Korean Clinical Imaging Guideline for Hemoptysis

In 2014, the American College of Radiology announced a guideline for appropriate diagnostic approach and treatment in patients with hemoptysis, according to severity of hemoptysis and risk of lung cancer. However, in Korea many patients have pulmonary fibrosis due to previous tuberculosis or have active tuberculosis. Therefore, application of this guideline is not appropriate. The Korean Society of Radiology and Korean Society of Thoracic Radiology proposed a guideline more closely matching the real state of diagnostic approach and treatment of patients with hemoptysis in Korea. The guideline was prepared in consensus by a development committee, working party, and an advisory committee. The process of the guideline proposal was based on methodology for developing evidence-based clinical imaging guidelines: joint recommendations by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. The clinical imaging guideline for adult patients with hemoptysis is as follows. Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast enhanced chest CT is recommended in patients with two lung cancer risks (> 40 years old and > 30 packs per year smoking history), moderate hemoptysis (> 30 cc/24 hours) or recurrent hemoptysis. Contrast enhanced chest CT is also recommended for patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.

Erratum: Korean Clinical Imaging Guideline for Hemoptysis

On page 83 and 85, there were repeated typographical error of foot note in Table 2, Table 3, and Table 4. We have revised “adated” to “adapted.”

2018 Korean Clinical Imaging Guideline for Hemoptysis

In 2014, the American College of Radiology (ACR) announced the guideline for the appropriate diagnostic approach and treatment of patients according to the severity of hemoptysis and risk for lung cancer. However, the application of the ACR guideline in Korea may not be appropriate, because many patients in Korea have active tuberculosis or pulmonary fibrosis due to previous tuberculosis. The Korean Society of Radiology and Korean Society of Thoracic Radiology have proposed a new guideline suitable for Korean practice. This new guideline was prepared through the consensus of a development committee, working party, and an advisory committee. The guideline proposal process was based on an evidence-based clinical imaging guideline proposed by the development committee. Clinical imaging guideline for adult patients with hemoptysis is as follows: Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast-enhanced chest CT is recommended in patients with two risk factors for lung cancer (> 40 years old and > 30 pack-year smoking history), moderate hemoptysis (> 30 mL/24 hours) or recurrent hemoptysis. Contrast-enhanced chest CT is also recommended in patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.

Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.

Imaging Guidelines for Enhancing Justifications for Radiologic Studies

Justification in the field of radiology refers to the appropriate use of radiologic imaging modalities, and may be achieved by establishing clinical imaging guidelines (CIGs). Recently, CIGs have been shown to be useful in selecting the proper medical imaging modality, resulting in the reduction of inappropriate radiologic examinations, thereby enhancing justifications. However, the development of CIGs is both time-consuming and difficult as the methodology of evidence-based medicine should be adhered to. Thus, although the radiologic societies in developed countries such as the United Kingdom and USA are already developing and implementing CIGs in their clinical practices, CIGs are not yet readily available in many other countries owing to differences in medical circumstances and resources. In this review, we assess the role and limitations of CIGs by examining the current status of CIGs in developed countries, and also describe the specific efforts made to establish CIGs in Korea.