Abstract
Defining what is appropriate or inappropriate with respect to CT scanning is challenging. There are a variety of influences on scan utilization in children, some more widely recognized and acknowledged than others. It is important to understand the contribution of these elements as we move toward improved utilization. This must be through partnerships and shared efforts and accountability. These efforts include improved resources such as consensus appropriateness criteria and guidelines including decision rules and support. But there also need to be trench-based strategies on the part of practicing radiologists to model cooperative behavior rather than blame-centered behavior.
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References
Slovis TL, Berdon WE (2002) Panel discussion. Pediatr Radiol 32:242–244
Cascade PN, Webster EW, Kazerooni EA (1998) Ineffective use of radiology: the hidden cost. AJR Am J Roentgenol 170:561–564
Venkatesh AK, Kline JA, Courtney DM (2012) Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure: quantifying the opportunity for improvement. Arch Intern Med 172:1028–1032
Frush DP, Applegate K (2004) Computed tomography and radiation: understanding the issues. J Am Coll Radiol 1:113–119
Dorfman AL, Fazel R, Einstein AJ et al (2011) Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med 165:458–464
Sierzenski P, Brink J, Amis ES et al (2014) Application of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine. Ann Emerg Med 63:25–32
Linscott LL, Kessler MM, Kitchen DR et al (2002) CT for pediatric, acute, minor head trauma: clinician conformity to published guidelines. AJNR Am J Neuroradiol 34:1252–1256
ABIM Foundation, ACP–ASIM Foundation, European Federation of Internal Medicine (2002) Medical professionalism in the new millennium: a physician charter. Ann Intern Med 136:243–246
Hricak H, Brenner DJ, Adelstein SJ et al (2011) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258:889–905
American College of Radiology (2013) ACR developing standards to support USPSTF recommended CT lung cancer screening programs. http://www.acr.org/about-us/media-center/press-releases/2013-press-releases/acr-developing-standards-to-support-uspstf-recommended-ct-lung-cancer-screening-programs. Accessed 2 Feb 2014
American College of Radiology (2013) ACR appropriateness criteria. http://www.acr.org/Quality-Safety/Appropriateness-Criteria. Accessed 2 Feb 2014
American College of Radiology (2013) Practice guidelines and technical standards.http://www.acr.org/Quality-Safety/Standards-Guidelines. Accessed 2 Feb 2014
U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (2014) National Guideline Clearinghouse http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CCUQFjAA&url=http%3A%2F%2Fwww.guideline.gov%2F&ei=knXtUpGLB4WCyQGsi4DICQ&usg=AFQjCNFFnQCjAILj74mtVKsU7EMBpX3EeQ. Accessed 2 Feb 2014
Williams CH, Frush DP (2012) Compendium of national guidelines for imaging of the pediatric patient. Pediatr Radiol 42:82–94
Lee SI, Krishnaraj A, Chatterji M et al (2012) When does a radiologist's recommendation for follow-up result in high-cost imaging? Radiology 262:544–549
Frush DP, Frush KS, Oldham KT (2009) Imaging of acute appendicitis in children: EU versus U.S.or US versus CT? A North American perspective. Pediatr Radiol 39:500–505
Joynt KE, Le ST, Orav EJ et al (2014) Compensation of chief executive officers at nonprofit U.S. hospitals. JAMA Intern Med 174:61–67
Levin DC, Rao VM, Parker L et al (2008) Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral. J Am Coll Radiol 5:1206–1209
Levin DC, Rao VM (2011) The effect of self-referral on utilization of advanced diagnostic imaging. AJR Am J Roentgenol 196:848–852
Bhargavan M, Sunshine JH, Hughes DR (2011) Clarifying the relationship between nonradiologists’ financial interest in imaging and their utilization of imaging. AJR Am J Roentgenol 197:W891–W899
Hryhorczuk AL, Mannix RC, Taylor GA (2012) Pediatric abdominal pain: use of imaging in the emergency department in the United States from 1999 to 2007. Radiology 263:778–785
Studdert DM, Mello MM, Sage WM et al (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 293:2609–2617
Massachusetts Medical Society (2008) Investigation of defensive medicine in Massachusetts. Informational Report 1-08-02 November 2008. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CCgQFjAA&url=http%3A%2F%2Fwww.massmed.org%2Fdefensivemedicine%2F&ei=EnztUtbIE4XYyQHU2YCgDg&usg=AFQjCNHfcXfugPmSSyw4Wz6oi9HrPlRMzg&bvm=bv.60444564,d.aWc. Accessed 2 Feb 2014
Bogdanich W (2011) West Virginia hospital overradiated brain scan patients, records show. The New York Times, 5 Mar 2011. http://www.nytimes.com/2011/03/06/health/06radiation.html?_r=1. Accessed 1 Feb 2014
Bogdanich W, McGinty JC (2010) Radiation worries for children in dentist’s chairs. The New York Times. 22 Nov 2010. http://www.nytimes.com/2010/11/23/us/23scan.html?_r=1&pagewanted=allNY. Accessed 1 Feb 2014
Bogdanich W (2009) Radiation overdoses point up dangers of CT scans. The New York Times, 15 Oct 2009. http://www.nytimes.com/2009/10/16/us/16radiation.html?_r=1. Accessed 1 Feb 2014
Redberg RF, Smith-Bindman R (2013) We are giving ourselves cancer. The New York Times (opinion page). http://www.nytimes.com/2014/01/31/opinion/we-are-giving-ourselves-cancer.html?_r=0. Accessed 1 Feb 2014
Lu MT, Tellis WM, Fidelman N et al (2012) Reducing the rate of repeat imaging: import of outside images to PACS. AJR Am J Roentgenol 198:628–634
Hendee WR, Becker GJ, Borgstede JP et al (2010) Addressing overutilization in medical imaging. Radiology 257:240–245
Boland GW, Thrall JH, Gazelle GS et al (2011) Decision support for radiologist report recommendations. J Am Coll Radiol 8:819–823
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Dr. Frush has no financial interests, investigational or off-label uses to disclose.
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Frush, D.P. Deciding why and when to use CT in children: a radiologist’s perspective. Pediatr Radiol 44 (Suppl 3), 404–408 (2014). https://doi.org/10.1007/s00247-014-3016-y
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DOI: https://doi.org/10.1007/s00247-014-3016-y