A campaign to reduce children’s exposure to unnecessary radiation has dropped imaging referrals by 25% with no reports of misdiagnoses, according to new research published Monday.
Amid an increase in radiology referrals, particularly CT, providers in Brazil recently sought to right-size the use of medical imaging for vulnerable pediatric populations. They undertook a campaign to promote awareness about properly justifying some of the most ordered exams in the ED.
Based on data from a three-year period (2015-2018), the educational effort is paying off.
“The campaign resulted in a substantial reduction in radiological referrals while promoting a radiation protection culture in the department,” Mônica Oliveira Bernardo, with the Pontifical Catholic University of São Paulo, and co-authors wrote March 7 in the journal Insights into Imaging. “Simple education initiatives can contribute to both financial and radiation doses savings, particularly important in radiosensitive cohorts. Continuous education is especially important to change the culture of overuse, as well as information and communication to patients and carers about the benefits and risks of ionizing radiation.”
A total of 19 healthcare facilities participated in the initiative, representing 29% of the national market share and concentrated in the country’s south and southeast. Those involved developed resources including individual “dose cards,” detailing information about the campaign and tracking each child’s radiological procedures, including type of exam and facility name. They also created written and audio-visual educational materials for both patients and providers, along with an implementation guide, and imaging referral recommendations.
The campaign launched around June 2016, with Bernardo et al. analyzing data before the intervention and afterward. In the 12 months that followed the campaign (June 2017–May 2018), there was a reduction of roughly 13,000 referrals. The largest number of exams performed in these institutions was chest X-rays (73%) while the largest age group requested was between 0-4 years old (63%). There was also a “significant” association between type of exam and the patient’s age group.
Bernardo et al. also noted several challenges during the project, including scale, along with differing cultures and organizational structures between units. Overcoming them required “considerable planning” and organization, including regular meetings and communication to maximize engagement.
“As with any such projects of scale, operating cost was not trivial, but was well compensated by savings in resources and radiation burden from the demonstrated reduction in imaging referrals,” the authors advised. “Throughout the present study, we emphasized to imaging professionals that if the radiological examination is necessary, especially tomography, dose optimization recommendations should be followed.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.