What’s New

June 2018

Head Injury (Adult)

UPDATE: This pathway has been streamlined. The Canadian CT Head rules are recommended to guide the use of CT head in adults presenting with an acute blunt head injury. Clinical judgement should be used in the decision to perform imaging in patients who present without loss of consciousness or amnesia, as there is still a risk of intracranial injury in these patients if other risk factors are present. View the pathway

Abdominal Aortic Aneurysm (Repair Follow-up)

UPDATE: The imaging recommendations for follow-up of endovascular aortic aneurysm repair (EVAR) have been updated based on the 2018 Society for Vascular Surgery practice guidelines. CTA and duplex US are recommended at one-month and one-year post-op, then annual surveillance with duplex US may be appropriate thereafter. View the pathway

Bronchiectasis

UPDATE: More details now included in teaching points. An updated search and review of the literature further supported recommendations and there are no major changes to the pathway. View the pathway

Acute Scrotal Pain

UPDATE: This algorithm has been simplified. Testicular torsion is a clinical diagnosis and imaging is not indicated prior to surgical exploration. Any presentation that is suspicious or equivocal for testicular torsion should be referred to an emergency department for urgent surgical assessment. View the pathway

Spinal Cord Compression (Suspected)

UPDATE: This algorithm has been simplified. All patients with suspected acute spinal cord should be urgently assessed by a senior clinician, which includes emergency or medical physicians and surgeons, and proceed to MRI if clinical findings are consistent with acute spinal cord compression. View the pathway

Peripheral Stent Follow-Up

UPDATE: The algorithm has been revised to focus on the use of ABI and Doppler US for close surveillance, as well as to consider which patients require follow-up. The increasing use of non-invasive angiography has also been incorporated. View the pathway

Hyperthyroidism

UPDATE: The algorithm has been updated to include consideration of thyroid hormone resistance and the presence of TSH receptor antibodies. Grave’s disease can often be diagnosed clinically and imaging is not required unless the aetiology of hyperthyroidism is uncertain. View the pathway

May 2018

Chest X-Ray (Pre-operative)

UPDATE: Following a review of the current literature and guidelines, the indications for preoperative chest radiographs have been revised. Chest radiographs may be indicated for the evaluation of patients with acute symptoms, as well as for surgical planning and oncology staging. View the pathway

Non-Small Cell Lung Cancer (Staging)

UPDATE: This pathway has been significantly revised and simplified. The AJCC Cancer Staging System guidelines are now included and there is new information on the role of PET/CT. View the pathway

April 2018

Phaeochromocytoma

UPDATE: This pathway has been simplified with an update of teaching points following review of the current literature. Adrenal gland CT is recommended to evaluate biochemically confirmed phaeochromocytoma, with information on complimentary functional tests. View the pathway

Cushing’s Syndrome

UPDATE: The revised pathway now focusses on the importance of biochemical diagnosis prior to imaging, including considering ectopic ACTH production when very high levels are present. The algorithm also includes information on IPSS. View the pathway

March 2018

Goitre (Investigation)

UPDATE: Following a review of the current literature, thyroid ultrasound is no longer routinely indicated in the investigation of goitre. View the pathway

February 2018

Hyperaldosteronism (Primary Suspected)

UPDATE: Now includes information on adrenal vein sampling and confirmatory testing. View the pathway

Pulmonary Embolism (Haemodynamically Stable)

UPDATE: Low-dose CT now removed from the pathway and the use of lower limb ultrasound has been revised. This update now includes information on the Pulmonary Embolism Rule-Out Criteria (PERC). There is a new ‘What do I need to know’ box with quick questions to help clinicians decide on appropriate investigations. View the pathway

December 2017

Deep Venous Thrombosis (Arm)

UPDATE: More details now included in teaching points. An updated search and review of the literature further supported recommendations and there are no major changes to the pathway. View the pathway

Deep Venous Thrombosis (Leg)

UPDATE: More details now included in teaching points. An updated search and review of the literature further supported recommendations and there are no major changes to the pathway. View the pathway

Solid Pulmonary Nodules

UPDATE: Now revised to incorporate the 2017 Fleishner Society Guidelines for management of pulmonary nodules detected on CT scans, with management now divided according to the CT attenuation of the nodule. There is a new ‘What do I need to know’ box with quick questions to help clinicians decide on appropriate follow-up. View the pathway

Paediatric: Scoliosis (Adolescent)

UPDATE: This algorithm has been simplified and no longer includes ‘lateral bending views’ and ‘pre-operative MRI’. Indications for CT have been revised and specialist orthopaedic opinion is now also advised. View the pathway

Paediatric: Magnetic Resonance Imaging

UPDATE: This pathway has now been simplified with updated references and a revision of the teaching points. View the pathway

November 2017

NEW: Subsolid Pulmonary Nodules

This new pathway provides guidance on the imaging surveillance of adult patients with subsolid pulmonary nodules. This pathway is based on guidelines that do not apply to patients younger than 35 years, immunocompromised patients or patients with cancer. View the pathway

Paediatric: Knee Pain

UPDATE: Now includes more information on the use of MRI. An updated search and review of the literature further supported recommendations there are no major changes to the pathway. View the pathway

October 2017

Paediatric: Headache (Recurrent)

UPDATE: Now includes more information is on the use of MRI versus CT, with expansion of teaching points and further details on ‘Red flags’. An updated search and review of the literature further supported recommendations and there are no major changes to the pathway. View the pathway

Paediatric: Head Trauma

UPDATE: Algorithm now changed to incorporate the PECARN decision rules along with the CATCH rules. There are now more details on the role of MRI in the sub-acute setting. View the pathway