Skip to main content
SpringerLink
Log in

Imaging utilization commentary: a radiology perspective

  • ALARA: BUILDING BRIDGES BETWEEN RADIOLOGY AND EMERGENCY MEDICINE
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

To adhere to the ALARA concept, imaging should be limited to studies that actually contribute to the management of the patient. For example, by applying the Ottawa Ankle Rule and the Ottawa Knee Rule, fewer radiographs are required to evaluate ankle and knee trauma in children. Chest radiographs usually do not contribute to the management of children presenting with typical acute bronchiolitis or asthma, and they can be detrimental because consolidation resulting from retained secretions is interpreted as pneumonia and the child is started on antibiotics unnecessarily. Moreover, a radiograph of the abdomen has poor validity and reproducibility for the diagnosis of constipation. The Pediatric Emergency Care Applied Research Network (PECARN) and the Pediatric Emergency Research in Canada (PERC) are currently developing decision rules for the use of CT in the assessment of minor head injuries in children, which should reduce its utilization in this condition. PECARN is also developing a decision rule for the use of CT in the assessment of abdominal trauma in children. CT is frequently used for the diagnosis of appendicitis in children, but appendicitis can be diagnosed clinically. If imaging is required, appendicitis can often be diagnosed with US, and CT need only be used in the minority of cases where the diagnosis is still in doubt. Utilization guidelines for pediatric imaging studies obtained in children in the emergency setting can improve yield and help in the more efficient management of often scarce health care resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Broder J, Fordham LA, Warshaver DM (2007) Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006. Emerg Radiol 14:227–232

    Article  PubMed  Google Scholar 

  2. Bhargavan M, Sunshine JH (2005) Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology 234:824–832

    Article  PubMed  Google Scholar 

  3. Picano E (2004) Sustainability of medical imaging. BMJ 328:578–580

    Article  PubMed  Google Scholar 

  4. Mold JW, Stein HF (1986) The cascade effect in the clinical care of patients. N Engl J Med 314:512–514

    PubMed  CAS  Google Scholar 

  5. Rang M (1972) The Ulysses syndrome. Can Med Assoc J 106:122–123

    PubMed  CAS  Google Scholar 

  6. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  PubMed  CAS  Google Scholar 

  7. Brody AS, Frush DP, Huda W et al (2007) Radiation risk to children from computed tomography. Pediatrics 120:677–682

    Article  PubMed  Google Scholar 

  8. Stiell IG, Greenberg GH, McKnight RD et al (1993) Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA 269:1127–1132

    Article  PubMed  CAS  Google Scholar 

  9. Stiell I, Wells G, Laupacis A et al (1995) Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group. BMJ 311:594–597

    PubMed  CAS  Google Scholar 

  10. Leddy JJ, Kesari A, Smolinski RJ (2002) Implementation of the Ottawa ankle rule in a university sports medicine center. Med Sci Sports Exerc 34:57–62

    Article  PubMed  Google Scholar 

  11. Wynn-Thomas S, Love T, McLeod D et al (2002) The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical centres in New Zealand. NZ Med J 115:U184

    Google Scholar 

  12. Plint AC, Bulloch B, Osmond MH et al (1999) Validation of the Ottawa ankle rules in children with ankle injuries. Acad Emerg Med 6:1005–1009

    Article  PubMed  CAS  Google Scholar 

  13. Chande VT (1995) Decision rules for roentgenography of children with acute ankle injuries. Arch Pediatr Adolesc Med 149:255–258

    PubMed  CAS  Google Scholar 

  14. Stiell IG, Wells GA, Hoag RH et al (1997) Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA 278:2075–2079

    Article  PubMed  CAS  Google Scholar 

  15. Stiell IG, Greenberg GH, Wells GA et al (1996) Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA 275:611–615

    Article  PubMed  CAS  Google Scholar 

  16. Emparanza JI, Aginaga JR, Estudio Multicentro en Urgencias de Osakidetza: Reglas de Ottawa (EMUORO) Group (2001) Validation of the Ottawa knee rules. Ann Emerg Med 38:364–368

