{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T13:03:33Z","timestamp":1776344613926,"version":"3.51.2"},"reference-count":48,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[1991,6,1]],"date-time":"1991-06-01T00:00:00Z","timestamp":675734400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med Decis Making"],"published-print":{"date-parts":[[1991,6]]},"abstract":"<jats:p> The authors discuss the assessment of the contribution of diagnostic imaging to the patient management process. A hierarchical model of efficacy is presented as an organizing structure for appraisal of the literature on efficacy of imaging. Demonstration of efficacy at each lower level in this hierarchy is logically necessary, but not sufficient, to assure efficacy at higher levels. Level 1 concerns technical quality of the images; Level 2 addresses diagnostic ac curacy, sensitivity, and specificity associated with interpretation of the images. Next, Level 3 focuses on whether the information produces change in the referring physician's diagnostic thinking. Such a change is a logical prerequisite for Level 4 efficacy, which concerns effect on the patient management plan. Level 5 efficacy studies measure (or compute) effect of the information on patient outcomes. Finally, at Level 6, analyses examine societal costs and benefits of a diagnostic imaging technology. The pioneering contributions of Dr. Lee B. Lusted in the study of diagnostic imaging efficacy are highlighted. <\/jats:p>","DOI":"10.1177\/0272989x9101100203","type":"journal-article","created":{"date-parts":[[2007,3,18]],"date-time":"2007-03-18T04:13:15Z","timestamp":1174191195000},"page":"88-94","source":"Crossref","is-referenced-by-count":1033,"title":["The Efficacy of Diagnostic Imaging"],"prefix":"10.1177","volume":"11","author":[{"given":"Dennis G.","family":"Fryback","sequence":"first","affiliation":[]},{"given":"John R.","family":"Thornbury","sequence":"additional","affiliation":[]}],"member":"179","published-online":{"date-parts":[[1991,6,1]]},"reference":[{"key":"atypb1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198811033191810"},{"key":"atypb2","volume-title":"Ionizing radiation exposure of the population of the United States, NCRP Report No. 93","author":"National Council on Radiation Protection and Measurements.","year":"1987"},{"key":"atypb3","volume-title":"Exposure of the U.S. population from diagnostic medical radiation, NCRP Report No. 100","author":"National Council on Radiation Protection and Measurements.","year":"1989"},{"key":"atypb4","volume-title":"The effects on population of exposure to low levels of ionizing radiation. Committee on Biological Effects of Ionizing Radiation","author":"National Academy of Sciences\/National Research Council.","year":"1980"},{"key":"atypb5","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.163.2.3550886"},{"key":"atypb6","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.156.1.4001422"},{"key":"atypb7","volume-title":"Introduction to medical decision making","author":"Lusted LB","year":"1968"},{"key":"atypb8","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(55)90525-0"},{"key":"atypb9","doi-asserted-by":"publisher","DOI":"10.1126\/science.130.3366.9"},{"key":"atypb10","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8400400408"},{"key":"atypb11","volume-title":"Effectiveness and efficiency. Random reflections on health services","author":"Cochrane AL","year":"1972"},{"key":"atypb12","doi-asserted-by":"publisher","DOI":"10.1148\/114.3.561"},{"key":"atypb13","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.131.1.1"},{"key":"atypb14","volume-title":"Efficacy of diagnostic x-ray procedures","author":"Lusted LB","year":"1980"},{"key":"atypb15","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-96-2-246"},{"key":"atypb16","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198505000-00030"},{"key":"atypb17","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(86)90046-8"},{"key":"atypb18","first-page":"439","volume":"17","author":"McNeil BJ","year":"1976","journal-title":"J Nucl Med."},{"key":"atypb19","first-page":"94","volume":"10","author":"Fryback DG","year":"1983","journal-title":"J Neuroradiol."},{"key":"atypb20","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-108-3-402"},{"key":"atypb21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03440200057023"},{"key":"atypb22","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.143.1.7063747"},{"key":"atypb23","doi-asserted-by":"publisher","DOI":"10.1126\/science.3287615"},{"key":"atypb24","doi-asserted-by":"publisher","DOI":"10.1148\/74.2.178"},{"key":"atypb25","unstructured":"Lusted LB Receiver operating characteristic analysis and its significance in interpretation of radiologic images. In Potchen EJ, ed. Current concepts in radiology. Vol. 2, pp. 117-130. St. Louis: C. V. Mosby, 1975."},{"key":"atypb26","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8400400203"},{"key":"atypb27","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8800800208"},{"key":"atypb28","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8800800309"},{"key":"atypb29","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8900900307"},{"key":"atypb30","doi-asserted-by":"publisher","DOI":"10.1097\/00004424-199005000-00019"},{"key":"atypb31","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9001000105"},{"key":"atypb32","first-page":"557","volume":"94","author":"Griner PF","year":"1981","journal-title":"Ann Intern Med."},{"key":"atypb33","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8800800403"},{"key":"atypb34","volume-title":"Assessment and modification of clinical utility in diagnostic radiology: the oral cholecystogram and the upper gastrointestinal examinations","author":"Food and Drug Administration.","year":"1985"},{"key":"atypb35","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1542\/peds.60.5.669","volume":"60","author":"Sane SM","year":"1977","journal-title":"Pediatrics."},{"key":"atypb36","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1980.03310060038020"},{"key":"atypb37","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.131.1.5"},{"key":"atypb38","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.134.6.1111"},{"key":"atypb39","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-111-1-58"},{"key":"atypb40","first-page":"322A","volume":"29","author":"Marton KI","year":"1981","journal-title":"Clin Res."},{"key":"atypb41","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197507312930502"},{"key":"atypb42","first-page":"389","volume":"144","author":"McNeil BJ","year":"1977","journal-title":"Surg Gynecol Obstet."},{"key":"atypb43","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8500500309"},{"issue":"7","key":"atypb44","first-page":"4","volume":"45","year":"1989","journal-title":"Am Coll Radiol Bull"},{"key":"atypb45","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198601023140111"},{"key":"atypb46","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-111-5-389"},{"key":"atypb47","first-page":"591","volume":"25","author":"Chang P.","year":"1990","journal-title":"A decision analysis perspective. Invest Radiol."},{"key":"atypb48","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8800800409"}],"container-title":["Medical Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0272989X9101100203","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0272989X9101100203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T06:10:37Z","timestamp":1740809437000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0272989X9101100203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,6]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1991,6]]}},"alternative-id":["10.1177\/0272989X9101100203"],"URL":"https:\/\/doi.org\/10.1177\/0272989x9101100203","relation":{},"ISSN":["0272-989X","1552-681X"],"issn-type":[{"value":"0272-989X","type":"print"},{"value":"1552-681X","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,6]]}}}