radiology-consensus-guideline

Radiology Consensus and Guideline Development

Use this skill to design, run-plan or audit a consensus statement, appropriateness project, practice parameter, technical standard or clinical practice guideline. It owns the panel/process, evidence-to-decision record, consensus protocol, recommendation ledger and lifecycle plan. It does not perform the underlying systematic review, confer society endorsement, set a legal standard of care or let expert voting substitute for evidence.

Choose the product and mode

First declare the product: clinical-practice-guideline, appropriateness-criteria, practice-parameter, technical-standard, expert-consensus-statement or research-priority/definition-consensus. Do not use these labels interchangeably.

Mode	Use when	Required result
scoping	product, users, questions or authority are unsettled	scope, product decision, stakeholders, evidence needs and stop conditions
protocol	a versioned development plan is needed before evidence/panel decisions	panel, COI, evidence, consensus, consultation and update protocol
evidence-to-decision	a frozen evidence synthesis must become recommendation judgments	GRADE/compatible EtD ledger with explicit uncertainty
formal-consensus	Delphi, RAND/UCLA or nominal group work is planned or audited	prespecified rounds, thresholds, denominator, feedback, dissent and reporting record
audit-update-retire	an existing statement/guideline is reviewed for trustworthiness or currency	method audit, surveillance result, update/retirement and supersession map

Read references/evidence-to-recommendation.md for the systematic-review handoff, GRADE/EtD and recommendation wording. Read references/formal-consensus-methods.md only for a formal consensus exercise. Read references/radiology-guidance-lifecycle.md for appropriateness criteria, practice parameters, technical standards, implementation, updating and retirement. Verify methods and authority through references/source-registry.md.

Input passport

Record:

product and mode | sponsor/developer and actual adoption authority | jurisdiction/organization | scope, population, modality/test/intervention/comparator/outcomes/setting | intended users and affected people | panel roles, patient/public members and COI records | frozen systematic-review handoff/version/currency | certainty framework | consensus method and prespecified rule | draft and consultation artifacts | implementation context | publication/update/retirement owner | user authority for edits or external communication.

Missing adoption authority, panel decisions, COI management, patient/public participation, evidence certainty or official status remains NOT_VERIFIED. Advisory drafting is not an endorsed guideline.

Choose the evidence lane for the declared product. A clinical recommendation presented as evidence-based requires the relevant systematic-review/EtD handoff. A research-priority or definition-consensus exercise instead requires transparent item generation, search/mapping or stakeholder evidence, panel judgments and limits; use NOT_APPLICABLE_GRADE when it makes no clinical-effect or recommendation-strength claim. A generic Delphi protocol does not require an invented effect synthesis or GRADE rating.

Core evidence and recommendation states

• Evidence handoff: EVIDENCE_READY, EVIDENCE_PARTIAL, EVIDENCE_ABSENT or EVIDENCE_STALE.
• Recommendation: DRAFT, CONDITIONAL, STRONG, NO_RECOMMENDATION, RESEARCH_ONLY, SUPERSEDED or RETIRED only when defined by the selected framework and authorized process.
• Consensus result: CONSENSUS_REACHED, CONSENSUS_NOT_REACHED, STABLE_DISAGREEMENT, ATTRITION_LIMITED or NOT_ASSESSABLE.

Evidence certainty, recommendation strength and consensus percentage are different fields. A high vote does not upgrade low/absent evidence, and a low-certainty body does not automatically prohibit a strong recommendation when a transparent framework supports an exceptional case.

