Sage Journals: Discover world-class research

Abstract

The Canadian Association of Radiologists (CAR) Cancer Expert Panel is made up of physicians from the disciplines of radiology, medical oncology, surgical oncology, radiation oncology, family medicine/general practitioner oncology, a patient advisor, and an epidemiologist/guideline methodologist. The Expert Panel developed a list of 29 clinical/diagnostic scenarios, of which 16 pointed to other CAR guidelines. A rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of the remaining 13 scenarios. Recommendations from 21 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop the recommendation for these scenarios. During recommendation formulation, one additional scenario was mapped to an existing CAR guideline scenario, leaving 12 scenarios with new recommendations. The guideline focuses on cancer diagnosis and does not cover cancer staging, follow-up, and surveillance. This guideline presents the methods of development and the referral recommendations for suspected pancreatic cancer, suspected liver cancer, incidental liver mass, incidental colon mass or suspected colon cancer, suspected anal cancer, suspected penile cancer, suspected cervical cancer, suspected endometrial/uterine cancer, suspected vulvar cancer, suspected vaginal cancer, suspected haematologic malignancies, and suspected skin cancer. The guideline also points to other CAR guidelines for suspected neck, thyroid, brain, lung, intracardiac/pericardial, esophageal/gastric, renal, adrenal, bladder, testicular, prostate and ovarian cancers, suspected soft tissue mass or tumour, suspected bone tumour, suspected bone tumour --myeloma, suspected spine tumours, and incidental lung cancer.

Résumé

Le groupe d’experts en imagerie du cancer de l’Association canadienne des radiologistes (CAR) regroupe des médecins spécialistes des disciplines de la radiologie, l’oncologie médicale, l’oncologie chirurgicale, la radio-oncologie et l’oncologie dans le cadre d’une pratique générale, ainsi qu’une représentante des patients et une épidémiologiste spécialisée en méthodologie de l’élaboration de lignes directrices. Le groupe d’experts a élaboré une liste de 29 scénarios cliniques/diagnostiques, y compris 16 scénarios qui réfèrent à d’autres lignes directrices de la CAR. Le groupe a entrepris une revue rapide des articles publiés en vue de repérer les lignes directrices relatives aux demandes d’examen élaborées de façon systématique qui fournissent des recommandations pour les 13 autres scénarios. Les recommandations de 21 lignes directrices et critères de contextualisation du cadre GRADE (notation des recommandations, analyses, développements et évaluations) concernant la structure des lignes directrices ont été utilisées pour rédiger les énoncés de recommandations couvrant ces scénarios. Au cours de la rédaction des recommandations, une correspondance a été établie entre un autre des scénarios et des lignes directrices de la CAR; ce sont donc 12 scénarios qui ont fait l’objet de nouvelles recommandations. Les lignes directrices portent sur le diagnostic du cancer, et ne couvrent pas la stadification, le suivi, ni la surveillance de celui-ci. Ces lignes directrices présentent les étapes à suivre et les recommandations d’orientation dans les cas de cancer du pancréas présumé, de cancer du foie présumé, de masse hépatique de découverte fortuite, de masse du côlon de découverte fortuite ou de cancer du côlon présumé, de cancer de l’anus présumé, de cancer pénien présumé, de cancer du col de l’utérus présumé, de cancer de l’endomètre/de l’utérus présumé, de cancer de la vulve présumé, de cancer du vagin présumé, de malignités hématologiques présumées et de cancer de la peau présumé. Elles réfèrent également à d’autres lignes directrices de la CAR en cas de cancer présumé du cou, de la thyroïde, du cerveau, du poumon, du péricarde/de la région cardiaque, de l’œsophage/de l’estomac, du rein, de la glande surrénale, de la vessie, du testicule, de la prostate ou des ovaires, de masse ou tumeur présumée des tissus mous, de tumeur osseuse ou myélome présumé, de tumeur de la colonne vertébrale présumée et de cancer du poumon de découverte fortuite.

