title: Sequential test selection by quantifying of the reduction in diagnostic uncertainty for the diagnosis of proximal caries.
abstract: BACKGROUND
  In order to determine the presence or absence of a certain disease, multiple diagnostic tests may be necessary. Performance of these tests can be sequentially evaluated.
  
  
  OBJECTIVE
  The aim of the study is to determine the contribution of the test in each step, in reducing diagnostic uncertainty when multiple tests are sequentially used for the diagnosis.
  
  
  METHODS
  Diagnostic accuracy study.
  
  
  METHODS
  Radiographs of seventy-three patients of the Department of Dento-Maxillofacial Radiology of Hacettepe University Faculty of Dentistry were assessed. Panoramic (PAN), full mouth intraoral (FM), and bitewing (BW) radiographs were used for the diagnosis of proximal caries in the maxillary and mandibular molar regions. Diagnostic performance of radiography was sequentially evaluated by using the reduction in diagnostic uncertainty.
  
  
  RESULTS
  FM provided maximum diagnostic information for ruling in potential in the maxillary and mandibular molar regions in the first step. FM provided more diagnostic information than BW radiographs for ruling in the mandibular region in the second step. In the mandibular region, BW radiographs provided more diagnostic information than FM for ruling out in the first step.
  
  
  CONCLUSIONS
  The presented method in this study provides the clinicians with a solution for the decision of the sequential selection of diagnostic tests for the correct diagnosis of the presence or absence of a certain disease.
authors.affiliation: Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Arslan
authors.affiliation: Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ahmet Ergun
authors.initials: AE
authors.lastname: Karaağaoğlu
authors.affiliation: Department of Dento-Maxillofacial Radiology, Hacettepe University Faculty of Dentistry, Ankara, Turkey.
authors.forename: Nursel
authors.initials: N
authors.lastname: Akkaya
authors.affiliation: Department of Dento-Maxillofacial Radiology, Hacettepe University Faculty of Dentistry, Ankara, Turkey.
authors.forename: Leyla Berna
authors.initials: LB
authors.lastname: Cağırankaya
authors.affiliation: Department of Dento-Maxillofacial Radiology, Hacettepe University Faculty of Dentistry, Ankara, Turkey.
authors.forename: Ayşe Özden
authors.initials: AÖ
authors.lastname: Kansu
authors.affiliation: Department of Dento-Maxillofacial Radiology, Hacettepe University Faculty of Dentistry, Ankara, Turkey.
authors.forename: Hilmi
authors.initials: H
authors.lastname: Kansu
keywords: Test sequence; proximal caries; radiographic methods; reduction in uncertainty