RSNA 2014: Too many children receive unnecessary chest X-rays

Researchers at the Mayo Clinic in Rochester, Minnesota, have determined that in most cases, X-ray procedures performed on children with chest pain and other symptoms are unnecessary and provide no clinical benefit, according to a study presented Dec. 3, at the annual meeting of the Radiological Society of North America in Chicago.

For the study, Ann Packard, a radiologist at Mayo Clinic, and co-author, Kristin B. Thomas, head of the pediatric division at Mayo Clinic and an assistant professor of radiology at Mayo Medical School, analyzed data from more than 700 pediatric chest X-rays order between 2008 and 2014 in Mayo's outpatient, inpatient and emergency room settings.

While the American College of Radiology has issued appropriateness criteria for chest radiography in adults, "there are limited guidelines for chest X-rays in kids, with the exception of fever of unknown origin," Packard said at a press conference. "This prompted our study."

The symptoms for which the exams were ordered included chest pain, dizziness, fainting, posture orthostatic hypotension (a condition in which a person's blood pressure suddenly drops when that individual stands up from a sitting or prone position), and spells (or a general feeling of being unwell).

Packard and Thomas found that every X-ray ordered for problems such as fainting or dizziness did not change treatment.

Forty-five of the 330 chest X-rays ordered for chest pain were positive, with the most common finding being that of pneumonia. But, according to Packard, 88 percent of the exams ordered for chest pain had no effect on treatment.

"Chest X-rays can be a valuable exam when ordered for the correct indications, Packard said. "However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost. This study addresses both of these issues, which is important not only for physicians but also for young patients and their parents."

To learn more:
- here's the study abstract (.pdf)