Keywords

cancer diagnostic imaging referrals guideline recommendations

Introduction

Beginning in March 2024, an Expert Panel (EP) made up of physicians from the disciplines of radiology, medical oncology, surgical oncology, radiation oncology, family medicine/general practitioner oncology, a patient advisor, and an epidemiologist/guideline methodologist met to develop a new set of recommendations specific to referral pathways for suspected and incidental cancers. Through discussion (via a virtual meeting) followed by offline communication, the EP developed a list of 29 clinical/diagnostic scenarios to be covered by this guideline. These recommendations are intended primarily for referring clinicians (eg, family physicians, specialty physicians, nurse practitioners); however, they may also be used by radiologists, individuals/patients, and patient representatives.

Our methods describing the guideline development process, including the rapid scoping review to identify the evidence base, has been published in CMAJ Open¹ and an editorial to this series of guideline publications is available in CARJ.² The application of well-established scoping review and rapid review guidance (JBI,³ Cochrane Handbook,⁴ Cochrane Rapid Review Methods Group⁵) and guideline methodology (ie, Grading of Recommendations Assessment, Development, and Evaluation or GRADE^6,7) were used to identify the evidence-base and to guide the Expert Panel in determining the strength and direction of the recommendations for each clinical scenario (Table 1). The quality of conduct and reporting of the included guidelines identified in the scoping review were evaluated with the AGREE-II checklist,⁸ using a modified scoring system. In instances where guidelines were lacking, expert consensus was used to develop the recommendation. Contextualization to the Canadian health care system was considered for each recommendation, with discussion around the factors found in the Evidence to Decision framework in GRADE for guidelines (eg, balance of desirable and undesirable outcomes, values and preferences, resources implications).⁷

Table 1.

Recommendation Text, Symbol, and Interpretation.

Recommendation	AGAINST	FOR
STRONG	Strong, against “we recommend against” (↓↓) ▪ All or almost all informed people would not recommend/choose the course of action and only a small proportion would.	Strong, for “we recommend” (↑↑) ▪ All or almost all informed people would recommend/choose the course of action and only a small proportion would not. ▪ Request discussion if the intervention is not offered.
CONDITIONAL	Conditional, against “we suggest against” (↓) ▪ Most informed people would not recommend/choose the course of action, but a substantial number would. ▪ This may be conditional upon patient values and preferences, the resources available or the setting in which the intervention will be implemented.	Conditional, for “we suggest” (↑) ▪ Most informed people would recommend/choose the course of action, but a substantial number would not. ▪ This may be conditional upon patient values and preferences, the resources available or the setting in which the intervention will be implemented.

Note. Down arrows are red and Up arrows are green when available in colour. Created using the guidance provided in Andrews et al.⁶

A systematic search for guidelines (with an a priori defined inclusion criteria) was run in Medline and Embase on May 25, 2024. The search was limited to publications from 2019 onward (Supplemental Appendix 1). Supplemental searching included the following national radiology and/or guideline groups: the American College of Radiology and the National Institute for Health and Care Excellence. Recommendations for each clinical scenario were formulated over one virtual meeting on October 19th, 2024. External review and feedback were obtained from radiologists, an emergency physician, a family physician, a spine surgeon, and a nurse practitioner. The full guideline can be found on the CAR website (www.car.ca).

Results

Systematic Scoping Review

A total of 6217 records were identified through the electronic database and 2 additional records were added from the supplemental search. Twenty-one guidelines were included (Figure 1). Potentially relevant guidelines published in languages other than English can be found in Supplemental Appendix 2. A list of excluded records with justifications for exclusion is available upon request. Most guidelines were rated as moderate or high quality, using the modified AGREE-II checklist⁸ (Supplemental Appendix 3). The number of guidelines included per clinical/diagnostic scenario ranged from 0 to 7, with a median of 2 guidelines per clinical scenario.

Figure 1.

PRISMA flow diagram.

Recommendations

Additional details of the included guidelines, including which imaging modalities (eg, computed tomography [CT], magnetic resonance imaging [MRI], radiograph [XR], ultrasound [US]) that were discussed can be found in Supplemental Appendix 4.

