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To determine if radiology residents who used a structured reporting system (SRS) produced higher quality reports than residents who used conventional free-text dictation to report cranial magnetic resonance (MR) imaging in patients suspected of having a stroke.The study was approved by an institutional review board and was HIPAA compliant; informed consent was obtained. This study included residents, with 16 in the control group and 18 in the intervention group. For phase 1, each subject reviewed the same set of 25 brain MR imaging cases and dictated the cases by using free-text conventional dictation. For phase 2, 4 months later, the control group repeated the same process, whereas the intervention group reread the same MR imaging cases by using SRS to create reports. Resident-generated reports were graded for accuracy and completeness by a neuroradiologist on the basis of consensus interpretations and criterion standard diagnoses as established with at least 6 months of clinical follow-up, imaging follow-up, and/or histologic examination where appropriate. Accuracy and completeness scores were analyzed by using a Wilcoxon signed rank test for paired data and a Mann-Whitney U test for nonpaired data. Intervention group residents were surveyed regarding their opinions of SRS.For phase 1 reports, no significant difference in accuracy or completeness scores between control and intervention groups was found. Decreases in accuracy (91.5 to 88.7) and completeness (68.7 to 54.3) scores for phase 2 compared with phase 1 for the intervention group were found; increases in accuracy (91.4 to 92.4) and completeness (67.8 to 71.7) scores for phase 2 compared with phase 1 for the control group were found (all P values.001). The most common complaints were that the SRS was overly constraining with regard to report content and was time-consuming to use.While there are many potential benefits of structuring radiology reports, such changes cannot be assumed to improve report accuracy or completeness. Any SRS should be tested for effect on intrinsic report quality.

Radiology research involves comparisons that deal with the presence or absence of various imaging signs and the accuracy of a diagnosis. In this article, the authors describe the statistical tests that should be used when the data are not distributed normally or when they are categorical variables. These nonparametric tests are used to analyze a 2 x 2 contingency table of categorical data. The tests include the chi2 test, Fisher exact test, and McNemar test. When the data are continuous, different nonparametric tests are used to compare paired samples, such as the Mann-Whitney U test (equivalent to the Wilcoxon rank sum test), the Wilcoxon signed rank test, and the sign test. These nonparametric tests are considered alternatives to the parametric t tests, especially in circumstances in which the assumptions of t tests are not valid. For radiologists to properly weigh the evidence in the literature, they must have a basic understanding of the purpose, assumptions, and limitations of each of these statistical tests.

To compare negative appendectomy and perforation rates in children who underwent ultrasonography (US), computed tomography (CT), or no imaging before urgent appendectomy.All children who underwent urgent appendectomy during a 4(1/2)-year period were identified in a surgical billing database. Pathology reports were coded as negative or as showing acute inflammation or perforation. Imaging up to 14 days before appendectomy or abscess drainage was noted, and imaging-based diagnoses were compared with pathologic findings. Patient age and sex were recorded.Two hundred ninety-nine children, 176 (59%) male and 123 (41%) female (mean age, 10.4 years; age range, 1--21 years), underwent urgent appendectomy. One hundred twenty-six (42%) underwent no imaging, 121 (41%) underwent US with or without CT, and 52 (17%) underwent CT only; 44 (15%) underwent both US and CT. There were significantly higher rates of appendectomy with normal pathologic findings ("negative appendectomy") in patients who underwent no imaging (14% [18 of 126]) or US (17% [20 of 121]) versus the rates in those who underwent CT only (2% [one of 52]) (P =.02 and P =.007, respectively). The negative appendectomy rate was 7% in 96 patients who underwent CT with or without prior US. The perforation rates were not significantly different.As compared with children who underwent no preoperative imaging and those who underwent US, children who underwent CT had a significantly lower negative appendectomy rate, without a significantly higher perforation rate.

To evaluate the accuracy of helical computed tomography (CT) for the diagnosis of appendicitis in children and to assess the utility of CT in establishing alternative diagnoses.The medical records of 154 children (median age, 12 years; age range, 1-20 years) who were suspected to have appendicitis and who underwent CT were reviewed. The gastrointestinal tract was opacified in 151 of 154 patients: Only orally administered contrast material was used in 126 patients; only rectally administered contrast material, in 21 patients; and both oral and rectal contrast material, in four patients. CT findings were correlated with surgical and histopathologic findings or with clinical follow-up findings.Sixty-four CT scans were interpreted as positive for appendicitis and included 58 true-positive and six false-positive scans. Ninety scans were interpreted as negative and included 87 true-negative and three false-negative scans. CT had a sensitivity of 95% and a specificity of 94% for the diagnosis of appendicitis. In addition, in 32 (34%) of 93 patients without appendicitis, an alternative diagnosis was established on the basis of CT findings.Helical CT is useful in a pediatric population to diagnose or exclude appendicitis and to establish an alternative diagnosis.

