title: Reporting instructions significantly impact false positive rates when reading chest radiographs.
abstract: OBJECTIVE
  To determine the impact of specific reporting tasks on the performance of radiologists when reading chest radiographs.
  
  
  METHODS
  Ten experienced radiologists read a set of 40 postero-anterior (PA) chest radiographs: 21 nodule free and 19 with a proven solitary nodule. There were two reporting conditions: an unframed task (UFT) to report any abnormality and a framed task (FT) reporting only lung nodule/s. Jackknife free-response operating characteristic (JAFROC) figure of merit (FOM), specificity, location sensitivity and number of true positive (TP), false positive (FP), true negative (TN) and false negative (FN) decisions were used for analysis.
  
  
  RESULTS
  JAFROC FOM for tasks showed a significant reduction in performance for framed tasks (P = 0.006) and an associated decrease in specificity (P = 0.011) but no alteration to the location sensitivity score. There was a significant increase in number of FP decisions made during framed versus unframed tasks for nodule-containing (P = 0.005) and nodule-free (P = 0.011) chest radiographs. No significant differences in TP were recorded.
  
  
  CONCLUSIONS
  Radiologists report more FP decisions when given specific reporting instructions to search for nodules on chest radiographs. The relevance of clinical history supplied to radiologists is called into question and may induce a negative effect.
  
  
  CONCLUSIONS
  • Framed reporting tasks increases false positive rates when searching for pulmonary nodules • False positive results were observed in both nodule-containing and nodule-free cases • Radiologist's decision-making may be influenced by clinical history in thoracic imaging.
authors.affiliation: Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, NSW, Australia. john.robinsonmrs@sydney.edu.au.
authors.forename: John W
authors.initials: JW
authors.lastname: Robinson
authors.affiliation: Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, NSW, Australia.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Brennan
authors.affiliation: Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, NSW, Australia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mello-Thoms
authors.affiliation: Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, NSW, Australia.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Lewis
mesh_terms: D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D015588:Observer Variation; D011857:Radiographic Image Interpretation, Computer-Assisted; D013902:Radiography, Thoracic / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Decision-making; Observer performance; Pulmonary nodules; Radiologists; Thoracic imaging