Faculty Collaboration Database

Appropriateness of imaging procedure requests: do radiologists agree? AJR Am J Roentgenol 1997 Jul;169(1):11-4

Date

07/01/1997

Pubmed ID

9207492

DOI

10.2214/ajr.169.1.9207492

Scopus ID

2-s2.0-1842412459 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVE: We explored the agreement among radiologists in their evaluation of the appropriateness of individual requests for imaging procedures.

MATERIALS AND METHODS: We reviewed 318 noninterventional CT, sonographic, MR imaging, and nuclear medicine procedures ordered at a general internal medicine clinic during 8 months in 1995. Five subspecialty radiologists used data from the radiology request from and clinic notes to independently rate the appropriateness of each requested imaging procedure on a four-point scale. The radiologists were unaware of the results achieved by each procedure. Each case was reviewed by at least three radiologists, of whom at least one had relevant subspecialty expertise. Agreement among radiologists was analyzed using Cohen's kappa statistic and weighted kappa statistics and Cronbach's alpha statistic.

RESULTS: Nonchance agreement (kappa) was .19 +/- .05; weighted kappa was .24 +/- .05. Interrater agreement was significantly greater than that expected from chance alone (p < .01). The composite score, defined as the average of the radiologists' scores for each case, showed moderate reliability, as evidenced by a value for Cronbach's alpha of 70.

CONCLUSION: In the absence of explicit criteria, we found modest but statistically significant agreement among radiologists about the appropriateness of individual requests for imaging procedures. The disagreement among radiologists highlights the importance of developing well-reasoned, explicit criteria by which to judge the appropriateness of diagnostic radiology procedures. Further study is needed to elucidate the relationship between appropriateness and actual patient outcomes.

Author List

Kahn CE Jr, Michalski TA, Erickson SJ, Foley WD, Krasnow AZ, Lofgren RP, Quiroz FA, Rand SD

Author

Scott J. Erickson MD Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Diagnostic Imaging
Female
Health Services Misuse
Humans
Internal Medicine
Male
Middle Aged
Observer Variation
Radiology
Referral and Consultation