International Journal of Technology Assessment in Health Care



HOW TO UNDERTAKE A CLINICALLY RELEVANT SYSTEMATIC REVIEW IN A RAPIDLY EVOLVING FIELD

(Magnetic Resonance Angiography)


Marie E. Westwood a1c1, Steven Kelly a1c1, Elizabeth Berry a1c1, John M. Bamford a2c1, Michael J. Gough a2c1, C. Mark Airey a3c1, Linda M. Davies a4c1, James F. M. Meaney a5c1, Jane Cullingworth a5c1 and Michael A. Smith a6c1
a1 University of Leeds
a2 United Leeds Teaching Hospitals NHS Trust
a3 University of Leeds
a4 University of York
a5 United Leeds Teaching Hospitals NHS Trust
a6 University of Leeds

Abstract

Objectives: The aim was to determine which generations of the evolving technology of magnetic resonance angiography (MRA) are currently of clinical relevance in two clinical applications. Our purpose was to plan a systematic review that would be valuable both to purchasers driven by cost-effectiveness and to practicing clinicians.

Methods: Information was gathered from a search of major bibliographic databases, from a short questionnaire sent to 500 U.K. vascular radiologists and vascular surgeons, and from local clinical experts. We asked which of the MRA techniques were currently used and, assuming availability, what would be their technique of choice.

Results: There were 206 published articles that satisfied preliminary inclusion criteria: 69 discussed 2D time of flight (TOF); 47, 3D TOF; and 38, contrast-enhanced techniques. There were 162 questionnaires returned (60 radiologists, 102 surgeons). Of the total respondents, 77/162 (48%) used MRA in the assessment of carotid artery stenosis; 47/77 (61%) used 2D TOF; 32/77 (42%), 3D TOF; and 26/77 (34%), contrast-enhanced techniques. Thirty-five of 162 (22%) respondents used MRA in the assessment of peripheral vascular disease (PVD); 15/35 (43%) used 2D TOF, 4/35 (11%) used 3D TOF, and 22/35 (63%) used contrast-enhanced techniques. For those wishing to use MRA, contrast-enhanced techniques were the method of choice.

Conclusions: The TOF methods that represent earlier generations of the technology remain clinically relevant, and will therefore be included in our systematic review. To ensure complete and relevant coverage in reviews of other evolving technologies, it would be advisable to obtain data for guidance in a similar way.


Key Words: Technology; Health care; Assessment; Technology; Angiography; Magnetic resonance; Review literature; Online systems.

Correspondence:
c1 The authors thank A. Jackson and all those who completed a questionnaire. This work was carried out with the financial support of the Secretary of State for Health under the NHS Health Technology Assessment Programme, project 97/13/04. The views and opinions expressed do not necessarily reflect those of the Secretary of State for Health. In part, this work was undertaken by the Leeds Teaching Hospitals NHS Trust, which received funding from the NHS Executive. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive.