Individually tailored CT protocols: maximizing safety and efficacy

V. Matarese

 

Introduction

Guidelines help practitioners give the best possible care [ 1]. For diagnostic imaging, procedural guidelines standardize technically complex protocols by recommending instrumental settings, patient preparation, image processing, etc. The guidance may consist of the collective expertise of a group of researchers (e.g. those who work with instrument manufacturers), a consensus based on broad clinical experience, or a synthesis of the evidence base [ 2]. The recommendations aim to maximize the safety and efficacy of the examination; they may also rationalize costs and protect operators from criticism. However, the guidance is not binding and does not replace individualized medical decision-making.
To help bridge the gap between guidelines (which standardize procedures to the “average” patient) and individualized care, researchers have begun to develop individualized guidelines. This new form of guideline distinguishes patients into subgroups based on demographic and clinical parameters, including comorbidities, concurrent treatments and other risk factors [ 3]. The first evidence that individualized guidelines are advantageous was provided in 2011 for blood pressure management [ 4].
CT is a technically complex diagnostic tool. For each of its numerous clinical applications, established protocols help radiologists maximize the diagnostic yield while minimizing potential harm to patients, but it is clear that a one-size-fits-all approach is ineffective. Protocols must be adapted, taking into account the particular patient’s characteristics and diagnostic needs. At present, individualized CT guidelines have not been developed, but knowledge on how these protocols can be tailored is amassing. Speaking at a satellite symposium of the 2013 European Congress of Radiology, three expert radiologists explained how CT protocols can be individually tailored to maximize safety and efficacy.

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