Journal of the American College of Radiology : JACR
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Sinonasal imaging is performed in 2 major clinical scenarios: inflammatory rhinosinusitis or suspected mass lesion. Rhinosinusitis affects more than 16% of the US population annually. It poses an immense economic burden, accounting for more than 26 million outpatient visits annually and costing more than $4.3 billion annually in direct medical expenses. ⋯ The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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The author reviews the dilemmas posed by incidental radiologic findings and provides an analysis of factors that underlie how radiologists handle them. Particular attention is paid to professional standards that mediate clinical decision making and communication in the setting of risk. The author concludes that individual radiologists should report the incidental findings they detect and use existing evidence-based recommendations when possible. Such recommendations, however, face their own challenge in maintaining consistency with norms around risk-related decision making in other clinical realms.
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Radiology practice guidelines have been developed to help radiologists achieve quality and safety in their clinical practice. One means to promote the use of practice guidelines in radiology is through the wider use of reporting templates, also known as "structured reporting." This article presents specific examples in which radiology reporting templates can promote adherence to guidelines, gather data for quality improvement efforts, and facilitate compliance with performance incentive programs.