title: Clinical imaging guidelines part 1: a proposal for uniform methodology.
abstract: Inappropriate imaging can lead to unnecessary medical radiologic exposures and cost and may not answer the clinical question. Imaging referral guidelines inform the justification of radiologic procedures and facilitate the choice of the best test first, but their acceptance by referrers, use, and value may be limited by shortcomings in the methodology of development. Focusing on common, essential elements of methodology will help guideline developers. In 2012 and 2013, the International Atomic Energy Agency hosted Technical Meetings on Radiation Protection of Patients Through the Development of Appropriateness Criteria in Diagnostic Imaging. Participants identified and agreed on issues concerning development of imaging referral guidelines. Items based on the Appraisal of Guidelines for Research and Evaluation II instrument were amended with additional items including development and consensus group composition. Consensus was sought on 28 items, 18 of which were agreed should be uniform, and 10 should allow for regional differences. Further work is required to encourage, provide, and identify higher quality evidence and to agree on a grading system for recommendations. Many key areas are common to guideline developers globally, opening the way for international collaboration to help demystify, simplify, and justify.
authors.affiliation: Department of Clinical Radiology, Northwick Park Hospital, Harrow, United Kingdom. Electronic address: denis.remedios@imperial.ac.uk.
authors.forename: Denis
authors.initials: D
authors.lastname: Remedios
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: James
authors.initials: J
authors.lastname: Brink
authors.affiliation: Radiation Protection of Patients Unit, Division of Radiation, Transport and Waste Safety, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Ola
authors.initials: O
authors.lastname: Holmberg
authors.affiliation: Department of Radiology, Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda.
authors.forename: Michael
authors.initials: M
authors.lastname: Kawooya
authors.affiliation: Department of Radiology, Royal Perth Hospital, Perth, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Mendelson
authors.affiliation: Future Medical Imaging Group, Melbourne, Australia.
authors.forename: Anusha
authors.initials: A
authors.lastname: Naidoo
authors.affiliation: Department of Diagnostic Imaging, Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Reed
authors.affiliation: Department of Radiology, Wake Forest University, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Bettmann
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D007391:International Cooperation; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000592:standards*; D011835:Radiation Protection / Q000592:standards*; D011871:Radiology / Q000592:standards*; D014481:United States
keywords: Imaging; appropriateness; guidelines; justification