Applying 'technology assessment' and 'evidence based medicine' theory to interventional radiology - Part 1: Suggestions for the phased evaluation of new procedures

AIM: To compare and contrast interventional radiology (IR) clinical and res earch practices with the technology assessment and evidence-based medicine (EBM) paradigms and make suggestions for the phased evaluation of new IR pr ocedures. MATERIALS AND METHODS: Course literature of the Association of University R adiologists' 'Basic Technology Assessment for Radiologists' course and the McMaster University Health Information Research Unit's 'How to Teach Eviden ce-Based Medicine 1999' course were used to identify major publications in each discipline. A computer search was performed to seek other relevant lit erature. A model of traditional development of IR procedures was developed. Suggestions for the phased evaluation of IR procedures were derived. RESULTS: As in diagnostic radiology, several levels of progressively strong er IR study design can be described and related to EBM 'levels of evidence' . These range from case reports and case series through case-control and co hort studies to randomized controlled trials (RCTs), The major weakness in the existing IR literature is the predominance of small, uncontrolled, case series. Randomized controlled trials are likely to provide the best possib le evidence of effectiveness. They are expensive and randomization is somet imes unethical or impractical. Case-control and cohort studies have been un der-utilized. Evidence-based medicine indices of benefit and harm have not yet been applied in IR and may have clinical advantages over traditional st atistical methods. A literature search (10 years) using MeSH terms 'radiolo gy, interventional' and 'efficacy' yielded 30 papers. Combining 'radiology, interventional' and 'evidence-based medicine' yielded no papers. Comparati ve searches substituting the term 'diagnostic imaging' for 'radiology, inte rventional' yielded 4883 and 62 papers, respectively. CONCLUSION: Principles of technology assessment and EBM can be applied to t he investigation of new IR procedures. A tool is needed to simplify the app lication of EBM analytic methods. Better education in research methods is n eeded to raise the levels of evidence provided by the bulk of IR research a nd allow new procedures to be introduced into practice appropriately. Malon e, D. E. & MacEneaney, P. M. (2000). Clinical Radiology 55, 929-937. (C) 20 00 The Royal College of Radiologists.