Scenario Analysis: Preparing for an advanced review in Oral and Maxillofacial Radiology, particularly one focused on quality and safety in the Indo-Pacific region, presents a unique challenge. Candidates must navigate a vast amount of information, identify the most relevant and current best practices, and understand the specific regulatory landscape applicable to their practice within the Indo-Pacific context. The difficulty lies in discerning high-yield preparation materials from general radiology resources and in aligning study efforts with the quality and safety standards expected in a specialized, regional review. Effective preparation requires a strategic, evidence-based approach rather than a haphazard one. Correct Approach Analysis: The best approach involves a structured, multi-faceted strategy that prioritizes official guidelines and peer-reviewed literature directly relevant to Indo-Pacific quality and safety standards in Oral and Maxillofacial Radiology. This includes consulting the latest recommendations from recognized professional bodies within the Indo-Pacific region, such as national radiology associations or regional quality assurance committees. Furthermore, engaging with recent, high-impact peer-reviewed articles focusing on quality improvement, radiation safety protocols, and diagnostic accuracy in oral and maxillofacial imaging is crucial. A timeline should be developed that allocates sufficient time for in-depth review of these prioritized resources, incorporating practice questions and case study analysis to solidify understanding and identify knowledge gaps. This method ensures that preparation is targeted, up-to-date, and aligned with the specific requirements of the advanced review, thereby maximizing the likelihood of success and promoting adherence to regional best practices. Incorrect Approaches Analysis: Relying solely on general radiology textbooks published several years ago, without considering their applicability to current Indo-Pacific quality and safety standards, is an inadequate approach. Such materials may not reflect the latest advancements in technology, evolving safety protocols, or specific regional regulatory nuances, leading to a knowledge base that is outdated and potentially misaligned with the review’s objectives. Focusing exclusively on a broad range of international radiology journals without a specific filter for oral and maxillofacial radiology or quality and safety aspects relevant to the Indo-Pacific region is also problematic. While these journals contain valuable information, the sheer volume and lack of targeted focus can lead to inefficient study and a failure to grasp the most critical elements for the review. This approach risks diluting effort on less relevant topics. Devoting the majority of preparation time to memorizing a large volume of historical case studies without understanding the underlying quality and safety principles or their regional context is another flawed strategy. While case studies are important for application, without a foundational understanding of the principles and regulatory framework, memorization alone does not equate to competent practice or the ability to critically evaluate quality and safety measures. Professional Reasoning: Professionals facing this preparation challenge should adopt a systematic approach. First, identify the precise scope and expected learning outcomes of the Advanced Indo-Pacific Oral and Maxillofacial Radiology Quality and Safety Review. Second, research and prioritize authoritative sources, including regional professional bodies, regulatory guidelines, and recent, high-impact peer-reviewed literature specifically addressing quality and safety in oral and maxillofacial radiology within the Indo-Pacific context. Third, develop a realistic study timeline that allows for thorough comprehension, application through practice questions and case reviews, and iterative refinement of knowledge. Finally, seek feedback from peers or mentors if possible to validate understanding and identify areas requiring further attention. This structured, evidence-based, and context-aware methodology ensures efficient and effective preparation.