A guideline is intended to guide and not be an absolute rule. Medical care is complex and should be based on evidence, a clinician’s expert judgment, the patient’s circumstances, values, preferences, and resource availability. Not all imaging modalities are available in all clinical environments, particularly in rural or remote areas of Canada. Decisions about patient transfer, use of alternative imaging or serial clinical examination and observation can be complex and difficult. Therefore, the expected benefits of recommended imaging, risks of travel, patient preference, and other factors must be considered. The guideline recommendations are designed to assist the choice of imaging modality in situations where it is deemed clinically necessary to obtain imaging.

Unless the panel agreed a specific protocol is required to optimize patient care/diagnosis, the recommendations do not specify when contrast should or should not be used, as this decision may vary based on clinical presentation, regional practice preferences, preference of the referring clinician, radiologist, and/or the patient, and resource availability.

We reviewed relevant recommendations related to the 13 clinical/diagnostic scenarios previously published by radiology and specialty societies, including: the Canadian Association of Radiologists,⁹ the American College of Radiology,¹⁰ American Association for the Study of Liver Diseases,¹¹ the American Society of Clinical Oncology,¹² the Argentinian clinical practice guideline,¹³ the British Gynaecological Cancer Society,¹⁴ the British Society for Haematology,¹⁵ the European Association of Urology-American Society of Clinical Oncology,¹⁶ the European Society of Gynaecological Oncology, the International Society of Ultrasound in Obstetrics and Gynecology, the International Ovarian Tumour Analysis group and the European Society for Gynaecological Endoscopy,¹⁷ the European Society of Gynaecological Oncology jointly with the European Society for Radiotherapy & Oncology and the European Society of Pediatric Oncology,¹⁸ the German Clinical Practice guideline,¹⁹ the German Society for Digestive and Metabolic Disorders,²⁰ the German Society for Gynecology and Obstetrics, the Gynecology Oncology Working Group of the German Cancer Society and the German Cancer Aid,²¹ the Italian Association of Medical Oncology,²² the Italian Society for Ultrasound in Obstetrics and Gynecology,²³ the Japan Pancreas Society,²⁴ the Joint French clinical practice guideline,²⁵ the Korean Liver Cancer Association,²⁶ the Korean National Cancer Center,²⁷ the Liver Cancer Study Group of Japan,²⁸ and the Philippine guideline.²⁹

Seventeen scenarios (see note below) in this guideline refer to the CAR Head and Neck guideline,³⁰ the CAR Central Nervous System guideline (accepted in CARJ December 2024), the CAR Thoracic guideline,³¹ the CAR Cardiovascular guideline,³² the CAR Musculoskeletal guideline,³³ the CAR Spine guideline,³⁴ the CAR Gastrointestinal guideline,³⁵ the CAR Genitourinary guideline,³⁶ and the CAR Obstetrics and Gynecology guideline.³⁷

Note: During the formulation of the recommendations for CA23. Suspected ovarian cancer, the Cancer EP noted that the recommendations from the CAR Obstetrics and Gynecology guideline aligned with the recommendations being discussed. Therefore, we direct the reader to that guideline.³⁷

Recommendations are presented in Table 2.

Table 2.

Cancer Recommendations.

