Faculty Bibliography

The expression of diagnostic certainty in radiology reports is common and used to inform clinicians and patients about the degree of confidence a radiologist has in a finding or differential diagnosis. However, radiologists express diagnostic certainty in myriad ways, which leads to ambiguity and risk of misdirected clinical management. Standardizing how diagnostic certainty is expressed is likely to improve the fidelity of information transfer between radiologists and referring providers and patients. In recognition of the need to improve the clarity of diagnostic tests, the American College of Radiology Commission on Quality and Safety convened a working group of radiologists with expertise and interest in radiology reporting and diagnostic communication. The group's task was to summarize current knowledge and challenges in the expression of diagnostic certainty in radiology reports, and to offer recommendations for establishing greater consensus. Although there is insufficient agreement at this time to formally recommend one diagnostic certainty scale over another, two examples from single-site experiences and one consensus scale favored by this writing group are provided for consideration and pilot testing by radiology practices.

PURPOSE/OBJECTIVE:As differences in imaging patterns may indicate unnecessary care, this study examined differences in repeat imaging rates between imaging studies interpreted by a nonphysician practitioner (NPP) versus a radiologist. METHODS:This multiyear (2013-2022) retrospective study evaluated imaging performed on Medicare fee-for-service beneficiaries using a CMS Research Identifiable File. Imaging studies, grouped by anatomic region and modality (eg, shoulder radiography [XR]) with ≥30 repeat studies within 90 days for both NPP-interpreted and radiologist-interpreted index studies, were included. Logistic regression was used to assess the likelihood of repeat imaging within 90 days for NPP-interpreted versus radiologist-interpreted index studies, adjusted for patient gender, age, race or ethnicity, comorbidities, urbanicity, and community income. RESULTS:There were 1,397,002 imaging studies that met the selection criteria. Of these, repeat imaging occurred for 12.5%. Unadjusted repeat imaging rates were higher for NPP-interpreted versus radiologist-interpreted imaging for XR (20.4% versus 14.6%), ultrasound (11.6% versus 4.5%), and MR (8.8% versus 3.8%). Adjusted for covariates, the odds ratio (OR) for repeat imaging was higher for NPP-interpreted versus radiologist-interpreted imaging: 1.35 (95% confidence interval [CI]: 1.33-1.37) for XR, 2.41 (95% CI: 2.21-2.63) for ultrasound, and 2.56 (95% CI: 1.81-3.64) for MR. By anatomic region-modality, these ORs ranged from 1.39 (95% CI: 1.34-1.44) for shoulder XR to 3.40 (95% CI: 2.80-4.14) for abdominal ultrasound, but was not significantly different for knee XR (OR: 1.01, 95% CI: 0.99-1.04). CONCLUSION/CONCLUSIONS:Among Medicare beneficiaries, imaging studies are more likely to be repeated when interpreted by a NPP than when interpreted by a radiologist. Potential excess reimaging has implications for unnecessary care.