The majority of chest X-rays ordered for children do not affect how individual patients are treated, a finding that raises questions about why those tests are ordered, according to a newly released study.
X-rays performed in 88% of 330 children who visited hospitals with chest pains did not change the clinical treatment that those children received, according to the study, released Wednesday at the Radiological Society of North America's annual meeting in Chicago.
In particular, the study's authors cited chest X-rays ordered for syncope, spells, indicated postural orthostatic hypotension and dizziness as having no impact on the treatment of 330 children, while X-rays ordered for about 12% of the children did influence treatment. Those patients were being treated for pneumonia, bronchial inflammation, or trauma.
The 330 children ranged in age from newborn to 17 years old and were treated in inpatient, outpatient and emergency department settings.
“There are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost,” said Dr. Ann Packard, radiologist at the Mayo Clinic in Rochester, Minn.
Reducing patient exposure to radiation has been a primary focus for radiologists for several years. Unnecessary exams are a particular area of focus, given the costs associated with the tests, broader concern about radiation dose, and whether radiation exposure can lead to cancer later in life. A study published in 2013 said that increasing utilization of computed tomography, which has a higher radiation dose than an X-ray, in children may mean those patients are at a higher risk of getting cancer.
Chest X-rays in children are common - and they are also over-performed, Packard said during a news conference. While the radiation associated with a chest X-ray is very low, concerns still exist about exposure and costs, she added.
Packard said it's unclear why physicians order chest X-rays for children for symptoms such as dizziness or fainting. One possible reason may be that doctors have traditionally ordered the exams, with little debate about whether they are necessary. “No one has taken the time to look back for a reason to do the exam,” she said.
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