FIG. 10.1 ● “4S” level of organization of evidence from research. (Adapted from Haynes RB. Of studies, summaries, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evid-Based Ment Health. 2001;4(2):37–39 with permission from BMJ Publishing Group Limited.)
Detailed methods for searching online databases have been described.10
AMERICAN COLLEGE OF RADIOLOGY APPROPRIATENESS CRITERIA
ACR Appropriateness Criteria (ACR AC) are designed to aid health-care providers in choosing the most appropriate imaging or therapeutic procedure for a given specific clinical scenario (Fig. 10.2).12 A multidisciplinary panel of experts develops ACR AC using published data and, when needed, expert opinion. In addition to radiologists, physicians from other medical specialties participate in expert panels to provide appropriate clinical perspectives. ACR AC are developed following the guidelines issued by the Agency for Healthcare Research and Quality as designed by the Institute of Medicine. More than 200 ACR AC have been published, covering nearly 1,000 clinical variants. ACR AC are available for scientific, research, and informational purposes. Additionally, ACR licenses ACR AC for use in commercial products including electronic health record and decision support system software packages. ACR AC criteria are also published on the ACR’s website13 as well as in various radiology journals.
Each ACR AC includes a narrative summary of the evidence, a ratings table (Fig. 10.2), and an evidence table (Fig. 10.3). The evidence tables include the citation, the type of study, the number of patients or events studies, the study objective, the results, and a rating of the study quality. The ratings table includes the variant of the clinical condition, a rating for each radiologic procedure, comments provided by the panel, and a relative radiation level (Fig. 10.4).
1. Evidence-Based Radiology Working Group. Evidence-based radiology: a new approach to the practice of radiology. Radiology. 2001;220(3):566–575.
2. Guyatt GH. Evidence-based medicine (editorial). Ann Intern Med. 1991;114(suppl 2):A16.