Principles of Evidence-Based Imaging for Adults and Children

  • L. Santiago MedinaEmail author
  • C. Craig Blackmore
  • Kimberly E. Applegate
  • Enrique Alvarado
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


The standard medical education in Western medicine has emphasized skills and knowledge learned from experts, particularly those encountered in the course of postgraduate medical education and through national publications and meetings. This reliance on experts, referred to by Dr. Paul Gerber of Dartmouth Medical School as “eminence-based medicine,” is based on the construct that the individual practitioner, particularly a specialist devoting extensive time to a given discipline, can arrive at the best approach to a problem through his or her experience. The practitioner builds up an experience base over years and digests information from national experts who have a greater base of experience due to their focus in a particular area. The evidence-based imaging (EBI) paradigm, in contradistinction, is based on the precept that a single practitioner cannot through experience alone arrive at the best course of action. Assessment of appropriate medical care should instead be derived through an evidence-based process. The role of the practitioner, then, is not simply to accept information from an expert but rather to assimilate and critically assess the research evidence that exists in the literature to guide a clinical decision. This chapter will discuss what evidence-based imaging is and what the evidence-based process is and how to apply this process.


Evidence-based imaging process Evidence-based imaging paradigm Formulating clinical question Identifying medical literature Assessing medical literature Economic analysis Applying the evidence 



We appreciate the contribution of Ruth Carlos, MD, MS, to the discussion of likelihood ratios in this chapter.


  1. 1.
    Levin A. Ann Intern Med. 1998;128:334–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Evidence-Based Medicine Working Group. J Am Med Assoc. 1992;268:2420–5.CrossRefGoogle Scholar
  3. 3.
    The Evidence-Based Radiology Working Group. Radiology. 2001;220:566–75.CrossRefGoogle Scholar
  4. 4.
    Wood BP. Radiology. 1999;213:635–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Poisal JA, et al. Health Aff. 2007;26:w242–53.CrossRefGoogle Scholar
  6. 6.
    Davis K. N Engl J Med. 2008;359:1751–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Hulley SB, Cummings SR. Designing clinical research. Baltimore: Williams & Wilkins; 1998.Google Scholar
  8. 8.
    Kelsey J, Whittemore A, Evans A, Thompson W. Methods in observational epidemiology. New York: Oxford University Press; 1996.Google Scholar
  9. 9.
    Blackmore C, Cummings P. AJR Am J Roentgenol. 2004;183(5):1203–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Medina L, Aguirre E, Zurakowski D. Neuroimaging Clin N Am. 2003;13:157–65.CrossRefPubMedGoogle Scholar
  11. 11.
    Medina L. AJNR Am J Neuroradiol. 1999;20:1584–96.PubMedGoogle Scholar
  12. 12.
    Sunshine JH, McNeil BJ. Radiology. 1997;205:549–57.CrossRefGoogle Scholar
  13. 13.
    Black WC. AJR Am J Roentgenol. 1990;154:17–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Sox HC, Blatt MA, Higgins MC, Marton KI. Medical decision making. Boston: Butterworth; 1988.Google Scholar
  15. 15.
    Metz CE. Semin Nucl Med. 1978;8:283–98.CrossRefPubMedGoogle Scholar
  16. 16.
    Singer M, Applegate K. Radiology. 2001;219:611–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Weinstein MC, Fineberg HV. Clinical decision analysis. Philadelphia: WB Saunders; 1980.Google Scholar
  18. 18.
    Carlos R. Acad Radiol. 2004;11:141–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Detsky AS, Naglie IG. Ann Intern Med. 1990;113:147–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Doubilet P, Weinstein MC, McNeil BJ. N Engl J Med. 1986;314:253–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.Google Scholar
  22. 22.
    Hillemann D, Lucas B, Mohiuddin S, Holmberg M. Ann Pharmacother. 1997;31:974–9.CrossRefGoogle Scholar
  23. 23.
    Medina L, Aguirre E, Bernal B, et al. Radiology. 2004;230:49–54.CrossRefPubMedGoogle Scholar
  24. 24.
    Appel LJ, Steinberg EP, Powe NR, et al. Med Care. 1990;28:324–37.CrossRefPubMedGoogle Scholar
  25. 25.
    Evens RG. Cancer. 1991;67:1245–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Yin D, Forman HP, Langlotz CP. AJR Am J Roentgenol. 1995;165:1323–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Medina L, Crone K, Kuntz K. Pediatrics. 2001;108:E101.CrossRefPubMedGoogle Scholar
  28. 28.
    Ware JE, Sherbourne CD. Med Care. 1992;30:473–83.CrossRefPubMedGoogle Scholar
  29. 29.
    Jarvik J, Hollingworth W, Martin B, et al. J Am Med Assoc. 2003;289:2810–8.CrossRefGoogle Scholar
  30. 30.
    Blackmore CC, Magid DJ. Radiology. 1997;203:87–91.CrossRefPubMedGoogle Scholar
  31. 31.
    Zou K, Fielding J, Ondategui-Parra S. Acad Radiol. 2004;11:127–33.CrossRefPubMedGoogle Scholar
  32. 32.
    Langlotz C, Sonnad S. Acad Radiol. 1998;5(suppl 2):S269–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Littenberg B, Moses LE. Med Decis Mak. 1993;13:313–21.CrossRefGoogle Scholar
  34. 34.
    Fiebach JB, et al. Stroke. 2004;35(2):502–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Fryback DG, Thornbury JR. Med Decis Mak. 1991;11:88–94.CrossRefGoogle Scholar
  36. 36.
    Blackmore C. Radiology. 2005;235(2):371–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Yousem DM, Beauchamp NJ. Radiology Business practice: how to succeed. Elsevier Health Sciences, 2007.Google Scholar
  38. 38.
    American Medical Association. Medicare RBRVS: The Physicians’ Guide 2015.Google Scholar
  39. 39.
    Hsiao WC, Dunn DL, Verrilli DK. NEJM. 1993;328(13):928–33.CrossRefPubMedGoogle Scholar
  40. 40.
    Moorefield JM, MacEwan DW, Sunshine JH. Radiology. 1993;187(2):317–26.CrossRefPubMedGoogle Scholar
  41. 41.
    Jaeschke R, Guyatt GH, Sackett DL. JAMA. 1994;271:703–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Malone D. Radiology. 2007;242(1):12–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • L. Santiago Medina
    • 1
    • 2
    Email author
  • C. Craig Blackmore
    • 3
  • Kimberly E. Applegate
    • 4
  • Enrique Alvarado
    • 5
  1. 1.Nicklaus Children’s Hospital, Miami Children’s Health SystemsMiamiUSA
  2. 2.Florida International University Herbert Wertheim College of MedicineMiamiUSA
  3. 3.Department of Radiology, Center for Health Care Improvement ScienceVirginia Mason Medical CenterSeattleUSA
  4. 4.Department of RadiologyUniversity of Kentucky Children’s HospitalLexingtonUSA
  5. 5.Department of Diagnostic RadiologyPuerto Rico Children’s HospitalBayamónPuerto Rico

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