Should We Abstain from Routine Use of Radiologic Imaging in Fitness to Dive Assessments? A call for action

Area of Science:

• Diving Medicine
• Radiology
• Occupational Health

Background:

• Fitness-to-dive assessments aim to prevent diving incidents by identifying medical risks.
• Routine radiologic imaging, including chest X-rays (CXR) and chest computed tomography (CT), is frequently used in these evaluations.
• Concerns exist regarding the utility and impact of routine imaging for asymptomatic divers.

Purpose of the Study:

• To critically reevaluate the necessity of routine radiologic imaging in fitness-to-dive assessments.
• To examine the limitations of CXR and CT in identifying diving-related risks.
• To advocate for evidence-based guidelines regarding diver imaging.

Main Methods:

• Review of current practices in fitness-to-dive assessments.
• Analysis of the sensitivity and specificity of radiologic imaging for asymptomatic divers.
• Discussion of incidental findings and their implications for diver disqualification.

Main Results:

• Routine radiologic imaging in asymptomatic divers may lead to disqualification without clear evidence of increased diving risk.
• The sensitivity and specificity of CXR and CT for detecting significant diving-related pathology in asymptomatic individuals are limited.
• Incidental findings on imaging can create challenges in fitness-to-dive decisions.

Conclusions:

• A critical reevaluation of routine radiologic imaging for fitness-to-dive is warranted.
• There is a need for community-driven consensus to establish evidence-based guidelines for diver imaging.
• The necessity of routine CXR and CT for asymptomatic divers requires further investigation and justification.