A Secondary Analysis to Identify Patient-Centered Outcomes in the ACR’s Appropriateness Criteria

There is a growing body of literature indicating imaging testing can affect patients cognitively, socially, behaviorally, and emotionally. The extent to which these patient-centered outcomes (PCOs) are reported in the imaging literature is unclear. Identifying PCOs may facilitate shared decision making around imaging testing. To identify PCOs across a spectrum of clinical topics included in the ACR’s Appropriateness Criteria (AC). We systematically reviewed AC evidence tables for eligible articles of studies conducted in any clinical setting in high-income countries. Included studies reported PCOs occurring as a direct or indirect result of an imaging test performed for any reason (eg, diagnosis, screening, surveillance, or staging). PCOs and the methods used to measure them were extracted through a secondary analysis and descriptive synthesis. Our search identified 89 articles that reported outcomes of radiation exposure (n = 37), downstream testing (n = 20), complications (n = 19), incidental findings (n = 10), quality of life (n = 7), physical discomfort (n = 5), patient values and experiences (n = 4), patient financial and time costs (n = 4), psychosocial outcomes (n = 4), and test duration (n = 2). These outcomes were rarely reported from the patient perspective and were measured using a range of standardized or validated and nonstandardized methods. We identified few PCOs incorporated in the AC. Our findings reflect the historical emphasis of diagnostic research on accuracy, clinical utility, and selected outcomes (eg, adverse events). As radiology moves to a more patient-centered approach, it will be important to measure PCOs reported directly from patients.