Fryback D G, Thornbury J R
Department of Preventive Medicine, University of Wisconsin-Madison 53706.
Med Decis Making. 1991 Apr-Jun;11(2):88-94. doi: 10.1177/0272989X9101100203.
The authors discuss the assessment of the contribution of diagnostic imaging to the patient management process. A hierarchical model of efficacy is presented as an organizing structure for appraisal of the literature on efficacy of imaging. Demonstration of efficacy at each lower level in this hierarchy is logically necessary, but not sufficient, to assure efficacy at higher levels. Level 1 concerns technical quality of the images; Level 2 addresses diagnostic accuracy, sensitivity, and specificity associated with interpretation of the images. Next, Level 3 focuses on whether the information produces change in the referring physician's diagnostic thinking. Such a change is a logical prerequisite for Level 4 efficacy, which concerns effect on the patient management plan. Level 5 efficacy studies measure (or compute) effect of the information on patient outcomes. Finally, at Level 6, analyses examine societal costs and benefits of a diagnostic imaging technology. The pioneering contributions of Dr. Lee B. Lusted in the study of diagnostic imaging efficacy are highlighted.
作者们讨论了诊断成像对患者管理过程的贡献评估。提出了一个疗效层次模型，作为评估成像疗效文献的组织结构。在这个层次结构中，较低层次的疗效证明在逻辑上是必要的，但不足以确保较高层次的疗效。第1级涉及图像的技术质量；第2级涉及与图像解读相关的诊断准确性、敏感性和特异性。接下来，第3级关注信息是否会改变转诊医生的诊断思维。这种改变是第4级疗效的逻辑前提，第4级疗效涉及对患者管理计划的影响。第5级疗效研究衡量（或计算）信息对患者结局的影响。最后，在第6级，分析考察诊断成像技术的社会成本和效益。文中强调了李·B·卢斯特博士在诊断成像疗效研究方面的开创性贡献。
