Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016

Kwan, Marilyn L.; Miglioretti, Diana L.; Marlow, Emily; Bowles, Erin J. Aiello; Weinmann, Sheila; Cheng, Stephanie; Deosaransingh, Kamala; Chavan, Prachi; Moy, Lisa M.; Bolch, Wesley E.; Duncan, James R.; Greenlee, Robert T.; Kushi, Lawrence H.; Pole, Jason D.; Rahm, Alanna Kulchak; Stout, Natasha K.; Smith‐Bindman, Rebecca

doi:10.1001/jamanetworkopen.2019.7249

Cited by 35 publications

(20 citation statements)

References 30 publications

(55 reference statements)

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“…The Radiation Induced Cancers (RIC) study is a National Institutes of Health funded retrospective cohort designed to evaluate fetal and childhood imaging exposure and subsequent cancer risk [ 21 , 22 ]. This analysis included data from six U.S. integrated health care systems (Harvard Pilgrim Health Care, Kaiser Permanente (KP) Hawaii, KP Northern California, KP Northwest, KP Washington, and Marshfield Clinic Health System) and five tertiary care centers in Ontario, Canada, that treat children with cancer (Children’s Hospital of Eastern Ontario, Kingston Health Science Centre, Hospital for Sick Children, McMaster Children’s Hospital and Children’s Hospital, London Health Science Centre).…”

Section: Methodsmentioning

confidence: 99%

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Long-term medical imaging use in children with central nervous system tumors

et al. 2021

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Background Children with central nervous system (CNS) tumors undergo frequent imaging for diagnosis and follow-up, but few studies have characterized longitudinal imaging patterns. We described medical imaging in children before and after malignant CNS tumor diagnosis. Procedure We conducted a retrospective cohort study of children aged 0–20 years diagnosed with CNS tumors between 1996–2016 at six U.S. integrated healthcare systems and Ontario, Canada. We collected computed topography (CT), magnetic resonance imaging (MRI), radiography, ultrasound, nuclear medicine examinations from 12 months before through 10 years after CNS diagnosis censoring six months before death or a subsequent cancer diagnosis, disenrollment from the health system, age 21 years, or December 31, 2016. We calculated imaging rates per child per month stratified by modality, country, diagnosis age, calendar year, time since diagnosis, and tumor grade. Results We observed 1,879 children with median four years follow-up post-diagnosis in the U.S. and seven years in Ontario, Canada. During the diagnosis period (±15 days of diagnosis), children averaged 1.10 CTs (95% confidence interval [CI] 1.09–1.13) and 2.14 MRIs (95%CI 2.12–2.16) in the U.S., and 1.67 CTs (95%CI 1.65–1.68) and 1.86 MRIs (95%CI 1.85–1.88) in Ontario. Within one year after diagnosis, 19% of children had ≥5 CTs and 45% had ≥5 MRIs. By nine years after diagnosis, children averaged one MRI and one radiograph per year with little use of other imaging modalities. Conclusions MRI and CT are commonly used for CNS tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors.

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Section: Methodsmentioning

confidence: 99%

“…Methods to collect and categorize imaging data have been previously described [ 21 , 22 ]. Briefly, in the U.S., we identified imaging examinations using a combination of electronic medical record and external claims billing data.…”

Section: Methodsmentioning

confidence: 99%

Long-term medical imaging use in children with central nervous system tumors

et al. 2021

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“…13 The rate of CT use in pregnant patients has markedly increased during the last decade, and most of these examinations were performed for suspected PE. 14 The incidence of PE in children appears to be quite low, but it is often underestimated. 15 However, the use of hormonal contraceptives among adolescents is increasing, especially among younger adolescents (12 to 15 years old), 16 and contraceptives are prescribed to patients as young as 10 years old 17 for various medical reasons such as excessive or irregular menstruation or treatment of acne.…”

Section: Introductionmentioning

confidence: 99%

Individualization of computed tomography protocols for suspected pulmonary embolism: a national investigation of routines

et al. 2020

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Objective: Given the extensive use of computed tomography (CT) in radiation-sensitive patients such as pregnant and pediatric patients, and considering the importance of tailoring CT protocols to patient characteristics for both the radiation dose and image quality, this study was performed to investigate the extent to which individualization of CT protocols is practiced across Norway. Methods: This cross-sectional study involved collection of CT protocols and administration of a mini-questionnaire to obtain additional information about how CT examinations are individualized. All public hospitals performing CT to detect pulmonary embolism were invited, and 41% participated. Results: Tailoring a standard protocol to different patient groups was more common than using dedicated protocols. Most of the available radiation dose-reduction approaches were used. However, implementation of these strategies was not systematic. Children and pregnant patients were examined without using dedicated CT protocols or by using protocol adjustments focusing on radiation dose reduction in 30% and 39% of the hospitals, respectively. Conclusion: Practice optimization is needed, especially the development of dedicated CT protocols or guidelines that tailor the existing protocol to pediatric and pregnant patients. Practice might benefit from a more systematic approach to individualization of CT examinations, such as inserting tailoring instructions into CT protocols.

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“…In a recent article in JAMA, Khan et al described the use of Computed Tomographic (CT) imaging as well as conventional radiography, angiography, fluoroscopy and nuclear imaging during pregnancy in more than 2.2 million women experiencing over 3.4 million pregnancies in the USA and Ontario, Canada. (1) Between 1996 and 2016 in the United States, CT imaging rates increased from 2.0/1000 pregnancies to 11.4/1000 in 2007 and decreased to 9.3/1000 by 2016. The equivalent increase in Ontario was from 2.0/1000 pregnancies in 1996 to 6.2/1000 in 2016.…”

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confidence: 99%