If implemented as planned, comparative effectiveness studies will shed light on the optimal choice of imaging modality for a number of applications. Projects were grouped into quartiles to rank their priority. Individual projects could lead to numerous studies. Imaging-related priorities are listed below.
First quartile
• Treatment strategies for atrial fibrillation including surgery, catheter ablation, and pharmacologic treatment (imaging is essential for surgical planning for this procedure);
• Management strategies for ductal carcinoma in situ (DCIS); and
• Imaging technologies in diagnosing, staging, and monitoring patients with cancer including PET, MRI, and CT.
Second quartile
• Film-screen or digital mammography alone with mammography plus MRI in community practice-based screening of breast cancer in high-risk women of different ages, risk factors, and race or ethnicity;
• New screening technologies, such as fecal immunochemical tests and CT colonography, with usual care (fecal occult blood tests and colonoscopy) in preventing colorectal cancer; and
• Outcomes of care with obstetric ultrasound studies and care without the use of ultrasound in normal pregnancies.
Third quartile
• Traditional risk stratification for coronary heart disease and noninvasive imaging using coronary artery calcium and carotid intima media thickness measures with other approaches on coronary heart disease outcomes;
• Formulary management practices with usual practices in controlling hospital expenditures for products other than drugs, including medical devices (surgical hemostatic products, radiocontrast, interventional cardiology devices, and others); and
• Traditional with new imaging modalities, such as routine imaging, MRI, CT, and PET, when ordered for neurological and orthopedic indications by primary care practitioners, emergency department physicians, and specialists.
Fourth quartile
• CT angiography with conventional angiography in assessing coronary stenosis in patients at moderate pretest risk of coronary artery disease; and
• Diagnostic imaging performed by nonradiologists and radiologists.
