Measuring appropriateness of diagnostic imaging: a scoping review

Walther, Felix; Eberlein-Gonska, Maria; Hoffmann, Ralf-Thorsten; Schmitt, Jochen; Blum, Sophia F. U.

doi:10.1186/s13244-023-01409-6

Insights into Imaging

Table 2 Characteristics of included studies

From: Measuring appropriateness of diagnostic imaging: a scoping review

Ref.	Year	Country	Population age*	Sector	Number of participants	Modality type of examination	Comparing body regions	Appropriateness definition	Rating	Intervention, (Control)	Methods Study design	Evidence level	Mono-/ multicenter	Data sources	Statistics
[62]	2006	UK	Adult	Inpatient	252	XR	–	National GL	Single	–	PC	3e	Mono	Clinical	Analytic
[63]	2010	USA	N/A	Outpatient	459	MRI, CT	Yes	National GL	N/A	–	RC	3e	Mono	Clinical	Analytic
[64]	2013	CAN	N/A	Inpatient	1901	MRI, CT	Yes	National GL	Single	–	RC	4a	Multi	Secondary	Descriptive
[23]	2018	SPA	Adult	Inpatient	2022	CT, XR	Yes	EU	Single	–	C–S	3e	Multi	Clinical	Analytic
[65]	2018	PAK	Adult	N/A	1205	CT	–	ACR	N/A	–	RC	3e	Mono	Clinical	Analytic
[66]	2019	AUS	Adult	Inpatient	109	XR	–	National GL	N/A	–	RC	3e	Mono	Clinical	Analytic
[67]	2020	ZAF	Adult	Inpatient	515	MRI, CT	–	ACR	N/A	–	RC	3e	Mono	Clinical	Analytic
[68]	2014	ZAF	Adult	N/A	219	MRI, CT	–	ACR	N/A	–	RC	4a	Mono	Clinical	Descriptive
[69]	2018	USA	Adult	Inpatient	88	MRI	Yes	ACR	Double independent	–	RC	4a	Mono	Clinical	Descriptive
[70]	2013	SPA	Adult	Outpatient, inpatient	584	MRI	–	EU	N/A	–	PC	3e	Multi	Primary	Analytic
[71]	2018	SPA	Adult	Outpatient	300	MRI	No	ACR	Single	–	RC	3e	Mono	Clinical	Analytic
[72]	2007	UK	N/A	Inpatient	121	CT	–	National GL	Consensus	–	RC	4a	Mono	Clinical	Descriptive
[22]	2020	POR	Adult	Inpatient	1427	CT, US	–	ACR	N/A	–	RC	3e	Mono	Clinical	analytic
[73]	2010	USA	Adult	Inpatient	2295	CT	–	ACR	Single	–	RC	4a	Mono	Clinical	Descriptive
[74]	2016	USA	Child	Inpatient	207	MRI, CT	–	ACR	N/A	–	RC	3e	Mono	Clinical	Analytic
[75]	2018	GHA	Adult	Outpatient	161	MRI	–	ACR	N/A	–	RC	4a	Mono	Clinical	Descriptive
[76]	2020	USA	Adult	Inpatient	1005	CT	–	National GL, ACR	Double independent	–	PC	3e	Mono	Clinical	Analytic
[77]	2012	USA	Adult	Inpatient	243	CT	–	National GL	Single	–	RC	3e	Mono	Clinical	Analytic
[78]	2011	ITA	Adult	Inpatient	500	CT, XR, US	–	National GL	N/A	–	RC	4a	Mono	Clinical	Descriptive
[79]	2013	USA	Child, adult	Inpatient	182	CT	–	Own	Single	–	RC	3e	Mono	Clinical	Analytic
[80]	2018	CAN	Adult	Inpatient	1087	MRI	Yes	National GL, ACR	Single	–	PC	4a	Multi	Clinical	Descriptive
[81]	2021	GHA	Child, adult, elderly	Outpatient, inpatient	11,806	CT	–	ACR	Double independent	–	RC	4a	Multi	Clinical	Descriptive
[82]	2016	USA	Adult	Inpatient	108	MRI, XR¹	–	ACR	Single	–	RC	3e	Mono	Clinical	Analytic
[83]	2020	FIN	Child, adult	Inpatient	430	CT, XR	–	National GL	Single	Referral GL + education (B/A)	RC	2d	Mono	Clinical	Analytic
[84]	2002	UK	N/A	Inpatient	171	XR	–	National GL	Double independent	–	PC	4a	Mono	Clinical	Descriptive
[85]	2012	USA	Adult	Inpatient	1325	CT², XR	–	ACR	Double independent	–	RC	4a	Mono	Clinical	Descriptive
[86]	2010	USA	N/A	Inpatient	251	CT	–	National GL, ACR	N/A	–	RC	4a	Mono	Clinical	Descriptive