Clinical/diagnostic scenario and recommendations
CA01. SUSPECTED NECK CANCER
For suspected neck cancer, see the CAR Head and Neck guideline,³⁰ scenario: ▪ H04. Neck mass of unknown origin, including salivary gland mass
CA02. SUSPECTED THYROID CANCER
For suspected thyroid cancer, see the CAR Head and Neck guideline,³⁰ scenario: ▪ H03A. Thyroid and parathyroid disease: Palpable nodule, including goiter
CA03. SUSPECTED BRAIN CANCER
For suspected brain cancer, see the CAR Central Nervous System guideline (accepted in CARJ Dec 2024), scenarios: ▪ CN04. Headache ▪ CN07. Cranial neuropathy, brain stem symptoms ▪ CN09A. Vestibular cochlear symptoms, Hearing loss ▪ CN09B. Vestibular cochlear symptoms, Vertigo ▪ CN12. Epilepsy and seizure ▪ CN14. Intracranial space-occupying lesions
CA04. SUSPECTED LUNG CANCER
For suspected lung cancer, see the CAR Thoracic guideline,³¹ scenarios: ▪ TH13. Chronic cough ▪ TH16. Haemoptysis ▪ TH20. Suspected mediastinal lesion ▪ TH21. Suspected mediastinal lymphadenopathy ▪ TH22. Elevated diaphragm on chest radiograph
CA05. INCIDENTAL LUNG CANCER
For incidental lung nodule, see the CAR Thoracic guideline,³¹ scenario: ▪ TH19. Incidental lung nodule
CA06. SUSPECTED INTRACARDIAC/PERICARDIAL CANCER
For suspected intracardiac/pericardial cancer, see the CAR Cardiovascular guideline,³² scenario: ▪ CV05B. Intracardiac/pericardial: Masses
CA07. SUSPECTED SOFT TISSUE MASS OR TUMOUR
For suspected soft tissue mass or tumour, see CAR Musculoskeletal system guideline,³³ scenario: ▪ M07. Soft tissue mass or tumour
CA08. SUSPECTED BONE TUMOUR
For suspected soft tissue mass or tumour, see the CAR Musculoskeletal system guideline,³³ scenario: ▪ M04. Bone tumour—Primary For suspected bone tumour metastases, see the CAR Musculoskeletal system guideline,³³ scenario: ▪ M05. Bone tumour—Metastases
CA09. SUSPECTED BONE TUMOUR—MYELOMA
For suspected primary bone tumour—myeloma, see the CAR Musculoskeletal system guideline,³³ scenario: ▪ M6. Bone tumour—Myeloma
CA10. SUSPECTED SPINE TUMOUR
For suspected tumour of the spine, see the CAR Spine guideline,³⁴ see scenario: ▪ SP07. Suspected spinal tumour
CA11. SUSPECTED ESOPHAGEAL/GASTRIC CANCER
For suspected esophageal/gastric cancer, see the 2024 CAR Gastrointestinal guideline,³⁵ scenarios: ▪ GI01. Dysphagia/dyspepsia ▪ GI03A. Epigastric pain ▪ GI04. Chronic abdominal pain ▪ GI07. Chronic GI bleeding
CA12. SUSPECTED PANCREATIC CANCER ^9,22,24,27
1. In adults with suspected pancreatic cancer, we recommend CT as the initial imaging modality (↑↑).
CA13. SUSPECTED LIVER CANCER ^{9-11,13,26,28,29}
1. In adults with suspected hepatocellular carcinoma, we recommend liver protocol MRI or CT as the initial imaging modality (↑↑). MRI is preferred, as there is better contrast resolution. The decision for CT or MRI may be based on availability and expertise.
