Methodology for ESR iGuide content

The European Society of Radiology (ESR) considers the use of evidence-based referral guidelines in clinical practice essential to ensure the appropriate utilisation of medical imaging for patients. Since 2014, the ESR has been working with the American College of Radiology (ACR) to develop referral guidelines for Europe, based on the ACR Appropriateness Criteria (AC) and appropriate use criteria developed by the ACR Rapid Response Committee.

This paper sets out the methodology used by the ESR’s Referral Guidelines Subcommittee to adapt the ACR criteria for use in the European clinical decision support (CDS) platform ESR iGuide. The ESR adheres to the ACR’s original methodology as far as applicable, and has established additional methodological guidance for its experts, establishing several key principles:

Any changes to existing recommendations, and any additional guidelines, should be based on evidence as far as possible

Expert opinion, judgement, European practice standards, should only function as a supplement when necessary

Appropriateness recommendations should give no consideration to national or institutional circumstances, costs, or availability of equipment.

The cooperation between the ACR and ESR on appropriate use criteria and imaging referral guidelines provides added value to both societies as European studies and guidelines from European subspecialty societies of radiology are fed into the process and the exchange of views among the experts makes the guideline development and review process more robust.

The ESR’s aim is to ensure referrers and patients benefit from the best possible guidance for appropriate imaging.

Collaboration, campaigns and champions for appropriate imaging: feedback from the Zagreb workshop

Abstract

Leading radiologists and representatives from national radiation protection regulatory authorities and health ministries from 19 countries of the European region worked together with five experts at the workshop on justification and appropriate use of imaging in Zagreb, Croatia, from 26 to 28 October 2017 jointly organised by the IAEA and the European Society of Radiology. The workshop served as a forum to exchange information on challenges and solutions for improving justification and the appropriate use of diagnostic imaging. Common barriers to improving the use of imaging referral guidelines were discussed and the need for increased collaboration identified. Examples of good practices were presented, including use of Clinical Decision Support (CDS) systems to facilitate rapid and good justification decisions. The workshop identified some of the needs of European countries for achieving more appropriate imaging proposing wider use of collaboration, campaigns and champions.

Main messages

• Drivers for appropriate imaging in Europe are similar to those elsewhere globally.

• Implementing imaging referral guidelines is the main barrier to more appropriate imaging.

• Clinical Decision Support systems (CDS) facilitates good referral practice and justification decisions.

• Collaboration, campaigns and champions may improve awareness, appropriateness and audit.

Summary of the proceedings of the international forum 2016: "Imaging referral guidelines and clinical decision support - how can radiologists implement imaging referral guidelines in clinical routine?"

The International Forum is held once a year by the ESR and its international radiological partner societies with the aim to address and discuss selected subjects of global relevance in radiology. In 2016, the issue of implementing imaging referral guidelines in clinical routine was analysed. The legal environment in the USA requires that after January 1, 2017, physicians must consult government-approved, evidence-based appropriate-use criteria through a clinical decision support system when ordering advanced diagnostic imaging exams. The ESR and the National Decision Support Company are developing "ESR iGuide", a clinical decision support system for European imaging referral guidelines using ESR imaging referral guidelines based on ACR Appropriateness Criteria. In many regions of the world, the situation is different and quite diverse, depending on the specific features of health care systems in different countries, but there are, unlike in the USA and EU, no legal obligations to implement imaging referral guidelines into the clinical practice. Imaging referral guidelines and clinical decision support implementation is a complex issue everywhere and the legal environment surrounding it even more so; how they will be implemented into the clinical practice in different areas of the world needs yet to be decided.

MAIN MESSAGES

• Implementation of imaging referral guidelines in clinical routine is needed. • Potential benefits are improved appropriateness in referrals and reduction of unnecessary radiation exposure. • The educational benefits include new insights through data collection and reporting. • The system will potentially highlight the lack in quality or availability of equipment.