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The overarching goal of promoting evidence-based practice is at the core of all research within the Center for Evidence-Based Imaging. 

Clinical decision support for imaging.

Browse below to learn more about some of our previous research in the CDS space.

1. Fitch K, Bernstein S, Aguilar M, Burnand B, LaCalle J. The RAND/UCLA Appropriateness Method User’s Manual, Santa Monica, CA: RAND Corporation, 2001.
2.Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. Aug 05 1995;311(7001):376-80. doi:10.1136/bmj.311.7001.376
3.Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD, Physicians ACoC. The solitary pulmonary nodule. Chest. Jan 2003;123(1 Suppl):89S-96S. doi:10.1378/chest.123.1_suppl.89s
4.MacMahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. Jul 2017;284(1):228-243. doi:10.1148/radiol.2017161659
5.Barrett T, Turkbey B, Choyke PL. PI-RADS version 2: what you need to know. Clin Radiol. Nov 2015;70(11):1165-76. doi:10.1016/j.crad.2015.06.093
6.Hashmi AA, Iftikhar SN, Munawar S, et al. International Society of Urological Pathology (ISUP)-Grade Grouping in Prostatic Adenocarcinoma and its Prognostic Implications. Cancer Invest. Mar 2022;40(3):211-218. doi:10.1080/07357907.2021.2019263
7.Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017 Sep – Oct 2017;17(5):738-753. doi:10.1016/j.pan.2017.07.007
8.Megibow AJ, Baker ME, Morgan DE, et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. Jul 2017;14(7):911-923. doi:10.1016/j.jacr.2017.03.010
9.Hecht EM, Khatri G, Morgan D, et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: recommendations for Standardized Imaging and Reporting from the Society of Abdominal Radiology IPMN disease focused panel. Abdom Radiol (NY). 04 2021;46(4):1586-1606. doi:10.1007/s00261-020-02853-4
10.Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. Apr 2015;148(4):824-48.e22. doi:10.1053/j.gastro.2015.01.014
11.Mayo-Smith WW, Song JH, Boland GL, et al. Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. Aug 2017;14(8):1038-1044. doi:10.1016/j.jacr.2017.05.001
12.Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. Aug 16;175(2):G1-G34. doi:10.1530/EJE-16-0467
13.Kapoor A, Morris T, Rebello R. Guidelines for the management of the incidentally discovered adrenal mass. Can Urol Assoc J. Aug 2011;5(4):241-7. doi:10.5489/cuaj.11135
14.Zeiger MA, Thompson GB, Duh QY, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009 Jul-Aug 2009;15(5):450-3. doi:10.4158/EP.15.5.450

Consensus Development

Four expert multispecialty panels will convene to build consensus based on available evidence (see right) on recommendations for diagnosis and management of findings that may lead to a diagnosis of lung, prostate, pancreatic or adrenal cancer. We will utilize a Modified Delphi process1 or nominal group technique (Expert Panel)2 to generate agreement on recommendations that will be implemented as CDS across MGB. The recommendations will be discussed as units of evidence. Guidelines, for instance, may contain more than 1 (often >10) units of evidence, or specific recommendations.

Evidence to be represented as CDS and evaluated by units of evidence

Lung findings (e.g., nodules)

American College of Chest Physician guidelines,3 Fleischner Society guidelines4

Prostate lesions

Prostate Imaging Reporting & Data System (PI-RADS),5 International Society of Urological Pathology Gleason grading6

Pancreas lesions

International consensus Fukuoka guidelines,7 American College of Radiology white paper,8 Society of Abdominal Radiology panel,9 American Gastroenterological Association technical review10

Adrenal findings

American College of Radiology white paper,11 European Society of Endocrinology,12 Canadian Urological Association,13 American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons14

As part of the consensus process, surveys will be administered to panel members. Evidence will be assessed for consensus.

CDS development and implementation: We will represent the units of evidence derived from consensus as CDS.


The Harvard Medical School Library of Evidence (HMS-LOE)

A longtime collaborator of CEBI, the Harvard Medical Library of Evidence was led with the gial of creating a provider-led, sustainable, public repository of medical evidence. Harvard’s Public Repository of Evidence for Clinical Decision Support is free to the public.

The effective use of a clinical decision support system means patients get the right tests, the right medications, and the right treatment, particularly for chronic conditions.


  1. PLAW-113publ93 Section 218(b)
    This is the section of PAMA entitled “Promoting Evidence Based Care” that requires the use of Appropriate Use Criteria.
  2. Recommendations to CMS for PAMA Feb 13, 2015
    This letter presents the PAMA implementation recommendations from institutional and radiology leaders from Brigham and Women’s Hospital, University of California Health System (UCLA and UCSF), New York-Presbyterian Hospital-Weill Cornell Medical Center and Geisinger Health System.
  3. Implementing PAMA Summary of Approach
    This is a slide set summarizing the recommendations of the BWH, UC, NYPH-WCMC, Geisinger letter.
  4. MID Report to Congress
    This is CMS’ report to Congress describing the results of the Medicare Imaging Demonstration, which was the largest ever experiment testing the delivery imaging clinical decision support based on professional society guidelines.
  5. Advisory Board document
    Why you should think twice about the Medicare Imaging Demonstration. This document describes some of the lessons of the MID, concluding that the MID shows “how not to implement CDS.”
  6. CEBI Book of Evidence Dec 5, 2014
    This document provides a primer on imaging CDS and summarizes peer reviewed research done at BWH showing the impact of targeted interventions using high quality evidence. a. Consider posting links to the list of publications as a separate document so people can link to the journals. This list could then be updated regularly, and could be expanded to include articles that are not generated by CEBI.
  7. Sistrom et al – 2009 (Radiology), and Ip et al – 2013 (American Journal of Medicine)
    These articles use data gathered contemporaneously in response to the same Partners Healthcare System pay-for-performance initiative with local Massachusetts payers. The Sistrom article attributes changes in imaging utilization to the use of imaging CDS, while the IP article attributes changes to the multi-faceted radiology medical management program, physician and institutional incentives and other factors.
  8. HMS eLibrary of Evidence Website
  9. Final AUC Rule
    This is the Final AUC Rule published by CMS in November 2015, describing the requirements to become a Qualified Provider Led Entity and the process a QPLE must follow to create or modify Appropriate Use Criteria
  10. Discussion of Final AUC RuleThis is the contemporaneous discussion of the Final AUC Rule published by CMS in November 2015, discussing the comments received on the proposed AUC rule, the changes made by CMS and providing guidance for the interpretation of the Final AUC Rule
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