Radiographic Diagnostic Evaluation in Children
In the diagnostic evaluation and treatment control of scoliosis, radiographic diagnosis plays an integral role, which is confirmed by the numerous radiographs accompanying the article. Many of the radiographs are easily identified as originating from (presumably) the United States, rather than Germany. For radiographic diagnostic evaluation of children, particular standards need to be adhered to for radiation protection and image quality. The German Medical Association has published a guideline (1). Adherence to this guideline, especially its paragraph relating to the specific requirements in pediatric setting is monitored by medical institutions. If the guidelines are not adhered to, measures taken range from advice to withdrawal of the license to conduct radiographic studies. In any case, an investigation will be undertaken at the affected party’s expense.
The images reproduced in the article have severe deficiencies in terms of the guideline. In pediatric radiography, coning down is important. The borders of the irradiated field should be visible in the film. None of the images show a recognizable display of the irradiated area. This is particularly important in children, since they still have radiation-sensitive, hematopoietic bone marrow in almost all sections of the skeleton and should not unnecessarily be exposed to radiation due to a lack of coning down. No right or left indicator appear on the film.
In several images, no or indadequate gonadal protection was applied. In the quality control for radiological diagnostic evaluation of statutory health insurance physicians (2) , this would be categorized as breaking the rules relating to gonadal protection and therefore as a severe deficiency in terms of the required quality. A rule furthermore imposes a stronger obligation to adhere to it than a guideline, which allows for deviation when the reasons are sound.
Since this CME article appeared in the journal of the German Medical Association, existing rules and guidelines should be adhered to, especially in the interests of children.
Dr. med. Cornelia Schröder
Univ.-Prof. Dr. med/Univ Zürich Reinhard Schumacher
Förderverein „Kind und Radiologie“ e. V., c/o Kinderradiologie
Prüner Gang 16–20, 24103 Kiel, Germany
|1.||Leitlinien der Bundesärztekammer zur Qualitätssicherung in der Röntgendiagnostik – Qualitätskriterien röntgendiagnostischer Untersuchungen – vom 23.11.2007|
|2.||Richtlinien der Kassenärztlichen Vereinigung Rheinland-Pfalz zur Qualitätssicherung in der radiologischen Diagnostik einschließlich der Computertomographie durch Stichproben vom 22.11.2007|
|3.||Trobisch P, Suess O, Schwab F: Idiopathic scoliosis. Dtsch Arztebl Int 2010; 107(49): 875–84. VOLLTEXT|