Scenario Analysis: This scenario is professionally challenging because it requires a radiologist to navigate the nuanced requirements for advanced quality and safety reviews within a specific regional framework, the Indo-Pacific. Misinterpreting the purpose or eligibility criteria can lead to wasted resources, non-compliance, and ultimately, compromised patient care and safety standards. The challenge lies in discerning the precise intent and scope of the “Advanced Indo-Pacific Oral and Maxillofacial Radiology Quality and Safety Review” beyond a general understanding of quality assurance. Correct Approach Analysis: The best professional practice involves a thorough understanding that the Advanced Indo-Pacific Oral and Maxillofacial Radiology Quality and Safety Review is specifically designed to elevate diagnostic accuracy, patient safety protocols, and the overall standard of care in oral and maxillofacial radiology across participating Indo-Pacific nations. Eligibility is typically determined by adherence to established regional quality benchmarks, demonstrated commitment to continuous professional development in advanced imaging techniques, and a proactive approach to implementing evidence-based safety practices. This approach is correct because it aligns with the fundamental principles of regulatory compliance and professional responsibility, ensuring that advanced reviews serve their intended purpose of enhancing regional radiology standards and patient outcomes. Incorrect Approaches Analysis: One incorrect approach is to assume the review is a generic accreditation process applicable to any radiology practice globally. This fails to acknowledge the specific “Indo-Pacific” designation, which implies adherence to regional guidelines and standards that may differ from international norms. Such a broad interpretation neglects the targeted nature of the review and its potential focus on specific regional challenges or advancements. Another incorrect approach is to believe that simply possessing advanced imaging equipment automatically qualifies a practice for the review. While advanced technology is a component of quality, the review’s purpose extends beyond equipment to encompass the radiologist’s expertise, interpretation skills, safety protocols, and the overall quality management system. Focusing solely on hardware overlooks the critical human and procedural elements essential for advanced quality and safety. A further incorrect approach is to view the review as an optional enhancement rather than a potentially mandatory or highly recommended component for practices aiming for the highest standards within the Indo-Pacific region. This perspective undervalues the review’s role in establishing and maintaining a benchmark for excellence and may lead to a lack of proactive engagement, thereby missing opportunities for significant quality improvement and potential regulatory alignment. Professional Reasoning: Professionals should approach such reviews by first identifying the specific regulatory body or governing entity overseeing the “Advanced Indo-Pacific Oral and Maxillofacial Radiology Quality and Safety Review.” Subsequently, they must consult the official documentation, guidelines, and eligibility criteria published by that entity. This involves understanding the review’s stated objectives, the scope of its assessment, and the specific requirements for participation. A proactive stance, seeking clarification from the governing body when necessary, is crucial to ensure accurate understanding and successful engagement with the review process, ultimately benefiting patient safety and diagnostic quality.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for diagnostic information with the ethical and regulatory obligations to ensure patient safety and informed consent, particularly when dealing with potentially vulnerable patients or complex imaging procedures. The radiologist must navigate potential conflicts between the referring clinician’s request and the patient’s best interests, adhering to established quality and safety standards. Correct Approach Analysis: The best professional practice involves a comprehensive review of the referral, including a thorough assessment of the clinical indication and the necessity of the proposed imaging modality. This includes verifying patient identification, reviewing previous relevant imaging and medical history, and confirming that the requested examination is appropriate and aligns with established diagnostic protocols and patient safety guidelines. This approach is correct because it prioritizes patient well-being and adherence to quality assurance standards, ensuring that the imaging procedure is justified, safe, and will yield diagnostically useful information. It directly addresses the core principles of responsible medical practice and regulatory compliance by proactively identifying potential risks and ensuring the procedure is clinically sound. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the imaging request solely based on the referring clinician’s directive without independent verification or critical assessment of the clinical indication. This fails to uphold the radiologist’s professional responsibility to ensure the appropriateness and safety of the examination, potentially leading to unnecessary radiation exposure or the performance of an ineffective diagnostic procedure. It bypasses essential quality control measures and can be seen as a dereliction of duty to the patient. Another incorrect approach is to defer all decision-making to the referring clinician, assuming their request is always optimal and requires no radiologist input beyond execution. This undermines the collaborative nature of patient care and the radiologist’s expertise in imaging. It neglects the radiologist’s role in quality assurance and patient safety, potentially overlooking contraindications or alternative, safer diagnostic pathways. A further incorrect approach is to prioritize speed of service over thoroughness, initiating the imaging procedure without adequately confirming all necessary pre-procedural checks. This can lead to errors in patient identification, incorrect imaging protocols, or overlooking critical patient factors that might influence the procedure’s safety or diagnostic yield. Such haste compromises the integrity of the diagnostic process and patient safety. Professional Reasoning: Professionals should adopt a systematic, patient-centered approach. This involves critically evaluating every referral, engaging in clear communication with the referring clinician when necessary, and adhering strictly to established protocols for patient identification, consent, and procedural safety. The decision-making process should be guided by a commitment to evidence-based practice, ethical principles, and regulatory requirements, always prioritizing the patient’s well-being and the quality of diagnostic information.

