Diagnostic Imaging Studies Performed in Children Over a Nine-Year Period

Abstract

BACKGROUND AND OBJECTIVE: Diagnostic imaging procedures (DIPs) producing radiation exposure in children have been associated with increased cancer risk. To develop effective clinical practice interventions that reduce pediatric radiation exposure, a longitudinal assessment of DIP ordering practices in the current clinical climate was performed. Our objective was to determine the prevalence and characteristics of DIPs ordered by physicians in an independent physicians association treating a general pediatric population. METHODS: DIP insurance claims from 2001 to 2009 were obtained from an independent physicians association in a large metropolitan area. Current Procedural Terminology codes, associated International Classification of Diseases, Ninth Revision codes, and patient demographics associated with DIPs were retrieved from insurance claim data and analyzed. RESULTS: Overall, 214 538 DIPs were performed on 63 116 children from 2001 to 2009 at a rate of 1 DIP associated with ionizing radiation per 21 patient-months. Over the study period, performance of computed tomography, MRI, ultrasound, and radiography all significantly increased (P < .001 for all). Higher radiation DIPs were most frequently performed in the inpatient and emergency settings on older boy patients for gastrointestinal and congenital disorders. The 3 most common International Classification of Diseases, Ninth Revision codes associated with higher radiation DIPs were abdominal pain, headache, and head injury. CONCLUSIONS: DIPs are frequently performed in children and higher radiation DIPs account for an increasing proportion of DIPs performed, especially among children evaluated in the inpatient and emergency department settings and those with gastrointestinal and neurologic symptoms, and congenital anomalies. Our findings may help guide development of clinical practice interventions to reduce DIP-related radiation exposure in youth.