Reinforcing protocols EBM was regarded as useful for developing evidence-based protocols and guidelines. This was particularly relevant in directing decisional pathways for inexperienced referrers. Protocols were seen to protect radiologist’s decisions as “you get in trouble for missing something, you don’t get in trouble for over-investigating buy inhibitor something.” Optimising outcomes Ensuring patient safety Some were convinced that EBM had demonstrable impact on ensuring safe patient care. There was reference to studies assessing safe dosages of

gadolinium in patients with renal impairment, reducing the incidence of nephrogenic systemic fibrosis. Participants remarked on the “increasing number of normal examinations which meant they were scanning more people, and that they were not selecting them correctly.” They felt a burden of responsibility—“we definitely do cause the public harm, we just don’t know how many [malignancies] is due to us yet” and believed that applying EBM in diagnostic radiology

could reduce overexposing patients to unnecessary ionising radiation and risk of malignancies. Maximising efficiency Participants felt certain that the financial costs to public hospitals incurred by performing excessive radiological tests and procedures could be minimised by applying EBM. Some suggested that evidence-based referral guidelines may reduce the number of unnecessary diagnostic tests ordered by referrers and improve economic and service efficiency. Availability of access Requiring immediacy Simple and direct access to information was important. Most used Google or PubMed as their primary search engine. Some relied on email updates or review articles to keep up-to-date. Evidence summaries offered information that “had already been critically appraised, filtered out so most of the rubbish wasn’t there.” Being

unable to access journals due to institutional restrictions “added an extra element of difficulty” however, some participants who had received EBM training felt confident about searching for high-quality scientific research using MEDLINE and the Cochrane Library. Anacetrapib Inadequacy of evidence Radiological technologies often “progressed before the evidence could come out.” Some observed that diagnostic procedures (eg, CT angiograms for vertebral artery dissection) were used without supporting evidence. In radiological research, some felt that relevant outcomes could not be feasibly measured, for example if it necessitated surgical or autopsy proof. Research in diagnostic imaging was unavailable particularly for rare clinical cases. They felt that, “there’s no culture of [radiology] research except in little pockets and enclaves in different institutions few and far between.