Letter from the Guest Editors

Article Outline

• Copyright

Evidence-based practice (EBP) is defined as the integration of the best research evidence with clinical expertise and patient values and expectations. Best research evidence implies validated and clinically relevant research, which also encompasses patient-centered clinical research into diagnostic test (or treatment), accuracy, prognosis, efficacy, and safety. As new evidence emerges, it should replace any older evidence to ensure (or improve) accuracy, prognosis, efficacy, and safety. Clinical expertise is the ability to use one's clinical skills, experience, and knowledge to rapidly and correctly diagnose the particular patient's state of health and, given the patient's clinical state and the clinical setting, to assess the risks and benefits of different interventions. Patient values are the unique preferences, concerns, and expectations which patients bring to the clinical encounter; these must be integrated into any diagnostic or treatment plan.

In this issue of Seminars in Roentgenology, we provide a comprehensive review on the subject of evidence-based medicine (and radiology). Evidence-based medicine is the process of lifelong self-directed learning in which caring for patients leads to the search for, critical appraisal of, and incorporation into practice of, valid and clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues. Although, EBP is now a relatively well-established topic among health care providers in general, standard EBP is usually taught with regard to medicine (as the name evidence-based medicine suggests), where therapeutic trials, randomized controlled trials (RCT), and so forth are the mainstay of the literature. In radiology, which is predominantly concerned with diagnostic and imaging studies (and some therapeutic studies within interventional radiology), differences exist. Therefore, we have written this issue of the journal with specific emphasis on how EBP applies to radiology, both diagnostic and interventional, transferring the principles of evidence-based practice (EBP) to create evidence-based radiology (EBR).

This issue is designed so that the first section will give the reader essential Background Knowledge on EBP and EBR. This is the theory section, or the “see one” section. The next section is the Application Section and consists of several critically appraised topics (or CATs). This is the practical section, or the “do one” section. We end with a section on teaching EBP (and EBR), the “teach one” section.

This issue opens with an article by Dr Kelly, Evidence Based Practice—An Overview. This gives the reader a grounding in the theory and principles of EBP (and EBR). The principles of EBP are (1) formulate answerable questions, (2) search effectively for evidence, (3) critically appraise evidence about diagnosis, treatment, and etiology for its validity and applicability, (4) apply the evidence to clinical practice, and (5) evaluate how you are doing. Therefore, this article is followed by an article on Asking an Answerable Question and another article on Searching the Literature. Dr Cronin then presents articles on critically appraising the primary evidence in general, with specific articles on critically appraising diagnostic imaging studies (diagnostic radiology) and therapeutic studies (interventional radiology). The next article by Dr Dwamena assesses critically appraising the secondary evidence, specifically meta-analyses. There are also 2 articles on Application and Evaluation of the EBP process by Dr Cronin.

The next section, the Application Section, consists of several critically appraised topics (or/CATs). The first is a neuroradiology topic—written by Drs Petrou and Foerster at the Johns Hopkins Hospital— a review of computed tomography (CT) vs magnetic resonance angiography in the evaluation of symptomatic carotid artery stenosis. The next CAT is from Dr Julianna Czum at the Dartmouth Hitchcock Medical Center. She reviews a cardiac topic, 16 vs 64-slice CT for the detection of coronary artery disease. The next article is an abdomen topic, CT colonography vs colonoscopy for the detection of colon cancer from Drs El-Maraghi and Kielar at the Royal Victoria Hospital of Barrie and the University of Ottawa. The last CAT is a musculoskeletal topic, ultrasound vs magnetic resonance imaging for the detection of rotator cuff injury, presented by Drs Kelly and Fessell at the University of Michigan.

The next section, the Teach Section, consists of an article that uses an EBP evaluation of coronary CT angiography as a reflection upon a self-directed learning experience. This article is written by Dr Julianna Czum at the Dartmouth Hitchcock Medical Center and outlines her experiences with teaching herself EBP. The last article Evidence-Based Practice Journal Club is a reflection of our experience in setting up an EBP journal club for the radiology residents at the University of Michigan.

Finally, we also present a Case of the Season, Left Ventricle Pseudothrombus: A Potential Pitfall on Cardiac CT, by lead author Dr Jacek Strzelczyk at the University of Manitoba.

We thank all of the authors for all their hard work and diligence in providing the readers with a comprehensive review on this timely and exciting topic. We also thank Dr Jannette Collins for giving us this wonderful opportunity to serve as guest co-editors. Finally, we thank the Association of University Radiologists (AUR) for their support through the General Electric Radiology Research Academic Fellowship (GERRAF), which has allowed both of us the time and opportunity to further discover the joys of EBP/EBR, to develop an interest in the topic, and to develop an Evidence-Based Practice/Radiology Journal Club with the radiology residents at the University of Michigan.