Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation

Malone, J. F.; Guleria, Rajender; Craven, C. Jackson; Horton, Paul; Järvinen, H; Mayo, John R.; O'Reilly, Geraldine; Picaño, Eugenio; Remedios, D.; Heron, John Le; Rehani, Madan M.; Holmberg, Ola; Czarwinski, Renate

doi:10.1259/bjr/42893576

Cited by 162 publications

(154 citation statements)

References 42 publications

(77 reference statements)

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“…LUS can help to better characterize and stratify the patients, and for the follow-up of lung abnormalities. If these results will be confirmed by further studies on larger populations, the routine use of LUS for pediatric patients with suspected pneumonia could reduce the number of CXR performed, reducing the potentially harmful radiation burden, as now recommended by the Food and Drug Administration (FDA), 30 the International Atomic Energy Agency (IAEA), 31 and the President's Cancer Panel 2010. 32 …”

Section: Resultsmentioning

confidence: 95%

Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

Caiulo

Gargani

Caiulo

et al. 2012

Pediatric Pulmonology

176

161

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Summary. Background: The diagnosis of community-acquired pneumonia (CAP) is based mainly on the patient's medical history and physical examination. However, in severe cases a further evaluation including chest X-ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work-up of pneumonia. Aim: To describe the ultrasonographic appearance of CAP at presentation and during the follow-up. Methods: A total of 102 patients with clinical signs and symptoms suggesting pneumonia, who underwent a clinically driven CXR, were evaluated by LUS on the same day. LUS signs of pneumonia included subpleural lung consolidation, B-lines, pleural line abnormalities, and pleural effusion. The diagnostic gold standard was the ex-post diagnosis of pneumonia made by two independent experienced pediatricians on the basis of clinical presentation, CXR and clinical course following British Thoracic Guidelines recommendations. Results: A final diagnosis of pneumonia was confirmed in 89/102 patients. LUS was positive for the diagnosis of pneumonia in 88/89 patients, whereas CXR was positive in 81/89. Only one patient with normal LUS examination had an abnormal CXR, whereas 8 patients with normal CXR had an abnormal LUS. LUS was able to detect pleural effusion resulting from complicated pneumonia in 16 cases, whereas CXR detected pleural effusion in 3 cases. Conclusions: LUS is a simple and reliable imaging tool, not inferior to CXR in identifying pleuro-pulmonary alterations in children with suspected pneumonia. During the course of the disease, LUS allows a radiation-free follow-up of these abnormalities.

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Section: Resultsmentioning

confidence: 95%

Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

Caiulo

Gargani

Caiulo

et al. 2012

Pediatric Pulmonology

176

161

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“…In diagnostic imaging, justification inevitably includes consideration of any and all of the alternative procedures possibly available that require no or less exposure to ionising radiation [1,2]. Authoritative sources suspect that a considerable proportion of radiological examinations are inappropriate [3]. It is known that knowledge of radiation dose and related risks is poor among both physicians and radiologists, and risks are often underestimated [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…It is known that knowledge of radiation dose and related risks is poor among both physicians and radiologists, and risks are often underestimated [4][5][6]. The International Commission on Radiological Protection has emphasised that education, training and practice play a crucial role in improving the professionalism of justification [3].…”

Section: Discussionmentioning

confidence: 99%

“…However, with respect to justification or its implementation, fewer attempts have been made, and those attempts have not yet been sufficiently successful [3,21]. Optimisation of the radiological examination protocols and dose is extremely important, but careful selection of patients for the examinations and, whenever possible, the use of imaging modalities without ionising radiation, may be equal or more effective tools towards reducing patient dose.…”

Section: Discussionmentioning

confidence: 99%

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Justification of CT examinations in young adults and children can be improved by education, guideline implementation and increased MRI capacity

Tahvonen

Oikarinen²,

Pääkkö³

et al. 2013

BJR

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Objective: To determine whether the justification of CT examinations performed on young patients can be improved by various interventions and whether these have an effect on the total number of CTs performed. Methods: Specific interventions-education, guideline implementation and increased MRI capacity-were introduced at the Oulu University Hospital, Oulu, Finland, following a previous study demonstrating unjustified use of CT examination in young patients. In the present study, the justification of 177 CT examinations of the lumbar and cervical spine, head, abdomen, nasal sinuses and trauma performed on patients aged under 35 years in 2009 was analysed retrospectively by looking at requests and corresponding patient files. The indications of the examinations were compared with the referral guidelines recommended by the European Commission. Results from our previously published similar study carried out before the interventions were used as a reference.

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“…In this cultural and economic milieu, "pay per volume" is the rule, and implementing appropriateness and optimization in your laboratory can be dangerous for your professional survival. 16 This praxis can no longer be accepted, and we need to have more efficient tools than "moral suasion" to force cardiologists to comply with high safety standards. In practice, this is best obtained through a systematic implementation of the 3 A's strategy proposed by the International Atomic Energy Agency in 2012 16 :…”

Section: The Governance Of Radiological Responsibility: the 4 A's Appmentioning

confidence: 99%

Reduction of Radiation to Children

Andreassi

2014

Circulation

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Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation

Cited by 162 publications

References 42 publications

Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

Justification of CT examinations in young adults and children can be improved by education, guideline implementation and increased MRI capacity

Reduction of Radiation to Children

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