Many Chest Radiographs in Children Unnecessary

December 4, 2014

Chest radiographs ordered for children, particularly for indications such as syncope or dizziness, do not alter the course of treatment.

CHICAGO - Certain indications for chest radiographs for children did not add any benefit, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

In an effort to guide physicians away from taking too many X-rays among children, researchers from the Mayo Clinic in Rochester, MN, performed a retrospective study to evaluate common indications for chest radiographs in the pediatric population and whether the images altered clinical management.

"Chest X-rays can be a valuable exam when ordered for the correct indications," researcher Ann Packard, MD, radiologist, Mayo Clinic, said in a release. "However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost."

The researchers reviewed 719 previously acquired chest radiographs from 2008 to 2014 of children aged newborn to 17.

Indications for radiographNumber of exams
Chest pain377
Syncope or presyncope98
General feeling of being unwell or under distress (“spells”)21
Postural orthostatic hypotension (POTS)37
Dizziness185
Cyclical vomiting1

Eighty-two of the 719 exams were excluded due to congenital or other known heart disease, and other causes.

The researchers found that in approximately 88% of the remaining 637 patients, the exam did not alter clinical treatment. None of the patients who underwent X-rays for indications including syncope, spells, POTS, dizziness, or cyclical vomiting had any finding that affected treatment. Thirty-nine of the 330 non-excluded X-rays for chest pain were positive for pneumonia, bronchial inflammation, trauma, or other conditions.

"Approximately 12 percent of the chest X-rays for chest pain were positive and included respiratory symptoms such as cough, fever or trauma," Packard noted in the release. "