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To the Editor,
We would like to thank Dr Arora1 for emphasising some of the issues we raised in our article “Pitfalls in imaging the fail elderly”.2 It is humbling to receive this positive response; ensuring appropriateness of investigation of frail and elderly patients is truly a global endeavour.
On the point of published guidance, the UK Royal College of Radiologists have long produced evidence-based guidelines, now in its 7th edition. This is available online (http://www.irefer.org.uk/), in print or as an app for mobile devices. However, the topic of imaging the frail elderly is not specifically covered in this publication.
We particularly applaud the author's reinforcement of the onus on radiologists to promote awareness of the consequences of radiological studies in this group of patients. In part, the “Choosing Wisely” campaign in the USA puts this into practice but is not particularly aimed at the frail elderly. While the healthcare model in the USA does differ somewhat from that in the UK, the development of short lists of evidence-based recommendations has inspired us to develop a list of our own. We present a list of five recommendations aimed at clinicians requesting radiological investigations in frail elderly patients: