Evidence-based use of diagnostic imaging: reliability and validity

doi:10.1017/CBO9780511978074.006

2 - Evidence-based use of diagnostic imaging: reliability and validity

Published online by Cambridge University Press: 05 March 2012

Sara B. DeMauro and

Edited by

Monica Epelman and

Sara B. DeMauro: Affiliation:
University of Pennsylvania
Haresh Kirpalani: Affiliation:
University of Pennsylvania
Haresh Kirpalani: Affiliation:
Children's Hospital of Philadelphia
Monica Epelman: Affiliation:
Children's Hospital of Philadelphia
John Richard Mernagh: Affiliation:
McMaster University, Ontario

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Summary

Recent commentaries describe the dearth of evidence upon which to base most imaging decisions [1]. The lack of instructive literature is arguably an even larger deficiency in newborn medicine than in adult medicine. Unfortunately, very few imaging modalities have been subject to randomized trial evaluation to assess the value of imaging as a supplement to sound clinical assessment. The irrational drivers of increased imaging and increased use of more sophisticated modalities include fears of liability and clinicians' or patients'/parents' wishes to have the “best” and “latest” imaging technology. In adult practice in Massachusetts, a survey indicated that more than 28% of diagnostic tests were performed for fear of litigation [2]. To use modern imaging technology efficiently and effectively, the clinician is advised to apply some fundamentals of clinical epidemiology. Below we provide a simple critical approach to assessing the potential value of imaging technology in patient diagnosis and management.

Reliability: how reproducible are the results?

“Reliability” refers to the reproducibility or repeatability of results. There are two important types of reliability: intra-rater reliability and inter-rater reliability. Intra-rater reliability is the reproducibility of interpretation of a diagnostic study by one individual. In other words, it asks: “On a different day, would the radiologist/film reader give the same report?” Interrater reliability refers to the repeatability of interpretations between individuals.

Type: Chapter
Information: Imaging of the Newborn , pp. 7 - 10

DOI: https://doi.org/10.1017/CBO9780511978074.006 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2011

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References

1. B. J., Hillman, J. C., Goldsmith. The uncritical use of high-tech medical imaging. N Engl J Med 2010; 363(1):4–6.Google Scholar

2. Massachusetts Medical Society (2008) Investigation of Defensive Medicine in Massachusetts: November 2008. Informational Report I-08, Waltham, Massachusetts Medical Society. Available at: www. massmed.org/AM/Template. (accessed February 1, 2011).

3. J. R., Landis, G. G., Koch. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1):159–74.Google Scholar

4. M. P., Moya, G. S., Bisset, R. L., Auten, et al. Reliability of CXR for the diagnosis for bronchopulmonary dysplasia. Pediatr Radiol 2001; 31:339–42.Google Scholar

5. P., Davis, S., Turner-Gomes, K., Cunningham, et al. Precision and accuracy of clinical and radiological signs in premature infants at risk of patent ductus arteriosus. Arch Pediatr Adolesc Med 1995; 149(10):1136–41.Google Scholar

6. S. R., Hintz, T., Slovis, D., Bulas, et al. Interobserver reliability and accuracy of cranial ultrasound interpretation in premature infants. J Pediatr 2007; 150(6):592–6.Google Scholar

7. A., DiNapoli, D., DiLallo, C. A., Perucci, et al. Inter-observer reliability of radiological signs of necrotizing enterocolitis in a population of high-risk newborns. Paediatr Perinat Epidemiol 2004; 18:80–7.Google Scholar

8. C. A., Coursey, C. L., Hollingsworth, A. M., Gaca, et al. Radiologists' agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants. AJR Am J Roentgenol 2008; 191:190–7.Google Scholar

9. L. J., Woodward, P. J., Anderson, N. C., Austin, et al. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006; 355:685–94.Google Scholar

10. S., Straus, S. R., Richardson, P., Glaszion, R. B, Haynes. (2011) Evidence-Based Medicine: How to Practice and Teach EBM, 4th Edition, London, Elsevier.Google Scholar

11. Centre for Evidenced Based Medicine (2009) EBM Calculators. www.cebm.net/index.aspx?o=1159 (accessed July 19, 2010).

12. S. R., Hintz, M., O'Shea. Neuroimaging and neurodevelopmental outcomes in preterm infants. Semin Perinatol 2008; 32(1):11–19.Google Scholar

13. G. K., Suresh. Neonatal MRI and neurodevelopmental outcomes [letter]. N Engl J Med 2006; 355(22):2373–4.Google Scholar

14. D. T., Teachey. Neonatal MRI and neurodevelopmental outcomes [letter]. N Engl J Med 2006; 355(22):2374.Google Scholar

15. G. H., Guyatt, P. X., Tugwell, D. H., Feeny, et al. A framework for clinical evaluation of diagnostic technologies. CMAJ 1986; 134:587–94.Google Scholar