Methodology for ESR iGuide content

The European Society of Radiology (ESR) considers the use of evidence-based referral guidelines in clinical practice essential to ensure the appropriate utilisation of medical imaging for patients. Since 2014, the ESR has been working with the American College of Radiology (ACR) to develop referral guidelines for Europe, based on the ACR Appropriateness Criteria (AC) and appropriate use criteria developed by the ACR Rapid Response Committee. This paper sets out the methodology used by the ESR’s Referral Guidelines Subcommittee to adapt the ACR criteria for use in the European clinical decision support (CDS) platform ESR iGuide. The ESR adheres to the ACR’s original methodology as far as applicable, and has established additional methodological guidance for its experts, establishing several key principles: Any changes to existing recommendations, and any additional guidelines, should be based on evidence as far as possible. Expert opinion, judgement, European practice standards, should only function as a supplement when necessary. Appropriateness recommendations should give no consideration to national or institutional circumstances, costs, or availability of equipment. The cooperation between the ACR and ESR on appropriate use criteria and imaging referral guidelines provides added value to both societies as European studies and guidelines from European subspecialty societies of radiology are fed into the process and the exchange of views among the experts makes the guideline development and review process more robust. The ESR’s aim is to ensure referrers and patients benefit from the best possible guidance for appropriate imaging.