Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach—Part 3: Spinal Disorders
Section snippets
Reporting of Topics Included in the Development of the Diagnostic Imaging Practice Guidelines1
An initial literature review considered 10 clinical questions pertaining to imaging of musculoskeletal conditions to evaluate the pertinence of developing diagnostic imaging guidelines. This initial review led to a research project divided into 9 phases: (1) literature search; (2) independent literature assessment; (3) guideline development specific recommendations; (4) first external review; (5) consensus panel (modified Delphi); (6) public website; (7) second external review; (8) final draft
Methods for Synthesizing Evidence
- (a)
Literature search and independent literature assessment of spinal disorders: Quality of diagnostic accuracy studies (QUADAS),3 Appraisal of Guidelines Research and Evaluation (AGREE),4 and Stroke Prevention and Educational Awareness Diffusion (SPREAD).5
- (b)
Initial draft: template based on European Commission classification (2001).6
- (c)
Expert consensus: a 2-round modified Delphi process was used to generate consensus among an international panel of more than 60 experts in musculoskeletal disorders.
What Is the Role of These Guidelines?
These evidence-based diagnostic imaging practice guidelines are intended to assist primary care providers and students in decision making regarding the appropriate use of diagnostic imaging for specific clinical presentations. The guidelines are intended to be used in conjunction with sound clinical judgment and experience. For example, other special circumstances for radiographic imaging studies may include: patient unable to give a reliable history; crippling cancer phobia focused on back
Are There Potential Risks Associated With Conventional Radiographs?
Although somewhat controversial,20, 21, 22, 23 it is important to remember that health hazards of all forms of radiation are cumulative.23, 24, 25, 26, 27, 28, 29, 30 The Biological Effects of Ionizing Radiation (BEIR) 2005 report released by the National Academy of Sciences adds further support to the “linear-no-threshold” model of cancer risk from ionizing radiation exposure.31 In summary, this report concludes that ionizing radiation is dangerous even at low doses and that there are no safe
Acknowledgment
We appreciate the efforts of the many people who assisted in this process, listed in Appendix G.
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