Discordance in Clinical Recommendations Regarding the Use of Imaging

Am J Med Qual. 2020 Mar/Apr;35(2):117-124. doi: 10.1177/1062860619851561. Epub 2019 May 21.


As physicians strive to provide evidence-based care, challenges arise if different entities disseminate divergent Appropriate Use Criteria (AUC) or clinical guidelines on the same topic. To characterize these challenges in one field, this study reviews the literature on comparisons of clinical recommendations regarding medical imaging. The PubMed database was searched for the years 2013-2018 for studies describing discordance among clinical recommendations regarding the performance of imaging. Of the 406 articles identified, 15 met the selection criteria: 8 qualitative and 7 quantitative. Reasons for discordance varied, with lack of evidence often cited. Quantitative studies often found that different decisions would be reached depending on the clinical recommendation followed. Nonetheless, quantitative studies also tended not to consider one set of recommendations superior to another. The findings of this review might help clinicians seek guidance more thoughtfully and could inform use of guidelines and AUC for quality improvement and clinical decision support.

Keywords: appropriate use criteria; clinical guidelines; evidence-based medicine; imaging; radiology.

Publication types

  • Review

MeSH terms

  • Clinical Decision-Making
  • Diagnostic Imaging*
  • Evidence-Based Medicine*
  • Practice Guidelines as Topic*