{"id":7432,"date":"2020-10-27T10:59:53","date_gmt":"2020-10-27T10:59:53","guid":{"rendered":"https:\/\/sgr-ssr.ch\/smarter-medicine-empfehlungen\/"},"modified":"2025-11-12T12:29:46","modified_gmt":"2025-11-12T12:29:46","slug":"smarter-medicine-recommandations","status":"publish","type":"post","link":"https:\/\/sgr-ssr.ch\/fr\/smarter-medicine-recommandations\/","title":{"rendered":"Smarter Medicine Recommandations"},"content":{"rendered":"

[et_pb_section fb_built= »1″ _builder_version= »4.4.8″][et_pb_row column_structure= »1_4,3_4″ _builder_version= »4.4.8″][et_pb_column type= »1_4″ _builder_version= »4.4.8″][et_pb_sidebar area= »et_pb_widget_area_16″ _builder_version= »4.4.8″ hover_enabled= »0″][\/et_pb_sidebar][\/et_pb_column][et_pb_column type= »3_4″ _builder_version= »4.4.8″][et_pb_text _builder_version= »4.4.8″ text_font= »|600||||||| » text_text_color= »#28b9da » text_font_size= »32px » text_line_height= »1.1em » custom_margin= »||15px||| »]<\/p>\n

SMARTER MEDICINE \u2013 CHOOSING WISELY SWITZERLAND<\/p>\n

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Recommandations de la Soci\u00e9t\u00e9 suisse de radiologie (SGR-SSR)<\/p>\n

[\/et_pb_text][et_pb_toggle title= »1. En cas de suspicion d\u2019embolie pulmonaire, n\u2019effectuer un CT-scanner que si la probabilit\u00e9 pr\u00e9test d\u2019embolie pulmonaire est forte ou mod\u00e9r\u00e9e. » open_toggle_text_color= »#000000″ closed_toggle_text_color= »#000000″ _builder_version= »4.4.8″ title_font= »|||||||| » title_font_size= »16px » body_font_size= »14px » custom_margin= »||29px||| » open_toggle_text_color__hover_enabled= »on|hover » open_toggle_text_color__hover= »#28b9da » closed_toggle_text_color__hover_enabled= »on|hover » closed_toggle_text_color__hover= »#28b9da »]<\/p>\n

Les patients pr\u00e9sentant des sympt\u00f4mes et des signes d\u2019une embolie pulmonaire aigu\u00eb n\u00e9cessitent des investigations rapides: anamn\u00e8se et examen m\u00e9dical approfondis avec \u00e9valuation de la probabilit\u00e9 clinique de l\u2019affection, analyses m\u00e9dicales et examens d\u2019imagerie. Le recueil de la probabilit\u00e9 clinique pr\u00e9test peut permettre d\u2019\u00e9viter des investigations suppl\u00e9mentaires inutiles (analyses m\u00e9dicales, examens d\u2019imagerie).<\/p>\n

R\u00e9f\u00e9rences:<\/strong><\/em><\/span><\/p>\n

Jacobo Kirsch, J, Brown, RKJ, Henry, TS, Javidan-Nejad, C, Jokerst, C, Julsrud, PR, Kanne, JP,Kramer, CM, Leipsic, JA, Panchal, KK, Ravenel, JG, Shah, AB, Mohammed, TLH, Woodard, PK, Abbara, S, Expert Panels on Cardiac and Thoracic Imaging. ACR Appropriateness Criteria\u00ae Acute Chest Pain- Suspected Pulmonary Embolism. (VA) American College of Radiology (ACR); 2016. Disponible sous: https:\/\/acsearch.acr.org\/docs\/69404\/Narrative\/<\/a><\/em><\/p>\n

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jim\u00e9nez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, \u00c1inle FN, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019 Oct 9;54(3). pii: 1901647.<\/em><\/p>\n

