Memorial Sloan Kettering has mapped out a structured methodology to define appropriate use criteria (AUC) for advanced imaging exams tailored to our patient population.
Define the Specific Needs of Cancer Patients
We start by looking at a wide range of reasons to use a particular test, known as clinical conditions; patients’ specific diseases; and the related signs and symptoms patients experience. Treatment requirements for oncology patients are very different from those for other patients.
We have created multidisciplinary teams called Imaging Disease Management Teams (IDMTs) that bring together medical experts from across MSK, including radiologists, medical oncologists, and surgeons, to discuss the unique clinical scenarios they observe in our patient population.
The concept of multidisciplinary Disease Management Teams (DMTs) was introduced at MSK more than 20 years ago. DMTs function as the heart of team-based decision-making and innovative research. Specialists from a wide range of disciplines meet regularly to discuss individual patient treatment strategies. The IDMTs are an extension of this well-established model, with a specific focus on advanced imaging.
Review Existing Scientific Evidence
The Evidence-based Cancer Imaging Program (ECIP) has implemented a structured evidentiary review methodology to create, modify, or endorse AUC for the ordering of advanced diagnostic imaging exams. IDMTs are focused on subspecialized clinical domains based on clinical practice needs, evidentiary gaps, and Priority Clinical Areas (PCAs). We will endorse existing AUC where we determine the quality of evidence provided is consistent with our standards of care, clinically relevant, and valid for the cancer patient population. If our experts determine that existing AUC do not adequately meet our requirements, we will then develop or modify AUC that are more appropriately aligned to our patients’ needs.
The MSK Medical Library is integral to the IDMT process. Working in partnership with the Harvard Library of Evidence, existing medical literature is surveyed to identify what best practices may already exist for medical imaging in these or similar scenarios so that our patients benefit from the collective knowledge of other academic institutions and medical societies.
With that information in hand, the IDMTs apply their in-depth knowledge to determine whether these imaging standards are appropriate for oncology patients. This process is iterative and highly collaborative; our teams work with the MSK Medical Library and biostatisticians to analyze the available data. Grading of evidence is performed independently by two research informationists using the Oxford Centre for Evidence-Based Medicine grading system. IDMT members review and discuss the results of the evidentiary review and then finalize the AUC.
Ensure Our Unique Patient Needs are Met
The advances in science and research associated with identifying optimal cancer care are never-ending. As a result, we are always striving to identify the best solutions. We are continually establishing new IDMTs, monitoring the evidence published in medical literature, and learning from our own internal observations. Our Clinical Council for Cancer Imaging (CCCI) serves as our overall steering committee and governing body to ensure this process stays on point. In the same way that we look to leverage the expertise of others where it exists, MSK also openly shares our knowledge to ensure the best care for oncology patients everywhere.
To learn more about the team of experts focused on this process, see Our Team.