Skip to main content

Table 14 Overview of imaging identified as low-value in pediatrics sorted by body system

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

 

[286,287,288]

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

[290, 291]

Minor head injury

0–6.6% relevant findings

 

[292, 293]

Brain MRI/CT

Headache

4–28.8% relevant findings

 

[294,295,296,297]

Post-op head XR

Cochlear implant surgery

Do not change patient management

 

[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

 

[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

 

[303]

Abdominal XR

Children doing UGI

Do not change patient management

 

[304]

Idiopathic constipation

Low diagnostic accuracy

Clinical examination would be sufficient

[305, 306]

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

 

[308, 309]

Gastroesophageal reflux (neonates)

Do not change patient management

 

[310]

Scrotal US

Pediatric Cryptorchidism

Low diagnostic accuracy

Clinical examination would be sufficient

[311, 312]

Tc-99 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

 

[314,315,316]

Falls

Two-fold increase in use of CT

 

[317]

Trauma

No relevant findings in low level injury

 

[287, 318, 319]

Do not change patient management

 

[320, 321]

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

 

[168]

Post-op humerus XR

Supracondylar humerus fracture

Do not change patient management

 

[323]

Do not change patient management

 

[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

 

[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

 

[328]

Serial follow-up wrist XR

Distal wrist fracture

Do not change patient management

 

[329]

Routine XR pelvis

Blunt trauma

Do not change patient management

Clinical examination as screening

[330, 331)

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

 

[333]

Routine follow-up calf XR

Physeal facture of distal tibia

Do not change patient management

 

[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

 

[338]

Chest XR

Chest tube removal

6.4% relevant finding

X-ray symptomatic children only

[339, 340]

CVC placement

Do not change patient management

 

[341]

Pneumonia

Do not change patient management

Use ultrasound chest instead

[342]

Bronchiolitis

Do not change patient management

 

[343]

Cardiac imaging

Echocardiogram

Cardiac disease

11% change in patient management

 

[344]

Myelomeningocele

Do not change patient management

Critical condition is clinically identifiable

[345]

  1. XR X-ray, CT computed tomography, MRI magnetic resonance imaging, US ultrasound