DIAGNOSTICAL APPROPRIATENESS – IMAGING, LABORATORY AND TERRITORIAL BETWEEN AND CLINIC VALUE (ATD/27)

Scientific rationale

Thediagnostic appropriateness is the premise of every good management of the path of diagnosis and care, yet remains the most neglected dimension of clinical appropriateness. The risk is not only to investigate too little, but to investigate too much, too often or the wrong patient. Needless, redundant or unmodified tests generate false positives, incidentalomas, anxiety, diagnostic cascades, exposure avoidable to radiation and waste, without improving outcomes. The decision to request an examination should be accompanied, with equal dignity, that of not requiring it, not repeating it or suspending its follow-up. The guiding principle is that an examination should be required when its result can change the clinical decision. This requires knowledge of predictive value and pre-test probability, a well-placed clinical question and ability to resist defensive medicine and induced question. From here is born Choosing Wisely, with its recommendations of "non-do", also in radiology (SIRM) and nuclear medicine (AINM). In Italy the appropriateness is also a normative and organizational reference (conditions of arrogance, priority criteria, justification and optimization in the use of ionizing radiation), while artificial intelligence faces the prescriptive path with opportunities and limits to be evaluated. The morning addresses the theme on four sides: principles, imaging, laboratory and territory, with the contribution of radiologist, nuclear doctor, laboratory doctor, doctor of general medicine and biomedical engineer, to build a shared culture of the appropriate examination between territory and hospital.