Technology assessment in radiology: putting the evidence in evidence-based radiology

In this review, which is part of a larger series on evidence-based practice in radiology, the relationship between technology assessment (TA) and the practice of evidence-based radiology (EBR) is discussed. TA guides researchers in the methods required to be reliable providers of unbiased and relevant evidence. Meanwhile, EBR equips radiologists with the skills needed to be discerning consumers of that evidence. Both paradigms aim to improve the effectiveness of health care spending. In this review, it is argued that EBR can be only as good as the TA on which it is based. However, TA is particularly complex in regard to diagnostic radiology because of the many links in the chain between the interim objective (to make the correct diagnosis) and the ultimate goal (to improve patient health). In this article, the development of TA in medicine in general and, more specifically, the TA hierarchy for the evaluation of diagnostic imaging are described. Some of the improvements in the pool of evidence during the past 30 years are documented, and some of the remaining tensions between TA and EBR are highlighted.