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Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children
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ACR Appropriateness Criteria® Ingested or Aspirated Foreign Body-Child.

, Mariana L Meyers1, Michael M Moore2

  • 1Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.

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|January 6, 2026
PubMed
Summary

Pediatric foreign body (FB) ingestion or aspiration requires specific imaging guidelines. Radiographs are typical initial steps, with CT scans or ultrasound used for further evaluation based on suspected FB type and location.

Keywords:
AUCAppropriate Use CriteriaAppropriateness Criteriaaspiration/aspiratedchildforeign body/bodiesingestion/ingestedpediatricwater beads

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Area of Science:

  • Pediatric Radiology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Foreign body (FB) ingestion or aspiration is a frequent cause of pediatric emergency department visits.
  • Timely and accurate diagnosis is crucial for appropriate management and preventing complications.

Purpose of the Study:

  • To outline evidence-based imaging guidelines for pediatric foreign body ingestion or aspiration.
  • To provide a structured approach for selecting appropriate imaging studies based on clinical suspicion and prior imaging results.

Main Methods:

  • Development of three variants of imaging recommendations based on clinical scenarios (initial imaging, negative initial radiographs for ingested FB, negative initial radiographs for aspirated FB).
  • Utilized the American College of Radiology Appropriateness Criteria methodology, including systematic literature review and expert consensus (RAND/UCLA Appropriateness Method).

Main Results:

  • Variant 1 (initial imaging): Neck, chest, abdomen, and pelvis radiographs are standard; low-dose noncontrast chest CT is appropriate for radiolucent FB suspicion.
  • Variant 2 (ingested FB, negative radiographs): Chest CT without contrast is usual; fluoroscopic esophagram, CT abdomen/pelvis, or abdomen ultrasound (for water beads) may be considered.
  • Variant 3 (aspirated FB, negative radiographs): CT chest without contrast is usual; decubitus chest radiographs and fluoroscopy are generally not appropriate.

Conclusions:

  • These guidelines offer a systematic approach to imaging pediatric patients with suspected foreign body ingestion or aspiration.
  • The recommendations aim to optimize the use of diagnostic imaging, ensuring appropriate study selection for effective diagnosis and management.