Tests, treatments, and procedures for healthcare providers and consumers to question

Australia's peak health professional colleges, societies and associations have developed lists of recommendations of the tests, treatments, and procedures that healthcare providers and consumers should question.

Each recommendation is based on the latest available evidence. Importantly, they are not prescriptive but are intended as guidance to start a conversation about what is appropriate and necessary.

As each situation is unique, healthcare providers and consumers should use the recommendations to collaboratively formulate an appropriate healthcare plan together.

The Royal Australian and New Zealand College of Radiologists

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  1. Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (localised bone tenderness or inability to weight-bear as defined in the Rules).
  2. Don’t request duplex compression ultrasound for suspected lower limb deep venous thrombosis in ambulatory outpatients unless the Wells Score (deep venous thrombosis risk assessment score) is greater than 2, OR if less than 2, D dimer assay is positive.
  3. Don’t request any diagnostic testing for suspected pulmonary embolism (PE) unless indicated by Wells Score (or Charlotte Rule) followed by PE Rule-out Criteria (in patients not pregnant). Low risk patients in whom diagnostic testing is indicated should have PE excluded by a negative D dimer, not imaging.

  4. Don't perform imaging for patients with non-specific acute low back pain and no indicators of a serious cause for low back pain.
  5. Don't request imaging of the cervical spine in trauma patients, unless indicated by a validated clinical decision rule.
  6. Don’t request computed tomography (CT) head scans in patients with a head injury, unless indicated by a validated clinical decision rule.
  7. Don’t initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ≥50y with early-stage invasive breast cancer without considering shorter treatment schedules.
  8. Don’t initiate management of low risk prostate cancer without discussing active surveillance.
  9. Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.
  10. Don't routinely add adjuvant whole-brain radiation therapy to stereotactic radiosurgery for limited brain metastases.
  11. Don’t routinely use extensive locoregional therapy in most cancer situations where there is metastatic disease and minimal symptoms attributable to the primary tumour.