Excerpt

The purpose of this project was to provide national guidance on the optimal use of ^99mTc during a situation of reduced supply. To accomplish this, our objective at CADTH was:

• to develop, taking a national perspective, a priority ranking of the most common clinical uses of ^99mTc for use by decision-makers at various levels of the health system (i.e., institution, health authority, or jurisdiction) during a period of reduced supply of the isotope.

Early in the project, CADTH and MIIMAC acknowledged that a priority ranking constructed taking a national perspective will not accurately reflect the local contexts of all jurisdictions in which it is meant to be used. Given this, our second objective was:

• to design a customizable, web-based prioritization tool that allows decision-makers the opportunity to create personalized priority lists specific to their institution, health authority, or jurisdiction for use during a period of reduced supply of the isotope.

Contents

• INTRODUCTION
• ISSUE
• OBJECTIVES
• METHODOLOGY
  • Medical Isotopes and Imaging Modalities Advisory Committee
  • Multi-Criteria Decision Analysis (MCDA)
  • Identifying the relevant criteria
  • Identifying the clinical uses of ^99mTc to be prioritized
  • Summary of clinical uses, interventions, and comparators included in the MCDA
  • Generation of research reports to inform the MCDA process
  • Producing a ranking
• RESULTS
• DISCUSSION
  • Summary
  • Web-based prioritization tool
  • Strengths and Weaknesses of this Assessment
  • Generalizability of Findings
  • Knowledge Gaps
• CONCLUSIONS AND IMPLICATIONS FOR DECISION-MAKING
• REFERENCES
• APPENDIX 1 Members of the Medical Isotopes and Imaging Modalities Advisory Committee (MIIMAC) as of March 2012
• RESEARCH REPORTS
  • APPENDIX 2.1 Detection of Lower Gastrointestinal Bleeding
  • APPENDIX 2.2 Detection of Bile Leak
  • APPENDIX 2.3 Detection of Acute Pulmonary Embolism
  • APPENDIX 2.4 Diagnosis of Fracture
  • APPENDIX 2.5 Diagnosis of Acute Osteomyelitis
  • APPENDIX 2.6 Imaging Bone Metastases in Breast, Prostate, and Lung Cancers
  • APPENDIX 2.7 Assessment of Prognosis Post-Myocardial Infarction
  • APPENDIX 2.8 Detection of Ischemia
  • APPENDIX 2.9 Preoperative Assessment Prior to Major Vascular, Non-Cardiac Surgery
  • APPENDIX 2.10 Evaluation of Painful Prostheses
  • APPENDIX 2.11 Implantable Cardioverter-Defibrillator Decision-Making
  • APPENDIX 2.12 Diagnosis of Acute Cholecystitis
  • APPENDIX 2.13 Evaluation of Renal Function Post-Transplant
  • APPENDIX 2.14 Assessment of Chemotherapy-Induced Cardiotoxicity
  • APPENDIX 2.15 Diagnosis of Acute or Subacute Avascular Necrosis
  • APPENDIX 2.16 Identification of the Sentinel Lymph Node in Patients with Breast Cancer
  • APPENDIX 2.17 Suspected Obstructive Uropathy
  • APPENDIX 2.18 Evaluation of Renovascular Hypertension
• SUMMARY FOR RADIOLOGISTS

Authorship: Michelle Mujoomdar, Erin Russell, François Dionne, and Kimberlee Lambe were responsible for planning, authoring, and reviewing the report. Michelle Mujoomdar led the project team and was the liaison between MIIMAC and CADTH. Erin Russell, Kristen Moulton, and Christine Murray were responsible for authoring and revising select research reports. Erin Russell was responsible for reviewing cost estimates for all reports. Sarah McGill performed literature searches and verified bibliographic references.

Acknowledgements: We would like to acknowledge the following:

The Program for Assessment of Technology in Health (PATH) Research Institute for performing literature searches and authoring research reports for the project; Dr. Tammy Clifford for critical review of the report; Kelly Farrah and Monika Mierzwinski-Urban for performing literature searches; Adina Gottardi and Kim Ghosh for project management support.

Conflicts of Interest: None declared.

Suggested citation:

Mujoomdar M, Russell E, Dionne F, Moulton K, Murray C, McGill S, Lambe K. Optimizing health system use of medical isotopes and other imaging modalities [Internet]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2012 (Optimal Use Report, volume 2, issue 1A).

This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the —source documentation) available to CADTH at the time it was prepared.

The information in this report is intended to help health care decision-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision making process nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report.

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.

Production of this report is made possible through a financial contribution from Health Canada. This document may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third-party sites is governed by the owners’ own terms and conditions set out for such sites. CADTH does not make any guarantee with respect to any information contained on such third-party sites and CADTH is not responsible for any injury, loss, or damage suffered as a result of using such third-party sites.