Required workflow

1. Lock the product and authority. Define who will use the output, for which decision, and who can officially adopt/endorse it. Use “draft” or “advisory” until a verified process confers status.
2. Scope the decision. Specify population, imaging scenario, modality/test, comparator, downstream action, patient-important outcomes, setting, exclusions and equity/access questions.
3. Constitute the panel. Include relevant clinical disciplines, radiologists, referrers, technologists/medical physicists when technical decisions are material, methodologists, implementers and patients/public or other affected representatives. Record balance, recruitment, roles, COI assessment, management and recusals.
4. Accept the product-appropriate evidence handoff. For an evidence-based clinical recommendation, require search currency, study-family/effect-row identity, risk-of-bias/ applicability, synthesis and certainty from radiology-systematic-review. For priorities or definitions, record item sources, mapping/search limits, stakeholder input and traceable revision; a full effect review is required only if the intended claim needs it. Do not relabel selected references or panel memory as a systematic review.
5. Run the applicable decision process. For clinical recommendations, record benefits/harms, certainty, values/preferences, resources, equity, acceptability and feasibility. Link diagnostic accuracy to downstream management and patient outcomes. For priorities or definitions, report explicit selection criteria, content/semantic judgments and dissent without inventing clinical effects, GRADE certainty or recommendation strength.
6. Use formal consensus only for its declared purpose. Prespecify method, panel, rounds, anonymity/interactions, feedback, denominator, threshold, stability, attrition, tie/disagreement handling and stopping. Use templates/consensus-guideline-protocol.md.
7. Draft atomic recommendations or consensus items. Each clinical recommendation states population/scenario, action, comparator/conditions, strength, certainty, rationale, harms/burden, implementation conditions, exceptions, dissent and research gaps. Use templates/recommendation-etd-ledger.md. For priorities/definitions, use the item register and formal-consensus result sections instead; include wording, provenance, scope, rationale and status, with clinical EtD fields not applicable.
8. Consult and quality-control. Preserve stakeholder comments, responses, panel changes, unresolved disagreement and external review. Reporting-checklist completion does not prove method quality or endorsement.
9. Plan implementation and lifecycle. Define dissemination, feasibility tools, monitoring, surveillance, update triggers, versioning, supersession and retirement. Imaging technology, contrast/tracers, dose, reconstruction, AI versions and clinical standards can make guidance stale.

Stop and escalation gates

Return GUIDANCE_STOP_AND_REFRAME when product or adoption authority is misrepresented; scope or decision scenarios are undefined; the evidence packet is missing/stale for a claim presented as evidence-based; material panel COI cannot be managed; affected patients/public or essential disciplines are systematically excluded without justification; consensus thresholds are chosen after results; attrition, dissent or denominator is hidden; expert votes are used to manufacture evidence; or a current clinical recommendation could expose patients to unreviewed harm.

Escalate formal endorsement, legal/regulatory interpretation and individual patient decisions to the responsible society, institution, regulator or clinical team. The skill may prepare evidence and drafts but cannot adopt, endorse or implement official guidance.

Output contract

1. Product, scope and authority passport
2. Panel/stakeholder/patient-public and COI matrix
3. Product-appropriate evidence handoff and currency verdict — systematic review for the clinical evidence claim, or item-generation/mapping/stakeholder evidence for priorities and definitions
4. Question/outcome and imaging-scenario map
5. GRADE or compatible evidence-to-decision ledger when applicable; otherwise NOT_APPLICABLE_GRADE plus the item-selection/definition rationale
6. Consensus protocol and result — rounds, thresholds, denominator, attrition and dissent
7. Recommendation or consensus-item ledger — strength, certainty and consensus kept separate; clinical strength/certainty is not invented for a terminology or research-priority item
8. Implementation, equity, monitoring and research-gap plan
9. Consultation, external-review and change-response record
10. Version, update, supersession and retirement plan with exact non-endorsement boundary

Handoffs and non-ownership

• Search, screening, extraction, risk of bias, synthesis and evidence certainty -> radiology-systematic-review; current clinical facts -> radiology-clinical-domain.
• Quantitative Delphi/RAND agreement or comparative inference -> radiology-stats; CEA/CUA, budget impact, ICER/QALY, PSA/VOI and economic-model evidence consumed by an EtD -> radiology-health-economics. This skill weighs the supplied economic evidence in a recommendation; it does not build or authorize the economic model.
• Reporting guideline/quality checklist -> radiology-reporting; prose, tables, figures and decks -> their artifact owners.
• Society boards, institutions, regulators and clinical teams retain endorsement, adoption, implementation, legal and patient-care authority.