title: Toward a Framework for Benefit-Risk Assessment in Diagnostic Imaging: Identifying Scenario-specific Criteria.
abstract: Diagnostic imaging has many effects and there is no common definition of value in diagnostic radiology. As benefit-risk trade-offs are rarely made explicit, it is not clear which framework is used in clinical guideline development. We describe initial steps toward the creation of a benefit-risk framework for diagnostic radiology.
  
  
  
  We performed a literature search and an online survey of physicians to identify and collect benefit-risk criteria (BRC) relevant to diagnostic imaging tests. We operationalized a process for selection of BRC with the use of four clinical use case scenarios that vary by diagnostic alternatives and clinical indication. Respondent BRC selections were compared across clinical scenarios and between radiologists and nonradiologists.
  
  
  
  Thirty-six BRC were identified and organized into three domains: (1) those that account for differences attributable only to the test or device (n = 17); (2) those that account for clinical management and provider experiences (n = 12); and (3) those that capture patient experience (n = 7). Forty-eight survey participants selected 22 criteria from the initial list in the survey (9-11 per case). Engaging ordering physicians increased the number of criteria selected in each of the four clinical scenarios presented. We developed a process for standardizing selection of BRC in guideline development.
  
  
  
  These results suggest that a process relying on elements of comparative effectiveness and the use of standardized BRC may ensure consistent examination of differences among alternatives by way of making explicit implicit trade-offs that otherwise enter the decision-making space and detract from consistency and transparency. These findings also highlight the need for multidisciplinary teams that include input from ordering physicians.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington.
authors.forename: Maria
authors.initials: M
authors.lastname: Agapova
authors.affiliation: Department of Radiology, School of Medicine, University of Washington, 325 Ninth Ave, Seattle, WA 98104. Electronic address: bres@u.washington.edu.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Bresnahan
authors.affiliation: Department of Radiology, School of Medicine, University of Washington, 325 Ninth Ave, Seattle, WA 98104.
authors.forename: Ken F
authors.initials: KF
authors.lastname: Linnau
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.affiliation: General Electric Healthcare, Waukesha, Wisconsin.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Higashi
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington.
authors.forename: Larry
authors.initials: L
authors.lastname: Kessler
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington.
authors.forename: Beth
authors.initials: B
authors.lastname: Devine
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D003952:Diagnostic Imaging / Q000379:methods*; D017598:Efficiency, Organizational; D006801:Humans; D018579:Patient Selection; D011859:Radiography / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*
keywords: Benefit-risk assessment; appropriateness criteria; diagnostic imaging; imaging guidelines