Transcript Evidenced Based Practice in Medical Imaging

Evidenced Based Practice
in Medical Imaging
Kevin D. Evans, PhD, RT, RDMS,
RVS
Objectives of this presentation




Discuss what is Evidence Based Practice.
Review an example of how EBP might be
used.
Describe the levels of EBP and how it might
effect patient care decisions.
Discuss the future of EBP in the Radiologic
Sciences.
What is EBP?



Evidence Based Practice is the
use of research information to
help in recommending to patients
the best next step in their health
care.
EBP is based on the idea that
scientific evidence exists to assist
in making decisions for patients.
In Medical Imaging this is a
relatively new concept and it is
highly dependent on the Internet.
How is EBP used clinically?



EBP is dependent on the
practitioner using the internet to tap
into research that has been
conducted in medical imaging to
assist in the process of making a
decision on the next step in the
treatment or diagnosis of a patient.
Primarily the Radiologist would use
this as a means to recommend the
best next step for a patient or
referring physician.
Often Advanced Practice
technologists are put in the situation
of suggesting studies that are
suitable for referring physicians or
Radiologists.
How does EBP work?


The best example of the use
EBP is when a patient’s
imaging examination presents
with a result that is much like
a list of other presentations.
With a difficult to confirm
diagnosis and plus a
treatment that is not routinely
recommended without
confirmation, the physician is
forced to consider other tests
to confirm the diagnosis.
An ERB example to consider





A patient enters the ER with a
complaint of lower abdominal pain.
The patient is young and has had
similar complaints of lower
abdomen pain.
The ER physician would like to
confirm that the patient has
appendicitis.
Lab values have come back from
the blood test and indicate a border
line white count.
What is the best imaging test for the
appendix???
An ERB example to consider



The ER physician orders a
KUB or abdomen x-ray of the
young patient.
The hope was that an
obstructed large colon could
be seen by an enlarged
appendix.
Although gas appears in the
right hepatic flexure of the
colon…..the RLQ looks
good!!???
An ERB example to consider


The ER physician is
frustrated with the x-ray
and now thinks that
perhaps an ultrasound of
the appendix might
reveal the swollen
appendix.
Having heard about this
at a conference…he
orders the exam for this
young patient.
An ERB example to consider


Although the appendix
showed up in one view of
the ultrasound, the ER
physician doesn’t want to
wake up the surgeon on
call without being
absolutely sure that this is
appendicitis.
To make sure he is right,
the ER physician orders a
CT of the abdomen.
ERB can save money and time for
the patient



In the example provided, the ER
physician used a number of
imaging examinations to try to
find out the correct diagnosis.
The best way to have
approached the diagnosis would
have been to used the internet to
pull up some literature about the
best imaging examination for
appendicitis.
Often the technologist can
suggest studies to assist the
physician.
Using research to inform practice

Using the computer to
uncover published studies
on the efficiency or
effectiveness of certain
imaging techniques is an
example of single search
evidence that is being
conducted to advise a
patient or physician to
optimize the diagnosis of
the patient and eliminate
waste.
Types of EBP studies

The lowest order of evidence based studies are those that are
considered case studies.


The next higher order of evidence based studies are those that
involve expert reviews of a number of cases that have been
encountered in practice.


A single case study of using an imaging technique might not work on
every patient that comes for this exam.
The author is biased and remarks on cases from their own practice that
might involve highly trained individuals and be hard to reproduce.
The best evidence based studies are those that are a systematic
review of the existing literature in the field.

The author provides a review of all the published studies involving the use
of an imaging technique and suggests that statistically it is not any more
reliable than the exam being currently used.
Utilization of EBP



The best scenario is to use the
existing literature that provides
a systematic review of a
technique and use that
information to inform practice.
Praxis is the term used for
research that informs practice
and helps to provide patients
with the best quality health care
without increasing costs.
The KUB demonstrates the
appendix obstructing gas in the
colon. Low cost and high yield
for diagnosis.
Utilization of EBP


Review of the literature
reveals that Stavros and
Rapp in Denver, Colorado
are able to demonstrate the
appendix on 65% of their
patients
What kind of EBP does this
represent and should we use
this to recommend
implementing this study in
our ultrasound lab??
Utilization of EBP


Dr. Merritt at Thomas Jefferson
University published a review
of CT cases that have been
published and makes
recommendations based on the
frequency that appendicitis has
been diagnosed with this
modality and recommends that
certain types of patients are not
well suited for this kind of
exposure and expense.
What type of EBP is this an
example of for technologists
and physicians?
The Future of EBP



EBP in the imaging profession is
relatively new and under
developed.
The best way to build evidence
about imaging techniques is to
foster research in our profession
and publish the important studies
and cases that we encounter.
Case studies will push others to
review all the literature
published and provide analysis
of the technique.
Where do studies fit?