Toward evidence-based decisions in diagnostic radiology: a research and rating process for multiple decision-makers

The use of diagnostic imaging tests and the development of evidence-based guidelines, reviews, and other materials have both undergone substantial growth in recent years. However, the proliferation of evidence-based information has not translated into the universal deployment of medical and coverage policy for diagnostic imaging that is similarly evidence-based. One possible reason is the failure of those institutions generating evidence-based information to format findings in an accessible manner for all relevant stakeholders. The Institute for Clinical and Economic Review has developed a simple and transparent method for rating evidence that is accessible to clinicians, patients, payers, and other policy makers. The authors describe this process in relation to three imaging-based examples (computed tomographic colonography, coronary computed tomographic angiography, and positron emission tomography for dementia neuropathology). The issues raised, controversies considered, and use of the ratings in setting policy are discussed in relation to each example.