Radiologists inconsistent with how they convey diagnostic certainty

Diagnostic certainty phrases (DCPs) are common in radiology reports, helping the radiologist convey certainty in an imaging finding or its clinical significance. According to a new study published in Academic Radiology, however, radiologists use a wide variety of DCPs, and reducing this variation could improve the overall quality of radiology reports.  

The authors studied the DCPs used at a single academic medical center in 2016, tracking DCPs shown to have good agreement between radiologists and referring physicians. Overall, 43 percent of all radiology reports were found to include at least a single DCP. A DCP was used in 68 percent of all CT reports, making it the most common modality to feature such a phrase.

“Only 3 percent of these DCPs were those that previous studies have shown as having good agreement between radiologists and referring physicians,” wrote Ronilda Lacson, MD, PhD, department of radiology at Brigham and Women’s Hospital in Boston, Massachusetts. “These DCPs with good agreement are typically used to express extremes of certainty; radiologists utilize these terms when they are ‘most certain’ (e.g., ‘diagnostic of') or believe a phrase as conferring a 100 percent likelihood of a diagnosis.”

A high level of variation was noted in the use of DCPs with good agreement between physicians, which the authors described as “not surprising.”

“Further studies could assess whether years in practice or physician risk profiles are associated with variation in DCP usage,” the authors wrote. “Interventions to harmonize the use of DCPs among individual radiologists, including minimizing use of DCPs without ‘good agreement,’ may be helpful to reduce ambiguity of reports for referring providers and patients.”