Medina LS, Sanelli PC, Jarvik JG, eds. Evidence-Based Neuroimaging Diagnosis and Treatment: Improving the Quality of Neuroimaging in Patient Care. Springer; 2013; $239.
Evidence-Based Neuroimaging Diagnosis and Treatment: Improving the Quality of Neuroimaging in Patient Care, edited by Drs. Medina, Sanelli, and Jarvik, is an important new publication that deals with issues we do not consider often enough in our daily work: that is, is there evidence that the imaging we are performing is meaningful and has a positive effect on patient care and outcomes?
In a logical and easy-to-read manner, topics are presented succinctly with important accompanying tables/charts/images without burdening the reader with overwhelming statistics and data. I particularly like the fact that each chapter begins with key points (a reminder of the effective communication dictum of "tell 'em what you are going to tell 'em, then tell 'em"), followed by the information each author wishes to convey. Admixed are what a few authors have called Take-Home Tables (I have already copied them, but I won't take them home), which boils down the essentials of some easily forgotten but important metrics and statistics.
There are 100 authors/co-authors; the editors have called on experts in many areas of neuroradiology and associated specialties. There are 5 sections to the book: (1) An Overview of Evidence-Based Imaging (2 chapters); (2) Special Topics in Evidence-Based Imaging (6 chapters); (3) Brain (18 chapters); (4) Spine (6 chapters); (5) Head and Neck (7 chapters). For those who feel a bit shaky in medical statistics and related topics, the first 2 chapters contain excellent material in a digestible form. The second part of the book contains topics/issues which arise frequently but are not to be easily found in our journals—for example, what to do about incidental findings, the value of decision support systems, radiation exposure in imaging, contrast risks, medicolegal issues in neuroimaging, and regulatory concerns. While these topics would seem to require many pages, the authors cover the material nicely in less than 100 pages.
The remainder of the book takes us to specific diagnoses, drawing us to look at what evidence there is for what we do in these diseases. So, as just one example, let's look at seizure disorders. The chapter starts with an outline of what is contained in the 20 following pages, then the key points (11) and background information such as pathophysiology, epidemiology, and societal costs. What follows is the meat of the chapter; that is, an enumeration of the main issues involved in seizures, each of which has a separate section in which a brief (1-3 sentences) summary is given, followed by paragraphs of supporting evidence under the heading. We read here of evidence related to what types of seizures should be imaged, what specific studies are utilized in temporal lobe epilepsy (and which are more sensitive/specific), whether high-field (3T) imaging improves detection of causative lesions, and what functional imaging is most beneficial (PET, fMRI, DTI). Each chapter in this book goes through the same format; some have images, some don't. But, of course, the inclusion of imaging studies per se is not the object of the book.
The reader of this review can imagine the plethora of diagnoses and conditions. Looking over the topics, one could always think of one or two more subjects, but the common issues are deftly covered. The book also goes into treatment (as the book title indicates), so we encounter an analysis, for example, of treatment options for aneurysms (coiling vs. clipping), where 2 of the 3 authors are neurosurgeons, or the embolic material to be used in AVM treatment, or the value of various procedures related to spine intervention. Of course, each of these topics cover a number of other issues related to aneurysms, AVMs, or spine injections.
The authors have blazed a new trail in radiology publications and are to be congratulated for that. The book should be read by every neuroradiologist. It puts into perspective and educates the reader on those problems we will certainly encounter in justifying what we do as scrutiny by governmental agencies increases.
Original Article: http://www.ajnrblog.org/2013/06/21/evidence-based-neuroimaging-diagnosis-and-treatment-improving-the-quality-of-neuroimaging-in-patient-care/
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