More than 10 years ago, driven by the Consilium Radiolocicum, The College of Medical imaging elaborated medical imaging guidelines.
The guidelines were written in close collaboration with the clinical sections of the Royal Belgian Radiology Society, and posted on the INAMI/RIZIV website in 2004.(NL/FR). Later on, the medical imaging college and the consilium radiologicum tried to actualize the guidelines and optimize their diffusion.
An agreement with the societe française de radiologie allowed us to use their “Guide du Bon Usage des examens d’imagerie médicale” . Then, the Consilium adapted those guidelines to the Belgian situation. Thanks to BELMIP (Belgian Medical Imaging Platform), the guidelines were published online.
A specific study of the medical imaging college in 2012 dealt with the application of those guidelines in the hospital practice. The study concluded that in order to cope with those guidelines, Magnetic resonance imaging (MRI) must be widely available and deprogrammed. The liberalisation will effectively start in 2015. To this end 36 additional MRI sites are required, starting with the hospitals, currently without MRI
The guidelines must help the prescribers to choose the most appropriate medical imaging test to assist in answering the clinical question. Every radiologist is supposed to be knowledgeable about these guidelines.
In February 2014, a new law was accepetd (active starting April 2014) that gives the right to the radiologist to substitute the requested medical imaging test, with the most appropriate test , based on his experience, expertise, existing directives and the patient context.
The “INAMI-RIZIV” underlines that to obtain a “justified” medical imaging test, the prescription must be judged by the radiologist before its execution. In order to appreciate the prescription, the radiologist must take into account pertinent medical imaging tests already performed, provided that the radiologist knows which medical imaging tests were already performed.
The responsibility for doing a medical imaging test is shared: the prescriber must obtain all necessary information and ask a clear clinical question. The radiologist performs the most relevant medical imaging test and justifies this in his imaging report. As a consequence, expertise is shared with prescribers. Should another test be done than the one originally proposed, it is the duty of the radiologist to inform the referring physician and the patient why.
The “INAMI-RIZIV” also hopes that the guidelines published in Dutch and in French on the “SPF-santé publique website” will be applied more effectively in the future.
The BSR also expects to be able to restrict radiation exposure, particularly amongst vulnerable groups such as children.
The guidelines will be actualised continuously from 2014 on, thanks to the publication of “focus in medical imaging”, a journal (under a similar format as Folia Pharmacotherapeutica)that will be distributed to more than 40000 physicians, in order to inform them about novelties in medical imaging. The publication will also include special editions dedicated to well-defined types of pathologies.