Survey far the establishment of imaging procedure guideline using EBM approach

收集基本信息，采用循证医学方法制定影像学检查指南。本研究共设两个研究问题，并收集相关文献进行综述：1）影像学检查方法如何用于肺外转移瘤的筛查？2)影像学检查如何用于社区获得性肺炎（CAP）的管理？1)主要参考ASCO和ATS/ERS的指南，并复习相关文献。讨论的器官有脑、骨、肾上腺和肝。还讨论了成本效益分析。在英文文献中，影像学诊断如何用于寻找胸外转移瘤主要分为以下两种方式：A）当临床症状怀疑有转移时，应考虑适应症。T、N因子也影响胸外转移的发生率及影像学检查的指征。(ASCO、ATS/ESR）B）对异位妊娠的影像学检查 ...更多信息 无论有无症状，都应进行CIC转移。(The加拿大肺癌组织）在考虑成本-效果分析时应谨慎，因为各国的医疗保险制度或医疗经济状况存在显著差异，并且肺癌转移的影像学评估适应症也不同。虽然诊断的准确性及其对生存率的贡献应予以考虑，但需要考虑包括日本医疗保险制度或医疗经济在内的可变社会因素来制定指南。2）为了解决临床问题“社区获得性肺炎（CAP）的管理是否需要CT？“，采用循证医学方法进行回顾性文献调查。通过PubMed（1966-2004）和Ichushi Web（1983-2004）检索描述疑似CAP患者影像学检查的引文，然后将其转移到参考书目软件中。查阅文献摘要，选择主要讨论CAP诊断程序或其意义的文献。通过填写“摘要表”评价每篇稿件的详细信息和证据等级。同时分析了世界上已发表的关于CAP管理的指南。从CAP的影像学角度对186篇文献进行了分析，结果发现，共有34篇文献对CAP的影像学诊断描述可接受，尚未对CAP的CT适应症进行系统研究，也没有文献的证据等级评定为2b以上。这些文献表明，尽管CT提供了比胸部X线摄影更详细的信息，但其临床意义尚不确定。CT在CAP患者中的应用尚缺乏高度评价的证据，需要从医疗费用和放射暴露等方面对CT在CAP中的应用进行严格的指导。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