AAP National Conference: Let evidence guide choice of imaging studies :

You’re caring for an infant who is vomiting. Do you order an upper GI series? A toddler presents with injuries suggestive of physical abuse. Which imaging studies should you get?

These and other questions will be addressed during a session titled “Choosing an Imaging Study: Radiology for the Non-Radiologist” from 2-3:30 p.m. Monday (S3120) in Room 306 of Moscone South and from 8:30-10 a.m. Tuesday (S4030) in Room 309 of Moscone South.

The seminar will be led by Johanne Dillon, M.D., division chief of pediatric radiology at UK HealthCare and assistant professor of radiology and pediatrics at the University of Kentucky College of Medicine, and Erich Maul, D.O., M.P.H., FAAP, associate professor of pediatrics at the University of Kentucky College of Medicine and a member of the AAP Section on Hospital Medicine.

“The presentation will emphasize evidence-based imaging and how to do it,” Dr. Dillon said.

She and Dr. Maul will review the American College of Radiology (ACR) Appropriateness Criteria (http://www.acr.org/quality-safety/appropriateness-criteria) and teach attendees how to use them.

Dr. Dillon suggested attendees bring a smartphone or tablet to the session so they can see how to access the criteria and get a feel for what they include.

“The ACR Appropriateness Criteria provide extremely useful and user-friendly information on variety of pediatric topics,” Dr. Dillon said.

Topics include developmental dysplasia of the hip, fever without a source, head trauma, headache, hematuria, limping child age 0-5 years, seizures, sinusitis, suspected physical abuse, urinary tract infection and vomiting in infants up to 3 months of age. For each topic, there is a list of radiologic procedures, a rating of how appropriate a procedure is for a clinical condition and relative radiation level.

Usually, pediatricians don’t overuse imaging studies, Dr. Dillon said.

“Pediatricians are typically very well aware of the need to avoid unnecessary ionizing radiation exposure in their patients. They know that children’s tissues are more radiosensitive than those of adults,” Dr. Dillon said.

The same, however, cannot always be said for parents. Therefore, pediatric health care providers can review the Appropriateness Criteria with caregivers who want an imaging study that is not indicated and explain how the evidence shows which study is the best one to answer the question about their child, she said.

During the interactive portion of the session, cases will be presented and attendees will be asked which imaging study or studies would be most appropriate to answer the clinical question. In addition, images of diagnostic quality will be shown, and attendees will have an opportunity to describe findings.

“We all need to be doing evidence-based imaging,” Dr. Dillon said. “We want you to know how to do it. We will stand on our heads to help you do it.”