The Appropriateness of Imaging
To ensure a common basis for discussion among patients, practitioners, payers and regulators, it is necessary to unambiguously define an otherwise elusive concept: the appropriateness of diagnostic imaging.
Schematic shows cost-effectiveness plane with appropriateness terms superimposed on effectiveness axis (x-axis, e). Procedures falling near the origin of the effectiveness axis would be considered equivocal in appropriateness (between inappropriate and appropriate). As shown here, cost (y-axis, $) is orthogonal to appropriateness and is an independent consideration. (Radiology 2009;251:637-649) © RSNA, 2009. All rights reserved. Printed with permission. |
In a review article in the June issue of Radiology (RSNA.org/radiology), Christopher L. Sistrom, M.D., M.P.H., of the University of Florida in Gainesville, offers a conceptual framework for defining the appropriateness of imaging by comparing and contrasting the complementary roles of clinical trials, technology assessment, decision-analytic modeling and consensus methods. Specifically, he discusses:
• Imaging procedures and clinical scenarios
• Technology assessment hierarchy
• Decision-analytic models
• Cost-effectiveness
• RAND/UCLA appropriateness method
• Imaging appropriateness criteria
Dr. Sistrom defines appropriateness in terms of the expected net health outcome attributable to a diagnostic imaging procedure applied in a specific clinical scenario, expressed in quality-adjusted life-years.
"This comprehensive definition of the appropriateness of imaging shares context with economic analysis informed by technology assessment and thus complements, rather than contradicts, evidence-based imaging," he concludes.
(Radiology 2009;251:637-649)
To access this Radiology article now, click here.
Varying Appearances of Cholangiocarcinoma: Radiologic-Pathologic Correlation
Although cholangiocarcinomas with typical imaging features can be easily diagnosed, not all tumors show typical findings and may mimic a variety of tumorous and nontumorous lesions. Understanding the pathologic characteristics of each type of tumor can be helpful in developing a differential diagnosis and in treatment planning of cholangiocarcinomas, the second most common primary malignancy of the liver.
 Intraductal papillary neoplasm of the biliary tract with marked mucin production. Contrast-enhanced CT scan (a) and T2-weighted MR image (b) show a markedly dilated intrahepatic duct with mural nodules or irregular wall thickening (arrow). Photograph of the gross specimen (c) reveals an intraluminal plaquelike or papillary mass (arrow) and mucin (arrowhead). (RadioGraphics 2009;29:683–700) © RSNA, 2009. All rights reserved. Printed with permission. |
In an article in the May-June issue of RadioGraphics (RSNA.org/radiographics), Yong Eun Chung, M.D., of the Yonsei University Health System in Seoul, Korea, and colleagues discuss cholangiocarcinoma in terms of:
• Epidemiologic features, risk factors and morphologic classification
• Typical imaging appearances and their correlation with pathologic
findings
• Findings that can help differentiate cholangiocarcinoma from other benign or malignant diseases
"Cholangiocarcinoma can be classified on the basis of gross morphologic features into mass-forming, periductal infiltrating and intraductal types and the imaging features may depend on the underlying causative risk factors," Dr. Chung and colleagues conclude. "With pathologic correlation, these imaging findings can be related to emerging pathologic concepts of intraductal papillary neoplasm of the biliary tract and biliary intraepithelial neoplasia."
To access this RadioGraphics article now, click here.
RadioGraphics to Feature Three AFIP Best Cases
Instead of two, the July-August issue of RadioGraphics will feature three "best cases" from the Armed Forces Institute of Pathology (AFIP) as judged by the staff at the Department of Radiologic Pathology. Radiologic-pathologic correlation is emphasized and the causes of the imaging signs of various diseases are illustrated. AFIP cases also are now featured once a month in RSNA Weekly, delivered by e-mail to members and viewable online at RSNA.org/rsnaweekly/current.html.
