This week we change direction from the official Choosing Wisely lists to highlight an excellent resource in guiding Imaging referrals.

Your patient Ms. AB, age 38, comes in for followup, having been seen in the local ER for acute RLQ pain, with an ultrasound report showing a simple 3 cm cyst on the right ovary. She is feeling better, but does report her sister, age 54 has just been diagnosed with an “ovarian tumour.”

We often see these type of reports and often a radiologist recommendation for followup.

So what do we really need to do?

The Canadian Association of Radiologists (CAR) is clear: Simple cysts < 5 cm in premenopausal women do not need followup. There is no proven value in screening for ovarian cancer even in increased risk patients (see Quick Links for more information). 

The full CAR referral guideline webpage is a head to toe, system by system list of imaging tests, comparing the modalities of CT, MRI, Ultrasound and X-Ray, with recommendation grade and radiation dose. It can be useful at the point of care to show patients what the best practices are for imaging (see Quick Links).

It is sometimes difficult to NOT follow a radiologist's advice when it is written in the report. The resources listed above might prove useful in discussion with radiologists about reports that are at odds with the guidelines.