Radiologist Preferences, Agreement, and Variability in Phrases Used to Convey Diagnostic Certainty in Radiology Reports

Abstract

Purpose: To understand radiologists' preference and variability in phrases for expressing diagnostic certainty in radiology reports.

Materials and methods: This institutional review board-approved study was part of a quality improvement initiative to improve the quality of radiology reports at a tertiary academic hospital. Sixteen phrases commonly used in radiology reports to convey diagnostic certainty were extracted from prior publications. The degree of diagnostic certainty was divided into six arbitrary categories by an expert panel. We used an anonymous online survey to query 239 radiologists at our institution regarding their preferred phrase for each category. We evaluated the distribution of preferred phrases, performed cluster analysis to find groups of phrases used to describe specific diagnostic certainty categories, and calculated Krippendorff's α to evaluate how reliably radiologists use various phrases to express diagnostic certainty.

Findings: In all, 59.4% (142 of 239) of radiologists completed the survey. The most commonly preferred phrases were "consistent with" (45.1%; 64 of 142) for 100% confident, "highly suggestive of" (46.5%; 66 of 142) for very high likelihood, "most likely" (31.0%; 44 of 142) for high likelihood, "may represent" (50.7%; 72 of 142) for intermediate likelihood, "unlikely" (47.2%; 67 of 142) for low likelihood, and "very unlikely" (40.1%; 57 of 142) for very low likelihood. Cluster analysis identified six groups of phrases used to indicate a similar level of diagnostic certainty; however, Krippendorff's α was 0.217, indicating radiologists do not consistently use the same phrases for similar degrees of confidence.

Conclusion: Wide variability persists among radiologists' preferences for phrases used to convey diagnostic certainty. Interventions to improve consistency of use of these phrases may help reduce ambiguity and improve quality of radiology reports.

Keywords: Diagnostic certainty; agreement; radiology report; survey.