The main aim of the ESR IRG WG is to develop the content for ESR iGuide by reviewing and adapting the ACR Appropriateness Criteria and the ACR Select content and making it applicable to Europe.
Working closely with the ACR rapid response team,
the CDS content for ACR Select and ESR iGuide is maintained and updated on a continuous basis,
with new content versions released at least once per year.
Methodology
The chair of the WG is charged with developing a methodology for the WG's work.
The methodology for the ACR Appropriateness Criteria is the basis for the work of the ESR IRG WG and is adhered to as far as applicable.
The basic principles are that any changes ESR experts make to the guidelines should be based on scientific evidence to the largest extent possible,
using experience as well as expert opinion,
judgement and experience of European practice standards only as a supplement where necessary.
No consideration should be given to national,
local or institutional circumstances or the availability or quality of imaging equipment,
as the resulting guidelines should be generic and equally applicable anywhere in Europe.
From this evidence-based core,
users,
institutions or countries implementing ESR iGuide can make localisations to the content as necessary.
The appropriateness of imaging exams is expressed on a numeric scale of 1 (least appropriate) to 9 (most appropriate).
Exams are rated for over 1,600 indications in ESR iGuide for a defined gender (male/female/either) and age range.
The ratings are grouped into three categories:
1-3 (red): usually not appropriate
4-6 (yellow): may be appropriate
7-9 (green): usually appropriate
The ESR iGuide content is divided into 10 different topic areas,
each overseen by a dedicated expert within the WG:
A.
Breast Imaging
B.
Cardiac Imaging
C.
Gastrointestinal Imaging
D.
Muscoloskeletal Imaging
E.
Neurologic Imaging
F.
Paediatric Imaging
G.
Thoracic Imaging
H.
Vascular Imaging
I.
Urogenital Imaging
J.
Women's Imaging
ESR 2017/2018 content version
The latest edition of ESR iGuide content,
based on version 13 of the ACR Select content,
has different appropriateness ratings in 12.3 percent* of all scored decision support rules.
In 7.5 percent* of these rules the rating category changed,
signifying a significant re-assessment of appropriateness.
The following is a breakdown of the changes made by the ESR in the latest content version.
A.
Breast Imaging
Number of indications/scenarios: 54
Number of scored decision support rules: 364
Number of score changes: 24 (6.6%)
Number of category changes: 12 (3.3%)
Most frequently changed modality: Ultrasound (7 category changes)
B.
Cardiac Imaging
Number of indications/scenarios: 78
Number of scored decision support rules: 1079
Number of score changes: 535 (49.6%)
Number of category changes: 309 (28.6%)
Most frequently changed modality: CT (111 category changes)
C.
Gastrointestinal Imaging
Number of indications/scenarios: 148
Number of scored decision support rules: 1394
Number of score changes: 74 (5.3%)
Number of category changes: 46 (3.3%)
Most frequently changed modality: CT (13 category changes)
D.
Muscoloskeletal Imaging*
Number of indications/scenarios: 464
Number of scored decision support rules: 4229
Number of score changes: 212 (5%)
Number of category changes: 147 (3.5%)
Most frequently changed modality: Ultrasound (60 category changes)
E.
Neurologic Imaging
Number of indications/scenarios: 315
Number of scored decision support rules: 3260
Number of score changes: 596 (18.3%)
Number of category changes: 334 (10.3%)
Most frequently changed modality: CT (173 category changes)
F.
Paediatric Imaging
Number of indications/scenarios: 320
Number of scored decision support rules: 2465
Number of score changes: 212 (8.6%)
Number of category changes: 203 (8.2%)
Most frequently changed modality: MRI (84 category changes)
G.
Thoracic Imaging
Number of indications/scenarios: 97
Number of scored decision support rules: 653
Number of score changes: 43 (6.6%)
Number of category changes: 24 (3.7%)
Most frequently changed modality: CT (9 category changes)
SUMMARY: We agreed with the majority of the guidelines in thoracic radiology.
Our few suggestions did not modify substantially the guidelines (minor downgrading or upgrading) but suggested technical changes (CT with or without contrast) or introducing other techniques such as PET-CT,
Ultrasound or Mammography.
We also feel that additional guidelines will be needed especially in the follow-up of lung cancer.
H.
Vascular Imaging
Number of indications/scenarios: 37
Number of scored decision support rules: 375
Number of score changes: 127 (33.9%)
Number of category changes: 43 (11.5%)
Most frequently changed modality: MRI (13 category changes)
I.
Urogenital Imaging
Number of indications/scenarios: 75
Number of scored decision support rules: 842
Number of score changes: 14 (1.7%)
Number of category changes: 9 (1.1%)
Most frequently changed modality: CT,
Nuclear Medicine,
Ultrasound (2 category changes each)
J.
Women's Imaging*
Number of indications/scenarios: 37
Number of scored decision support rules: 531
Number of score changes: 36 (6.8%)
Number of category changes: 18 (3.4%)
Most frequently changed modality: MRI (8 category changes)
*The review of the MSK and Women's imaging topics was not complete at the time of poster submission,
the statistics are therefore preliminary.