1 Principles of Evidence-Based Imaging

  • L. Santiago Medina
  • C. Craig Blackmore
  • Kimberly E. Applegate
Chapter

Abstract

The standard medical education in Western medicine has emphasized skills and knowledge learned from experts, particularly those encountered in the course of postgraduate medical education, and through national publications and meetings. This reliance on experts, referred to by Dr. Paul Gerber of Dartmouth Medical School as “eminence-based medicine” (1), is based on the construct that the individual practitioner, particularly a specialist devoting extensive time to a given discipline, can arrive at the best approach to a problem through his or her experience. The practitioner builds up an experience base over years and digests information from national experts who have a greater base of experience due to their focus in a particular area. The evidence-based imaging (EBI) paradigm, in contradistinction, is based on the precept that a single practitioner cannot through experience alone arrive at an unbiased assessment of the best course of action. Assessment of appropriate medical care should instead be derived through evidence-based process. The role of the practitioner, then, is not simply to accept information from an expert, but rather to assimilate and critically assess the research evidence that exists in the literature to guide a clinical decision (2–4).

Keywords

Placebo Obesity Radionuclide Perforation Appendicitis 

Notes

Acknowledgment:

We appreciate the contribution of Ruth Carlos, MD, MS, to the discussion of likelihood ratios in this chapter.

References

  1. 1.
    Levin A. Ann Intern Med 1998;128:334–336.PubMedGoogle Scholar
  2. 2.
    Evidence-Based Medicine Working Group. JAMA 1992;268:2420–2425.CrossRefGoogle Scholar
  3. 3.
    The Evidence-Based Radiology Working Group. Radiology 2001;220:566–575.CrossRefGoogle Scholar
  4. 4.
    Wood BP. Radiology 1999;213:635–637.PubMedGoogle Scholar
  5. 5.
    Poisal JA et al. Health Aff 2007;26:w242–w253.CrossRefGoogle Scholar
  6. 6.
    Davis K. N Engl J Med 2008;359:1751–1755.PubMedCrossRefGoogle Scholar
  7. 7.
    Hulley SB, Cummings SR. Designing Clinical Research. Baltimore: Williams & Wilkins, 1998.Google Scholar
  8. 8.
    Kelsey J, Whittemore A, Evans A, Thompson W. Methods in Observational Epidemiology. New York: Oxford University Press, 1996.Google Scholar
  9. 9.
    Blackmore C, Cummings P. AJR Am J Roentgenol 2004;183(5):1203–1208.PubMedGoogle Scholar
  10. 10.
    Medina L, Aguirre E, Zurakowski D. Neuroimaging Clin N Am 2003;13:157–165.PubMedCrossRefGoogle Scholar
  11. 11.
    Medina L. AJNR Am J Neuroradiol 1999;20:1584–1596.PubMedGoogle Scholar
  12. 12.
    Sunshine JH, McNeil BJ. Radiology 1997;205:549–557.Google Scholar
  13. 13.
    Black WC. AJR Am J Roentgenol 1990;154:17–22.PubMedGoogle Scholar
  14. 14.
    Sox HC, Blatt MA, Higgins MC, Marton KI. Medi­cal Decision Making. Boston: Butterworth, 1988.Google Scholar
  15. 15.
    Metz CE. Semin Nucl Med 1978;8:283–298.PubMedCrossRefGoogle Scholar
  16. 16.
    Singer M, Applegate K. Radiology 2001;219: 611–620.PubMedGoogle Scholar
  17. 17.
    Weinstein MC, Fineberg HV. Clinical Decision Analysis. Philadelphia: WB Saunders, 1980.Google Scholar
  18. 18.
    Carlos R. Acad Radiol 2004;11:141–148.PubMedCrossRefGoogle Scholar
  19. 19.
    Detsky AS, Naglie IG. Ann Intern Med 1990;113:147–154.PubMedGoogle Scholar
  20. 20.
    Doubilet P, Weinstein MC, McNeil BJ. N Engl J Med 1986;314:253–256.PubMedCrossRefGoogle Scholar
  21. 21.
    Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.Google Scholar
  22. 22.
    Hillemann D, Lucas B, Mohiuddin S, Holmberg M. Ann Pharmacother 1997;31:974–979.Google Scholar
  23. 23.
    Medina L, Aguirre E, Bernal B, Altman N. Radiology 2004;230:49–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Appel LJ, Steinberg EP, Powe NR, Anderson GF, Dwyer SA, Faden RR. Med Care 1990;28:324–337.PubMedCrossRefGoogle Scholar
  25. 25.
    Evens RG. Cancer 1991;67:1245–1252.PubMedCrossRefGoogle Scholar
  26. 26.
    Yin D, Forman HP, Langlotz CP. AJR Am J Roentgenol 1995;165:1323–1328.PubMedGoogle Scholar
  27. 27.
    Medina L, Crone K, Kuntz K. Pediatrics 2001;108:E101.PubMedCrossRefGoogle Scholar
  28. 28.
    Ware JE, Sherbourne CD. Med Care 1992;30:473–483.PubMedCrossRefGoogle Scholar
  29. 29.
    Jarvik J, Hollingworth W, Martin B, et al. JAMA 2003;2810–2818.Google Scholar
  30. 30.
    Blackmore CC, Magid DJ. Radiology 1997;203: 87–91.PubMedGoogle Scholar
  31. 31.
    Medina L, Aguirre E, Altman N. Acad Radiol 2003;10:139–144.PubMedCrossRefGoogle Scholar
  32. 32.
    Zou K, Fielding J, Ondategui-Parra S. Acad Radiol 2004;11:127–133.PubMedCrossRefGoogle Scholar
  33. 33.
    Langlotz C, Sonnad S. Acad Radiol 1998;5(suppl 2):S269–S273.PubMedCrossRefGoogle Scholar
  34. 34.
    Littenberg B, Moses LE. Med Decis Making 1993;13:313–321.PubMedCrossRefGoogle Scholar
  35. 35.
    Terasawa T, Blackmore C, Bent S, Kohlwes R. Ann Intern Med 2004;141(7):37–546.Google Scholar
  36. 36.
    Fryback DG, Thornbury JR. Med Decis Making 1991;11:88–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Blackmore C. Radiology 2005;235(2):371–374.PubMedCrossRefGoogle Scholar
  38. 38.
    Jaeschke R, Guyatt GH, Sackett DL. JAMA 1994;271:703–707.PubMedCrossRefGoogle Scholar
  39. 39.
    Malone D. Radiology 2007;242(1):12–14.PubMedCrossRefGoogle Scholar
  40. 40.
    Medina LS, Blackmore DD. Evidence-Based Imaging: Optimizing Imaging in Patient. New York: Springer Science+Business Media, 2006.Google Scholar

Copyright information

© Springer New York 2011

Authors and Affiliations

  • L. Santiago Medina
    • 1
  • C. Craig Blackmore
  • Kimberly E. Applegate
  1. 1.Department of RadiologyMiami Children’s HospitalMiamiUSA

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