Point-of-care decision support shown to reduce childhood radiation exposure

Hypothesizing that decision-support tools applied at the point of care lead to lower radiation doses and higher compliance with ACR guidelines, researchers have applied a simulated scenario and come back with two thumbs up—one for clinical decision support and the other for pediatric imaging.   

Led by Christopher Bunt, MD, a U.S. Air Force officer and a professor at the Uniformed Services University of the Health Sciences in Bethesda, Md., the team reviewed a pediatric hematuria (blood in urine) scenario as approached by 115 physicians within the 17 family medicine training programs in the Military Health System. They first looked at imaging decision-making without decision support, then randomized a cohort of participants to deploy ACR-based decision-support tools.

The simulation study was double-blinded, and its results suggested that point-of-care access to estimated radiation exposure information, along with imaging guidelines, does indeed influence imaging ordering.

Most tellingly, the team documented a statistically significant difference in imaging modality selection when a group received the ACR guidelines after their initial imaging choice—an effect that was absent when a group received estimated exposure info prior to making the call. A subgroup that reviewed ACR criteria after initial imaging choice increased its use of ultrasound over not only CT but also over multiple types of x-ray.

“[I]nformation helps save kids from unnecessary radiation exposure,” Bunt said in prepared remarks. “As a parent, I want my kids to receive the imaging studies that they need to diagnose and treat illness or injury. Making sure that these decisions are supported by evidence and are safe for my children is extremely important. Our study helps parents feel comfortable about their clinician's decisions.”

To see the numbers behind the conclusions, read the full study online in the Journal of the American Board of Family Medicine.