Diagnostic certainty

Diagnostic certainty is a component of all cases and reflects how well the diagnosis has been established. It is crucial that the certainty of a diagnosis is not overstated. Doing so only reduces the utility of the Radiopaedia case library and undermines your own credibility as a contributor. 

Please be pedantic and sceptical or your own cases and strive to establish the diagnosis with supporting information. 

The user interface to set Diagnostic certainty (DC) is visible immediately below the title in case edit mode. It comprises a slider, with descriptions of each state. 

  1. Possible
    • the preferred diagnosis is one of a number of possible diagnoses, and although it is perhaps more likely, other conditions remain viable alternatives.
    • cases like this are sometimes worthwhile, but often they are not.
    • what you need to do: include a discussion on why you favour your diagnosis.
    • be prepared for your case to be rejected for publication; that's ok, you can always keep it as one of your unlisted cases.
  2. Probable
    • the preferred diagnosis is far more likely (>90%) than any alternative, but the diagnosis has not been established. 
  3. Almost certain
    • you have good reasons to believe the diagnosis was confirmed, but you do not have direct access to the proof and cannot upload it
    • examples: 
      • you collected this case some time ago and have included "path proven" in the description but not the actual histology report
      • a secondary source states the diagnosis (e.g. the referral, or the treating unit or a colleague tells you the result of a biopsy) but you haven't seen the report yourself
    • imaging is almost pathognomonic but it is conceivable that an unusual appearing other entity could have similar appearances
    • examples:  
  4. Certain
    • the diagnosis is 100% certain based on:
      • unequivocal or pathognomonic imaging appearance
      • clinical, surgical or pathological proof directly obtained from a primary source by the uploader (e.g. directly from the histology report).
    • where appropriate you should include substantiating evidence (e.g. histology report/slides, diagnostic laboratory test/values)
    • Not sure? Ask yourself this: "Would a journal accept the diagnosis if you submitted it as a case report?" In other words, would a cynical and sceptical third party agree that there was no doubt about the diagnosis? Only if your honest answer is "yes" then should the diagnosis be considered "Certain". 
  5. Not applicable
    • the images are not of a patient with a particular diagnosis
    • examples:
      • normal scan for teaching purposes
      • diagrams, illustrations, or flow chart

The diagnostic certainty of a case has many implications and functions. 

Firstly it has a strong influence on case completeness, and therefore when sorting search results by case completeness cases with high DC will be favoured. Similarly, these cases will be more frequently shown in Quiz Mode. 

Secondly, search results will show the DC level as a coloured dot (matching the slider). 

Thirdly, search results can be (soon) filtered to only show cases of a minimum DC (e.g. at least confirmed but unsubstantiated). 

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