title: Clinical imaging guidelines part 2: Risks, benefits, barriers, and solutions.
abstract: A recent international meeting was convened by two United Nations bodies to focus on international collaboration on clinical appropriateness/referral guidelines for use in medical imaging. This paper, the second of 4 from this technical meeting, addresses barriers to the successful development/deployment of clinical imaging guidelines and means of overcoming them. It reflects the discussions of the attendees, and the issues identified are treated under 7 headings: ■ Practical Strategy for Development and Deployment of Guidelines; ■ Governance Arrangements and Concerns with Deployment of Guidelines; ■ Finance, Sustainability, Reimbursement, and Related Issues; ■ Identifying Benefits and Radiation Risks from Radiological Examinations; ■ Information Given to Patients and the Public, and Consent Issues; ■ Special Concerns Related to Pregnancy; and ■ The Research Agenda. Examples of topics identified include the observation that guideline development is a global task and there is no case for continuing it as the project of the few professional organizations that have been brave enough to make the long-term commitment required. Advocacy for guidelines should include the expectations that they will facilitate: (1) better health care delivery; (2) lower cost of that delivery; with (3) reduced radiation dose and associated health risks. Radiation protection issues should not be isolated; rather, they should be integrated with the overall health care picture. The type of dose/radiation risk information to be provided with guidelines should include the uncertainty involved and advice on application of the precautionary principle with patients. This principle may be taken as an extension of the well-established medical principle of "first do no harm."
authors: Trinity College Centre for Health Sciences, St. James Hospital, Dublin, Ireland.
authors: James
authors: J
authors: Malone
authors: World Health Organization, Radiation and Environmental Health Programme, Department of Public Health and Environment, Geneva, Switzerland.
authors: Maria
authors: M
authors: del Rosario-Perez
authors: Federal Agency for Nuclear Control, Brussels, Belgium.
authors: Lodewijk
authors: L
authors: Van Bladel
authors: Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors: Seung Eun
authors: SE
authors: Jung
authors: Radiation Protection of Patients Unit, Radiation Safety & Monitoring Section, Division of Radiation, Transport and Waste Safety/Department of Nuclear Safety & Security, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria.
authors: Ola
authors: O
authors: Holmberg
authors: Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address: mabettmann@gmail.com.
authors: Michael A
authors: MA
authors: Bettmann
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D038622:Internationality; D017410:Practice Guidelines as Topic; D011835:Radiation Protection / Q000592:standards*; D011871:Radiology / Q000592:standards*
keywords: Appropriateness guidelines; communication; health outcomes; radiation and pregnancy; radiation risk; referral guidelines