Penn Medicine · Imaging AUC

How does the AUC program develop topics?

All topics are reviewed at least annually and updated as needed.  New topics modeled on the American College of Radiology Appropriateness Criteria must be approved by the Penn Imaging AUC Steering Committee.

The author begins each AUC topic with a narrative discussing relevant medical literature and providing variant tables and evidence summary. The variant tables summarize the recommendations of the committee for the diagnostic procedures or treatments based on the risks and benefits. They also provide population estimates of radiation levels (relative radiation level designations) for diagnostic procedures that use ionizing radiation and the strength of evidence for the recommendation. When the strength of evidence does not appear on the variant table, an evidence summary is provided in the narrative. Finally, relevant medical literature is summarized to provide evidence for the clinical scenarios and the strengths or limitations of the relevant radiology procedures or treatments. The second component is an evidence table (ET). The ET summarizes the information about the citations embedded in the narrative, including the study type, number of patients, study objective, study results, and an assessment of the study’s quality. The ET is scored for quality by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.  Finally, the 3rd component, a literature search summary document, provides the strategy used to identify the peer reviewed literature and summarizes the articles included in and excluded from the narrative.

Process Overview

1. The author does a preliminary search of the relevant medical literature to identify articles to include in the topic. The author may request staff conduct additional searches, may use citations found in the bibliographies of relevant articles, or incorporate a limited number of citations they know of from personal expertise.

2. Imaging AUC staff then conducts a more thorough search of the literature to identify those related to the topic under consideration using keywords provided by the author and other defined search parameters.

3. The author creates (or revises) the variant descriptions to reflect the most likely or relevant presentations of the clinical condition. The author selects (or adds or removes) the relevant procedures/treatments that reflect current technology and medical practice. The author drafts (or revises) the summary of literature review, which interprets and summarizes the evidence, and embeds the relevant citations identified from the literature search.

4. Imaging AUC staff completes the evidence table (ET) for all of the citations embedded in the narrative.

5. Imaging AUC staff sends the narrative and ET to the author for (any) modifications and approval.

6. Author sends the narrative and ET to the working group for review and comments.

7. The author assesses the working group members’ comments and may modify the document based on these comments.

8. The working group members rate the appropriateness of the procedures/treatments on the variant tables using a modified Delphi method based on the RAND/UCLA Appropriateness Method.

9. After the 1st rating round is completed, the Imaging AUC staff summarizes the results for each procedure/treatment that was rated including median score and distribution, and comments by working group members. A disagreement/no disagreement calculation based on the IPRAS calculation described in the RAND/UCLA Appropriateness Method will then be applied.

10. A working group meeting/conference call will be held to review the results of the 1st rating round.

11. Notes from the meeting/call are provided to members.

12. The author edits the narrative based on the results of the first rating round and meeting/conference call.

13. A 2nd and final rating round is conducted for those procedures/treatments with disagreement and any others for which a re-rating was requested during subsequent meeting/conference call.

14. After the 2nd and final rating round, Imaging AUC staff summarizes the results and sends them to the author and working group chair for approval. Some modifications to the document may be incorporated as well as additional citations.

15. Imaging AUC staff sends the revised narrative and ET to the Imaging AUC Program Steering Committee for final review.

16. The author incorporates final revisions (if any) from the steering committee.

17. Imaging AUC staff sends the narrative to a professional editor.

18. Imaging AUC staff sends the final narrative and ET to the working group and Imaging AUC Program Steering Committee members for their records.

19. All approved AUCs are then posted here.