Scenario Analysis: This scenario presents a professional challenge in maintaining the highest standards of quality and safety in an advanced oral and maxillofacial radiology practice, specifically concerning the selection and management of dental materials, biomaterials, and infection control protocols. The complexity arises from the rapid evolution of biomaterials, the potential for subtle cross-contamination, and the critical need to align practice with current regulatory expectations and ethical obligations to patient well-being. A radiologist must not only possess technical expertise but also a robust understanding of material science and infection prevention to ensure diagnostic accuracy and patient safety. Correct Approach Analysis: The best professional practice involves a proactive and evidence-based approach to material selection and infection control. This includes establishing a rigorous protocol for evaluating new dental materials and biomaterials based on their documented biocompatibility, longevity, and potential for interference with imaging modalities, as well as their adherence to relevant national and international standards for medical devices. Furthermore, it necessitates the continuous review and enhancement of infection control procedures, including sterilization, disinfection, and waste management, ensuring they meet or exceed current guidelines from reputable bodies such as the World Health Organization (WHO) and national health authorities. This approach prioritizes patient safety, diagnostic integrity, and regulatory compliance by embedding quality and safety into the core operational framework of the practice. Incorrect Approaches Analysis: Relying solely on historical material usage without periodic re-evaluation fails to address advancements in biomaterials and potential emerging risks, potentially leading to the use of suboptimal or even hazardous materials. This approach neglects the ethical duty to provide the best available care and may contravene regulatory requirements for using approved and safe materials. Adopting infection control measures based on anecdotal evidence or outdated practices poses a significant risk of inadequate sterilization or disinfection, increasing the likelihood of healthcare-associated infections. This directly violates fundamental ethical principles of patient care and contravenes stringent regulatory mandates for infection prevention in healthcare settings. Implementing new materials or infection control techniques without consulting peer-reviewed literature or regulatory guidance introduces an element of guesswork into critical safety processes. This lack of evidence-based decision-making is professionally irresponsible and ethically unsound, as it prioritizes convenience or novelty over established safety and efficacy standards mandated by regulatory bodies. Professional Reasoning: Professionals should adopt a systematic decision-making process that begins with understanding the specific context and potential risks. This involves consulting current, authoritative guidelines and regulations from relevant national and international health and professional bodies. A critical evaluation of available evidence, including peer-reviewed research and manufacturer data, is essential when selecting materials or updating protocols. Continuous professional development and a commitment to lifelong learning are crucial to stay abreast of advancements in biomaterials and infection control. Finally, a culture of safety that encourages open reporting of near misses and adverse events should be fostered to drive ongoing improvement.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s assessment of their best interests, compounded by the need for effective interprofessional communication and referral within the Indo-Pacific healthcare context. Navigating this requires a delicate balance of respecting patient autonomy while ensuring appropriate care and adhering to ethical and professional standards. The best approach involves a thorough and documented discussion with the patient regarding the radiologist’s findings, the implications for their oral and maxillofacial health, and the rationale for referral to a specialist. This discussion should clearly outline the benefits of specialist consultation, address any patient concerns or misconceptions, and explore alternative management strategies if feasible and safe. Obtaining informed consent for the referral, or documenting the patient’s refusal and the consequences thereof, is paramount. This aligns with the ethical principles of patient autonomy and beneficence, and professional guidelines that mandate clear communication and shared decision-making. In many Indo-Pacific jurisdictions, patient rights and informed consent are legally enshrined, and professional bodies emphasize the importance of patient-centered care. An incorrect approach would be to proceed with the referral without a comprehensive discussion, assuming the patient will understand or accept the necessity. This fails to uphold the principle of informed consent and can lead to patient distrust and non-compliance. Another incorrect approach is to dismiss the patient’s concerns outright and insist on the referral without exploring their perspective or providing adequate explanation. This demonstrates a lack of respect for patient autonomy and can be perceived as paternalistic, violating ethical standards of patient-provider relationships. Finally, failing to document the discussion and the patient’s decision, regardless of the outcome, represents a significant professional and potentially legal failing, as it leaves no record of due diligence or adherence to best practices in patient management and communication. Professionals should employ a structured decision-making process that prioritizes understanding the patient’s perspective, clearly communicating clinical findings and recommendations, exploring all reasonable options, and ensuring informed consent or documented refusal. This process should be iterative, allowing for questions and addressing concerns throughout.

