Assessment and Modification of Clinical Utility in Diagnostic Radiology: The Oral Cholecystogram and the Upper Gastrointestinal Examinations

摘要

The author studied diagnostic test efficacy by means of a three-phase approach. Three common gastrointestinal imaging procedures were included: the oral cholecystogram, the abdominal ultrasound, and the upper gastrointestinal radiograph. The three-phase study consisted of a questionnaire survey concerning physician's opinions about the OCG vs. the US, a prospective evaluation of the OCG and the US in the diagnosis of gallbladder disease, and a prospective evaluation of a decision rule designed to modify physician's use of the UGI. Authors found that the decision to order a gallbladder imaging test depended on institutional factors, test factors, and patient attributes. This finding was in contradistinction to stated physician opinions obtained during the initial survey. Further, the impact of either test on diagnostic certainty did not necessarily correlate with the impact of that test on therapeutic decisions. The decision rule developed had both a moderately high sensitivity and low specificity. The author was unsuccessful in modifying physician use of an upper GI by a previously developed decision rule.