[\/et_pb_toggle][et_pb_toggle title= »2. Lors des examens de CT\u2013scanner de l\u2019abdomen avec produit de contraste, restreindre l\u2019acquisition sans injection aux situations diagnostiques sp\u00e9cifiques. » open_toggle_text_color= »#000000″ closed_toggle_text_color= »#000000″ _builder_version= »4.4.8″ title_font= »|||||||| » title_font_size= »16px » body_font_size= »14px » custom_margin= »||30px||| » open_toggle_text_color__hover_enabled= »on|hover » open_toggle_text_color__hover= »#28b9da » closed_toggle_text_color__hover_enabled= »on|hover » closed_toggle_text_color__hover= »#28b9da »]<\/p>\n

Les protocoles de CT-scanners abdominaux ne devraient inclure une phase sans injection que si celle-ci apporte une information diagnostique suppl\u00e9mentaire. C\u2019est le cas pour les indications suivantes: caract\u00e9risation d\u2019une l\u00e9sion r\u00e9nale, d\u2019une l\u00e9sion surr\u00e9nale, d\u2019une l\u00e9sion h\u00e9patique, en cas d\u2019h\u00e9maturie, dans le cadre d\u2019un suivi post-op\u00e9ratoire abdominal, du suivi apr\u00e8s la mise en place d\u2019une endoproth\u00e8se, et en cas d\u2019h\u00e9morragie gastro-intestinale.<\/p>\n

 <\/p>\n

R\u00e9f\u00e9rences:<\/strong><\/em><\/span><\/p>\n

Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr. Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol. 2011 Nov;8(11):756-61. doi: 10.1016\/j.jacr.2011.05.011.<\/em><\/p>\n

Artigas JM, Mart\u00ed M, Soto JA, Esteban H, Pinilla I, Guill\u00e9n E. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings. Radiographics. 2013 Sep-Oct; 33(5):1453-1470. doi: 10.1148\/rg.335125072. Review.<\/em><\/p>\n

 <\/p>\n

[\/et_pb_toggle][et_pb_toggle title= »3. Lors des examens de CT\u2013scanner de l\u2019abdomen avec produit de contraste, restreindre l\u2019acquisition en phase veineuse tardive aux situations diagnostiques sp\u00e9cifiques. » open_toggle_text_color= »#000000″ closed_toggle_text_color= »#000000″ _builder_version= »4.4.8″ title_font= »|||||||| » title_font_size= »16px » body_font_size= »14px » custom_margin= »||30px||| » open_toggle_text_color__hover_enabled= »on|hover » open_toggle_text_color__hover= »#28b9da » closed_toggle_text_color__hover_enabled= »on|hover » closed_toggle_text_color__hover= »#28b9da »]<\/p>\n

Les protocoles de CT-scanners abdominaux ne devraient pr\u00e9voir de phase tardive (phase suivant une phase veineuse portale, h\u00e9patique ou n\u00e9phrographique apr\u00e8s l\u2019administration du produit de contraste) que si celle-ci apporte une information diagnostique suppl\u00e9mentaire. C\u2019est le cas pour les indications suivantes: caract\u00e9risation d\u2019une l\u00e9sion r\u00e9nale, d\u2019une l\u00e9sion surr\u00e9nale, d\u2019une l\u00e9sion h\u00e9patique, en cas d\u2019h\u00e9maturie, et si besoin d\u2019un uroscanner.<\/p>\n

 <\/p>\n

R\u00e9f\u00e9rences:<\/strong><\/em><\/span><\/p>\n

Chan MG, Cassidy FH, Andre MP, Chu P, Aganovic L. Delayed imaging in routine CT examinations of the abdomen and pelvis: is it worth the additional cost of radiation and time? AJR Am J Roentgenol. 2014 Feb;202(2):329-35. doi: 10.2214\/AJR.12.10468. PubMed PMID: 24450673.<\/em><\/p>\n

