CAR - Canadian Association of Radiologists

The Canadian Association of Radiologists is the national specialty association for radiologists, dedicated to medical imaging excellence in patient care

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Developing Quality Clinical Practice Guidelines at the CAR

As leaders in the Canadian radiology community, it is critical for the CAR to develop national standards and guidelines so patients can receive the optimal radiological result, no matter the procedure. CAR guidelines and clinical practice statements are submitted for open-access publication in the CARJ to disseminate to radiologists across Canada.

Dr. Iain Kirkpatrick has worked on producing a number of different practice guidelines, including a highly cited series of recommendations on the of the Management of Incidental Findings. He says the guideline publication process is a highly collaborative one.

“Typically, we put the guidelines together in an authored document and submit it to the membership for review. We address all the member feedback and then send the edited document to the CAR Board for approval. At that stage, we will submit the document to the CARJ for peer review. Along the way we receive guidance from CARJ staff on length/format preferences as we go.”

According to Dr. Kirkpatrick, there are several key steps to publishing quality guidelines on a consistent basis:

  • Build the right team: you want representation from different parts of the country, urban vs rural, academic vs community practice, and membership engagement is key.
  • Define your topic: particularly what to cover and what NOT to cover. Keep focused and make sure a project is possible to complete in a realistic time frame.
  • Literature review: we usually split up this work and build an online reference library for the entire group.
  • Group discussions around the outline and content, followed by assigning tasks to every member of the team that will be reviewed by the entire group in future meetings. Important or controversial points are always discussed as a group and agreed to by consensus.
  • The document needs to be clinically relevant and provide actionable guidance rather than simply a summary of the literature. We continuously come back to this point as it can be easy to forget when you are trying to summarize 100 papers on a topic.
  • We split up the writing duties by section, but the Chair edits them to ensure a consistent narrative voice, and every group member has the opportunity to comment or add to any section.
  • Community feedback: The first draft goes to CAR membership for review, so if we have missed a particular viewpoint or failed to address a certain question, that is usually caught during this part of the process.  We answer every comment made during the public review process.
  • Completion of a manuscript for the CARJ.

Dr. Kirkpatrick says creating manageable objectives and deadlines is crucial in such an in-depth academic process.

“I think setting realistic goals and milestones is one of the most important things to keep the process moving. The amount of data that needs to be filtered can be massive and sometimes overwhelming, and it is easy to lose sight of the finish line without always having an interim goal to head towards that feels manageable.  It keeps everyone motivated.  The other important thing is to have engaged committee members. Fortunately, there are plenty of those in the CAR.”

Later this month, Dr. Kirkpatrick will finalize the seventh set of practice guidelines he has helped develop during his career and will begin on his eighth in early 2023.

Looking for CAR clinical practice guidelines? The CARJ maintains a collection of CAR and affiliate guidelines, which are cross-listed on the CAR website.