Journal of Medical Diagnostic Methods
Open Access

Diagnostic History and Novel Analytical Techniques to Understanding of the Role of Clinical Assessment on Diagnostic Accomplishment

Samy McFarlane^{* *}Correspondence: Samy McFarlane, Department of Diagnostic, Osaka University, New York, USA, Email:

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About the Study

The impact of Diagnostic history on radiological accuracy is a widely discussed topic among imaging specialists and referring physicians alike, as its quality can have a considerable impact on the diagnostic accuracy of all medical imaging modalities. The utilization of diagnostic history supplied in a request form to aid in the construction of a diagnostic report is a smart general practice for radiologists all over the world. Diagnostic history or diagnostic information refers to all of the information outlining the referred patient's diagnostic condition and should include important details such as the patient's current issue, concurrent and prior medical history, current medications, allergies to medications including contrast media, fasting condition, suspected diagnosis, and the relevant diagnostic question. This, of course, implies that the diagnostic data is accurate and precise. The inclusion of diagnostic history must also ensure that it does not introduce any unhelpful biases into the reporting process, especially since it has been shown that reading chest radiographs with a specific preconception can result in a higher number of false positives than reading without a preconception or search task [1-3].

The impact of diagnostic history on diagnostic performance is crucial, especially considering the potential benefits of providing a high-quality diagnostic history to the radiologist in terms of improving the radiology report's accuracy, timeliness, reporting confidence, and diagnostic relevance. These are key areas to research in order to provide our medical patients and colleagues with a highly valued diagnostic imaging service. According to their findings, many studies matched their inclusion criteria revealed that diagnostic history enhanced diagnostic performance, six studies found no significant change in performance, and just one study reported a decline in diagnostic performance. They did, however, conclude that more recent studies using newer observer performance analysis techniques that take into account abnormality location and multiple abnormalities have shown an increase in false positives and no significant change in overall diagnostic performance with diagnostic history [4,5].

Another group's previous study, which used eye position analysis to examine the impact of prior abnormality prevalence expectation on expert radiologist performance, found that reader visual search was significantly altered at higher prevalence expectation rates, with radiologists searching longer when they thought an abnormality was more likely [6]. It has been shown that having an accurate diagnostic history is vital because it allows the radiologist to focus on addressing the critical diagnostic question presented by the referrer and ensures that the proper medical imaging technique is conducted. Although diagnostic history has the potential to improve observer performance and the advantages much outweigh the hazards, it appears that it may also bring interpretative error, as evidenced by modern methods of analysis such as an increase in false positive interpretations. As a result, being aware of any potential biases that can be introduced will help to mitigate any potential detrimental effects on the diagnostic interpretative process. An 'anchoring bias' (failure to alter initial diagnosis in light of contradictory facts) and/or a 'framing bias' (observer performance influenced by how a problem is phrased or presented) are the most common examples [7].

These biases can be mitigated in diagnostic reporting practice by radiologists attempting to disprove rather than confirm any postulated diagnosis presented on the request form, as well as performing an initial read without reviewing the clinical history in the first instance, then referring to the clinical history in subsequent reads and interrogating any differing findings to form a final diagnostic report [8]. It is obvious that including diagnostic history is critical to obtaining a positive diagnostic test.

Conclusion

Further research is needed, nevertheless, to better understand the cognitive and perceptual mechanisms at work, as well as to properly describe and estimate the specific effects of the factors involved, particularly when using the more sophisticated observer performance measuring methodologies available. When a radiologist analyses diagnostic history, we would be better able to characterize the level of any negative aspects involved, and we would be able to offer effective targeted actions to reduce these harmful impacts in the future.

References

1. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimizethem. Acad Med. 2003;78(8):775-780.

   [CrossRef] [Google Scholar] [PubMed]

2. Itri JN, Patel SH. Heuristics and cognitive error in medical imaging. AJR. 2018;210(5):1097-1105.

   [CrossRef] [Google Scholar] [PubMed]

3. Swensson RG, Hessel SJ, Herman PG. The value of searching films without specific preconceptions. Invest Radiol. 1985;20(1):100-107.

   [CrossRef] [Google Scholar] [PubMed]

4. Castillo C, Steffens T, Sim L, Caffery L. The effect of diagnostic information on radiology reporting: A Systematic Review. J Med Radiat Sci. 2020;68(1):1-15.

   [CrossRef] [Google Scholar] [PubMed]

5. Littlefair S, Thoms MC, Reed W, Pietryzk M, Lewis S, Brennan P, et al. Increasing prevalence expectation in thoracic radiology leads to overcall. Acad Radiol. 2016;23(3):284-289.

   [CrossRef] [Google Scholar] [PubMed]

6. Schechter MT, Sheps SB. Diagnostic testing revisited: Pathways through uncertainty. Can Med Assoc J. 1985;132(7):755-760.

   [CrossRef] [Google Scholar] [PubMed]

7. Reed WM, Ryan JT, McEntee MF, Evanoff MG, Brennan PC. The effect of abnormality-prevalence expectation on expert observer performance and visual search. Radiology. 2011;258(3):938-943.

   [CrossRef] [Google Scholar] [PubMed]

8. Robinson JW, Brennan PC, Thoms MC, Lewis SJ. Reporting instructions significantly impact false positive rates when reading chest radiographs. Euro Radiol. 2016;26(10):3654-3659.

   [CrossRef] [Google Scholar] [PubMed]