Updating Diagnostic Imaging Referral Guidelines

The Canadian Association of Radiologists (CAR) working in collaboration with national medical bodies and specialty societies is undertaking an update of the 13 Diagnostic Imaging Referral Guidelines. The project mandate is to “Produce a comprehensive set of evidence-based diagnostic imaging referral guidelines as a public good that are context-specific to the Canadian healthcare system. These guidelines will be produced following the grading of recommendations, assessment, development and evaluations (GRADE) framework, with recommendations integrated into a clinical decision support (CDS) system. An inaugural meeting took place in January 2021, to determine the order in which the guidelines would be updated.

The CAR established an Imaging Referral Guidelines Working Group with representatives from the Canadian Medical Association (CMA), the Canadian Association of Emergency Physicians (CAEP), the College of Family Physicians of Canada (CFPC), Choosing Wisely, the Nurse Practitioners Association of Canada (NPAC), and the Society of Rural Physicians of Canada (SRPC), the Canadian Spine Society, and the American College of Radiology, to produce a comprehensive set of evidence-based imaging referral recommendations for referring physicians. These guidelines will be informed by evidence from systematic reviews, which are considered essential to produce trustworthy guidelines.1 Assessing the certainty of the evidence of the primary studies and determining the strength of the recommendations will be performed following the GRADE framework.2,3 Last, these evidence-based recommendations will be made publicly available and integrated into a referral clinical decision-support (CDS) system to promote their adoption.

The CAR Imaging Referrals Guideline Working Group


The working group is made up of 19 members, with 18 members from across Canada and one member from the American College of Radiology. The working group co-chairs are Drs. Ryan Margau, radiologist, and Paul Pageau, emergency physician, with an additional 17 members consisting of radiologists and health care professionals, including surgeons, family physicians, nurse practitioners, and a patient advisor. The trauma and musculoskeletal sections were identified as the first modalities to establish the evidence review and guideline recommendation process to be used in all 13 sections of the CAR Diagnostic Imaging Referral Guidelines.

Trauma Expert Panel

In February and March, the Trauma Expert Panel was formed, with Dr. Nicolas Murray, an emergency and trauma radiologist at the Vancouver General Hospital, as the chair and six other members. Over the course of two meetings in March and April 2021, the group discussed the project mandate, conducted a topic prioritization exercise, and selected the area of cervical spine trauma as the pilot topic for the conduct of an evidence review and guideline recommendations.

Musculoskeletal Expert Panel

The musculoskeletal (MSK) system was selected to be undertaken concurrently with the trauma section. Recruitment of the MSK expert panel began in March 2021, with Dr. Kawan Rakhra, Head of the Musculoskeletal Imaging, Department of Medical Imaging at The Ottawa Hospital and Associate Professor of Radiology and Orthopaedic Surgery at the University of Ottawa, as the chair. Members for this expert panel are being finalized.

The objective of CDS is to ensure that patients are accessing the right test at the right time and that front line physicians have the necessary resources to help them with their recommended referrals for medical imaging in Canada.

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