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Chapter 10 - Evidence-Based Imaging

Evidence-based imaging consists of identifying the relevant imaging literature for a specific clinical question, understanding the strengths and limitations of the existing evidence, and then incorporating that evidence into clinical care. Although the radiology literature is abundant, there may be biases that can affect the validity of the published information, which must be identified through critical analysis. The effectiveness of imaging can be considered on multiple successive levels, from technical adequacy, to diagnostic accuracy, to diagnostic certainty, to medical decision making, to patient outcome, and finally to societal cost-effectiveness. Radiologists must be able to translate measures of accuracy into the more clinically relevant levels of effectiveness, including medical decision making and patient outcomes. Imaging is not appropriate without the potential to change management based on the study results. In practice, evidence-based imaging consists of incorporating research regarding the value of imaging at different levels of effectiveness to address whether imaging is appropriate and, if so, which imaging is preferred. This approach balances the benefits of imaging with the costs, both in dollars and in patient outcomes, including complications from incorrect diagnosis, incidental findings, and radiation effects. As healthcare increasingly focuses on appropriate use of imaging to improve quality and contain costs, radiologists must use the best evidence to maximize the value of imaging for patients and society.

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Chapter 7 - Radiology-Related Quality Programs and Organizations

A rapid growth in medical imaging tests since the 1990s has prompted concerns within the medical community and the public over patient exposure to ionizing radiation. Several quality assurance and improvement programs have been initiated to address these concerns. The Image Gently campaign focuses on reducing radiation dose from CT exams in children and has been endorsed by several professional medical organizations. Step Lightly is a similar campaign that focuses specifically on reducing radiation dose to children undergoing interventional radiologic procedures. The momentum generated by Image Gently was continued with Image Wisely, which carries the principles of lowering radiation dose while maintaining image quality to adult patient populations. The Dose Index Registry allows participating facilities to compare their dose data from CT exams to regional and national values and aims to encourage users to undertake quality measures to improve their dose profile. In addition to concerns over radiation exposure, the medical field, and radiology in particular, have been cited for not doing enough to prevent unnecessary medical tests and procedures. The Choosing Wisely campaign aims to ensure that medical tests are performed only when truly necessary and that they do not result in patient harm. Several additional national programs and organizations that contribute to improving medical and radiologic practice quality are briefly discussed.

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