Search and nonsearch protocols for radiographic consultation

Area of Science:

• Radiology
• Medical Imaging
• Diagnostic Accuracy

Background:

• Differentiating pulmonary nodules from normal findings on chest radiographs can be challenging.
• Previous readers' false-positive reports contribute to diagnostic ambiguity.

Purpose of the Study:

• To compare the diagnostic accuracy of two consultation protocols for interpreting ambiguous chest radiographic findings.
• To evaluate the effectiveness of a "search protocol" versus a "nonsearch protocol" in identifying pulmonary nodules.

Main Methods:

• Six radiologists reviewed 292 chest radiographs with ambiguous findings (120 simulated nodules, 172 normal).
• Nonsearch protocol: Reviewers rated likelihood of nodules at pre-identified locations.
• Search protocol: Reviewers independently identified and rated all potential nodules, with unreported findings defaulted to negative.

Main Results:

• Receiver operating characteristic (ROC) analysis showed significantly higher accuracy for the search protocol for all reviewers.
• The search protocol improved the discrimination between true nodules and ambiguous normal findings.

Conclusions:

• A "search protocol" enhances radiologists' accuracy in second opinions for suspected pulmonary lesions.
• Independent review without prior knowledge of specific findings improves diagnostic performance in radiology.