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84 Can modifying imaging reports improve clinical care and improve health outcomes? A systematic review
  1. Caitlin Farmer1,2,
  2. Romi Haas1,2,
  3. Allison Bourne1,2,
  4. Denise O’Connor1,2,
  5. Jeffrey Jarvik3,4,
  6. Rachelle Buchbinder1,2
  1. 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  2. 2Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
  3. 3Departments of Radiology, Neurological Surgery and Health Services, School of Medicine, University of Washington, Seattle, WA, USA
  4. 4Departments of Pharmacy and Orthopaedic and Sports Medicine, School of Medicine, University of Washington, Seattle, WA, USA


Background Diagnostic imaging is often used to rule in or out serious pathology and the way the findings are communicated is an important component of clinical decision making. For example, incidental or normal-for-age findings are usually reported, although how these elements are incorporated into a report, and whether or not appropriate clinical context is provided is widely variable. Greater uncertainty in an imaging report can lead to higher levels of clinician anxiety, and increased preference for further, potentially unnecessary, testing or treatment. Modifying the report might be one strategy for addressing overdiagnosis and overtreatment of findings of little or doubtful significance.

Objectives The objective of this review was to synthesise the available evidence that modifying the imaging report (content, structure and/or delivery) improves care and healthcare outcomes including health service utilisation.

Selection criteria We included randomised and controlled trials, controlled before-after studies, interrupted time series and prospective and retrospective cohort studies. We included any studies involving health professionals receiving an imaging report about a patient, or studies where patients received a report about themselves. Interventions were any change or addition to the report compared with a standard report. All types of diagnostic imaging for all clinical conditions were included. Outcomes were measures of professional practice and adherence to evidence-based guidelines, healthcare utilisation and/or patient outcomes including comprehension of report (where relevant), satisfaction with care and adverse events.

Search methods We searched MEDLINE, Embase and THE WHO Clinical Trial Registry from inception to July 2018 using a search strategy developed in conjunction with an experienced librarian.

Data collection and analysis Two independent reviewers identified studies that met inclusion criteria and extracted data including imaging modality, disease type and/or body area, clinicians involved, type of intervention, patient population and outcomes assessed. They also assessed risk of bias using the Cochrane EPOC (Effective Practice and Organisation of Care) criteria. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

Results Fifteen studies met our inclusion criteria including six randomised trials (eight papers) and nine other studies. The randomised trials included three relating to osteoporosis, two to heart failure and one to musculoskeletal imaging, while the other studies related to cancer screening (n=4), cardiology (n=2), low back pain (n=2) and osteoporosis (n=1). The full analysis is in progress and an updated search to included additional studies to June 2019 is planned. Full results will be available for presentation at Preventing Overdiagnosis 2019.

Conclusions This review will synthesise the available data that has assessed the value of modifying the imaging report to improve appropriate care and reduce unnecessary overdiagnosis and overtreatment.

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