Decreasing Radiation Exposure in Pediatric Clavicle and Metatarsal Fractures: A QI Initiative
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Published on: September 11, 2011
Zoe Brown1, Michael Perry2, Amy W Wozniak3
1Loyola University Chicago Stritch School of Medicine, Maywood.
Insights
Implementing a standardized imaging protocol significantly reduced radiation exposure for pediatric clavicle and metatarsal fractures. This approach lowers healthcare costs and protects children from unnecessary medical radiation.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
- Radiation Safety
Background:
- Minimizing radiation exposure in pediatric patients is a critical public health goal.
- Standardized imaging protocols can reduce radiation in pediatric fracture management without compromising care quality.
- This study focuses on clavicle and metatarsal fractures in children.
Purpose of the Study:
- To evaluate the impact of a revised follow-up imaging protocol on radiation exposure in pediatric clavicle and metatarsal fractures.
- To determine if reducing the number of radiographic views affects fracture management outcomes.
Main Methods:
- A retrospective comparative study (Level III) was conducted.
- Follow-up imaging practices for pediatric metatarsal and clavicular fractures were analyzed before (2009-2014) and after (2016-2019) protocol changes.
- The protocol change reduced follow-up views from 3 to 2 for metatarsal fractures and from 2 to 1 for clavicle fractures.
Main Results:
- A statistically significant reduction in follow-up X-rays was observed for both clavicle (P<0.001) and metatarsal (P=0.004) fractures.
- Median views for metatarsal fractures decreased by one, aligning with the protocol adjustment.
- The majority of clavicle fractures (90.80%) were managed with one follow-up view post-protocol change, compared to 72.48% prior.
Conclusions:
- The revised imaging protocol successfully reduced radiation exposure in pediatric patients with nonoperatively managed clavicle and metatarsal fractures.
- Decreasing the number of X-rays taken enhances patient care quality and offers public health benefits, including cost reduction.
- Standardized protocols are effective in optimizing pediatric fracture imaging.
Background:
Protecting the pediatric population from unnecessary medical radiation is an important public health initiative. Efforts have been made to reduce radiation exposure in the treatment of pediatric fractures without compromising quality of care. Using a standardized protocol for imaging of pediatric clavicle and metatarsal fractures is a reliable method for reducing pediatric radiation exposure in the management of these fractures.
Methods:
In the year 2015, the senior author altered follow-up imaging practices for 2 common pediatric fractures: metatarsal and clavicular. Initial radiographic evaluation included the standard 3 views for metatarsal fractures and 2 views for clavicle fractures. This standard diagnostic procedure remained constant throughout the study. Follow-up x-rays from 2009 to 2014 routinely included 3 views of the foot and 2 views of the clavicle. The protocol was changed and from 2016 to 2019, follow-up x-rays for fractures routinely included 2 views of the foot and 1 view of the clavicle, thereby decreasing the number of x-rays utilized to manage these fractures.
Results:
There was a significant reduction in the number of clavicle x-rays (P<0.001) and metatarsal x-rays (P=0.004) taken in follow-up between the time-periods. Median values for metatarsal views decreased by 1, matching the adjustment in protocol. In addition, the vast majority of clavicle fractures (90.80%) were managed with 1 follow-up view in 2016 to 2019 compared with 2 views (72.48%) from 2009 to 2014.
Conclusions:
This study achieved a reduction in radiation exposure in pediatric patients with nonoperatively managed clavicle and metatarsal fractures. Improving the quality of care of patients through decreasing the number of x-rays taken protects individuals from adverse side effects, as well as offers various public health benefits in terms of reduction in expenditures.
Level Of Evidence:
Level III-retrospective comparative study.
