Appropriateness of pediatric CT utilization in clinical practice

Background: Justification of imaging investigations is important, particularly in pediatrics underwent investigation using a relatively higher radiation such as CT, due to the higher radiation sensitivity of children. Objective: To assess the difference of viewpoints between pediatric physicians and pediatric radiologists on the appropriateness of pediatric CT utilization in a tertiary-care university hospital with limited MR capacity. Methods: Pediatric medical records of head CT, chest CT, and abdominal CT were retrospectively reviewed in consecutive date of the examination until having 100 head CTs and 100 body CTs with complete clinical and imaging information. The physicians and the radiologists were asked to suggest the imaging modality of choice for each patient according to the given data, regardless of the hospital’s limitation. If the suggested modality of choice was not CT, the CT request would be considered as “inappropriate”. They additionally scored the CT appropriateness, firstly using individual judgement, and secondly using the ACR Appropriateness Criteria. Both scoring methods used the same rating scale from 1 to 9; score 1-3 was considered “inappropriate”. Results: From the viewpoint of the physicians and radiologists, the number of inappropriate CT request was 20% and 54% according to “the modality of choice”, 2.5% and 17% according to “individual judgement”, 12% and 22% according to the “ACR Appropriateness Criteria”. The main difference was not from no indication for imaging but from the selected modality of imaging. The radiologists suggested 52% of head CTs and 64% of abdominal CTs could have been replaced by MRI if available. Conclusion: There are ten-percent disagreement on appropriateness of pediatric CT request between physicians and the radiologists when using the same guidelines and considering the hospital limitation.