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Inherent Dangers in Radiologic Screening

Robert J. Stanley1

1 Department of Radiology, University of Alabama at Birmingham, 619 19th St. S., N342 JT, Birmingham, AL 35249-6830.



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  		Fig. 1. —Natural history of disease. Diagram illustrates that preclinical phase begins at onset and ends when signs or symptoms develop. Clinical phase then starts, ending with death. Detectable preclinical phase (DPCP) begins when disease is detectable by a test. Detection (X) during DPCP advances time of diagnosis by duration of lead time. (Reprinted from [4])

 


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  		Fig. 2. —Lead-time bias. Diagram shows that, with screening, time of diagnosis is advanced by lead time provided by positive test result. If earlier diagnosis has no effect on time of death from disease, then survival with testing is equal to survival without testing plus lead time. (Reprinted from [4])

 


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  		Fig. 3. —Length-time bias. Diagram shows how probability of detection is related to rate of disease progression. Length of each arrow represents length of detectable preclinical phase, from initial detectability to clinical diagnosis (Dx). Testing at a single moment detects four slowly progressive cases but only two rapidly progressive cases. Cases not detected by test (thin arrows) are diagnosed clinically either before or after time of testing. Thick arrows indicate detected cases. (Reprinted from [4])

 

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