CA14. INCIDENTAL LIVER MASS ¹⁰
1. In adults with suspicious liver mass on US, non-contrast/single-phase CT or non-contrast MRI, we recommend liver protocol MRI or CT as the next imaging modality (↑↑).
CA15. INCIDENTAL COLON MASS OR SUSPECTED COLON CANCER
1. In adults with incidental colon mass or suspected colon cancer, where colonoscopy is not feasible/possible, where colonoscopy was incomplete, or if the patient declines colonoscopy, we recommend CT colonography as the initial imaging modality (EP consensus).
CA16. SUSPECTED ANAL CANCER ^9,20
Diagnosis of anal cancer should be based on clinical examination/direct visualization.
CA17. SUSPECTED RENAL CANCER
For suspected renal cancer, see the CAR Genitourinary guideline,³⁶ scenario: ▪ GU06. Renal lesion
CA18. SUSPECTED ADRENAL CANCER
For suspected adrenal cancer, see the CAR Genitourinary guideline,³⁶ scenario: ▪ GU10. Adrenal mass
CA19. SUSPECTED BLADDER CANCER
For suspected bladder cancer, see the CAR Genitourinary guideline,³⁶ scenarios: ▪ GU01A. Haematuria: Gross haematuria ▪ GU01B. Haematuria: Microhaematuria ▪ GU11. Incontinence, urgency, and frequency
CA20. SUSPECTED TESTICULAR CANCER
For suspected testicular cancer, see the CAR Genitourinary guideline,³⁶ scenario: ▪ GU09. Scrotal mass or pain
CA21. SUSPECTED PENILE CANCER ¹⁶
Diagnosis of penile cancer should be based on clinical examination/direct visualization.
CA22. SUSPECTED PROSTATE CANCER
For suspected prostate cancer, see the CAR Genitourinary guideline,³⁶ scenario: ▪ GU13. Elevated PSA
CA23. SUSPECTED OVARIAN CANCER ^{9,12,17,23,25}
For suspected ovarian cancer, see the CAR Obstetrics and Gynecology guideline,³⁷ scenario: ▪ OG07. Evaluation of Adnexal mass
CA24. SUSPECTED CERVICAL CANCER ⁹
Diagnosis of cervical cancer should be made clinically (eg, Pap [Papanicolaou] smear, biopsy).
CA25. SUSPECTED ENDOMETRICAL/UTERINE CANCER ^9,14,21,23
1. In adults with suspected endometrial/uterine cancer, we recommend combined transabdominal and transvaginal US with Doppler as the initial imaging modalities (↑↑).
CA26. SUSPECTED VULVAR CANCER ⁹
Diagnosis of vulvar cancer should be based on clinical examination/direct visualization.
CA27. SUSPECTED VAGINAL CANCER ^9,18
Diagnosis of vaginal cancer should be based on clinical examination/direct visualization.
CA28. SUSPECTED HAEMATOLOGIC MALIGNANCIES ^9,15,19
Suspected lymphoma 1. In adults with suspected lymphoma, we recommend CT neck, chest, abdomen, pelvis as the initial imaging modality (↑↑). Suspected myeloma For suspected myeloma, see the CAR Musculoskeletal system guideline,³³ scenario: ▪ M6. Bone tumour—Myeloma Other haematologic malignancies Other haematologic malignancies may be diagnosed based on laboratory investigations.
CA29. SUSPECTED SKIN CANCER
Diagnosis of skin cancer should be based on clinical examination/direct visualization.