[87]	2019	IRE	N/A	Inpatient	297	XR	–	National GL	Single	iRefer GL (B/A)	RC	2d	Mono	Clinical	Descriptive
[88]	2013	ITA	Adult	–	3950	MRI, XR, US	–	EU	N/A	–	RC	4a	Mono	Clinical	Descriptive
[89]	2017	ITA	N/A	Inpatient	13,941	CT, XR	–	ACR, EU	> 2 independent	–	RC	4a	Mono	Clinical	Descriptive
[90]	1994	CAN	N/A	Outpatient, inpatient	198	MRI	–	Own	N/A	–	RC	3e	Mono	Clinical	Analytic
[91]	2015	USA	ADULT	Inpatient	100	MRI, CT, XR	–	ACR	Single	–	RC	4a	Mono	Clinical	Descriptive
[92]	2020	CMR	Adult	Outpatient, inpatient	511	CT	–	ACR	Double independent	–	RC	3e	Mono	Primary + clinical	Analytic
[21]	2019	FRA, LUX, BEL	Child, adult (undefined)	Inpatient	718	MRI, CT	Yes	National GL	N/A	–	RC	4a	Multi	Clinical	Descriptive
[20]	2019	CHE	Adult	Inpatient	1997	XR	–	National GL, ACR	N/A	–	RC	3e	Multi	Clinical	Analytic
[93]	2006	USA	Adult	Inpatient	660	CT	Yes	ACR	N/A	–	RC	4a	Mono	Clinical	Descriptive
[94]	2016	GER	N/A	Outpatient, inpatient	265	Various (N/A)	–	National GL	N/A	–	RC	4a	Multi	Secondary	Descriptive
[95]	2003	GER	N/A	Outpatient	3079	Various (N/A)	–	Own	Double independent	–	PC	4a	Multi	Clinical	Descriptive
[96]	2021	AUS	N/A	Inpatient	642	CT, XR	–	ACR, EU	> 2 independent	–	RC	4a	Mono	Clinical	Descriptive
[97]	1997	USA	Adult	Inpatient	180	Various (N/A)	–	Own	Single	Radiological consultation (B/A)	PC	2d	Mono	Clinical	Descriptive
[98]	2013	USA	Adult	N/A	507	CT	–	National GL	Single	–	PC	4a	Mono	Primary	Descriptive
[99]	2014	USA	Adult, elderly	Inpatient	388	CT	–	ACR	N/A	–	RC	3e	Mono	Clinical	Analytic
[100]	2013	FIN	Adult, child	Inpatient	150	MRI	Yes	EU	Double independent	–	RC	4a	Mono	Clinical	Descriptive
[101]	2018	ITA	Adult	Inpatient	853	MRI, CT	Yes	ACR	Self-assessment	–	RC	3e	Multi	Clinical	Analytic
[103]	2014	UK	N/A	Inpatient	3085	MRI, CT	–	National GL	Double independent	–	RC	4a	Multi	Primary + clinical	Descriptive
[104]	2016	AUS	N/A	Inpatient	386	CT, XR, US	–	National GL	Double independent	–	RC	4a	Mono	Clinical	Descriptive
[105]	2013	CAN	N/A	Outpatient	1000	MRI	Yes	Own	N/A	–	PC	4a	Multi	Clinical	Descriptive
[106]	2020	USA	N/A	Inpatient	445	CT	–	National GL	N/A	Clinical decision making (B/A)	PC	2d	Mono	Clinical	Analytic
[111]	2017	CAN	Adult	N/A	2417	CT	–	National GL	N/A	–	RC	3e	Mono	Clinical	Analytic
[107]	2021	CAN	Adult	Inpatient	2577	CT	–	National GL	Single	AUC—implementation (B/A)	RC	2d	Mono	Clinical	Analytic

ACR American College of Radiology; AUC Appropriate use criteria; AUS Australia; BEL Belgium; B/A Before-after; CAN Canada; CHE Switzerland; CMR Cameroon; CS Cross-sectional; CT Computed tomography; FIN Finland; FRA France; GER Germany; GHA Ghana; IRE Ireland; ITA Italy; LUX Luxembourg; MRI Magnetic resonance imaging; N/A Not applicable; PAK Islamic Republic of Pakistan; PC Prospective cohort; RC Retrospective cohort; SPA Spain; UK United Kingdom; US Ultrasound; USA United States of America; XR Radiography; y Years; ZAF South Africa
^* (median; mean) in studies included: child = 0–18y, adult = 18–65y, elderly > 65y
¹appropriateness results were provided for MRI solely
²appropriateness results were provided for radiography solely

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