PDF(Pubmed)
Abstract：
BACKGROUND: Lumbar spine diagnostic imaging reports may cause patient and clinician concern when clinically unimportant findings are not explicitly described as benign. Our primary aim was to determine the frequency that common, benign findings are reported in lumbar spine plain X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) reports as either normal for age or likely clinically unimportant.
METHODS: We obtained 600 random de-identified adult lumbar spine imaging reports (200 X-ray, 200 CT and 200 MRI) from a large radiology provider. Only reports requested for low back pain were included. From the report text, one author extracted each finding (e.g., \'broad-based posterior disc bulge\') and whether it was present or absent (e.g., no disc bulge) until data saturation was reached, pre-defined as a minimum of 50 reports and no new/similar findings in the last ten reports within each imaging modality. Two authors independently judged whether each finding was likely clinically unimportant or important. For each likely clinicially unimportant finding they also determined if it had been explicitly reported to be benign (expressed as normal, normal for age, benign, clinically unimportant or non-significant).
RESULTS: Data saturation was reached after coding 262 reports (80 X-ray, 82 CT, 100 MRI). Across all reports we extracted 3,598 findings. Nearly all reports included at least one clinically unimportant finding (76/80 (95%) X-ray, 80/82 (98%) CT, 99/100 (99%) MRI). Over half of the findings (n = 2,062, 57%; 272 X-Ray, 667 CT, 1123 MRI) were judged likely clinically unimportant. Most likely clinically unimportant findings (90%, n = 1,854) were reported to be present on imaging (rather than absent) and of those only 18% (n = 331) (89 (35%) X-ray, 93 (16%) CT and 149 (15%) MRI) were explicitly reported as benign.
CONCLUSIONS: Lumbar spine imaging reports frequently include findings unlikely to be clinically important without explicitly qualifying that they are benign.
METHODS: We obtained 600 random de-identified adult lumbar spine imaging reports (200 X-ray, 200 CT and 200 MRI) from a large radiology provider. Only reports requested for low back pain were included. From the report text, one author extracted each finding (e.g., \'broad-based posterior disc bulge\') and whether it was present or absent (e.g., no disc bulge) until data saturation was reached, pre-defined as a minimum of 50 reports and no new/similar findings in the last ten reports within each imaging modality. Two authors independently judged whether each finding was likely clinically unimportant or important. For each likely clinicially unimportant finding they also determined if it had been explicitly reported to be benign (expressed as normal, normal for age, benign, clinically unimportant or non-significant).
RESULTS: Data saturation was reached after coding 262 reports (80 X-ray, 82 CT, 100 MRI). Across all reports we extracted 3,598 findings. Nearly all reports included at least one clinically unimportant finding (76/80 (95%) X-ray, 80/82 (98%) CT, 99/100 (99%) MRI). Over half of the findings (n = 2,062, 57%; 272 X-Ray, 667 CT, 1123 MRI) were judged likely clinically unimportant. Most likely clinically unimportant findings (90%, n = 1,854) were reported to be present on imaging (rather than absent) and of those only 18% (n = 331) (89 (35%) X-ray, 93 (16%) CT and 149 (15%) MRI) were explicitly reported as benign.
CONCLUSIONS: Lumbar spine imaging reports frequently include findings unlikely to be clinically important without explicitly qualifying that they are benign.
摘要：
背景：当临床上不重要的发现未明确描述为良性时，腰椎诊断成像报告可能会引起患者和临床医生的关注。我们的主要目标是确定常见的频率，腰椎X线平片报道了良性发现，计算机断层扫描（CT）和磁共振成像（MRI）报告为年龄正常或可能在临床上不重要。
方法：我们获得了600份随机去识别的成人腰椎影像学报告（200张X射线，200CT和200MRI）来自大型放射科提供者。仅包括要求的下腰痛报告。从报告文本来看，一个作者提取了每个发现(例如，“宽基后部椎间盘凸起”)以及是否存在(例如，没有磁盘凸起)，直到达到数据饱和，预先定义为至少50份报告，并且在每种成像方式中的最后10份报告中没有新的/类似的发现。两位作者独立判断每个发现是否可能在临床上不重要或重要。对于每个可能的临床上不重要的发现，他们还确定是否已明确报告为良性（表示为正常，正常年龄，良性,临床上不重要或不重要)。
结果：对262份报告进行编码后达到数据饱和（80份X射线，82CT,100MRI）。在所有报告中，我们提取了3,598个发现。几乎所有报告都包括至少一个临床上不重要的发现（76/80（95％）X射线，80/82（98%）CT，99/100(99%)MRI)。超过一半的发现(n=2,062，57%；272X射线，667CT,1123MRI）被认为可能在临床上不重要。最有可能是临床上不重要的发现(90%，n=1,854）据报道存在于成像中（而不是不存在），其中只有18％（n=331）（89（35％）X射线，明确报告93（16％）CT和149（15％）MRI为良性。
结论：腰椎影像学报告通常包括不可能具有临床重要性的发现，而没有明确地证明它们是良性的。
方法：我们获得了600份随机去识别的成人腰椎影像学报告（200张X射线，200CT和200MRI）来自大型放射科提供者。仅包括要求的下腰痛报告。从报告文本来看，一个作者提取了每个发现(例如，“宽基后部椎间盘凸起”)以及是否存在(例如，没有磁盘凸起)，直到达到数据饱和，预先定义为至少50份报告，并且在每种成像方式中的最后10份报告中没有新的/类似的发现。两位作者独立判断每个发现是否可能在临床上不重要或重要。对于每个可能的临床上不重要的发现，他们还确定是否已明确报告为良性（表示为正常，正常年龄，良性,临床上不重要或不重要)。
结果：对262份报告进行编码后达到数据饱和（80份X射线，82CT,100MRI）。在所有报告中，我们提取了3,598个发现。几乎所有报告都包括至少一个临床上不重要的发现（76/80（95％）X射线，80/82（98%）CT，99/100(99%)MRI)。超过一半的发现(n=2,062，57%；272X射线，667CT,1123MRI）被认为可能在临床上不重要。最有可能是临床上不重要的发现(90%，n=1,854）据报道存在于成像中（而不是不存在），其中只有18％（n=331）（89（35％）X射线，明确报告93（16％）CT和149（15％）MRI为良性。
结论：腰椎影像学报告通常包括不可能具有临床重要性的发现，而没有明确地证明它们是良性的。
