Musculoskeletal Health and Sustainable Healthcare Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
PLoS One. 2024 Mar 13;19(3):e0297911. doi: 10.1371/journal.pone.0297911. eCollection 2024.
Lumbar spine diagnostic imaging reports may cause patient and clinician concern when clinically unimportant findings are not explicitly described as benign. Our primary aim was to determine the frequency that common, benign findings are reported in lumbar spine plain X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) reports as either normal for age or likely clinically unimportant.
We obtained 600 random de-identified adult lumbar spine imaging reports (200 X-ray, 200 CT and 200 MRI) from a large radiology provider. Only reports requested for low back pain were included. From the report text, one author extracted each finding (e.g., 'broad-based posterior disc bulge') and whether it was present or absent (e.g., no disc bulge) until data saturation was reached, pre-defined as a minimum of 50 reports and no new/similar findings in the last ten reports within each imaging modality. Two authors independently judged whether each finding was likely clinically unimportant or important. For each likely clinicially unimportant finding they also determined if it had been explicitly reported to be benign (expressed as normal, normal for age, benign, clinically unimportant or non-significant).
Data saturation was reached after coding 262 reports (80 X-ray, 82 CT, 100 MRI). Across all reports we extracted 3,598 findings. Nearly all reports included at least one clinically unimportant finding (76/80 (95%) X-ray, 80/82 (98%) CT, 99/100 (99%) MRI). Over half of the findings (n = 2,062, 57%; 272 X-Ray, 667 CT, 1123 MRI) were judged likely clinically unimportant. Most likely clinically unimportant findings (90%, n = 1,854) were reported to be present on imaging (rather than absent) and of those only 18% (n = 331) (89 (35%) X-ray, 93 (16%) CT and 149 (15%) MRI) were explicitly reported as benign.
Lumbar spine imaging reports frequently include findings unlikely to be clinically important without explicitly qualifying that they are benign.
当临床上不重要的发现未被明确描述为良性时，腰椎诊断影像学报告可能会引起患者和临床医生的关注。我们的主要目的是确定在腰椎 X 光、计算机断层扫描（CT）和磁共振成像（MRI）报告中，常见的良性发现被报告为年龄正常或可能临床上不重要的频率。
我们从一家大型放射科服务提供商处获得了 600 份随机的、去识别的成人腰椎影像学报告（200 份 X 光、200 份 CT 和 200 份 MRI）。仅包括因腰痛而要求的报告。从报告文本中，一位作者提取了每个发现（例如，“广泛的后椎间盘膨出”），并记录其是否存在（例如，无椎间盘膨出），直到达到数据饱和，预定义为至少 50 份报告，并且在每种影像学模式的最后 10 份报告中没有新的/类似的发现。两位作者独立判断每个发现是否可能临床上不重要。对于每个可能临床上不重要的发现，他们还确定是否明确报告为良性（表示为正常、年龄正常、良性、临床上不重要或无意义）。
在对 262 份报告（80 份 X 光、82 份 CT、100 份 MRI）进行编码后达到数据饱和。在所有报告中，我们共提取了 3598 个发现。几乎所有报告都至少包含一个临床上不重要的发现（76/80（95%）X 光、80/82（98%）CT、99/100（99%）MRI）。超过一半的发现（n=2062，57%；272 份 X 光、667 份 CT、1123 份 MRI）被判断为可能临床上不重要。大多数可能临床上不重要的发现（90%，n=1854）在影像学上被报告为存在，而在这些发现中，只有 18%（n=331）（89 份 X 光、93 份 CT 和 149 份 MRI）被明确报告为良性。
腰椎影像学报告经常包含临床上可能不重要的发现，而没有明确说明它们是良性的。
