Article Text

Download PDFPDF

Technical standards and practice guidelines: should we? Why now? Why SNIS?
  1. Joshua A Hirsch1,2,
  2. Philip M Meyers3,
  3. John Barr4,
  4. Mary E Jensen5,
  5. Collin Derdeyn6,
  6. Laxmaiah Manchikanti7
  1. 1Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Interventional Neuroradiology, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Radiology and Neurological Surgery, Columbia University, College of Physicians & Surgeons, New York, New York, USA
  4. 4Scripps Institute, San Diego, California, USA
  5. 5Interventional Neuroradiology, Departments of Radiology and Neurosurgery, University of Virginia Health Systems, Charlottesville, Virginia, USA
  6. 6Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, St Louis, Missouri, USA
  7. 7Pain Management Center of Paducah, Kentucky, USA
  1. Correspondence to
    Joshua A Hirsch, Interventional Neuroradiology, Massachusetts General Hospital, 55 Fruit Street, GRB 2, Boston, Massachusetts 02114, USA; hirsch{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

SNIS continues to develop and update practice guidelines for the delivery of NeuroInterventional care. This constant project represents a major societal undertaking. On occasion, it has bound our society to other medical groups. However, articulating what we believe to be “the correct” guidelines, at times places us at odds with others over critical issues. Why make this effort? Is it worth it?

In 2001, SNIS (then ASITN) published its first guidelines on NeuroInterventional therapies including aneurysms, arteriovenous malformations, head and neck tumors, epistaxis and acute ischemic stroke.1 2 3 4 5 6 7 8 These guidelines helped to define the “state-of-the-art” and served as a foundation for future clinical and technical advancement.

Other specialty societies as exampled by the American Society of Interventional Pain Physicians have embraced standards and guidelines and worked to involve their membership in the process by educating them in the method of evidence-based medicine (EBM).9 10 11 12 13 14 15

The Institute of Medicine defines clinical guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”.16 Such guidelines are statements developed and designed to assist both patient and provider in decision-making about the clinical circumstance that they may encounter. Where possible, clinical practice guidelines are statements of best practice that should be based on outcomes data of the treatments we employ.

In 1989, Congress mandated the creation of the Agency for Healthcare Policy and Research. This agency was given broad responsibility for supporting research, data development and related activities. At the same time, the National Academy of Sciences published a document indicating that guidelines are expected to enhance the quality, appropriateness, and effectiveness of healthcare services. While such conclusions might appear to be self-evident, one could argue that these goals have not been …

View Full Text


  • Competing interests None.