What's Revised

August 2016

Breast Screening (Above Average Risk Women)

An updated search and review of the literature further supported recommendations. The title of the pathway has been changed but there are no major changes to the pathway diagram. View the revised pathway

Renal Mass

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. IVP has been removed as initial imaging that discovers incidental renal masses. The use of DSMA for investigating suspected pseudo-tumours is no longer recommended. MRI is now recommended in particular circumstances. The pathway following the use of CT has been revised and incorporates the Bosniak classification. “What do I need to know” alerts have also been added to the pathway diagram. View the revised pathway

Colorectal Cancer (Suspected)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been expanded in accordance with recent strong evidence supporting the use of CT Colonography. View the revised pathway

Breast Screening

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The screening age has been changed to 50-74 years, potential harms of screening mammography have been added, 'breast self-examination' has been replaced with 'breast awareness' and the material on mammography has been expanded to include description of film and digital mammography. “What do I need to know” alerts have also been added to the pathway diagram. View the revised pathway

Thyroid Nodule (Incidental)

An updated search and review of the literature resulted in a major redrafting of the pathway diagram and recommendations. The diagram under "Solid nodule" now incorporates the management and follow-up of lesions according to size and ultrasonographic features. Information on ultrasound guided fine needle aspiration (FNA) includes the Bethesda System for Reporting Thyroid Cytopathology. The issue of sonographic surveillance and repeat FNA in clinical practice is addressed and follow-up management plans have been added. “What do I need to know” alerts have also been added to the pathway diagram. View the revised pathway

May 2016

Haematuria (Painless Visible)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The term ‘macroscopic haematuria’ has been changed to ‘visible haematuria’, urgent urological referral is stressed and investigations have been stratified according to the presence of low risk and high risk factors. Criteria for nephrology referral and urology follow-up have been added. “What do I need to know” alerts have also been added and the teaching points have been revised. View the revised pathway

Focal Liver Lesion (History of Malignancy)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. Investigations have been stratified according to the lesion’s characteristics (simple cyst, definitely benign, definitely metastatic, indeterminate). In patients with known extra extra-hepatic metastases, investigations have been further stratified according to the level of risk (low, intermediate, high). View the revised pathway

March 2016

Adrenal Mass (Incidental on CT)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been revised. Recommendations are stratified depending on the size of the detected lesion and whether imaging indicates a cyst, haematoma or myelolipoma. Further imaging and management is dependent on whether malignancy is suspected. View the revised pathway

Abdominal Aortic Aneurysm

An updated search and review of the literature further supported recommendations and did not result in a major change to the pathway diagram. View the revised pathway

Leg Ischaemia (Acute)

An updated search and review of the literature further supported recommendations, the use of CTA and MRA in particular, and did not result in a major change to the pathway diagram. Traumatic and non-traumatic versions of the pathway have been merged. View the revised pathway

February 2016

Pancreatic Cyst (Incidental)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been simplified, stratifying incidental lesions into three main categories based on the lesion size. Subsequent management plans and surveillance are dependent on the presence or absence of imaging findings of concern and if the patient is a suitable candidate for surgery. View the revised pathway

Hepatocellular Cancer (Surveillance)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been simplified. Ultrasound surveillance is recommended every six months. Investigation steps following the detection of a new lesion are stratified on simple cyst or complex / solid lesion. The benefits of contrast-enhanced ultrasound (CEUS) are emphasised. When lesions are suspicious or when CEUS is unavailable, links are provided to other pathways. View the revised pathway

Hepatocellular Cancer (Suspected)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been simplified. Investigation steps are stratified according to the size of the detected lesion, in accordance with current international guidelines. Follow-up imaging is recommended for lesions <1 cm. The need for further imaging for lesions >1cm is emphasised, preferably with MRI and a liver-specific contrast agent. In patients at high risk of HCC, lesions showing typical features of HCC on imaging can be considered as HCC without biopsy. Biopsy should be reserved for lesions with non-diagnostic appearance on imaging. View the revised pathway

Focal Liver Lesion (Investigation)

An updated search and review of the literature resulted in revisions to this summary pathway and its recommendations. The pathway diagram has been simplified. Investigation steps have been stratified according to how the liver lesion is first detected, associated clinical features, presence of risk factors for HCC and history of malignancy or extra-hepatic metastases. View the revised pathway

Respiratory Illness (Acute)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been revised including the addition of an Emergency Department / Intensive Care Unit pathway; lung ultrasonography is recommended for the evaluation of patients presenting with acute dyspnoea. View the revised pathway

Loin Pain (Renal Colic)

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. The pathway diagram has been simplified. Investigation steps are now first stratified according to first presentation, recurrent presentations, pregnant patients, clinically unwell patients. Patient’s age and the presence of symptoms and signs guide the choice of the initial imaging modality. Issues relating to imaging pregnant patients are considered including the use of MRI urography. Conventional IVP is considered almost obsolete for the diagnosis of renal colic and has been removed from the pathway. View the revised pathway

July 2015

Cholestatic Jaundice Pathway

An updated search and review of the literature did not result in any change to the pathway and its recommendations. The list of references was updated and expanded to support the current diagnostic algorithm. View the revised pathway

About Imaging: Imaging During Pregnancy and Lactation

This revised article provides information regarding risk-benefit analysis weighing up the potential maternal and fetal benefits against potential harm to the fetus when exposed to ionizing radiation during pregnancy. Statements regarding the use of iodinated contrast agents in pregnancy and lactation including alternative imaging modalities in pregnancy are supported by the latest evidence. View the revised article

Crohn's Disease (Suspected) Pathway

An updated search and review of the literature did not result in any change to the pathway and its recommendations. The list of references was updated and expanded to support the current diagnostic algorithm. View the revised pathway

Cholecystitis (Suspected Acute) Pathway

An updated search and review of the literature did not result in any major change to the pathway and its recommendations. The list of references was updated and expanded to support the current diagnostic algorithm. Provision of a new diagnostic criterion to assist clinical decision for the diagnosis of acute cholecystitis prior to the commencement of imaging pathways was added. View the revised pathway

Oesophageal Cancer (Staging) Pathway

An updated search and review of the literature resulted in revisions to this pathway and its recommendations. Information on oesophageal cancer staging based on the revised American Joint Committee on Cancer (AJCC) Cancer Staging Manual and Atlas has been added. The pathway provides a staging algorithm for patients with proven oesophageal cancer, indicating how imaging helps determine management. It is supported by literature on the specificity, sensitivity and predictive values of imaging modalities. View the revised pathway

Liver Lesion (Incidental) Pathway

An updated search and review of the literature resulted in major revisions to this pathway and its recommendations, with an emphasis on contrast enhanced ultrasonography (CEUS) for characterizing commonly encountered, benign, non-cystic incidental liver lesions. View the revised pathway

May 2015

Illiac Fossa Pain (Acute Right) Pathway

An updated search and review of the literature did not result in any change to the pathway and its recommendations. The list of references was updated with the addition of a new reference to support the use of preoperative imaging to reduce the rate of negative appendectomies, surgical complications and costs. View the revised pathway

April 2015

Website Redesign

The DIP website is republished with a new design and structure, giving it a more contemporary 'look and feel'.

March 2015

Osteoporosis (Suspected) Pathway

This pathway has been completely revised with an emphasis on detecting the disease in minimal trauma fractures, looking for biochemical evidence of osteoporosis and osteopenia, and assessing whether a patient has indications for a DEXA scan. View the revised pathway

Pathway Review Date

Each pathway diagram now includes a box which gives the date when the pathway was last reviewed and an alert that the pathway is subject to review and revision. This helps to mitigate the risk associated with a user referring in an outdated copy of the diagram rather than the safer strategy of always accessing the current source. View the Headache (Adult) Pathway as an example