title: Appropriateness of radiology procedures performed in children with gastrointestinal symptoms and conditions.
abstract: OBJECTIVE
  Exposure to ionizing radiation from diagnostic imaging procedures (DIPs) has been associated with an increased risk of cancer in children. In particular, gastrointestinal imaging has been identified as a significant factor that contributes to exposure of children to radiation during diagnostic procedures. We performed a longitudinal assessment of gastrointestinal-associated DIPs to identify practices that might be targeted to reduce exposure of pediatric patients to radiation.
  
  
  METHODS
  DIP insurance claims from 2001 through 2009 were obtained from an Independent Physicians Association in a large US metropolitan area. We retrieved and analyzed Current Procedural Terminology codes, associated International Classification of Diseases, 9th Revision, codes specific for gastrointestinal symptoms and conditions, and patient demographics associated with DIPs from insurance claims data.
  
  
  RESULTS
  Overall, 11,473 DIPs were performed on 6550 children with gastrointestinal symptoms; 1 in 30 patients received a DIP for a gastrointestinal complaint. Over the study period, the proportion of higher-radiation DIPs (computed tomography, fluoroscopy, and angiography) increased. Higher-radiation DIPs for gastrointestinal symptoms were performed more frequently in older children and in boys in the emergency department and in inpatient settings for diagnoses of abdominal pain, appendicitis, and noninfectious gastroenteritis.
  
  
  CONCLUSIONS
  Higher-radiation diagnostic imaging accounts for an increasing proportion of imaging procedures among children with gastrointestinal symptoms, even though these often are not recommended for evaluation of gastrointestinal disorders. Clinicians should be aware of these findings when ordering DIPs for gastrointestinal complaints, and clinical practice guidelines should be created to reduce diagnostic imaging-related radiation exposure in children.
authors.affiliation: Division of Pediatric Gastroenterology, Rady Children's Hospital, San Diego, California; Department of Pediatrics, University of California, San Diego, La Jolla, California.
authors.forename: Trevor
authors.initials: T
authors.lastname: Tompane
authors.affiliation: Division of Pediatric Gastroenterology, Rady Children's Hospital, San Diego, California.
authors.forename: Curtis W
authors.initials: CW
authors.lastname: Leong
authors.affiliation: Department of Pediatrics, Rady Children's Hospital, San Diego, California.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bush
authors.affiliation: San Diego Imaging, San Diego, California.
authors.forename: Nathaniel A
authors.initials: NA
authors.lastname: Chuang
authors.affiliation: Childrens Physicians Medical Group, San Diego, California.
authors.forename: Tanya
authors.initials: T
authors.lastname: Dansky
authors.affiliation: Division of Pediatric Gastroenterology, Rady Children's Hospital, San Diego, California; Department of Pediatrics, University of California, San Diego, La Jolla, California; Department of Pediatrics, Rady Children's Hospital, San Diego, California. Electronic address: jshuang@ucsd.edu.
authors.forename: Jeannie S
authors.initials: JS
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011871:Radiology / Q000379:methods*; D012189:Retrospective Studies; D014481:United States
keywords: Appropriateness; Diagnostic Imaging; Pediatrics; Radiation