Survey far the establishment of imaging procedure guideline using EBM approach

收集基本资料，采用循证医学方法制定影像指导原则。提出以下两个研究问题，并对相关文献进行综述：1)影像检查程序如何用于寻找肺外转移；2)影像检查程序如何用于社区获得性肺炎(CAP)的治疗？1)主要使用ASCO和ATS/ERS发表的指南，并对相关文章进行综述。讨论的器官有脑、骨、肾上腺和肝脏。并对成本效益分析进行了讨论。英文文献对胸外转移的影像诊断主要分为以下两种方式：1)临床症状怀疑有转移时应考虑适应证。T和N因素也影响胸外转移的发生率，以及影像检查的指征。2)胸腔外…的影像搜索无论症状是否存在，都应进行更多的颈静脉转移手术。(加拿大肺肿瘤学小组)在考虑成本效益分析时应谨慎，各国的医疗保险制度或医疗经济状况存在明显差异，肺癌转移的影像评估指征也不同。2)针对“社区获得性肺炎(CAP)的治疗是否需要CT？”这一临床问题，采用循证医学(EBM)方法进行了回顾性文献调查。应用计算机检索PubMed(1966-2004)和Ichushi Web(1983-2004)对疑似CAP患者影像检查过程的引文，并传输至书目软件。浏览文献摘要，选择主要讨论CAP的诊断程序或其意义的文章。通过填写《摘要表》对每份稿件的详细信息和证据水平进行评价。还分析了以前在世界上发表的关于CAP管理的指南。从CAP的影像角度对186篇文献进行了分析，结果发现34篇文献对CAP的影像诊断有可接受的描述。目前还没有关于CAP的CT指征的系统研究，也没有文章被评为2b以上的证据水平。这些文章表明，虽然CT提供了比胸片更详细的信息，但其临床意义尚不确定。找不到对CAP患者使用CT的高度评价的证据。CT在CAP中的应用需要严格的指导，从医疗费用和辐射暴露两方面考虑。较少

The basic information was collected to establish the imaging guideline using EBM procedure. The following two research questions were set and the related articles were collected and reviewed.1)How is the imaging procedures used for searching extrapulmonary metastasis?2)How is the imaging procedure used for the management of community acquired pneumonia(CAP)?1)The guidelines published from ASCO and ATS/ERS were mainly used and related articles were reviewed. The organs which were discussed were brain, bone, adrenal and liver. The cost-benefit analysis was also discussed. How is the imaging diagnosis used in searching for extrathoracic metastases are mainly divided into the following two ways in English literatures ;A)The indication should be considered when the clinical symptoms are suspicious of having metastasis. T and N factor also influences the incidence of extrathoracic metastases, as well as, the indication of imaging examination. (ASCO,ATS/ESR)B)The imaging search for extrathora … More cic metastases should be performed regardless whether the symptoms are existed or not. (The Canadian Lung Oncology Group) It should be careful when considering the cost-effective analysis that state of medical insurance system or medical economy is markedly variable among the countries and the indication of the imaging evaluation for the metastasis in lung cancer is also different. Although the diagnostic accuracy and its contribution to the survival rate should be considered, it is needed to establish the guideline with considering the variable social factors including medical insurance system or medical economy of Japan.2)To address the clinical question "Is CT needed for the management of community acquired pneumonia(CAP)?", a retrospective article survey was conducted with evidence based medicine (EBM) approach. The citations which described the imaging procedure for the patients suspected having CAP were retrieved by "PubMed(1966-2004)" and "Ichushi Web(1983-2004) and then transferred to bibliography software. The abstracts of articles were browsed and the articles in which the diagnostic procedures or its implications for CAP were mainly discussed were selected. The detailed information and evidence level of each manuscript was evaluated with filling "Abstract form". Previously published guidelines through the world regarding the management for CAP were also analyzed. A total of 186 articles were analyzed from the perspective of the imaging for CAP and, as a result, a total of 34 articles in which acceptable descriptions regarding the imaging diagnosis for the CAP were found. There has been no systematic study conducted concerning the CT indication for the CAP and no articles were rated above 2b in the evidence level. These articles have revealed that although CT provides more detailed information than chest radiography, its clinical significance is uncertain. The highly rated evidence justifying the use of CT for the patient with CAP could not be found. Strict guideline for the use of CT in CAP is needed from the aspects of medical cost and radiation exposure. Less