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[Comment] The theory and practice of imaging outcomes research

About a decade ago, triggered by unexplained growth and variability in cardiovascular testing,1 efforts to redefine imaging quality led to an appreciation of the importance of selecting the right test for the right patient (ie, giving rise to appropriate use criteria) and measuring the effect of testing on outcomes, in addition to measures such as image acquisition and interpretation.2 Although appropriate use criteria are now an established part of evidence-based cardiovascular care, imaging outcomes have not been defined in a more meaningful way, partly because of the many steps needed to translate test data into knowledge (ie, diagnostic thinking), action (ie, treatments), and ultimately outcomes.