The impact of clinical data on interpretation of thallium scintigrams |
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Authors: | Michael Simons J Anthony Parker Kevin J Donohoe James E Udelson Ernesto V Gervino |
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Institution: | 1. From the Department of Medicine (Cardiovascular Division), the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory, the Department of Radiology (Nuclear Medicine Division), Beth Israel Hospital, USA 2. Harvard Medical School, Tufts University School of Medicine, Boston, Mass. 3. the Department of Medicine (Cardiovascular Division), New England Medical Center Hospital, Tufts University School of Medicine, Boston, Mass.
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Abstract: | Background The availability of clinical information often influences the interpretation of diagnostic imaging information. Methods and Results In this study we examined the impact of such data on interpretation of exercise thallium scans and the differences in analysis of such information between radiologists and clinicians. Two hundred thirty-seven exercise tolerance test-thallium scans (122 in patients with suspected coronary disease and 115 in patients with documented coronary disease) were read prospectively, first without and then with the knowledge of clinical information. Test scores, the readers’ and clinicians’ interpretations of historic data, and any changes in readings or interpretation of scintigraphic data were recorded. We found that the addition of clinical information resulted in changes in interpretation of 63 test results (27%), 20 (8%) of them major. Furthermore, clinical data significantly affected final test scores in 26 patients (11%), potentially affecting clinical management in this group. The changes in test scores were triggered predominantly by differences in interpretation of perfusion abnormalities rather than thallium lung uptake or left ventricular dilation with exercise. The impact of clinical data on overall test scores was greater in patients with suspected than documented coronary disease (p<0.05). There was good agreement in assessment of clinical information between scan readers and a clinician in tests done in patients with suspected coronary artery disease but not in patients with known coronary disease. Conclusions We conclude that clinical information has major influences on the interpretation of thallium scans, and interpretation of data can vary significantly between cardiologists and radiologists depending on the nature of the clinical data. |
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