Supplemental Material

sj-pdf-1-caj-10.1177_08465371241312087 – Supplemental material for Canadian Association of Radiologists Cancer Diagnostic Imaging Referral Guideline

Supplemental material, sj-pdf-1-caj-10.1177_08465371241312087 for Canadian Association of Radiologists Cancer Diagnostic Imaging Referral Guideline by Candyce Hamel, Barb Avard, Howard Lim, Alex Mathieson, Alan Michaud, Kristoff Nelson, Devang Odedra, Jason Pantarotto, Anna Wilkinson and Karim Samji in Canadian Association of Radiologists Journal

Footnotes

Acknowledgements

We would like to thank: Becky Skidmore for creating the search strategies for the systematic scoping review, and the following individuals on the Diagnostic Imaging Referral Guidelines Working Group and external reviewers for providing feedback on the guideline (listed alphabetically): Alanna Coleman, Nicolas Dea, Cathy MacLean, Ryan Margau (WG co-chair), Paul Pageau (WG co-chair), Charlotte Yong-Hing, Kaitlin Zaki-Metias.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Canadian Medical Association.

ORCID iDs

Candyce Hamel

Alan Michaud

Jason Pantarotto

Anna Wilkinson

Supplemental Material

Supplemental material for this article is available online.

References

Hamel

Margau

Pageau

, et al. Canadian Association of Radiologists diagnostic imaging referral guidelines: a guideline development protocol. CMAJ Open. 2023;11(2):E248-E254. doi:10.9778/cmajo.20220098

Hamel

Venturi

Margau

Pageau

. Canadian Association of Radiologists diagnostic imaging referral guidelines. Can Assoc Radiol J. 2023;74:614-615. doi:10.1177/08465371231169746

Peters

Godfrey

McInerney

Munn

Tricco

Khalil

. Chapter 11: Scoping reviews. In: Aromataris

Munn

, eds. JBI Manual for Evidence Synthesis. The Joanna Briggs Institute; 2020. Accessed February 24, 2021. https://doi.org/10.46658/JBIMES-20-12

Higgins

Thomas

Chandler

, et al. Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (Updated February 2021); 2021. www.training.cochrane.org/handbook

Garritty

Gartlehner

Nussbaumer-Streit

, et al. Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. J Clin Epidemiol. 2021;130:13-22. doi:10.1016/j.jclinepi.2020.10.007

Andrews

Guyatt

Oxman

, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66(7):719-725. doi:10.1016/j.jclinepi.2012.03.013

Andrews

Schünemann

Oxman

, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66(7):726-735. doi:10.1016/j.jclinepi.2013.02.003

AGREE Next Steps Consortium. The AGREE II Instrument [Electronic Version]. Published 2017. Accessed March 3, 2022. https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf

Canadian Association of Radiologists. 2012 CAR Diagnostic Imaging Referral Guidelines. Canadian Association of Radiologists; 2012. Accessed July 5, 2021. https://car.ca/patient-care/referral-guidelines/

10.

Expert Panel on Gastrointestinal Imaging, Chernyak

Horowitz

, et al. ACR Appropriateness Criteria^® liver lesion-initial characterization. J Am Coll Radiol. 2020;17(11S):S429-S446. doi:10.1016/j.jacr.2020.09.005

11.

Singal

Llovet

Yarchoan

, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922-1965. doi:10.1097/HEP.0000000000000466

12.

Vanderpuye

Clemenceau

JRV

Temin

, et al. Assessment of adult women with ovarian masses and treatment of epithelial ovarian cancer: ASCO resource-stratified guideline. JCO Glob Oncol. 2021;7:1032-1066. doi:10.1200/GO.21.00085

13.

Piñero

Tanno

Aballay Soteras

, et al. Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma. Ann Hepatol. 2020;19(5):546-569. doi:10.1016/j.aohep.2020.06.003

14.

Morrison

Balega

Buckley

, et al. British Gynaecological Cancer Society (BGCS) uterine cancer guidelines: recommendations for practice. Eur J Obstet Gynecol Reprod Biol. 2022;270:50-89. doi:10.1016/j.ejogrb.2021.11.423

15.

Hughes

Yong

Ramasamy

, et al. Diagnosis and management of smouldering myeloma: a British Society for Haematology Good Practice Paper. Br J Haematol. 2024;204(4):1193-1206. doi:10.1111/bjh.19333

16.

Brouwer

Albersen

Parnham

, et al. European Association of Urology-American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update. Eur Urol. 2023;83(6):548-560. doi:10.1016/j.eururo.2023.02.027

17.

Timmerman

Planchamp

Bourne

, et al. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumours. Facts Views Vis Obgyn. 2021;13(2):107-130. doi:10.52054/FVVO.13.2.016

18.

Nout

Calaminus

Planchamp

, et al. ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer. Int J Gynecol Cancer. 2023;33(8):1185-1202. doi:10.1136/ijgc-2023-004695

19.

Zoellner

Herfarth

Herold

, et al. Clinical practice guideline: follicular lymphoma—diagnosis, treatment, and follow-up. Dtsch Arztebl Int. 2021;118(Forthcoming):320-325. doi:10.3238/arztebl.m2021.0022

20.

Vogl

Pereira

Helmberger

, et al. Updated S3 guidelines - diagnosis and treatment of colorectal carcinoma: relevance for radiological diagnosis and intervention. Rofo. 2019;191(4):298-310. doi:10.1055/a-0721-1947

21.

Emons

Steiner

Vordermark

, et al. Endometrial cancer. Guideline of the DGGG, DKG and DKH (S3-level, AWMF registry number 032/034-OL, September 2022). Part 1 with recommendations on the epidemiology, screening, diagnosis and hereditary factors of endometrial cancer, geriatric assessment and supply structures. Geburtshilfe Frauenheilkd. 2023;83(8):919-962. doi:10.1055/a-2066-2051

22.

