Evidence-based Practice in Radiology: Step 5 (Evaluate)—Caveats and Common Questions

So far, this series has described and illustrated the first four steps of the five-step evidence-based practice (EBP) process that was originally designed and taught by the medical epidemiologists of McMaster University (Hamilton, Ontario, Canada) and the National Health Service Centre for Evidence-Based Medicine (University of Oxford, Oxford, England). This article in the series first briefly considers the fifth step (evaluate). A more detailed consideration of caveats, common questions, and challenges relevant to EBP in radiology then follows. These are issues that merit some thought by those beginning or continuing work in EBP.

© RSNA, 2007


  • 1 Welch HG, Lurie JD. Teaching evidence-based medicine: caveats and challenges. Acad Med 2000; 75: 235–240. Crossref, MedlineGoogle Scholar
  • 2 Practicing EBM: evaluation. Web site of the Centre for Evidence-Based Medicine, University Hospital Network, Toronto, Ontario, Canada. http://www.cebm.utoronto.ca/practise/evaluate/index.htm#top. Accessed April 10, 2006. Google Scholar
  • 3 The clinical audit cycle. Principles for Best Practice in Clinical Audit. National Institute for Health and Clinical Excellence Web site. http://www.nice.org.uk/pdf/BestPracticeClinicalAudit.pdf. Accessed April 10, 2006. Google Scholar
  • 4 Clinical audit. GIMBE (Gruppo Italiano per la Medicina Basata sulle Evidenze) Web site. http://www.gimbe.org/Link/clinical_audit.htm. Accessed April 10, 2006. Google Scholar
  • 5 Naylor CD, Guyatt GH. Users' guides to the medical literature. XI. How to use an article about a clinical utilization review. Evidence-Based Medicine Working Group. JAMA 1996; 275: 1435–1439. Google Scholar
  • 6 Dickens C. A tale of two cities. London, England: Penguin Classics, 2003. Google Scholar
  • 7 Agency for Healthcare Research and Quality (AHRQ). United States Department of Health and Human Services Web site. http://www.ahrq.gov. Accessed April 10, 2006. Google Scholar
  • 8 Evidence-Based Radiology Working Group. Evidence-based radiology: a new approach to the practice of radiology. Radiology 2001; 220: 566–575. LinkGoogle Scholar
  • 9 Friedland DJ. Introduction. In: Evidence based medicine. Stamford, Conn: Appleton & Lange, 1988; 2–3. Google Scholar
  • 10 Wood BP. What's the evidence? Radiology 1999; 213: 635–637. LinkGoogle Scholar
  • 11 Skrabanek P. Nonsensus consensus. Lancet 1990; 335: 1446–1447. Crossref, MedlineGoogle Scholar
  • 12 Oxman AD, Guyatt GH. The science of reviewing research. Ann N Y Acad Sci 1993; 703: 125–133. Crossref, MedlineGoogle Scholar
  • 13 Dixon AK. The evidence base for diagnostic radiology. Eur Radiol 2000; 10(suppl 3): S347–S348. Crossref, MedlineGoogle Scholar
  • 14 Guidelines and standards. American College of Radiology Web site. http://www.acr.org/s_acr/sec.asp?CID=1848&DID=16053. Accessed April 10, 2006. Google Scholar
  • 15 Making the best use of a department of clinical radiology: guidelines for doctors. 5th ed. Royal College of Radiologists Web site. http://www.rcr.ac.uk/index.asp?PageID=310&PublicationID=71. Accessed April 10, 2006. Google Scholar
  • 16 Clinical Guidance. National Institute for Health and Clinical Excellence Web site. http://www.nice.org.uk/page.aspx?o=ourguidance. Accessed April 10, 2006. Google Scholar
  • 17 Financing health care: searching for a miracle solution. The Economist. August 18, 2005. http://www.economist.com/research/articlesBySubject/displayStory.cfm?story_ID=4293317&subjectid=348945. Accessed April 10, 2006. Google Scholar
  • 18 Sackett DL, Rosenberg WM, Muir Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn't. BMJ 1996; 312: 71–72. Crossref, MedlineGoogle Scholar
  • 19 Druss B. Evidence-based medicine: does it make a difference?—use wisely. BMJ 2005; 330:92. Google Scholar
  • 20 Grahame-Smith D. Evidence-based medicine: socratic dissent. BMJ 1995; 310: 1126–1127. Crossref, MedlineGoogle Scholar
  • 21 Sackett DL, Strauss SE, Richardson WS, Rosenberg W, Haynes RB. Introduction. In: Evidence based medicine: how to practice and teach EBM. 2nd ed. Edinburgh, Scotland: Churchill Livingstone, 2000; 1–12. Google Scholar
  • 22 Staunton M. Evidence-based radiology: steps 1 and 2—asking answerable questions and searching for evidence. Radiology 2007; 242(1): 23–31. LinkGoogle Scholar
