Search and nonsearch protocols for radiographic consultation.
Six radiologists, acting as radiograph reviewers, used two different consultation protocols to differentiate among 292 ambiguous chest radiographic findings: 120 simulated nodules and 172 normal findings (previous readers' false-positive reports of nodules). The nonsearch protocol identified each finding (by film location), and reviewers rated the likelihood of each finding's being a pulmonary nodule. The search protocol asked reviewers to report and rate all locations regarded as possible nodules on each radiograph and assigned a default negative rating to any unreported finding (nodule or normal structure). Receiver operating characteristic analyses demonstrated a significantly higher accuracy for each reviewer's search-protocol discriminations between these nodules and ambiguous normal findings. This superiority-of-search result suggests that radiologists' second opinions about suspected lesions might be more accurate when consultants follow a search protocol, independently reviewing radiographs without prior knowledge of the specific findings that concerned the primary radiograph readers.
Swensson
R G
RG
Department of Radiology, Harvard Medical School, Boston, MA 02115.
Theodore
G H
GH
D005189:False Positive Reactions; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D015588:Observer Variation; D012372:ROC Curve; D011871:Radiology / Q000592:standards*; D012017:Referral and Consultation; D013679:Technology, Radiologic