From: Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review
Type of imaging | Reason for examination | Outcome | Suggested practice by included study/studies | References |
---|---|---|---|---|
Neuro imaging | ||||
Head CT | Minor head injury | 33–50% relevant findings |  | |
Shunt-related complications | Few relevant findings | MRI diffusion weighted imaging should be used | [289] | |
Repeat head CT | Skull fracture | No relevant findings | Repeat only if patient develops symptoms | |
Minor head injury | 0–6.6% relevant findings |  | ||
Brain MRI/CT | Headache | 4–28.8% relevant findings |  | |
Post-op head XR | Cochlear implant surgery | Do not change patient management | Â | [298] |
C-spine CT/XR | Trauma | Of all included patients 12.8% screened with imaging while 0.2% needed treatment | X-ray would suffice | [299] |
Abdominopelvic imaging | ||||
Abdominal CT | Liver injury | CT should be avoided to reduce the use of ionizing radiation | Physical examination, FAST and Serum Transaminases should be used as screening | [300] |
Abdominal pain | Did not change patient management | Â | [301] | |
Repeat abdominal CT | Renal trauma | CT should be avoided to reduce the use of ionizing radiation | US should be used instead | [302] |
Abdominal MRI | Appendicitis | Do not change patient management | Â | [303] |
Abdominal XR | Children doing UGI | Do not change patient management | Â | [304] |
Idiopathic constipation | Low diagnostic accuracy | Clinical examination would be sufficient | ||
Rectal US | ||||
Colonic transit study | ||||
Thoracoabdominal XR | Determining the Position of Umbilical Venous Catheters | XR should be avoided to reduce the use of ionizing radiation | Use ultrasound instead | [307] |
UGI | Laparoscopic Gastrostomy Tube Placement | Do not change patient management | Â | |
Gastroesophageal reflux (neonates) | Do not change patient management | Â | [310] | |
Scrotal US | Pediatric Cryptorchidism | Low diagnostic accuracy | Clinical examination would be sufficient | |
Tc-99Â m MAG3/DMSA scan | Multicystic dysplastic kidney | Avoid for reducing the use of ionizing radiation | Use US instead | [313] |
Whole body imaging | ||||
Trauma CT | Blunt trauma | 18% relevant findings | Â | |
Falls | Two-fold increase in use of CT | Â | [317] | |
Trauma | No relevant findings in low level injury | Â | ||
Do not change patient management | Â | |||
Follow-up torso CT | Hodgkin’s lymphoma | Do not change patient management |  | [322] |
Musculo-skeletal imaging | ||||
Skeletal CT | Orthopedic trauma (spine, pelvis, lower extremities] | 20% relevant findings | Â | [168] |
Post-op humerus XR | Supracondylar humerus fracture | Do not change patient management | Â | [323] |
Do not change patient management | Â | [324] | ||
Do not change patient management | Type III fractures—XR within 7–10 days post-op or if clinical symptoms | [325] | ||
Elbow XR | Supracondylar humerus fracture | Do not change patient management | Â | [326] |
Wrist fracture | Do not change patient management | Image only children with symptoms | [327] | |
Follow-up forearm XR | Forearm fracture | Do not change patient management | Â | [328] |
Serial follow-up wrist XR | Distal wrist fracture | Do not change patient management | Â | [329] |
Routine XR pelvis | Blunt trauma | Do not change patient management | Clinical examination as screening | |
Routine follow-up Hip XR and US | Hip dysplasia | Routine follow-up (genetic risk)—do not change patient management |  | [332] |
XR after normal ultrasound do change patient management | Â | [333] | ||
Routine follow-up calf XR | Physeal facture of distal tibia | Do not change patient management | Â | [334] |
Ankle XR | Sever's disease | Low diagnostic accuracy | Clinical examination should be sufficient | [335] |
Follow-up Spine XR | Adolescent idiopathic scoliosis | Do not change patient management | 4-month control only should suffice | [336] |
Do not change patient management | X-ray only patients with pain | [337] | ||
Thoracic imaging | ||||
Chest CT | Esophageal atresia and tracheoesophageal fistula | Do not change patient management | Â | [338] |
Chest XR | Chest tube removal | 6.4% relevant finding | X-ray symptomatic children only | |
CVC placement | Do not change patient management | Â | [341] | |
Pneumonia | Do not change patient management | Use ultrasound chest instead | [342] | |
Bronchiolitis | Do not change patient management | Â | [343] | |
Cardiac imaging | ||||
Echocardiogram | Cardiac disease | 11% change in patient management | Â | [344] |
Myelomeningocele | Do not change patient management | Critical condition is clinically identifiable | [345] |