Radiologic Decision Making Affected by Outcomes Knowledge

May 31, 2016

Outcomes knowledge may sway radiograph interpretations.

Prior clinical knowledge affects radiologists’ interpretations, according to a study published in Academic Radiology.

Researchers from Australia, the United Kingdom, and Switzerland undertook a small study to determine if the expectation of abnormality and prior knowledge may have an influence on radiology interpretation and in later radiologic expert witness testimony.

Twelve board-certified radiologists interpreted 20 normal and 20 abnormal chest images, looking for pulmonary lesions. They were informed that the patients had presented with three weeks or longer of coughing. The radiologists were given the same images two weeks later, although they were unaware that the images were the same ones they had previous viewed. The second time, all the images were accompanied with the following information: “These images were reported normal but all of these patients have a lung tumor diagnosed on a subsequent radiograph six months later.”[[{"type":"media","view_mode":"media_crop","fid":"49057","attributes":{"alt":"radiology findings","class":"media-image media-image-right","id":"media_crop_6358389708898","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5900","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©venimo/Shutterstock.com","typeof":"foaf:Image"}}]]

The results showed a significant difference in how the images were read, depending on the description provided to the radiologists. The specificity increased outside the lobe of interest and decreased within the lobe of interest significantly in the second presentation, although case-based sensitivity and case-based specificity were unaffected.

“This study showed evidence that increased clinical information affects the performance of radiologists,” the researchers concluded. “This effect may bias expert witnesses in radiological malpractice litigation.”