Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations.

BACKGROUND: Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. OBJECTIVE: To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. MATERIALS AND METHODS: We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. RESULTS: We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. CONCLUSION: Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold.

Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades.

PURPOSE: To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades. METHODS: Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography. RESULTS: In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types. CONCLUSIONS: Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.

Head CT scan overuse in frequently admitted medical patients.

BACKGROUND: Patients frequently admitted to medical services undergo extensive computed tomography (CT) imaging. Some of this imaging may be unnecessary, and in particular, head CT scans may be over-used in this patient population. We describe the frequency of abnormal head CT scans in patients with multiple medical hospitalizations. METHODS: We retrospectively reviewed all CT scans done in 130 patients with 7 or more admissions to medical services between January 1 and December 31, 2011 within an integrated health care system. We calculated the number of CT scans, anatomic site of imaging, and source of ordering (emergency department, inpatient floor). We scored all head CT scans on a 0-4 scale based on the severity of radiographic findings. Higher scores signified more clinically important findings. RESULTS: There were 795 CT scans performed in total, with a mean of 6.7 (± SD 5.8) CT scans per patient. Abdominal/pelvis (39%), chest (30%), and head (22%) CT scans were the most frequently obtained. The mean number of head CT scans performed was 2.9 (SD ± 4.2). Inpatient floors were the major site of CT scan ordering (53.7%). Of 172 head CT scans, only 4% had clinically significant findings (scores of 3 or 4). CONCLUSIONS: Patients with frequent medical admissions are medically complex and undergo multiple CT scans in a year. The vast majority of head CT scans lack clinically significant findings and should be ordered less frequently. Interdisciplinary measures should be advocated by hospitalists, emergency departments, and radiologists to decrease unnecessary imaging in this population.

Neonatal small left colon syndrome in the offspring of diabetic mothers-an analysis of 105 children.

BACKGROUND AND AIM: Neonatal small left colon syndrome (NSLCS) is considered a rare cause of neonatal intestinal obstruction, with few documented cases in the English literature. Maternal diabetes has been reported in 40% to 50% of the published cases of NSLCS. Currently, the incidence of maternal diabetes is increasing, but there has been no study to ascertain the incidence and significance of NSLCS in this population. This review aims to assess the current significance of NSLCS and its association with maternal diabetes. MATERIALS AND METHOD: This was a retrospective review of 105 offspring of diabetic mothers who were admitted during the period 2004 to 2008 to our neonatal unit with special emphasis on associated NSLCS. RESULTS: There were 6 cases of intestinal obstruction in this group of 105 children. Five children, including a pair of twins, had classic features of NSLCS as demonstrated in the contrast enema with an abrupt transition at the splenic flexure and a narrow left colon. Conservative treatment was successful in all, negating the need for further invasive investigation. The sixth child had rectosigmoid Hirschprung disease. During the study period, there were no other cases of NSLCS in the nondiabetic population. CONCLUSION: Neonatal small left colon syndrome is the most common cause of intestinal obstruction in offspring of diabetic mothers. Neonatal small left colon syndrome can be confidently diagnosed in this population based on the classic clinical and radiologic findings. The incidence of NSLCS can be expected to increase as the incidence of maternal diabetes increases.