1/18/2019: Radiology report "disclaimers" increase the use of abdominal CT in the work-up of pediatric abdominal pain
1/15/2019: Disparities in Radiation Protection Burden from Trauma Evaluation at Pediatric Versus Nonpediatric Institutions
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2018 Butterfly Award
Priscilla Butler, MS, accepted the 2018 Butterfly Award at the 2018 RSNA in Chicago, Illinois on November 26, 2018.
To see previous Butterfly Awards....
By: Scott Alter, MD; Bria Walsh, MD; Patrick Lenehan, MD; Richard Shih, MD
Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a “disclaimer” is associated with additional imaging.
Design: Retrospective cohort. Setting: Community ED with volume of 85,000 annual visits. Population: Consecutive ED patients < 21-years-old with appendix U/S over 12-months. Radiologist reports were assessed for disclaimers and if definitive diagnoses of appendicitis were made. The incidence of subsequent CT imaging was determined and group differences between categories were calculated.
By: Daniel Lodwick MD, MS, Jennifer Cooper MS, Phd, Dani Gonzalez MD, Amy Lawrence MD, Choonsik Lee PhD, Rajesh Krishnamurthy MD, Peter Minneci MD, MHSc, Katherine Deans MD, MHSc
Computed tomography (CT) imaging protocols and prescribing practices vary across institutions. Pediatric trauma patients imaged at a pediatric trauma center (PTC) may receive less radiation than patients imaged at non-PTCs before transfer. Our objective was to determine differences in radiation exposure from imaging performed at a PTC versus non-PTCs.
This retrospective analysis included patients <18 y old who underwent CT imaging from January 2013 to August 2015 during a trauma-related encounter. Radiation doses from CT scans were estimated and compared between scans performed at our PTC and non-PTCs before patient transfer using propensity score–weighted median regression. Results Of 3530 CT scans, 3021 were performed at our PTC and 509 at non-PTCs. Patients imaged at non-PTCs were older and had higher injury severity (all P < 0.05). Patients imaged at non-PTCs more frequently had
•Patients’ awareness regarding imaging radiation dose and risks is overall poor.
•Most patients receive little to no information by their referring doctor regarding dose and risks.
•Awareness of dose and risks can facilitate shared decision making and reduce unnecessary radiation exposure.
•Findings may guide future initiatives to improve patients’ awareness of dose and risks.
Cumulative radiation exposure is linked to increasing the lifetime attributable risk of cancer. To avoid unnecessary radiation exposure and facilitate shared decision making, patients should be aware of these issues. This paper examines patients’ awareness of radiation dose and risks associated with medical imaging examinations.
By: kathryn Tinsley Anderson, Marisa A. Bartz-Kurycki, Mary T. Austin, Akemi L. Kawaguchi, Lillian S. Kao, Kevin P. Lally, Kuojen Tsao
Evidence-based guidelines recommend ultrasound (US) over computed tomography (CT) as the primary imaging modality for suspected pediatricappendicitis. Continued high rates of CT use may result in significant unnecessary radiation exposure in children. The purpose of this study was to evaluate variables associated with preoperative CT use in pediatric appendectomy patients.
A retrospective cohort study of pediatric patients who underwent appendectomy for acute appendicitis in 2015–2016 at National Surgical Quality Improvement Program for Pediatrics (NSQIP-P) hospitals was conducted.
By: Marco Branbilla, Andreana De Mauri, Domenico Lizio, Lucia Leva, Alessandro Carriero, Clara Carpeggiani, Eugenio Picano
The use of diagnostic imaging procedures with ionizing radiation and, in particular, of computed tomography (CT) in childrenrepresents a great benefit for the diagnosis and treatment of benignand malignant conditions.The population-based rates of the use of diagnostic imagingprocedures with ionizing radiation in children in United Stateswere recently reported by Dorfman et al. . They found that theseprocedures were performed in 42.5% of the 355,088 enrolled children and that CT studies, associated with substantially higher dosesof radiation than conventional diagnostic radiology, accounted for11.9% of all procedures and were performed repeatedly in a smallergroup of children (3.5%).The main concern in the use of procedures with radiation is thepotential long-term effect of radiation exposure, namely the wellknown association between radiation and increased cancer risk.Unfortunately, this radiation awareness may be suboptimal indoctors, including pediatricians [2,3].Most important…. [Read more…]
By: J. L. Portelli, J. P. McNulty, P. Bezzina, L. Rainford
To assess how referrers and practitioners disclose benefit-risk information about medical imaging examinations to paediatric patients and their parents/guardians; to gauge their confidence in doing so; and to seek their opinion about who is responsible for disclosing such information.
This study followed on from a previously published study, with a questionnaire distributed in staggered phases to 146 radiographers, 22 radiology practitioners, 55 emergency physicians and 43 paediatricians at a
By: Jason B. Hobbs, MD, Noah Goldstein, BS, Kimberly E. Lind, PhD, MPH, Deirdre Elder, MS, Gerald D. Dodd III, MD, James P. Borgstede, MD
Medical imaging is an increasingly important source of radiation exposure for the general population, and there are risks associated with such exposure; however, recent studies have demonstrated poor understanding of medical radiation among various groups of health care providers. This study had two aims: (1) analyze physicians’ knowledge of radiation exposure and risk in diagnostic imaging across multiple specialties and levels of training, and (2) assess the effectiveness of a brief educational presentation on improving physicians’ knowledge.
One of the worst fears parents have is getting a call from school, from a coach, from highway patrol, or even witnessing themselves that their child suffered a head injury. While more protective headgear during sports and child safety seats in cars has resulted in a decrease in the numbers of severe head injuries on playing fields and in motor vehicle accidents, head injuries in children continue to be a concern, not only in frequency, but in how to manage them. Traumatic Brain Injury (TBI) has become increasingly recognized in children, specifically regarding the need for better monitoring following concussions. A large portion of children with mild head injuries are seen by their primary care doctors, avoiding unnecessary visits to emergency rooms. However, TBI continues to be an issue, and its management has more recently become an area of study. A recent article looked at data from the National Hospital Ambulatory Care Medical Survey databases from 2007-2015, obtaining a representative sample of children under age 18 years visiting emergency departments for head injuries. Of the 14.3 million children studied, 32% underwent CT (computed tomography) scans of the brain if being evaluated for a head injury. These included those with injuries ranging from minor, without loss of consciousness, to major, with severe neurologic damage. There have been many initiatives over the past decade in providing better guidelines to tailor needs of children based on severity of injury, as the vast majority of children with minor or moderate TBI, even with signs of concussion, do not need CT scans. Despite many educational efforts, the 32% rate of CT scans for pediatric head injuries did not decline during the nine-year study period.
Dr. Christopher Giza, director of the UCLA Steve Tisch BrainSPORT Program, has several potential explanations
A children’s book entitled, Learning about X-rays with Lula and Ethan is based on one young child, Ethan, getting a head CT after having a minor playground injury. Read more here....