title: Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine.
abstract: Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
authors.affiliation: Section of Emergency Ultrasound, Department of Emergency Medicine, Christiana Care Health Services, Newark, Delaware. Electronic address: psierzenski@christianacare.org.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sierzenski
authors.affiliation: Potomac, Maryland.
authors.forename: Otha W
authors.initials: OW
authors.lastname: Linton
authors.affiliation: Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
authors.forename: E Stephen
authors.initials: ES
authors.lastname: Amis
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
authors.forename: D Mark
authors.initials: DM
authors.lastname: Courtney
authors.affiliation: Radiology Associates of the Fox Valley, Neenah, Wisconsin.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Larson
authors.affiliation: Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mahadevappa
authors.initials: M
authors.lastname: Mahesh
authors.affiliation: Harvard Medical School and Emergency Radiology Division, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Novelline
authors.affiliation: Division of Pediatric Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Frush
authors.affiliation: Department of Radiology, New Mexico VAHCS, Albuquerque, New Mexico.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Mettler
authors.affiliation: Morristown, New Jersey.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Timins
authors.affiliation: National Council on Radiation Protection and Measurements, Bethesda, Maryland.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Tenforde
authors.affiliation: National Council on Radiation Protection and Measurements, Bethesda, Maryland.
authors.forename: John D
authors.initials: JD
authors.lastname: Boice
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: James A
authors.initials: JA
authors.lastname: Brink
authors.affiliation: Department of Radiology, University of California, Davis, Sacramento, California.
authors.forename: Jerrold T
authors.initials: JT
authors.lastname: Bushberg
authors.affiliation: National Council on Radiation Protection and Measurements, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Schauer
mesh_terms: D004632:Emergency Medical Services / Q000592:standards*; D004635:Emergency Medicine / Q000592:standards*; D019983:Guideline Adherence; D017410:Practice Guidelines as Topic; D011835:Radiation Protection / Q000592:standards*; D011871:Radiology / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014481:United States