The Effect of Clinical History on Chest Radiograph Interpretations in a PACS Environment

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Abstract
The effect that accompanying patient information has on diagnostic accuracy in radiologic interpretation has been studied by many researchers but remains a matter of contention. Experiments in the past emphasized the chest film because this procedure is the one done most frequently in radiology. However, with the increasing importance of digital imaging, the role of patient history in these procedures should be assessed. The use of a model computerized patient history in the interpretation of digitized chest images that were displayed on a high-resolution workstation was studied. Two hundred forty-seven selected posteroanterior chest images that indicated disease and that indicated no disease were interpreted in random sequence by five board-certified radiologists, with and without accompanying patient histories. Readers were prompted by the response forms to evaluate images for the possible occurrence of interstitial disease, nodules, or pneumothorax. No significant differences (P = .05) in the detection of these abnormalities were noted between case readings with and without history for any of the radiologists or for the group as a whole. However, this methodology reflects a direct interpretation approach. The results of this study may not necessarily be applicable to individual prompts, different imaging procedures, or other abnormalities.