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Appropriateness of imaging procedure requests: do radiologists agree?
C E Kahn1, T A Michalski, S J Erickson
1Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA.
AJR. American Journal of Roentgenology
|July 1, 1997
Summary
Radiologists showed modest agreement on imaging appropriateness without explicit criteria. Developing clear guidelines is crucial for consistent diagnostic radiology procedure evaluation.
Area of Science:
- Radiology
- Medical Imaging
- Healthcare Quality
Background:
- Assessing the appropriateness of diagnostic imaging is vital for quality patient care.
- Variability in physician judgment can impact healthcare resource utilization.
Purpose of the Study:
- To evaluate the level of agreement among radiologists when assessing the appropriateness of imaging procedure requests.
- To identify the need for standardized criteria in radiology practice.
Main Methods:
- Review of 318 noninterventional imaging procedures (CT, ultrasound, MRI, nuclear medicine).
- Independent appropriateness ratings by five subspecialty radiologists using a four-point scale.
- Statistical analysis of interrater agreement using Cohen's kappa and Cronbach's alpha.
Main Results:
- Modest, statistically significant nonchance agreement was observed (kappa = 0.19, weighted kappa = 0.24).
- Interrater agreement exceeded chance expectations (p < .01).
- Moderate reliability was found for the composite appropriateness score (Cronbach's alpha = 0.70).
Conclusions:
- Radiologists exhibit limited agreement on imaging appropriateness without explicit guidelines.
- The findings underscore the necessity for developing clear, evidence-based criteria for diagnostic imaging.
- Further research is needed to link appropriateness assessment with patient outcomes.