The appropriateness of imaging: a comprehensive conceptual framework

Area of Science:

• Medical Imaging
• Health Services Research
• Health Economics

Background:

• Significant variation exists in diagnostic imaging utilization across similar populations in the United States.
• The concept of appropriateness in diagnostic imaging is not clearly defined, leading to inconsistent application.
• Understanding appropriateness is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

• To clarify and define the concept of appropriateness of diagnostic imaging procedures (DIPs).
• To establish a common framework for discussing DIP appropriateness, considering the patient and clinical setting.
• To link the concept of appropriateness to expected net health outcomes and cost-effectiveness.

Main Methods:

• Literature review to identify and define key components of diagnostic imaging appropriateness.
• Analysis of empirical research demonstrating variations in health service delivery.
• Comparison and contrast of clinical trials, technology assessment, decision-analytic modeling, and consensus methods for estimating appropriateness.

Main Results:

• Appropriateness is conceptualized as a logical extension of empirical findings on service variation.
• Appropriateness for an individual patient is defined by expected net health outcome.
• This definition connects appropriateness to the denominator used in cost-effectiveness analysis.

Conclusions:

• A clear definition of diagnostic imaging appropriateness is essential for consistent and effective healthcare.
• Multiple methodologies contribute to estimating appropriateness, each with complementary roles.
• The framework presented links diagnostic imaging use to patient outcomes and economic evaluation.