Health technology assessment is the systematic and quantitative evaluation of the safety, efficacy, and cost of health care interventions. This article outlines aspects of technology assessment of diagnostic imaging. First, it presents a conceptual framework of a hierarchy of levels of efficacy that should guide thinking about imaging test evaluation. In particular, the framework shows how the question answered by most evaluations of imaging tests, "How well does this test distinguish disease from the nondiseased state?" relates to the fundamental questions for all health technology assessment, "How much does this intervention improve the health of people?" and "What is the cost of that improvement?" Second, it describes decision analysis and cost-effectiveness analysis, which are quantitative modeling techniques usually used to answer the two core questions for imaging. Third, it outlines design and operational considerations that are vital if researchers who are conducting an experimental study are to make a quality contribution to technology assessment, either directly through their findings or as an input into decision analyses. Finally, it includes a separate discussion of screening--that is, the application of diagnostic tests to nonsymptomatic populations--because the requirements for good screening tests are different from those for diagnostic tests of symptomatic patients and because the appropriate evaluation methods also differ.

Since 1998, the Radiological Society of North America (RSNA), specifically the RSNA Publications Council and the Committee on International Radiology Education, have sponsored an editorial fellowship. Seven of us have completed this fellowship to date. At the behest of Radiology Editor Anthony V. Proto, MD, in this editorial we will attempt to distill these 4 years of experience with the RSNA Editorial Fellowship. We will share our comments and observations with potential applicants to the fellowship to convey what the editorial fellow should expect if he or she was to actually undertake it. Additionally, we will share our thoughts with the readers of Radiology in general. Although a few other biomedical journals have journalism fellowships (eg, the Fishbein Fellowship at the Journal of American Medical Association), we could find no published comments about the purpose, value, and experience gained from a medical journalism fellowship.

This introduction to biostatistics and measurement is the first in a series of articles designed to provide Radiology readers with a basic understanding of statistical concepts. Although most readers of the radiology literature know that application of study results to their practice requires an understanding of statistical issues, many may not be fully conversant with how to interpret statistics. The goal of this series is to enhance the ability of radiologists to evaluate the literature competently and critically, not make them into statisticians. © RSNA, 2002

In the past 20 years, there has been increasing recognition of the need to consider cost in medical decision making. This period has seen an explosion in the number of economic evaluations appearing in the medical literature. Cost-effectiveness analysis is an objective systematic technique for comparing alternative health care strategies on both cost and effectiveness simultaneously. Cost-effectiveness analysis can be used to inform medical decision makers in the establishment of clinical practice guidelines and in the setting of health policy. Cost-effectiveness analysis is a state-of-the-art research tool with its own terminology and methods. It is critical that radiologists become familiar with the concepts and procedures of cost-effectiveness analysis so they can properly evaluate cost-effectiveness analysis studies and be more knowledgeable participants in the health care decision-making process. This article explains the rationale, terminology, and methods of cost-effectiveness analysis as applied to radiology.

Editor: The term ‘‘Aunt Minnie’’ describes an imaging finding that is both perfectly obvious and pathognomonic of a disease (1,2). We have tried to answer the question of who coined the term by asking the family of the late Dr Edward B. Neuhauser. Gernda Neuhauser, his wife, is certain that he had no aunt or relative named Minnie. However, she believes that the term was adopted by her late husband from the lore of New England. It may have been a local phrase with special meaning, similar to ‘‘Uncle Charlie’’ or ‘‘Uncle Ben.’’ Regardless of its origin, it remains a useful descriptor in the practice of radiology today. A well-known example occurred approximately 4 years ago in the radiology department at Boston Children’s Hospital. A pediatrician was consulted for a second opinion regarding a 4-year-old child who was thought to have been battered. He brought the radiologist a skeletal survey. The radiologist looked at the survey and said, ‘‘This is leukemia.’’ Startled, the clinician protested that the complete blood cell count was normal. The radiologist replied, ‘‘What can I say? It’s an Aunt Minnie!’’ Several weeks later, a repeat complete blood cell count was abnormal and the child was symptomatic with leukemia.