The Image Gently Think A-Head Campaign: Keep Calm and Image Gently

Authors: Donald P. Frush, MD and Mathew P. Lungren, MD, MPH

Pediatric caregivers are often challenged while engaging parents and other family members in the setting of a child’s medical illness, a scenario often complicated by anxiety, lack of information, urgency, uncertainty, lack of control, and surrogate decision making [1. There are few situations more emblematic of this emotionally complex health care interaction than closed head injuries, particularly in very small children, in whom the consequences of missing serious closed head injuries can be profound. Every year in the United States, more than 22 million children visit the emergency department, and 600,000 are seen for minor head trauma [2, 3]. Although we talk about “minor” and “major” injury, there may not a clear delineation from a practical standpoint. Moreover, the emotive aspects on the part of the patient and family can influence decisions made by the health care team, a consequence of which can be lowering the threshold for performing a head CT examination. Head CT is one of the most common medical imaging tests ordered in this setting. Head CT accounts for an estimated 65% of all CT studies in children through 18 years of age, and roughly a quarter of head CT examinations are performed in children <7 years of age (unpublished data, ACR Dose Index Registry®). Larson et al [4 found that 87.3% of pediatric emergency visits leading to CT examinations were in nonpediatric focused emergency departments.

These factors may be especially persuasive when [Read more….]

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