Rodolfino E, Devicienti E, Micc\u00f2 M, Del Ciello A, Di Giovanni SE, Giuliani M, Conte C, Gui B, Valentini AL, Bonomo L. Diagnostic accuracy of MDCT in the evaluation of patients with peritoneal carcinomatosis from ovarian cancer: is delayed enhanced phase really effective? Eur Rev Med Pharmacol Sci. 2016 Nov;20(21):4426-4434.<\/em><\/p>\n

Johnson PT, Mahesh M, Fishman EK. Image Wisely and Choosing Wisely: Importance of Adult Body CT Protocol Design for Patient Safety, Exam Quality, and Diagnostic Efficacy. J Am Coll Radiol. 2015 Nov;12(11):1185-90. doi: 10.1016\/j.jacr.2015.02.021.<\/em><\/p>\n

Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr. Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol. 2011 Nov;8(11):756-61. doi: 10.1016\/j.jacr.2011.05.011.<\/em><\/p>\n

Loyer EM, Chin H, DuBrow RA, David CL, Eftekhari F, Charnsangavej C. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma: enhancement patterns with quadruple phase helical CT a comparative study. Radiology 1999;212:866-75.<\/em><\/p>\n

 <\/p>\n

[\/et_pb_toggle][et_pb_toggle title= »4. Ne pas syst\u00e9matiquement effectuer d\u2019imagerie de suivi par CT-scanner ou IRM en cas de d\u00e9couverte fortuite de kystes annexiels non suspects, inf\u00e9rieurs \u00e0 5 cm chez des femmes en \u00e2ge de procr\u00e9er. » open_toggle_text_color= »#000000″ closed_toggle_text_color= »#000000″ _builder_version= »4.4.8″ title_font= »|||||||| » title_font_size= »16px » body_font_size= »14px » custom_margin= »||30px||| » custom_padding= »||1px||| » open_toggle_text_color__hover_enabled= »on|hover » open_toggle_text_color__hover= »#28b9da » closed_toggle_text_color__hover_enabled= »on|desktop » closed_toggle_text_color__hover= »#28b9da »]<\/p>\n

Les kystes simples et h\u00e9morragiques sont presque toujours fonctionnels chez les femmes en \u00e2ge de procr\u00e9er. Le cancer de l\u2019ovaire, g\u00e9n\u00e9ralement kystique, ne se d\u00e9veloppe pas \u00e0 partir de ce type de kystes d\u2019aspect b\u00e9nin. Une \u00e9chographie de bonne qualit\u00e9 chez une femme en \u00e2ge de procr\u00e9er ne devrait pas aboutir \u00e0 la recommandation d\u2019une imagerie de suivi pour un corps jaune ou un kyste simple dont le diam\u00e8tre maximal est inf\u00e9rieur \u00e0 5\u00a0cm.<\/p>\n

 <\/p>\n

R\u00e9f\u00e9rences:<\/strong><\/em><\/span><\/p>\n

Levine D, Brown DL, Andreotti RF. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2010 256:943- 54.<\/em><\/p>\n

Harris RD, Javitt MC, Glanc P, Brown DL, Dubinsky T, Harisinghani MG, Khati NJ, Kim YB, Mitchell DG, Pandharipande PV, Pannu HK, Podrasky AE, Royal HD, Shipp TD, Siegel CL, Simpson L, Wall DJ, Wong- You-Cheong JJ, Zelop CM; Expert Panel on Women\u2019s Imaging. ACR Appropriateness Criteria\u00ae clinically suspected adnexal mass. Reston (VA) American College of Radiology (ACR); 2012, revised 2018. Available at: https:\/\/acsearch.acr.org\/docs\/69466\/Narrative<\/a><\/em><\/p>\n

Atri M, Alabousi A, Reinhold C, Akin EA, Benson CB, Bhosale PR, Kang SK, Lakhman Y, Nicola R, Pandharipande PV, Patel MD, Salazar GM, Shipp TD, Simpson L, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria\u00ae Clinically Suspected Adnexal Mass, No Acute Symptoms. Expert Panel on Women\u2019s Imaging. J Am Coll Radiol. 2019 May;16(5S): S77-S93.<\/em><\/p>\n