Silvestris

Brunetti

Bittoni

, et al. Clinical practice guidelines for diagnosis, treatment and follow-up of exocrine pancreatic ductal adenocarcinoma: evidence evaluation and recommendations by the Italian Association of Medical Oncology (AIOM). Cancers (Basel). 2020;12(6):1681. doi:10.3390/cancers12061681

23.

The Italian Society For Ultrasound In Obstetrics And Gynecology Sieog. The Italian guidelines on ultrasound in obstetrics and gynecology: executive summary of recommendations for practice. Eur J Obstet Gynecol Reprod Biol. 2022;279:176-182. doi:10.1016/j.ejogrb.2022.10.016

24.

Okusaka

Nakamura

Yoshida

, et al. Clinical practice guidelines for pancreatic cancer 2022 from the Japan Pancreas Society: a synopsis. Int J Clin Oncol. 2023;28(4):493-511. doi:10.1007/s10147-023-02317-x

25.

Lavoue

Huchon

Akladios

, et al. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: diagnostic exploration and staging, surgery, perioperative care, and pathology. J Gynecol Obstet Hum Reprod. 2019;48(6):369-378. doi:10.1016/j.jogoh.2019.03.017

26.

Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol. 2022;28(4):583-705. doi:10.3350/cmh.2022.0294

27.

Committee of the Korean clinical practice guideline for pancreatic cancer and National Cancer Center, Korea. Korean clinical practice guideline for pancreatic cancer 2021: a summary of evidence-based, multi-disciplinary diagnostic and therapeutic approaches. Pancreatology. 2021;21(7):1326-1341. doi:10.1016/j.pan.2021.05.004

28.

Kubo

Shinkawa

Asaoka

, et al. Liver cancer study group of Japan clinical practice guidelines for intrahepatic cholangiocarcinoma. Liver Cancer. 2022;11(4):290-314. doi:10.1159/000522403

29.

Barroso

David

Abisinia

, et al. The Philippine clinical practice guidelines for the diagnosis and management of hepatocellular carcinoma 2021. Philipp J Intern Med. 2021;59(3):166-195.

30.

Hamel

Avard

Campbell

Kontolemos

Murphy

. Canadian Association of Radiologists head and neck imaging referral guideline. Can Assoc Radiol J. 2024;75:473-478. doi:10.1177/08465371231217212

31.

Hamel

Avard

Belanger

, et al. Canadian Association of Radiologists thoracic imaging referral guideline. Can Assoc Radiol J. 2024;75:296-303. doi:10.1177/08465371231214699

32.

Hamel

Avard

Isaac

, et al. Canadian Association of Radiologists cardiovascular imaging referral guideline. Can Assoc Radiol J. 2024;75:721-734. doi:10.1177/08465371241246425

33.

Hamel

Avard

Gorelik

, et al. Canadian Association of Radiologists musculoskeletal system diagnostic imaging referral guideline. Can Assoc Radiol J. 2024;75:269-278. doi:10.1177/08465371231190807

34.

Hamel

Avard

Dea

, et al. Canadian Association of Radiologists spine imaging referral guideline. Can Assoc Radiol J. Published online October 22, 2024. doi:10.1177/08465371241290762

35.

Hamel

Avard

Belanger

, et al. Canadian Association of Radiologists gastrointestinal imaging referral guideline. Can Assoc Radiol J. 2024;75:462-472. doi:10.1177/08465371231217230

36.

Hamel

Avard

Brahm

, et al. Canadian Association of Radiologists genitourinary imaging referral guideline. Can Assoc Radiol J. Published online July 25, 2024. doi:10.1177/08465371241261317

37.

Hamel

Amir

Avard

, et al. Canadian Association of Radiologists obstetrics and gynecology diagnostic imaging referral guideline. Can Assoc Radiol J. 2024;75:261-268. doi:10.1177/08465371231185292

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.41 MB