Survey far the establishment of imaging procedure guideline using EBM approach

收集基本信息，采用循证医学程序建立影像学指南。设置了以下两个研究问题，并收集和回顾了相关的文章。1)如何使用影像学检查来寻找肺外转移？2)影像学检查如何用于社区获得性肺炎（CAP）的治疗？1)主要采用ASCO和ATS/ERS发表的指南，并对相关文献进行综述。所讨论的器官有脑、骨、肾上腺和肝。并对成本效益分析进行了讨论。影像学诊断是如何用于寻找胸外转移的，在英文文献中主要分为以下两种方法；A)当临床症状怀疑有转移时应考虑适应症。T和N因素也影响胸外转移的发生率，以及影像学检查的适应证。（ASCO,ATS/ESR）B)无论症状是否存在，均应进行更多的肿瘤转移的影像学检查。（The Canadian Lung Oncology Group）各国医疗保险制度或医疗经济状况存在明显差异，肺癌转移的影像学评价适应症也不同，在考虑成本效益分析时需要注意。虽然需要考虑诊断的准确性及其对生存率的贡献，但指南的制定需要考虑日本医疗保险制度或医疗经济等社会因素的变化。2)为了解决“社区获得性肺炎（CAP）的治疗是否需要CT”的临床问题，采用循证医学（evidence based medicine， EBM）方法进行回顾性文章调查。通过“PubMed（1966-2004）”和“Ichushi Web（1983-2004）”检索描述疑似CAP患者成像程序的引文，然后转移到参考书目软件中。浏览文章摘要，选择主要讨论CAP诊断程序或其意义的文章。通过填写“摘要表格”对每份稿件的详细信息和证据水平进行评估。还分析了以前在世界各地发表的关于CAP管理的指南。从CAP的影像学角度对186篇文章进行分析，发现有34篇文章对CAP的影像学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，没有文章的证据水平超过2b。这些文章表明，尽管CT提供了比胸片更详细的信息，但其临床意义尚不确定。没有高评价的证据证明在CAP患者中使用CT是合理的。从医疗费用和辐射暴露方面，需要对CT在CAP中的应用制定严格的指南。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