  • 23 Dodd JD. Evidence-based practice in radiology: steps 3 and 4—appraise and apply diagnostic radiology literature. Radiology 2007; 242(2): 342–354. LinkGoogle Scholar
  • 24 Maher MM, Hodnette PA, Kalra M. Evidence-based practice in radiology: steps 3 and 4—appraise and apply interventional radiology literature. Radiology 2007; 242(3): 658–670. LinkGoogle Scholar
  • 25 Halligan S, Altman DG. Evidence-based practice in radiology: steps 3 and 4—appraise and apply systematic reviews and meta-analyses. Radiology 2007; 243(1): 13–27. LinkGoogle Scholar
  • 26 Trinder L. A critical appraisal of evidence-based practice. In: Trinder L, Reynolds S, eds. Evidence-based practice: a critical appraisal. Oxford, England: Blackwell Science, 2000; 212–241. Google Scholar
  • 27 Auclair F. A point of view: on the nature of evidence. Ann RSPSC 1999; 32: 453–455. Google Scholar
  • 28 Curran JW, Essex M. Epidemic acquired immune deficiency syndrome: epidemiologic evidence for a transmissible agent. J Natl Cancer Inst 1983; 71: 1–4. MedlineGoogle Scholar
  • 29 Centers for Disease Control. Pneumocystis carinii pneumonia among persons with hemophilia A. MMWR Morb Mortal Wkly Rep 1982; 31: 365–367. MedlineGoogle Scholar
  • 30 Centers for Disease Control. Update on acquired immune deficiency syndrome (AIDS) among patients with hemophilia A. MMWR Morb Mortal Wkly Rep 1982; 31: 644–646, 652. MedlineGoogle Scholar
  • 31 Centers for Disease Control. Possible transfusion-associated acquired immune deficiency syndrome (AIDS): California. MMWR Morb Mortal Wkly Rep 1982; 31: 652–654. MedlineGoogle Scholar
  • 32 Krever H. Commission of inquiry on the blood system in Canada. Final report, volume 1. Ottawa, Ontario, Canada: Minister of Public Works and Government Services Canada, 1997. Google Scholar
  • 33 Kant I. Anthropology from a pragmatic point of view (1800). Gregor MJ, translator. The Hague, the Netherlands: Martinus Nijhoff, 1974. Google Scholar
  • 34 Dodd JD, MacEneaney PM, Malone DE. Evidence-based radiology: how to quickly assess the validity and strength of publications in the diagnostic radiology literature. Eur Radiol 2004; 14: 915–922. Crossref, MedlineGoogle Scholar
  • 35 Jaeschke R, Guyatt G, Lijmer J. The basics: using the medical literature—diagnostic tests. In: Guyatt G, Rennie D, eds. Users' guides to the medical literature: a manual for evidence-based clinical practice. Chicago, Ill: American Medical Association, 2002; 121–140. Google Scholar
  • 36 Kealey SM, MacEneaney PM, Dodd J, Gibney RG, Malone DE. Minimal preparation CT (MPCT) for suspected colon cancer in frail elderly patients: outcome analysis at 1 year. Clin Radiol 2004; 59: 44–52. Crossref, MedlineGoogle Scholar
  • 37 Cunningham P, Staunton M, Gibney RG, Malone DE. Imaging of acute appendicitis: comparison of CT and ultrasound using “Evidence-Based Medicine” methods [abstr]. Eur Radiol 2001; 11(6):C35. Google Scholar
  • 38 Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 2003; 139: 547–557. Crossref, MedlineGoogle Scholar
  • 39 Collins J, Rosado de Christenson M, Gray L, et al. General competencies in radiology residency training: definitions, skills, education and assessment. Acad Radiol 2002; 9: 721–726. Crossref, MedlineGoogle Scholar
  • 40 Societal Needs Working Group of the Royal College of Physicians of Canada. Skills for the new millennium: report of the societal needs working group—CanMEDS 2000 project. Ottawa, Ontario, Canada: Royal College of Physicians of Canada, 2000. Google Scholar
  • 41 Staunton M, Dodd JD, McCormick PA, Malone DE. Finding evidence-based answers to practical questions in radiology: which patients with inoperable hepatocellular carcinoma will survive longer following transcatheter arterial chemo-embolization? Radiology 2005; 237: 404–413. LinkGoogle Scholar
  • 42 Hawkins RC. The evidence based medicine approach to diagnostic testing: practicalities and limitations. Clin Biochem Rev 2005; 26: 7–18. MedlineGoogle Scholar
  • 43 Lentle BC. Radiology research: from 1970 through 1990 and toward 2000. Can Assoc Radiol J 1994; 45: 433–437. MedlineGoogle Scholar
  • 44 Isaacs D, Fitzgerald D. Seven alternatives to evidence based medicine. BMJ 1999; 319: 1618. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2007