Are we over using CT in young patients referred in emergency for acute abdominal pain: an useless dose burden.

Congress:

EuroSafe Imaging 2019

Poster Number:

ESI-0092

Type:

EuroSafe Imaging

Keywords:

Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide), Action 6 - Clinical audit tool for imaging, Radioprotection / Radiation dose, CT, Radiation safety, Acute

Authors:

M. T. Anzelmo, M. C. Terranova, M. Marrale, R. Lagalla, G. Lo Re, P. Romeo, A. Vinci, A. Crapanzano, S. Salerno

DOI:

10.26044/esi2019/ESI-0092

DOI-Link:

https://dx.doi.org/10.26044/esi2019/ESI-0092

Fig. 1: aetiologies of abdominal pain of 161 patients

Fig. 2: Score of appropriateness according IGuide [ESR iGuide 2017]

Fig. 3: dose bill and ED : effective dose measured according the CTDIvol considering an...

Fig. 4: dose bill and ED : effective dose measured according the CTDIvol considering an...

Background/introduction

We selected retrospectively, through the Radiology Information System (RIS) of our University Hospital, all patients between 15 and 46yrs (children less than 15yrs are not admitted to our Accident and Emergency Department – A&E as in our city insist a pediatric center) referred in emergency in from the A&E department to the Radiology Unit and submitted to abdominal CT for acute abdominal pain between January 2016 and December 2016. The patients selected for our study were 588. We decided do not include in our sample...

Description of activity and work performed

265/588patients had a crucial CT examination for diagnosis so CT was considered appropriate according Iguide [3]. 323/588patients had a diagnosis in witch the CT scan could be considered possibly appropriate for Iguide. Of these,138 had an inappropriate CT request according I guide [3];187 instead, despite CT has not confirmed the proposed diagnostic for referral, had an appropriate request based on the clinical suspicion and guidelines [3]. We have researched the most appropriate diagnostic method for161/588 patients with more frequently pathologies (Fig.1) (i.e.uncomplicated appendicitis, urolithiasis, Crohn’s...

Conclusion and recommendations

CT has changed the therapeutically approach addressing patient directly to the correct medical or surgical treatment but should be used only according guidelines. Various factors influencing over utilisation in many countries, of which, not to be underestimated the defensive medicine. A better clinical framing and a correct interpretation of the reference guidelines could reduced a helpful and unjustified exposure to ionizing radiation.

Personal/organisational information

Dr. Maria Teresa Anzelmo is Registrar in Diagnostic Radiology in the University of Palermo Policlinico Hospital

References

(1)Multisection CT Protocols: Sex- and Age-specifi c Conversion Factors Used to Determine Effective Dose from Dose-Length Product .Paul D. Deak , PhD Yulia Smal , MSc Willi A. Kalender , PhD .Radiology.rsna.org n Radiology: Volume 257: Number 1—October 2010 (2)Van Randen A, Laméris W, van Es HW, van Heesewijk HP, van Ramshorst B, Ten Hove W, Bouma WH, van Leeuwen MS, van Keulen EM, Bossuyt PM, Stoker J, Boermeester MA; OPTIMA Study Group. A comparison of the accuracy of Ultrasound and Computer Tomography in common...