Appropriateness of pediatric CT utilization in clinical practice
Keywords:ACR appropriateness criteria, appropriateness, computed tomography, justification, pediatrics
Background: Justification of imaging investigations is important, particularly in pediatrics underwent investigation using a relatively higher radiation such as CT, due to the higher radiation sensitivity of children.
Objective: To assess the difference of viewpoints between pediatric physicians and pediatric radiologists on the appropriateness of pediatric CT utilization in a tertiary-care university hospital with limited MR capacity.
Methods: Pediatric medical records of head CT, chest CT, and abdominal CT were retrospectively reviewed in consecutive date of the examination until having 100 head CTs and 100 body CTs with complete clinical and imaging information. The physicians and the radiologists were asked to suggest the imaging modality of choice for each patient according to the given data, regardless of the hospital’s limitation. If the suggested modality of choice was not CT, the CT request would be considered as “inappropriate”. They additionally scored the CT appropriateness, firstly using individual judgement, and secondly using the ACR Appropriateness Criteria. Both scoring methods used the same rating scale from 1 to 9; score 1-3 was considered “inappropriate”.
Results: From the viewpoint of the physicians and radiologists, the number of inappropriate CT request was 20% and 54% according to “the modality of choice”, 2.5% and 17% according to “individual judgement”, 12% and 22% according to the “ACR Appropriateness Criteria”. The main difference was not from no indication for imaging but from the selected modality of imaging. The radiologists suggested 52% of head CTs and 64% of abdominal CTs could have been replaced by MRI if available.
Conclusion: There are ten-percent disagreement on appropriateness of pediatric CT request between physicians and the radiologists when using the same guidelines and considering the hospital limitation.
Brody AS, Frush DP, Huda W, Brent RL RL; American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography. Pediatrics 2007;120:677-82.
Krille L, Dreger S, Schindel R, Albrecht T, Asmussen M, Barkhausen J, et al. Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys 2015;54:1-12.
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289-96.
Chodick G, Ronckers CM, Shalev V, Ron E. Excess lifetime cancer mortality risk attributable to radiation exposure from computed tomography examinations in children. Isr Med Assoc J 2007;9:584-7.
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380:499-505.
Dovales AC, da Rosa LA, Kesminiene A, Pearce MS, Veiga LH. Patterns and trends of computed tomography usage in outpatients of the Brazilian public healthcare system, 2001-2011. J Radiol Prot 2016;36:547-60.
Pearce MS, Salotti JA, McHugh K, Metcalf W, Kim KP, Craft AW, et al. CT scans in young people in Northern England: trends and patterns 1993-2002. Pediatr Radiol 2011;41:832-8.
Broder J, Fordham LA, Warshauer DM. Increasing utilization of computed tomography in the pediatric emergency department, 2000-2006. Emerg Radiol 2007;14:227-32.
Prabhakar AM, Misono AS, Hemingway J, Hughes DR, Duszak R Jr. Medicare Utilization of CT angiography from 2001 through 2014: continued growth by radiologists. J Vasc Interv Radiol 2016;27:1554-60.
Thomas KE. CT utilization--trends and developments beyond the United States’ borders. Pediatr Radiol 2011;41 Suppl 2:562-6.
European Commission. Radiation protection 118: referral guidelines for imaging [Internet]. [cited 2017 May 9] Available from: https://health.gov.mt/en/forms/Documents/radiation_protection.pdf.
American College of Radiology. ACR Appropriateness Criteria [Internet]. [cited 2019 July 14]. Available from: https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria.
Cascade PN, Webster EW, Kazerooni EA. Ineffective use of radiology: the hidden cost. AJR Am J Roentgenol 1998;170:561-4.
Oikarinen H, Merilainen S, Paakko E, Karttunen A, Nieminen MT, Tervonen O. Unjustified CT examinations in young patients. Eur Radiol 2009;19:1161- 5.
Lehnert BE, Bree RL. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J Am Coll Radiol 2010;7:192-7.
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993;342:1317-22.
Bautista AB, Burgos A, Nickel BJ, Yoon JJ, Tilara AA, Amorosa JK, et al. Do clinicians use the American College of Radiology Appropriateness criteria in the management of their patients? AJR Am J Roentgenol 2009;192:1581-5.
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