The Effect of Clinical History on Diagnostic Imaging Interpretation – A Systematic Review

Abstract

To provide updated information on the effect of clinical history on diagnostic image interpretation and to provide study methodology and design recommendations for future studies assessing the effect of clinical history on diagnostic image performance. A literature search of Medline, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted from database inception to July 21, 2020. Studies comparing diagnostic imaging performance with and without clinical history, using observers reading images under both conditions that used an independent reference standard were included. Twenty-two studies met the inclusion criteria, with 15 showing clinical history improved diagnostic performance. One study reported a decrease in diagnostic performance with clinical history and the remaining six studies found no significant change in performance. Two studies used the free response paradigm with both reporting clinical history increased location sensitivity, decreased specificity and had no overall change in diagnostic performance. The disease spectrum of included cases was largely unreported and a balanced reading design was not used in 19 studies. Most published studies found that clinical history improved diagnostic performance. More recent studies accounting for abnormality location and multiple abnormalities showed an increase in false positives and no significant change in overall diagnostic performance with clinical history.