Principles of Evidence-Based Imaging

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” (Levin, Ann Intern Med 128:334, 1998), 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 (Evidence-Based Medicine Working Group, J Am Med Assoc 268:2420–2425, 1992; The Evidence-Based Radiology Working Group, Radiology 220:566–575, 2001; Wood, Radiology 213:635–637, 1999.