Radiographs and aluminium: a pitfall for the unwary

Bradburn, D. M.; Carr, H; Renwick, Ian

doi:10.1136/bmj.308.6938.1226

Cited by 18 publications

(7 citation statements)

References 3 publications

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“…The low radiodensity of aluminium makes it almost "invisible" on radiographs, and the superiority of an HHMD at identifying ingested aluminium objects has been documented elsewhere. [29][30][31] Seikel et al 21 attempted to show that no training was required to be able to use the HHMD effectively. A convenience sample of non-doctors (such as porters and receptionists), with no previous experience in the use of a HHMD followed written instructions and scanned a maximum of one child each.…”

Section: Discussionmentioning

confidence: 99%

Detection of coins ingested by children using a handheld metal detector: a systematic review

Lee

2005

Emergency Medicine Journal

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To determine if the use of a handheld metal detector (HHMD) can safely reduce the number of radiographs requested in cases of coins ingested by children, a search was performed to identify prospective studies of the ability of an HHMD to identify the presence or absence of ingested coin in children (17 years or younger). Outcome measures were presence or absence of coin on metal detector screening, and accuracy of coin localisation. Inclusion and exclusion criteria were defined. MantelHaenszel (fixed effect model) pooling with 95% confidence intervals (CI) was used to calculate overall sensitivities and specificities. In total, 11 studies met the inclusion criteria. The overall sensitivity of the HHMD at detecting the presence of coins was 99.4% (95% CI 98.0 to 99.9%) and accuracy at localisation was 99.8% (98.5 to 100.0%). The overall specificity of the HHMD was 100% (76.8 to 100%). Use of the HHMD is an accurate, radiation free, and cost effective method of identifying and localising coins ingested by children. An algorithm for investigating children with coin ingestion is proposed. and other countries worldwide, 2-7 the ingested object that most frequently results in hospital attendance is a metal coin. A postal survey of parents in the US found that 4% of children had swallowed a coin at some time. Although the proportion of patients who are symptomatic following coin ingestion ranges from 7% to 64%, depending on the study chosen, 1 14 15 there is consensus that absence of symptoms does not exclude the presence of an impacted coin. Hence, most patients undergo radiological investigation. The use of a metal detector to determine presence or absence of metal foreign bodies as an alternative to standard radiographs has been advocated for more than 30 years, 16 yet, despite obvious advantages (time and lack of radiation) over standard radiographs, metal detector use has not been widely adopted in the UK.The aim of this review was to determine if the use of a handheld metal detector (HHMD) could safely reduce the number of radiographs requested in cases of coins ingested by children. METHODSCriteria for selection of studies Only prospective assessments of the ability of an HHMD to identify the presence or absence of ingested coins in children (17 years or below) were included. Outcome measures had to include either presence or absence of coin on metal detector screening, or accuracy of coin localisation. Case reports, editorials, and opinions were excluded.Studies were scored for internal and external validity and were excluded if the following criteria were not met. (a) The gold standard (radiograph(s)) was applied in all cases regardless of result. The gold standard investigation was considered to be a chest radiograph as a minimum. Serial radiographs, performed until a coin was located or excluded, were considered an acceptable alternative. (b) The HHMD operator was blinded to the results of the gold standard investigation.

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Section: Discussionmentioning

confidence: 99%

Detection of coins ingested by children using a handheld metal detector: a systematic review

Lee

2005

Emergency Medicine Journal

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“…Radiographs are generally recommended for localisation of these objects, as a missed oesophageal foreign body may have severe sequelae (31–36). Items made of thin aluminium, however, are frequently radiolucent and have been repeatedly described as providing strong metal detector signals even when they cannot be well seen on plain radiographs (25,26,37–40). Thus, metal detection may be superior to radiography specifically in the case of aluminium location.…”

Section: Tracking Other Swallowed Foreign Bodiesmentioning

confidence: 99%

Diagnostic uses of metal detectors: a review

Conners

2005

International Journal of Clinical Practice

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Metal detectors have been used for diagnostic purposes since 1881. They have been utilised to localise a myriad of foreign objects including bullets, intraocular metallic fragments, swallowed coins and other foreign bodies and medical devices. Rapid detection of metallic objects may facilitate diagnosis or treatment. Metal detectors are diagnostically useful because of their low expense, lack of radiation exposure and ease of use. This article reviews the history of metal detection in the practice of medicine and provides an overview of the utility of metal detectors in current diagnostic practice.

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“…11 Metal detectors are useful in locating aluminum foreign bodies. Tabs from aluminum cans do not reliably show in radiographs.…”

Section: Editor's Commentsmentioning

confidence: 99%