A pediatric imaging call to action

A couple of research projects featured in this weeks issue of FierceMedicalImaging illustrate continuing efforts to reduce the amount of radiation children are exposed to as a result of what ends up being inappropriate or unnecessary medical imaging.

In one study, researchers determined that minor head trauma in a child involving the loss of consciousness without any symptoms should not lead to the routine use of computed tomography.

In the other, researchers at the Mayo Clinic have developed a very simple algorithm that can help physicians diagnose appendicitis in children and reduce the need for a CT exam.

Despite these kinds of efforts, as well as others we've documented in FierceMedicalImaging, another group from Mayo believes we should be doing much more, and is calling on the American College of Radiology, the Joint Commission, the Intersociety Accreditation Commission and the Centers for Medicare & Medicaid Services to do something about it.

In a recent commentary published in the Journal of Patient Safety, Stephen Swensen, a radiologist at Mayo Clinic, and colleagues make an "Appeal for Safe and Appropriate Imaging of Children."

In the commentary, the authors pointed out that it has been a dozen years since a pair of articles in the American Journal of Roentgenology raised the issue of the "potentially serious pediatric patient risk from diagnostic imaging." Instead of reacting to those articles with urgency, the authors observed, the radiology community instead "has acted gradually."

Now, the authors want the organizations listed above to withhold the "privilege of imaging children" from hospitals unless they meet certain fundamental safe practice performance measures.

"Our plan is to engage [these organizations] with a proposal to include three safe practice performance measures for accreditation of all American hospitals and advanced diagnostic imaging facilities," they wrote.

These include the "right exam" (the use of the Pediatric Emergency Care Applied Research Network Clinical Prediction Rule for minor head trauma imaging), the "right way" (protocols to reduce dual-phase head and chest CT imaging) and the "right radiation dose" (use of size-specific pediatric CT imaging protocols).

"These safe practices are consistent with our professional obligation to perform imaging on children only when indicated, with the proper protocols, and with the correct radiation dose," the authors wrote.

Accreditation should only be one part of a multidimensional strategy to reduce unnecessary pediatric imaging, they added.

Whether or not withholding accreditation from hospitals is the most effective way of accomplishing the authors' objective, I agree that the medical community can still do a better job of improving the quality and care of the pediatric population when it comes to imaging and radiation risk. The measures they've proposed are a good step in that direction. - Mike (@FierceHealthIT)

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