprehension more effectively than highly detailed anatomical drawings, particularly in the context of surgical planning and patient education [26]. Because these drawings are primarily intended to support surgeons, they should follow the surgical perspective: findings located on the patient’s left side should be represented on the left side of the illustration, and the same applies to the right side, in contrast to conventional radiological orientation. There are now technologies available that enable the 3D mapping of endometriosis [7], including online programs. These tools offer advantages over 2D imaging technologies, such as the ability to visualize the disease from multiple angles and to render structures transparent, among other features. To facilitate the adoption of illustrations in endometriosis reports, Table 3 provides a step-by-step guide on how to get started.

Imaging is considered a revolution in the clinical management of endometriosis. Medical illustrations as complements to radiology reports enhance the communication of findings to surgeons and patients, bringing also benefits to the radiologists themselves, being therefore recommended by the relevant radiological society consensus on endometriosis.

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A.B., I.T.N., D.M.R., G.M.P.A.R.R.: data curation, review. L.P.C.: conceptualization, supervision, final review. Corresponding author Ethics declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Lauar, M.C.V., Clemente Oliveira, B., Giassi, K.d.S. et al. Medical illustrations in radiologic reports for endometriosis: improving communication with surgeons and patients. Insights Imaging 17, 140 (2026). https://doi.org/10.1186/s13244-026-02307-3 Received: Revised: Accepted: Published: Version of record: DOI: https://doi.org/10.1186/s13244-026-02307-3