\u00a0<\/span><\/p>\n

[\/et_pb_toggle][et_pb_toggle title= »5. Ne pas diagnostiquer un syndrome de congestion pelvienne uniquement sur la base d\u2019images de CT-scanner ou d\u2019IRM, mais seulement si les patientes remplissent \u00e0 la fois des crit\u00e8res cliniques et des crit\u00e8res d\u2019imagerie. » open_toggle_text_color= »#000000″ closed_toggle_text_color= »#000000″ closed_toggle_text_color_tablet= »#28b9da » closed_toggle_text_color_phone= »#28b9da » closed_toggle_text_color_last_edited= »on|phone » _builder_version= »4.4.8″ title_font= »|||||||| » title_font_size= »16px » closed_title_font= »|||||||| » body_font_size= »14px » custom_margin= »||30px||| » open_toggle_text_color__hover_enabled= »on|desktop » open_toggle_text_color__hover= »#28b9da » closed_toggle_text_color__hover_enabled= »on|desktop » closed_toggle_text_color__hover= »#28b9da »]<\/p>\n

Des veines pelviennes dilat\u00e9es sur des coupes de CT-scanner ou d\u2019IRM peuvent constituer une d\u00e9couverte fortuite sans pertinence clinique. Un reflux des veines ovariennes, une dilatation des veines ovariennes et une dilatation des veines para-ut\u00e9rines peuvent appara\u00eetre chez des patientes asymptomatiques. Pour pouvoir diagnostiquer un syndrome de congestion pelvienne, il faut prendre en compte les sympt\u00f4mes cliniques dans l\u2019interpr\u00e9tation des images.<\/p>\n

 <\/p>\n

R\u00e9f\u00e9rences:<\/strong><\/em><\/span><\/p>\n

Coakley FV, Varghese SL, Hricak H. CT and MRI of pelvic varices in women. J Comput Assist Tomogr. 1999 May-Jun;23(3):429-34.<\/em><\/p>\n

Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL. Managing incidental findings on abdominal and pelvic CT and MRI, Part 2: white paper of the ACR Incidental Findings Committee II on vascular findings. J Am Coll Radiol. 2013 Oct;10(10):789-94.<\/em><\/p>\n

Borghi C, <\/a>Dell’Atti L. <\/a>Pelvic congestion syndrome: the current state of the literature. Arch Gynecol Obstet.<\/a> 2016 Feb;293(2):291-301.<\/em><\/p>\n

 <\/p>\n

[\/et_pb_toggle][et_pb_button button_url= »https:\/\/sgr-ssr.ch\/wp-content\/uploads\/2020\/11\/SGR-SSR-Recommendations-Smarter-Medicine_2020-FR-1.pdf » button_text= »T\u00e9l\u00e9charger la liste d\u00e9taill\u00e9e en PDF » button_alignment= »left » admin_label= »Button » _builder_version= »4.4.8″ custom_button= »on » button_text_size= »16″ button_text_color= »#28b9da » button_border_color= »#28b9da » button_icon_color= »#28b9da » custom_margin= »||50px||| » button_text_color_hover= »#28b9da » button_border_color_hover= »#28b9da » button_letter_spacing_hover= »0″ saved_tabs= »all » button_text_size__hover_enabled= »off » button_one_text_size__hover_enabled= »off » button_two_text_size__hover_enabled= »off » button_text_color__hover_enabled= »on » button_text_color__hover= »#28b9da » button_one_text_color__hover_enabled= »off » button_two_text_color__hover_enabled= »off » button_border_width__hover_enabled= »off » button_one_border_width__hover_enabled= »off » button_two_border_width__hover_enabled= »off » button_border_color__hover_enabled= »on » button_border_color__hover= »#28b9da » button_one_border_color__hover_enabled= »off » button_two_border_color__hover_enabled= »off » button_border_radius__hover_enabled= »off » button_one_border_radius__hover_enabled= »off » button_two_border_radius__hover_enabled= »off » button_letter_spacing__hover_enabled= »on » button_letter_spacing__hover= »0″ button_one_letter_spacing__hover_enabled= »off » button_two_letter_spacing__hover_enabled= »off » button_bg_color__hover_enabled= »off » button_one_bg_color__hover_enabled= »off » button_two_bg_color__hover_enabled= »off »][\/et_pb_button][et_pb_divider color= »#28b9da » divider_position= »center » _builder_version= »4.4.8″ width= »33% » custom_margin= »-10px||6px||| »][\/et_pb_divider][et_pb_text _builder_version= »4.4.8″ text_text_color= »#28b9da » text_font_size= »20px » text_line_height= »1.2em » custom_margin= »14px||13px||| »]<\/p>\n