Scenario Analysis: This scenario presents a professional challenge in balancing the need for consistent quality and safety in advanced oral and maxillofacial radiology with the practicalities of professional development and program integrity. Determining appropriate blueprint weighting, scoring thresholds, and retake policies requires careful judgment to ensure that the review process is both rigorous and fair, reflecting the evolving standards of the field. The challenge lies in establishing criteria that accurately assess competency without being unduly punitive or creating barriers to entry for qualified professionals. Correct Approach Analysis: The best professional practice involves a transparent and evidence-based approach to blueprint weighting, scoring, and retake policies. This means that the blueprint, which outlines the knowledge and skills assessed, should be developed collaboratively with subject matter experts and regularly updated to reflect current best practices and technological advancements in Indo-Pacific oral and maxillofacial radiology. Scoring thresholds should be set based on psychometric analysis to ensure they accurately differentiate between competent and less competent candidates, rather than arbitrary cut-offs. Retake policies should be clearly defined, offering opportunities for remediation and re-assessment after a defined period, with clear guidance on how candidates can improve their performance. This approach is correct because it aligns with principles of fair assessment, professional accountability, and continuous quality improvement, as often emphasized in professional accreditation and certification standards globally, ensuring that the review process serves its intended purpose of upholding high standards of patient care. Incorrect Approaches Analysis: One incorrect approach would be to base blueprint weighting solely on the perceived difficulty of topics without empirical data or expert consensus, leading to an unbalanced assessment that may not accurately reflect the importance of different areas in clinical practice. Setting scoring thresholds arbitrarily, without psychometric validation, risks either being too lenient, compromising the review’s effectiveness, or too stringent, unfairly excluding qualified professionals. Furthermore, a retake policy that is overly restrictive, with long waiting periods or limited opportunities, can hinder professional development and create unnecessary obstacles. Another incorrect approach involves making significant changes to the blueprint weighting or scoring thresholds without adequate notice or justification to candidates. This lack of transparency and communication can undermine the fairness and credibility of the review process. Retake policies that do not offer constructive feedback or guidance on areas for improvement are also problematic, as they fail to support candidates in their professional development. A third incorrect approach would be to rely on outdated blueprints and assessment criteria that do not reflect current advancements in Indo-Pacific oral and maxillofacial radiology. This can lead to the assessment of knowledge and skills that are no longer relevant or fail to evaluate emerging critical competencies. Retake policies that are inconsistent or applied subjectively, without clear guidelines, introduce an element of unfairness and unpredictability. Professional Reasoning: Professionals should approach blueprint weighting, scoring, and retake policies with a commitment to fairness, validity, and reliability. This involves: 1) establishing a clear and defensible rationale for all assessment criteria, grounded in current professional practice and evidence; 2) ensuring transparency in communication with candidates regarding all policies and procedures; 3) regularly reviewing and updating assessment frameworks to maintain relevance and rigor; and 4) implementing policies that support professional development and provide equitable opportunities for all qualified individuals to demonstrate competency.

Scenario Analysis: This scenario presents a professional challenge in balancing the need for comprehensive diagnostic imaging with patient safety and resource optimization. The radiologist must critically evaluate the necessity of additional imaging modalities beyond the initial request, considering potential benefits against radiation exposure, cost, and patient inconvenience, all within the framework of established quality and safety standards for Indo-Pacific oral and maxillofacial radiology. Careful judgment is required to avoid both under-investigation and over-investigation. Correct Approach Analysis: The best professional practice involves a thorough review of the initial clinical information and radiographic findings to determine if the requested imaging adequately addresses the diagnostic question. If the initial imaging reveals ambiguities or suggests further pathology that is directly relevant to the patient’s presenting complaint and could impact treatment planning, then a discussion with the referring clinician to justify and obtain consent for additional, targeted imaging is the most appropriate course of