Page 119 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
2 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Choosing Wisely
The American Boards in Internal Medicine have started an initiative to rationalise management.
The ABIM note: “waste and overuse are widespread in US medicine, affecting both the quality of care (up to 30,000 deaths annually from overuse) and costs to the health care system.”
Over 70 specialty societies have now created lists of tests or treatments that are overused, with the aim of avoiding unnecessary care.
Similar initiatives are now being undertaken in Australasia as ‘Choosing Wisely Australia’.
The Royal Australia and New Zealand College or Radiologists have published a list of the Top 5 things clinicians and consumers should question.
The Royal Australian College of Physicians has established the Evolve program which is working with speciality societies in Australasia to do the same thing.
We have included the relevant ‘Choosing Wisely’ recommendations in these guidelines.
In some cases more than one society has made similar recommendations so they are combined.
The general recommendations are listed here and the more specific ones are included in the relevant section in red font.
The ‘Choosing Wisely’ recommendations include:
Do not order chest radiography for screening purposes for patients being admitted to the hospital.
Avoid preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam
See the following links:
America’s Epidemic of Unnecessary Care - The New Yorker Choosing Wisely American Boards in Internal Medicine Choosing Wisely Recommendations Australia RANZCR 2015 Choosing Wisely in the UK BMJ 2015
Choosing Wisely Recommendations Australia ACEM 2015 US ACEM Top-Five List JAMA 2014
The National Community Radiology Access Criteria also include indications when imaging is not indicated. For example for include that referral for community X-ray is not typically indicated in:
• screening for lung cancer in an asymptomatic patient
• pneumonia follow-up unless there are risk factors or red flags, including age > 50 years,
significant smoking history, suspicious radiologic findings on initial CXR or incomplete clinical
resolution at six weeks
• routine assessment of hypertension
• routine monitoring of known pulmonary sarcoidosis
• routine X-ray for asbestos exposure surveillance
• follow-up of nodules detected on chest X-ray or CT other than where recommended by
reporting or reviewing specialist (consider referral for respiratory specialist review)
• initial investigation of heart murmur, unless signs of complications such as heart failure
• routine follow-up of asymptomatic patients on amiodarone.