Dipartimento di Scienze Medico-Chirurgiche, Unità di Radiologia, IRCCS Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
Eur Radiol. 2010 Jan;20(1):1-15. doi: 10.1007/s00330-009-1574-4.
To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this principle in the European radiological community.
Starting from Sackett's definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM's limitations. Delayed diffusion and peculiar features of evidence-based radiology (EBR) are defined with emphasis on the need to shift from the demonstration of the increasing ability to see more and better, to the demonstration of a significant change in treatment planning or, at best, of a significant gain in patient outcome. The "as low as reasonably achievable" (ALARA) principle is thought as a dimension of EBR while EBR is proposed as part of the core curriculum of radiology residency. Moreover, we describe the process of health technology assessment in radiology with reference to the six-level scale of hierarchy of studies on diagnostic tests, the main sources of bias in studies on diagnostic performance, and levels of evidence and degrees of recommendations according to the Centre for Evidence-Based Medicine (Oxford, UK) as well as the approach proposed by the GRADE working group. Problems and opportunities offered by evidence-based guidelines in radiology are considered. Finally, we suggest nine points to be actioned by the ESR in order to promote EBR.
Radiology will benefit greatly from the improvement in practice that will result from adopting this more rigorous approach to all aspects of our work.
概述放射学中循证医学（EBM）的相关内容，并为欧洲放射学界采用这一原则制定相关政策。
从 Sackett 对 EBM 的定义出发，我们阐述了 EBM 的自上而下和自下而上的方法以及 EBM 的局限性。EBR 中证据的延迟扩散和独特特征，以及从展示不断提高的观察和诊断能力，向展示治疗计划的显著改变，或最好是患者结果的显著改善转变的必要性，均被重点强调。“合理的尽可能低”（ALARA）原则被视为 EBR 的一个维度，而 EBR 被提议作为放射科住院医师核心课程的一部分。此外，我们还描述了放射科卫生技术评估的过程，参考了诊断测试研究的六级分层，以及在诊断性能研究中存在的主要偏倚来源，根据英国牛津循证医学中心（Centre for Evidence-Based Medicine，Oxford，UK）的证据水平和推荐等级，以及 GRADE 工作组提出的方法。我们还考虑了放射科循证指南带来的问题和机遇。最后，我们建议 ESR 采取九点措施，以促进 EBR。
通过采用这种更严格的方法来处理我们工作的各个方面，放射学将大大受益于实践的改进。
