‘Diagnostic Imaging Pathways’ is an online suite of evidence-based and consensus -based imaging guidelines and an educational tool, developed in Western Australia with the aim of optimizing appropriate choices of diagnostic imaging (DI) in a wide variety of clinical scenarios. DIP is aimed at referrers to DI, imaging technologists, radiologists and medical students.  

The idea for DIP was conceived in Western Australia about 20 years ago in response to the perceived problem of inappropriate imaging. In the published literature and anecdotally it is apparent that up to about 30% of imaging requests are inappropriate. Sometimes imaging is performed when it is not indicated (a common example being for acute uncomplicated low back pain of short duration), or the wrong imaging modality or protocol is used for the presenting clinical scenario. In addition to this inappropriate and/or misuse of DI, there is an unquantifiable number of patients who should undergo imaging but do not.

The inappropriate use of DI may lead, among other unwanted effects, to risks and costs without patient benefit, delay in diagnosis, and inefficient allocation of limited resources. There is also the burgeoning issue of the finding of incidental lesions, ‘over-diagnosis’ and ‘overtreatment’. “Over-diagnosis” refers to the phenomenon of investigation of incidental lesions which may be of no or little significance or relevance to the patient’s presentation but lead to further downstream imaging which may result in actual patient harm (so-called “cascade syndrome”).

Guidelines for referrers to DI are an essential part of ensuring the appropriate use of imaging, and a useful tool in the process of justification of imaging procedures.

DIP’s aims are to increase the appropriateness of DI by providing generic guidelines and education in multiple clinical scenarios. It has achieved acclaim both nationally in Australia, and internationally.

DIP has the following features:

• Free access
• Guidelines based on clinical scenarios categorized according to organ system
• A flow-chart / algorithmic format, unique to DIP
• The flow charts contain mouse “roll over” succinct pop-up messages and are hyperlinked within DIP to extensive referenced narrative text
• The guidelines are Evidence-based and Consensus-based
• Each guideline has been assessed by a multidisciplinary team, comprising radiologists, clinical specialists and, where relevant, General Practitioners and patient representatives.
• Teaching points (take-home messages in dot form)
• References are graded by level of evidence. There are hyperlinks to abstracts of article with high levels of evidence
• A ‘layered’ format allowing users to access minimum information required or delve deeper into the supporting evidence
• Image gallery (to be expanded)
• Information on imaging modalities, common procedures, radiation, etc., for health professionals and patients
• Regularly updated and reviewed
• The website hosts an “Ionizing Radiation” training module