AMA Publishing Group: Radiography Topic Collection

Impact of a Real-Time Computerized Duplicate Alert System on the Utilization of Computed Tomography

Wasser EJ, Prevedello LM, Sodickson A, et al. — Mon, 10 Jun 2013 00:00:00 GMT

The use of high-cost imaging modalities is rising rapidly. From 1995 through 2007, use of computed tomographic (CT) scans in the United States increased more than 4-fold; by 2006, CT and magnetic resonance imaging examinations were the fastest-growing physician-directed Medicare expenditure. An uncertain proportion of these examinations represent overuse.

Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer Creative Arts Therapies in Cancer Patients

Puetz TW, Morley CA, Herring MP. — Mon, 10 Jun 2013 00:00:00 GMT

Importance

Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients has been conducted.

Objectives

To estimate the effect of CAT on psychological symptoms and QOL in cancer patients during treatment and follow-up and to determine whether the effect varied according to patient, intervention, and design characteristics.

Evidence Review

We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies involving 1576 patients were included. We extracted data on effect sizes, moderators, and study quality. Hedges d effect sizes were computed, and random-effects models were used to estimate sampling error and population variance.

Findings

During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for homogeneous cancer groups in outpatient settings; significantly smaller reductions occurred in heterogeneous groups in outpatient settings.

Conclusions and Relevance

Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients, but this effect is reduced during follow-up.

The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk Computed Tomography in Pediatrics

Miglioretti DL, Johnson E, Williams A, et al. — Mon, 10 Jun 2013 00:00:00 GMT

Importance

Increased use of computed tomography (CT) in pediatrics raises concerns about cancer risk from exposure to ionizing radiation.

Objectives

To quantify trends in the use of CT in pediatrics and the associated radiation exposure and cancer risk.

Design

Retrospective observational study.

Setting

Seven US health care systems.

Participants

The use of CT was evaluated for children younger than 15 years of age from 1996 to 2010, including 4 857 736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001 and 2011.

Main Outcomes and Measures

Rates of CT use, organ and effective doses, and projected lifetime attributable risks of cancer.

Results

The use of CT doubled for children younger than 5 years of age and tripled for children 5 to 14 years of age between 1996 and 2005, remained stable between 2006 and 2007, and then began to decline. Effective doses varied from 0.03 to 69.2 mSv per scan. An effective dose of 20 mSv or higher was delivered by 14% to 25% of abdomen/pelvis scans, 6% to 14% of spine scans, and 3% to 8% of chest scans. Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys, and they were also higher for patients who underwent CT scans of the abdomen/pelvis or spine than for patients who underwent other types of CT scans. For girls, a radiation-induced solid cancer is projected to result from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans, depending on age. The risk of leukemia was highest from head scans for children younger than 5 years of age at a rate of 1.9 cases per 10 000 CT scans. Nationally, 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers.

Conclusions and Relevance

The increased use of CT in pediatrics, combined with the wide variability in radiation doses, has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.