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Quality Practice
Volume 12 No 3 I June 2016 27
The Diagnostic Imaging Pathways (DIP)
app ) is a decision
support tool to guide clinicians in
the appropriate and evidence based
usage of medical imaging. For a range
of common and important clinical
scenarios, the app provides both
an overview of the recommended
imaging pathway, as well as a step-by-
step interactive guide to choosing the
most appropriate imaging modality
or management. The app is intuitive
to use, simple in its appearance, and
would be able to readily be used in the
clinical environment.
The app would be ideal to use in
the primary care and emergency
department settings, and is designed
in a way that facilitates adaptation
for the individual patient situation. It
would also be ideal for radiologists
to refer to in determining which
investigation to recommend in a
particular clinical scenario or which
follow-up investigation to recommend.
The app would have value for trainees
in both radiology and other specialties
and can facilitate their learning
about the role of medical imaging in
diagnostic work-up of patients, and
highlights some of the ways in which
findings of radiology studies impacts
on subsequent management. When
used appropriately, the app’s guidelines
and decision support tool can help to
minimise unnecessary and inappropriate
imaging. For example, the ‘low back
pain’ pathway emphasises the need to
assess for the presence of ‘red flags’
prior to deciding on whether imaging
is indicated, and then encourages the
appropriate use of MRI rather than
the generally inappropriate, but still
commonly performed, lumbar spine CT.
Attempting to have a clinical decision
support tool which is applicable in a
wide variety of different healthcare
settings is a challenge. Availability
of resources, funding arrangements,
Medicare guidelines, patient and
clinician preference, and local practice
could make implementation in some
settings difficult. Also, some of the
guidelines seem a little out of date or
try to over-simplify areas that are more
complex. For example, the prostate
cancer staging pathway recommends
TRUS-guided prostate biopsy as the
initial imaging test, and recommends
endorectal MRI if prostate cancer is
probably locally advanced. In most
instances, prostate MRI (without an
endorectal coil) is considered to have a
more expanded role in the investigation,
staging and management of suspected
prostate cancer. Although the app is
simple to use and the pathways easy
to follow in most instances, this may
come at the cost of detail or accuracy,
particularly in more sub-specialised
clinical scenarios. Staying up to date
may be difficult in some instances, and
although I recently downloaded the app,
it seems that some of the guidelines
are several years old and do not reflect
the updated guidelines on the main
website.
In summary, the DIP app could play an
important role in clinical practice. Its
accessibility and easy-to-use format will
encourage its adoption into day-to-day
practice. It is a valuable tool for referrers
to have on hand and could facilitate
discussion between radiologists and
referrers to ensure appropriate and
evidence based imaging. It does have its
limitations which may pose challenges
to its more widespread implementation,
but it is an excellent resource, which
will continue to be further refined and
expanded.
Dr Mitchell Raeside
Diagnostic Imaging
Pathways App Review