action. This approach adheres to the principles of evidence-based practice and patient-centered care, ensuring that any further investigations are clinically indicated and contribute meaningfully to the diagnostic process and subsequent treatment plan, thereby upholding quality and safety standards by avoiding unnecessary radiation exposure and resource utilization. Incorrect Approaches Analysis: One incorrect approach involves proceeding with additional imaging modalities without a clear clinical indication or discussion with the referring clinician. This fails to adhere to the principle of judicious use of diagnostic imaging, potentially exposing the patient to unnecessary radiation and increasing healthcare costs without a commensurate diagnostic benefit. It also bypasses the collaborative aspect of patient care, undermining the referring clinician’s role in treatment planning. Another incorrect approach is to dismiss the need for further investigation solely based on the initial request, even if the radiographic findings clearly suggest a significant pathology that was not initially anticipated and is crucial for accurate treatment planning. This can lead to incomplete diagnoses and suboptimal treatment outcomes, failing to meet the quality and safety standards expected in advanced radiology practice. A third incorrect approach is to recommend a broad range of advanced imaging techniques without a specific diagnostic rationale, simply to be exhaustive. This demonstrates a lack of critical analysis and can lead to significant patient inconvenience, increased radiation dose, and unnecessary expenditure, without necessarily improving the diagnostic yield or treatment planning accuracy. Professional Reasoning: Professionals should adopt a systematic approach to image interpretation and treatment planning. This begins with a thorough understanding of the clinical history and the diagnostic question posed by the referring clinician. Following this, a meticulous interpretation of the initial imaging is performed, identifying any findings that are pertinent to the clinical question or suggest alternative diagnoses. If further imaging is deemed necessary, the rationale must be clearly articulated, and this should be communicated to the referring clinician for collaborative decision-making and appropriate patient consent. This iterative process ensures that diagnostic investigations are targeted, efficient, and ultimately contribute to optimal patient care and safety.

The investigation demonstrates a scenario where a radiologist must interpret complex imaging findings in the context of a patient’s evolving clinical presentation. The professional challenge lies in balancing the need for timely and accurate diagnosis with the ethical imperative to communicate findings responsibly and avoid causing undue patient anxiety or influencing treatment decisions prematurely. Careful judgment is required to determine the appropriate level of detail and certainty in reporting, especially when findings are subtle or require further investigation. The best approach involves a comprehensive interpretation of the radiographic findings, correlating them with the available clinical information, and clearly articulating any limitations or areas requiring further assessment. This includes identifying definitive findings, suggesting differential diagnoses for ambiguous findings, and recommending appropriate follow-up imaging or consultations. This approach is correct because it adheres to the principles of professional responsibility in medical imaging, ensuring that the report is both informative and clinically actionable, while also respecting the patient’s right to understand their condition. It aligns with the ethical obligation to provide accurate and unbiased diagnostic information to the referring clinician, enabling informed patient management. An approach that focuses solely on identifying gross abnormalities without considering subtle findings or their clinical implications is incorrect. This failure to conduct a thorough analysis can lead to missed diagnoses or incomplete assessments, potentially delaying appropriate treatment. Similarly, an approach that overstates the certainty of findings when they are equivocal or based on limited information is professionally unacceptable. This can lead to misdiagnosis, unnecessary interventions, and patient distress. An approach that neglects to recommend appropriate follow-up or correlation with other diagnostic modalities fails to provide a complete diagnostic service and can hinder effective patient care. Professionals should employ a systematic decision-making process that begins with a thorough review of the imaging study, followed by a critical correlation with all available clinical data. This process should include a consideration of the differential diagnoses for all observed findings, with a clear articulation of the most likely diagnosis and any significant alternatives. The report should then be structured to clearly communicate these findings, including any uncertainties or recommendations for further investigation, in a manner that is understandable to the referring clinician.

