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British Journal of Radiology 75 (2002),1005 © 2002 The British Institute of Radiology

Correspondence

Author's reply

The Editor—Sir,

We thank Dr MacEneaney for his comments regarding our paper [1]. We quite agree that the calculation of post-test probability should ideally be performed with Bayes' theorem, which requires knowledge of the sensitivity and specificity of the test/reader and pre-test probability of disease. Indeed, Doctors MacEneaney and Malone have published some excellent articles on this very topic [2].

However, in much of our research into the effectiveness of imaging [3, 4], we do, unlike in Dr MacEneaney's practice, insist that clinicians provide a measure of pre-test probability, given all available data, for their clinical diagnosis(es). In this way we can assess the diagnostic impact of imaging on the clinicians' working diagnosis(es). We can assess the number of diagnoses "ruled in or out" and any changes in confidence in retained diagnoses. This provides one measure of the diagnostic impact of a radiological test.

We are pleased that Dr MacEneaney agrees that it would be a step forward if clinicians and radiologists adopted a more uniform vocabulary indicating the degree of suspicion of disease in certainty of diagnoses. That was the intention of our article!

Yours etc.,

A K Dixon

Addenbrooke's Hospital, Box 219, Hills Road , Cambridge CB2 2QQ, UK

Received for publication August 29, 2002. Accepted for publication September 17, 2002.

References

  1. Hobby JL, Tom BD, Todd C, Bearcroft PW, Dixon AK. Communication of doubt and certainty in radiological reports. Br J Radiol 2000;73:999–1001.[Abstract]
  2. MacEneaney PM, Malone DE. The meaning of diagnostic test results: a spreadsheet for swift data analysis. Clin Radiol 2000;55:227–35.[Medline]
  3. Mackenzie R, Dixon AK. Measuring the effects of imaging: an evaluative framework. Clin Radiol 1995;50:513–8.[Medline]
  4. Hobby JL, Dixon AK, Bearcroft PWP, Tom BDM, Lomas DJ, Rushton N, et al. An assessment of the clinical effectiveness of MRI of the wrist. Radiology 2001;220:589–93.[Abstract/Free Full Text]

Related articles in BJR:

Re: Communication of doubt and uncertainty in radiological reports
P MacEneaney
BJR 2002 75: 1005. [Full Text]  




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