Effective choices for diagnostic imaging in clinical practice. Report of a WHO Scientific Group.

While this report was being prepared, two things became increasingly clear to those involved: firstly, that the proper use of the diagnostic equipment now available is very important and, secondly, that with such a wide field with so many variables, it is an almost impossible task to make specific recommendations. The comprehensive working papers produced by the members of the Scientific Group before the meeting were based on their own individual experience and a large number of professional publications, only the most significant of which have been referenced. Unfortunately most of the existing publications refer to imaging in departments which are of Level II or Level III, whereas Level I represents the most likely situation for most of the world. The Group acknowledged that none of the recommendations on imaging procedures will always be appropriate; changes will occur as knowledge grows and equipment improves, so that the report may be only a starting point to stimulate discussions and ideas. If proper care within economic bounds is to be given to all patients, their physicians must reach their own conclusions, based on reports, practice and conversations with their colleagues--particularly with imaging specialists. Hospitals must lay down their own protocols for imaging, guided by local circumstances, which should be reviewed at regular intervals and changed as experience grows. This will be of considerable educational benefit to junior staff as well as to their mentors. There should be a regularly scheduled review in every field of medicine. Techniques and ideas grow all the time and every effort should be made to stop using outdated methods in favour of the new, provided that the new is really more efficient in terms of patient care. Only too often during diagnostic imaging, an extra projection or another imaging procedure is added with little consideration of whether it will be of significant benefit to the patient. In addition, not all existing equipment can provide the required diagnostic information. For example, a WHO Scientific Group on the Indications for and Limitations of Major X-Ray Diagnostic Investigations (2) concluded that, at a first chest examination, only a posteroanterior view is needed. However, this will be sufficient only when a genuine high-kV radiographic technique is used; the output of some quite complex X-ray equipment does not always reach the level set on the controls.(ABSTRACT TRUNCATED AT 400 WORDS)