    Article  PubMed  CAS  Google Scholar 

  17. Bulloch B, Neto G, Plint A et al (2003) Validation of the Ottawa Knee Rule in children: a multicenter study. Ann Emerg Med 42:48–55

    Article  PubMed  Google Scholar 

  18. Brehaut JC, Stiell IG, Visentin L et al (2005) Clinical decision rules “in the real world”: how a widely disseminated rule is used in everyday practice. Acad Emerg Med 12:948–956

    Article  PubMed  Google Scholar 

  19. Bishop JY, Flatow EL (2005) Pediatric shoulder trauma. Clin Orthop 432:41–48

    PubMed  Google Scholar 

  20. Schuh S, Amina L, Upton A et al (2007) Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr 150:429–433

    Article  PubMed  Google Scholar 

  21. Bordley WC, Viswanathan M, King VJ et al (2004) Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 158:119–126

    Article  PubMed  Google Scholar 

  22. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (2006) Diagnosis and management of bronchiolitis. Pediatrics 118:1774–1793

    Article  Google Scholar 

  23. Philippe M, Mouillet E, Rachid LS (2006) Comparison of medical subject headings and standard terminology regarding performance of diagnostic tests. J Med Libr Assoc 94:221–223

    Google Scholar 

  24. Leech SC, McHugh K, Sullivan PB (1999) Evaluation of a method of assessing fecal loading on plain abdominal radiographs in children. Pediatr Radiol 29:255–258

    Article  PubMed  CAS  Google Scholar 

  25. de Lorijn F, vanRijn RR, Heijmans J et al (2006) The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy. Pediatr Radiol 36:43–49

    Article  PubMed  Google Scholar 

  26. Klassen TP, Reed MH, Stiell IG et al (2000) Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience. Acad Emerg Med 7:739–744

    Article  PubMed  CAS  Google Scholar 

  27. Palchak MJ, Holmes JF, Vance CW et al (2003) A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 42:492–506

    Article  PubMed  Google Scholar 

  28. Dunning J, Daly JP, Lomas JP et al (2006) Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 91:885–891

    Article  PubMed  CAS  Google Scholar 

  29. Oman JA, Cooper RJ, Holmes JF et al (2006) Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatics 117:e238–e246

    Article  Google Scholar 

  30. Pediatric Emergency Care Applied Research Network. https://www.pecarn.org/currentResearch/index.html. Accessed 5 March, 2008

  31. Ruess L, Sivit CJ, Eichelberger MR et al (1997) Blunt abdominal trauma in children: impact of CT on operative and nonoperative management. AJR 169:1011–1014

    PubMed  CAS  Google Scholar 

  32. Jindal A, Velmahos GC, Rofougaran R (2002) Computed tomography for evaluation of mild to moderate pediatric trauma: are we overusing it? World J Surg 26:13–16

    Article  PubMed  Google Scholar 

  33. Kosloske AM, Love CL, Rohrer JE et al (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:29–34

    Article  PubMed  Google Scholar 

  34. Smink DS, Finkelstein JA, Garcia Pena BM et al (2004) Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg 39:458–463

    Article  PubMed  Google Scholar 

  35. Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT—a prospective randomized study. Radiology 223:633–638

    Article  PubMed  Google Scholar 

  36. Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Diagnostic Imaging, Children’s Hospital, Health Sciences Centre, University of Manitoba, Winnipeg, Canada

    Martin H. Reed

  2. Department of Radiology, Children’s Hospital, 840 Sherbrook St., Winnipeg, Manitoba, Canada, R3A 1S1

    Martin H. Reed

Authors
  1. Martin H. Reed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin H. Reed.

Additional information

Dr. Reed has no relevant financial relationships or potential conflicts of interest related to the material to be presented.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reed, M.H. Imaging utilization commentary: a radiology perspective. Pediatr Radiol 38 (Suppl 4), 660–663 (2008). https://doi.org/10.1007/s00247-008-0982-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-008-0982-y

Keywords

Search

Navigation