Critically Assessing the Literature:Understanding Error and Bias

  • C. Craig Blackmore
  • L. Santiago Medina
  • James G. Ravenel
  • Gerard A. Silvestri
  • Kimberly E. Applegate


The keystone of the evidence-based imaging (EBI) approach is to critically assess the research data that are provided and to determine if the information is appropriate for use in answering the EBI question. Unfortunately, the published studies are often limited by bias, small sample size, and methodological inadequacy. Further, the information provided in published reports may be insufficient to allow estimation of the quality of the research. Two recent initiatives, the CONSORT (1) and the STARD (2), aim to improve the reporting of clinical trials and studies of diagnostic accuracy, respectively. However, these guidelines are only now being implemented.


Carotid Artery Disease Beta Error Imaging Literature Standard Bias Methodological Inadequacy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Moher D, Schulz K, Altman D. JAMA 2001;285:1987–1991.CrossRefPubMedGoogle Scholar
  2. 2.
    Bossuyt PM, Reitsma J, Bruns D, et al. Acad Radiol 2003;10:664–669.CrossRefPubMedGoogle Scholar
  3. 3.
    Hulley SB, Cummings SR. Designing Clinical Research. Baltimore: Williams and Wilkins, 1998.Google Scholar
  4. 4.
    Medina L, Zurakowski D. Radiology 2003;226:297–301.CrossRefPubMedGoogle Scholar
  5. 5.
    Gallagher E. Acad Emerg Med 1999;6:1084–1087.CrossRefPubMedGoogle Scholar
  6. 6.
    Lang T, Secic M. How to Report Statistics in Medicine. Philadelphia: American College of Physicians, 1997.Google Scholar
  7. 7.
    Gardener M, Altman D. Br Med J 1986:746–750.Google Scholar
  8. 8.
    Medina L, Aguirre E, Zurakowski D. Neuroimag Clin North Am 2003;13:157–165.CrossRefGoogle Scholar
  9. 9.
    Medina L. AJNR 1999;20:1584–1596.PubMedGoogle Scholar
  10. 10.
    Donner A. Stat Med 1984;3:199–214.CrossRefPubMedGoogle Scholar
  11. 11.
    Maclure M, Schneeweiss S. Epidemiology 2001;12:114–122.CrossRefPubMedGoogle Scholar
  12. 12.
    Reid MC, Lachs MS, Feinstein AR. JAMA 1995;274:645–651.CrossRefPubMedGoogle Scholar
  13. 13.
    Lijmer JG, Mol BW, Heisterkamp S, et al. JAMA 1999;282:1061–1066.CrossRefPubMedGoogle Scholar
  14. 14.
    Blackmore C. Acad Radiol 2004;11:134–140.CrossRefPubMedGoogle Scholar
  15. 15.
    Ransohoff DF, Feinstein AR. N Engl J Med 1978;299:926–930.CrossRefPubMedGoogle Scholar
  16. 16.
    Black WC. AJR 1990;154:17–22.PubMedGoogle Scholar
  17. 17.
    Begg CB, McNeil BJ. Radiology 1988;167:565–569.PubMedGoogle Scholar
  18. 18.
    Schulz K, Chalmers I, Hayes R, Altman D. JAMA 1995;273:408–412.CrossRefPubMedGoogle Scholar
  19. 19.
    Terasawa T, Blackmore C, Bent S, Kohlwes R. Ann Intern Med 2004;141:537–546.PubMedGoogle Scholar
  20. 20.
    Marcus P. Lung Cancer 2003;41:37–39.CrossRefPubMedGoogle Scholar
  21. 21.
    Hosek R, Flanders W, Sasco A. Am J Epidemiol 1996;143:193–201.PubMedGoogle Scholar
  22. 22.
    Patz E, Goodman P, Bepler G. N Engl J Med 2000;343:1627–1633.CrossRefPubMedGoogle Scholar
  23. 23.
    Black WC, Welch HG. AJR 1997;168:3–11.PubMedGoogle Scholar
  24. 24.
    Black W, Haggstrom D, Welch H. J Natl Cancer Inst 2002;94.Google Scholar
  25. 25.
    Kent DL, Haynor DR, Longstreth WT Jr, Larson EB. Ann Intern Med 1994;120: 856–871.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • C. Craig Blackmore
    • 1
  • L. Santiago Medina
    • 2
    • 3
  • James G. Ravenel
    • 4
  • Gerard A. Silvestri
    • 5
  • Kimberly E. Applegate
    • 6
  1. 1.Center for Health Care Solutions, Department of RadiologyVirginia Mason Medical CenterSeattleUSA
  2. 2.Co-Director Division of Neuroradiology and Brain Imaging, Director of the Health Outcomes, Policy, and Economics (HOPE) Center, Department of RadiologyMiami Children’s HospitalMiamiUSA
  3. 3.Former Lecturer in RadiologyHarvard Medical SchoolBostonUSA
  4. 4.Department of RadiologyThe Medical University of South CarolinaCharlestonUSA
  5. 5.Department of MedicineMedical University of South CarolinaCharlestonUSA
  6. 6.Department of RadiologyEmory University School of MedicineAtlantaUSA

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