Evidence-based radiology: why and how?

Sardanelli, Francesco; Hunink, M. G. Myriam; Gilbert, Fiona J.; Leo, Giovanni Di; Krestin, Gabriël P.

doi:10.1007/s00330-009-1574-4

Cited by 90 publications

(47 citation statements)

References 74 publications

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“…20 Although LOS is not included in the widely adopted standardized Valve Academic Research Consortium outcomes guiding the evaluation of TAVR, 21 there is an ample evidence that stresses that shorter LOS is associated with improved outcomes in the elderly. 7,[11][12][13] Similar to the principles of as low as reasonably achievable used in the quality improvement of procedures requiring radiation, 22 our intent was to target LOS as an indicator of multiple efforts aimed at optimizing patients' journey of care.…”

Section: Local Challenges In Implementationmentioning

confidence: 99%

Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway

Lauck

Wood

Baumbusch

et al. 2016

Circ: Cardiovascular Quality and Outcomes

129

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Abstract-We describe the development, implementation, and evaluation of a standardized clinical pathway to facilitate safe discharge home at the earliest time after transfemoral transcatheter aortic valve replacement. Between May 2012 and October 2014, the Heart Team developed a clinical pathway suited to the unique requirements of transfemoral transcatheter aortic valve replacement in contemporary practice. The components included risk-stratified minimalist periprocedure approach, standardized postprocedure care with early mobilization and reconditioning, and criteria-driven discharge home. Our aim was to reduce variation in care, identify a subgroup of patients suitable for early discharge (≤48 hours), and decrease length of stay for all patients. We addressed barriers related to historical practices, complex multidisciplinary stakeholder engagement, and adoption of length of stay as a quality indicator. We retrospectively reviewed the experiences of 393 consecutive patients; 150 (38.2%) were discharged early. At baseline, early discharge patients had experienced less previous balloon aortic valvuloplasty, had higher left ventricular ejection fraction, better cognitive function, and were less frail than the standard discharge group (>48 hours). Early discharge was associated with the use of local anesthesia, implantation of balloon expandable device, avoidance of urinary catheter, and early removal of temporary pacemaker. Median length of stay was 1 day for early discharge and 3 days for other patients; 97.7% were discharged home. There were no differences in 30-day mortality (1.3%), disabling stroke (0.8%), or readmission (10.7%). The implementation of a transcatheter aortic valve replacement clinical pathway shifted the program's approach to combine standardized processes and individual risk stratification. The Vancouver transcatheter aortic valve replacement clinical pathway requires a rigorous assessment to determine its efficacy, safety, and reproducibility. Goals and Vision of the ProgramTranscatheter aortic valve replacement (TAVR) is a recommended treatment for inoperable and select higher surgical risk patients with severe aortic stenosis. [1][2][3] In the first decade of therapy development, careful case selection, increased periprocedural expertise, and enhanced technology have contributed to improved outcomes and patient access to TAVR. 4,5 Interest is shifting from "How we do TAVR" to "How we care for TAVR patients" to further optimize outcomes, reduce health service utilization, and contribute to the sustained success of transcatheter heart valve therapies. 6 Duration of hospital stay is an indicator of quality of care and a predictor of outcome in the elderly population. 7 There is a significant variation in reported postprocedure length of stay (LOS) after TAVR, ranging from 1 to >10 days.8-10 Similar variation exists in patients' disposition at the time of discharge; for example, the US Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry reported i...

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Section: Local Challenges In Implementationmentioning

confidence: 99%

Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway

Lauck

Wood

Baumbusch

et al. 2016

Circ: Cardiovascular Quality and Outcomes

129

View full text Add to dashboard Cite

show abstract

“…Evidence Based Medicine (EBM) is concerned with systematically analyzing the available evidence to make both clinical decisions for individual patients and policy decisions. Evidence Based Radiology (EBR) follows similar principles, but Sardanelli et al [1] describe several ways in which it differs. Firstly the need for the decision maker to have an in depth knowledge of the physics of image generation and manipulation, as these can have a very large effect on performance measurements.…”

Section: Context: Evidence Based Radiologymentioning

confidence: 99%

Influencing clinicians and healthcare managers: can ROC be more persuasive?

Taylor‐Phillips

Wallis

Duncan

et al. 2010

Medical Imaging 2010: Image Perception, Observer Performance, and Technology Assessment

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“…However, adoption of EBM principles in radiology has greatly lagged behind other clinical specialities. 1,2 In fact, the clinical utility of less than one-third of diagnostic imaging procedures is supported by sufficient evidence; as opposed to merely experience and opinion. 2,3 According to EBM standards, systematic reviews constitute the highest level of evidence because they consolidate the evidence of multiple studies rather than relying on the results of one individual study, with its inherent biases, alone.…”

Section: Introductionmentioning

confidence: 99%

Advanced neuroimaging in the clinic: critical appraisal of the evidence base

Fink

Mogil

Lipton

2016

BJR

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The shortage of high-quality systematic reviews in the field of radiology limits evidence-based integration of imaging methods into clinical practice and may perpetuate misconceptions regarding the efficacy and appropriateness of imaging techniques for specific applications. Diffusion tensor imaging for patients with mild traumatic brain injury (DTI-mTBI) and dynamic susceptibility contrast MRI for patients with glioma (DSC-glioma) are applications of quantitative neuroimaging, which similarly detect manifestations of disease where conventional neuroimaging techniques cannot. We performed a critical appraisal of reviews, based on the current evidence-based medicine methodology, addressing the ability of DTImTBI and DSC-glioma to (a) detect brain abnormalities and/or (b) predict clinical outcomes. 23 reviews of DTI-mTBI and 26 reviews of DSC-glioma met criteria for inclusion. All reviews addressed detection of brain abnormalities, whereas 12 DTI-mTBI reviews and 22 DSC-glioma reviews addressed prediction of a clinical outcome. All reviews were assessed using a critical appraisal worksheet consisting of 19 yes/no questions. Reviews were graded according to the total number of positive responses and the 2011 Oxford Centre for evidence-based medicine levels of evidence criteria. Reviews addressing DTI-mTBI detection had moderate quality, while those addressing DSC-glioma were of low quality. Reviews addressing prediction of outcomes for both applications were of low quality. Five DTI-mTBI reviews, but only one review of DSC-glioma met criteria for classification as a meta-analysis/systematic/quantitative review. INTRODUCTIONEvidence-based medicine (EBM) principles have been widely adopted as the gold standard and even the expected basis for everyday clinical practice. However, adoption of EBM principles in radiology has greatly lagged behind other clinical specialities. 1,2 In fact, the clinical utility of less than one-third of diagnostic imaging procedures is supported by sufficient evidence; as opposed to merely experience and opinion. 2,3 According to EBM standards, systematic reviews constitute the highest level of evidence because they consolidate the evidence of multiple studies rather than relying on the results of one individual study, with its inherent biases, alone. 2,4 Optimal reviews, which adopt EBM practices, provide a comprehensive overview of primary investigations of a specific topic through systematically and comprehensively searching and critically appraising the literature. While many narrative and educational

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Evidence-based radiology: why and how?

Abstract: Radiology will benefit greatly from the improvement in practice that will result from adopting this more rigorous approach to all aspects of our work.

Cited by 90 publications

References 74 publications

Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway

Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway

Influencing clinicians and healthcare managers: can ROC be more persuasive?

Advanced neuroimaging in the clinic: critical appraisal of the evidence base

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