Diagnostic Imaging Pathways is developed with the aim of increasing the appropriate application of diagnostic imaging. The majority of contributors are employees of the Health Department of Western Australia. There are no constraints placed on the developers by any government body with regard to published data and the project is not aligned with any representative college, commercial or corporate entity. All research is conducted ethically and with sound methodology for the purposes of promoting best practice in medicine.
Justification of Recommendations
These pathways are evidence-based and scientific statistics such as sensitivity, specificity, positive and negative predictive values have been included, where appropriate to justify why one imaging modality has been chosen over another. Examples of imaging modalities include "ultrasound", "computed tomography", and "magnetic resonance imaging". Extensive feedback from clinicians has been obtained and incorporated into the pathways. Where there have been particular areas of conflicting opinion or controversy, discussion of the pathway has occurred at a clinical-radiological forum, allowing all opinions to be voiced and a consensus reached. In rare cases when differences in opinion have remained unresolved, the final decision rests with the Editor.
The Editor recognises that all imaging modalities are not available in some areas, especially in rural regions. In addition, general practitioners are unable to obtain a Medicare-rebate for their patients if requesting Magnetic Resonance Imaging (MRI). Availability of imaging modalities in rural regions varies greatly and for this reason, the most appropriate imaging investigation, based on evidence and consensus, has been listed with consideration to availability wherever possible. Further evaluation of the Diagnostic Imaging Pathways in the rural setting will enable the project to develop a more suitable version. The Editor has decided to include MRI in the Diagnostic Imaging Pathways where it is the most appropriate form of investigation. Where MRI is necessary, this should be regarded as an indication for specialist referral. In circumstances where adequate imaging substitutes for MRI are available, they have been included as options.
Justification of Benefits
The aim of the Diagnostic Imaging Pathways is to further the appropriate application of diagnostic imaging, thereby reducing the number of unnecessary imaging investigations and increasing the diagnostic yield of imaging investigations. Evaluation of the Diagnostic Imaging Pathways was conducted in 2003, involving both hospital-based clinicians and primary care physicians (general practitioners). This study, which has been published in the International Journal for Quality in Health Care, demonstrated that knowledge and requesting practice of both subject groups tended to become more aligned with the pathways after a period of dissemination, implementation and marketing. As such, the central objective to reduce inappropriate imaging appears achievable.
Last reviewed in May 2009.