Kids are getting many needless chest x-rays

Many chest radiographs performed on children don’t benefit them clinically and expose them to unnecessary radiation, according to a study presented at the annual meeting of the Radiological Society of North America.

To evaluate the clinical benefits of chest radiographs for common pediatric indications, researchers from the Mayo Clinic reviewed 719 radiographs of children aged from birth to 17 years: 377 for chest pain; 98 for syncope or presyncope; 21 for spells; 37 for pediatric postural orthostatic tachycardia syndrome (POTS); 185 for dizziness; and 1 for cyclical vomiting. They excluded 82 of the radiographs because of congenital or other known heart disease or other reasons.

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None of the 637 remaining radiographs that were ordered for syncope, spells, POTS, dizziness, or cyclical vomiting showed any findings that affected management. Likewise, about 88% of the 330 included radiographs for chest pain didn’t influence treatment; 39 were positive for pneumonia, bronchial inflammation, trauma, or other conditions.

The researchers conclude that “certain indications for chest radiograph may not add any benefit to the patient” and this information should be shared to reduce radiation exposure among children.

In a related commentary published online in the Journal of Patient Safety, physicians from the Mayo Clinic urge a collaborative effort to standardize safe imaging protocols for children. They call on the American College of Radiology, the Joint Commission, the Intersociety Accreditation Commission, and the Centers for Medicare and Medicaid Services to mandate 3 safety practices for accreditation of all US hospitals and advanced diagnostic imaging facilities:

• The right exam: minor head trauma imaging using the Pediatric Emergency Care Applied Research Network Clinical Prediction Rule;

• The right way: protocols to decrease dual-phase head and chest computed tomography (CT) imaging;

• The right radiation dose: using size-specific pediatric CT imaging protocols.

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