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Hamel C, Avard B, Belanger C, Chatterjee A, Hartery A, Lim H, Kanagaratnam S, Fung C. Canadian Association of Radiologists Gastrointestinal Imaging Referral Guideline. Can Assoc Radiol J 2024:8465371231217230. [PMID: 38183236 DOI: 10.1177/08465371231217230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
The Canadian Association of Radiologists (CAR) Gastrointestinal Expert Panel consists of radiologists, a gastroenterologist, a general surgeon, a family physician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 20 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 58 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 85 recommendation statements specific to the adult population across the 20 scenarios. This guideline presents the methods of development and the referral recommendations for dysphagia/dyspepsia, acute nonlocalized abdominal pain, chronic abdominal pain, inflammatory bowel disease, acute gastrointestinal bleeding, chronic gastrointestinal bleeding/anemia, abnormal liver biopsy, pancreatitis, anorectal diseases, diarrhea, fecal incontinence, and foreign body ingestion.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | | | - Avi Chatterjee
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Angus Hartery
- Eastern Health, Memorial University, St. Clare's, St. John's, NL, Canada
| | - Howard Lim
- University of British Columbia, BC Cancer, Vancouver Centre, Vancouver, BC, Canada
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Russo GK, Zaheer A, Kamel IR, Porter KK, Archer-Arroyo K, Bashir MR, Cash BD, Fung A, McCrary M, McGuire BM, Shih RD, Stowers J, Thakrar KH, Vij A, Wahab SA, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Upper Quadrant Pain: 2022 Update. J Am Coll Radiol 2023; 20:S211-S223. [PMID: 37236744 DOI: 10.1016/j.jacr.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Acute right upper quadrant pain is one of the most common presenting symptoms in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. This document focuses on the diagnostic accuracy of imaging studies performed specifically to evaluate acute right upper quadrant pain, with biliary etiologies including acute cholecystitis and its complications being the most common. An additional consideration of extrabiliary sources such as acute pancreatitis, peptic ulcer disease, ascending cholangitis, liver abscess, hepatitis, and painful liver neoplasms remain a diagnostic consideration in the right clinical setting. The use of radiographs, ultrasound, nuclear medicine, CT, and MRI for these indications are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin K Porter
- Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; Council Steering Committee, ACR
| | | | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Alice Fung
- Oregon Health & Science University, Portland, Oregon; Liver Reporting & Data System Technique Working Group
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama; Primary care physician
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - John Stowers
- Oregon Health & Science University, Portland, Oregon; American College of Surgeons
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Suda T, Shirota Y, Takimoto H, Tsukada Y, Takishita K, Nadamura T, Miyazawa M, Hodo Y, Wakabayashi T. Image quality of abdominal ultrasonography after esophagogastroduodenoscopy is preserved by using carbon dioxide insufflation: A non-inferiority test in the same subject. PLoS One 2022; 17:e0275257. [PMID: 36173985 PMCID: PMC9521841 DOI: 10.1371/journal.pone.0275257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Because bowel gas deteriorates the image quality of abdominal ultrasonography (AUS), it is common to perform AUS prior to esophagogastroduodenoscopy (EGD). This one-way order limits the availability of examination appointments. To evaluate whether EGD using insufflation of carbon dioxide (CO2), which is rapidly absorbed by the gastrointestinal mucosa, preserves the image quality of AUS performed subsequently, we designed a non-inferiority test in which each subject underwent AUS, EGD with CO2 insufflation, and a second AUS, in that order. All saved AUS moving images were randomized and imaging quality was evaluated at 16 organs using a four-point Likert-like scale that divides the depiction rate by 25%. Sample size was calculated to be 26 using the following: non-inferiority margin of –0.40 corresponding to depiction rate of –10%, difference of means of 0.40, common standard deviation of 1.25, power of 90%, and 1-sided α-level of 0.025. We enrolled 30 subjects. The mean and 95% confidence interval (CI) of the image quality score of all 16 organs at pre- and post-EGD AUS in the 30 subjects were 3.54 [3.48–3.60] and 3.46 [3.39–3.52], respectively. The difference in the means was 0.08 of the scores, corresponding to a 2% depiction rate. The effect size was 0.172. The image quality of post-EGD AUS was not inferior, as demonstrated by the 97.5% CI of the difference, which did not cross the non-inferiority margin of –0.40. In conclusion, the use of CO2 for insufflation in EGD does not cause much deterioration in the image quality of AUS performed subsequently. Therefore, it is permissible to perform EGD prior to AUS, which is expected to improve the efficiency of examination setup.
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Affiliation(s)
- Tsuyoshi Suda
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yukihiro Shirota
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
- * E-mail:
| | - Hiroaki Takimoto
- Medical Examination Center, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yasunori Tsukada
- Department of Radiology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Kensaku Takishita
- Department of Radiology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Takahiro Nadamura
- Department of Radiology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Masaki Miyazawa
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yuji Hodo
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Tokio Wakabayashi
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan
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