Scenario Analysis: This scenario presents a professional challenge due to the inherent variability in craniofacial anatomy and the potential for subtle oral pathologies to manifest with non-specific radiographic findings. The radiologist must balance the need for thorough diagnostic imaging with the principle of minimizing radiation exposure to the patient, adhering to the ALARA (As Low As Reasonably Achievable) principle. The quality and safety review necessitates an evaluation of the radiologist’s decision-making process in selecting appropriate imaging techniques and interpreting findings within the context of established quality standards. Correct Approach Analysis: The best professional practice involves a systematic approach that begins with a comprehensive review of the patient’s clinical history and the referring clinician’s specific diagnostic question. This is followed by the selection of the most appropriate imaging modality and technique that will provide the necessary diagnostic information with the lowest possible radiation dose. For suspected craniofacial anomalies or subtle oral pathologies, a detailed panoramic radiograph or a cone-beam computed tomography (CBCT) scan, depending on the diagnostic question, would be considered. The radiologist must then meticulously analyze the acquired images, correlating radiographic findings with anatomical landmarks and known pathological presentations, while critically evaluating image quality for diagnostic adequacy. This approach prioritizes diagnostic accuracy and patient safety by ensuring that the imaging chosen is both effective and judicious in its radiation use, aligning with the fundamental principles of responsible radiological practice. Incorrect Approaches Analysis: One incorrect approach would be to routinely order the highest resolution imaging modality, such as a full maxillofacial CBCT scan, for all suspected oral pathologies without a clear clinical indication. This fails to adhere to the ALARA principle by potentially exposing the patient to unnecessary radiation and increasing the cost of care without a commensurate increase in diagnostic benefit. Another incorrect approach would be to rely solely on a limited number of standard intraoral radiographs when the clinical question suggests a more complex anatomical region or potential pathology that requires a broader field of view or three-dimensional assessment. This could lead to missed diagnoses or incomplete information, compromising patient care. A third incorrect approach would be to interpret images without a thorough understanding of normal craniofacial anatomy and the potential variations, or without considering the differential diagnoses for observed radiographic findings, leading to misinterpretation and potentially incorrect treatment recommendations. Professional Reasoning: Professionals should adopt a problem-solving framework that begins with understanding the clinical context. This involves actively seeking information from the referring clinician to define the diagnostic objective. Subsequently, the radiologist must apply their knowledge of imaging physics, anatomy, histology, and pathology to select the most suitable imaging technique, always mindful of radiation safety guidelines. The interpretation phase requires critical analysis, correlation with clinical data, and consideration of differential diagnoses. Finally, clear and concise communication of findings and recommendations to the referring clinician is paramount for effective patient management.

This scenario presents a professional challenge because it requires the radiologist to balance the immediate diagnostic needs of the patient with the long-term implications of radiation exposure, particularly in the context of preventive dentistry and the potential for cumulative effects. The Indo-Pacific region, while diverse, generally adheres to principles of radiation protection that emphasize justification, optimization, and limitation of dose. The challenge lies in applying these principles judiciously to a patient presenting with recurrent symptoms, where the diagnostic benefit must be weighed against the ALARA (As Low As Reasonably Achievable) principle. The best professional practice involves a comprehensive assessment of the patient’s history, clinical signs, and previous radiographic findings to determine the most appropriate imaging modality and technique. This includes considering the use of lower-dose imaging options where diagnostically equivalent, and employing appropriate shielding and collimation. Specifically, if a digital intraoral radiograph can provide sufficient diagnostic information to assess the suspected recurrent caries or periodontal changes, it would be the preferred initial approach due to its significantly lower radiation dose compared to extraoral techniques. This aligns with the principle of optimization, ensuring that the dose is kept as low as reasonably achievable while still obtaining the necessary diagnostic information. Furthermore, adherence to established quality assurance protocols for radiographic equipment and processing ensures that images are of diagnostic quality, minimizing the need for repeat exposures. An incorrect approach would be to immediately resort to a higher-dose extraoral radiographic technique, such as a panoramic radiograph, without first exploring the diagnostic utility of lower-dose intraoral imaging. This fails to adhere to the optimization principle, as a potentially sufficient diagnostic yield could be achieved with a significantly lower radiation dose. This approach prioritizes expediency over radiation protection. Another incorrect approach would be to proceed with imaging without adequately reviewing the patient’s previous radiographic records. This could lead to unnecessary repeat imaging or the selection of an inappropriate modality, failing to leverage existing diagnostic information and potentially exposing the patient to additional radiation without clear justification. It neglects the principle of justification, as the need for new imaging should be clearly established based on the current clinical presentation and available history. Finally, an incorrect approach would be to perform the radiograph without ensuring all necessary radiation protection measures are in place, such as appropriate lead shielding for the patient and proper collimation of the X-ray beam. This directly violates the principle of limitation, which aims to prevent deterministic effects and keep stochastic effects as low as reasonably achievable. Professionals should employ a decision-making framework that begins with a thorough clinical assessment and review of patient history. This should be followed by an evaluation of available imaging modalities, prioritizing those with the lowest radiation dose that can still provide the necessary diagnostic information. Strict adherence to radiation protection principles (justification, optimization, limitation) and established quality assurance protocols is paramount. When in doubt, consultation with experienced colleagues or a review of current evidence-based guidelines is recommended.