\u00c9laboration de cette liste:<\/p>\n

[\/et_pb_text][et_pb_text _builder_version= »4.4.8″]<\/p>\n

En vue d\u2019\u00e9tablir cette liste \u00abTop 5\u00bb, le comit\u00e9 de la SGR-SSR a d\u2019abord effectu\u00e9 une pr\u00e9s\u00e9lection de dix recommandations, en tenant compte des recommandations \u00abChoosing Wisely\u00bb de l\u2019American College of Radiology (ACR, www.choosingwisely.org<\/a>). Pour \u00e9viter les redondances, les th\u00e8mes li\u00e9s \u00e0 l\u2019imagerie d\u00e9j\u00e0 abord\u00e9s par d\u2019autres soci\u00e9t\u00e9s de discipline sur www.smartermedicine.ch <\/a>ont \u00e9t\u00e9 ray\u00e9s de la liste.<\/p>\n

Ensuite, dans le cadre d\u2019ateliers, les membres du comit\u00e9 ex\u00e9cutif de la SGR-SSR ont \u00e9t\u00e9 invit\u00e9s \u00e0 \u00e9valuer de fa\u00e7on critique chacune des dix recommandations et \u00e0 examiner leur applicabilit\u00e9 en Suisse. \u00c0 l\u2019issue de ces ateliers, les cinq recommandations les plus pertinentes aux yeux de la SGR-SSR ont \u00e9t\u00e9 d\u00e9sign\u00e9es \u00e0 l\u2019unanimit\u00e9.<\/p>\n

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SMARTER MEDICINE \u2013 CHOOSING WISELY SWITZERLANDRecommandations de la Soci\u00e9t\u00e9 suisse de radiologie (SGR-SSR)Les patients pr\u00e9sentant des sympt\u00f4mes et des signes d\u2019une embolie pulmonaire aigu\u00eb n\u00e9cessitent des investigations rapides: anamn\u00e8se et examen m\u00e9dical approfondis avec \u00e9valuation de la probabilit\u00e9 clinique de l\u2019affection, analyses m\u00e9dicales et examens d\u2019imagerie. Le recueil de la probabilit\u00e9 clinique pr\u00e9test peut permettre […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"categories":[78],"tags":[],"class_list":["post-7432","post","type-post","status-publish","format-standard","hentry","category-qualite"],"acf":[],"yoast_head":"\nSmarter Medicine Recommandations - Schweizerische Gesellschaft f\u00fcr Radiologie<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sgr-ssr.ch\/fr\/smarter-medicine-recommandations\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Smarter Medicine Recommandations - Schweizerische Gesellschaft f\u00fcr Radiologie\" \/>\n<meta property=\"og:description\" content=\"SMARTER MEDICINE \u2013 CHOOSING WISELY SWITZERLANDRecommandations de la Soci\u00e9t\u00e9 suisse de radiologie (SGR-SSR)Les patients pr\u00e9sentant des sympt\u00f4mes et des signes d\u2019une embolie pulmonaire aigu\u00eb n\u00e9cessitent des investigations rapides: anamn\u00e8se et examen m\u00e9dical approfondis avec \u00e9valuation de la probabilit\u00e9 clinique de l\u2019affection, analyses m\u00e9dicales et examens d\u2019imagerie. 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