Department of Bioimaging and Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, 00168, Rome, Italy.
Radiol Med. 2010 Mar;115(2):238-45. doi: 10.1007/s11547-009-0429-z. Epub 2009 Sep 29.
To verify if a "two step" school-based scoliosis screening procedure could reduce childhood radiation exposure and, if so, to estimate the subsequent reduction in radiogenic cancer fatalities and in socio-economic burden.
Data from two different scoliosis screening programs (A and B) performed on a total of 8,995 children (age range 9-14) were examined. Children in program A (5,731 children) were screened using a "two-step" procedure in which school physicians performed the first clinical examination and uncertain cases were referred to an orthopaedist. The school physicians were previously instructed by orthopaedists in the recognition of a number of simple clinical signs. Children in program B (3,264 children) were screened using a "one-step" procedure in which the initial clinical examination was performed directly by an orthopedist. In both programs, suspected cases of scoliosis were then ascertained by the orthopaedist with Radiography. To evaluate the lifetime attributable risk of cancer mortality the guidelines of the International Commission on Radiological Protection Publication 60 were followed. The economic cost of the performed X-ray examination was calculated assuming the current National Health Service's reimbursement to hospitals of euro 35 per X-Ray exam. The statistic significance of the difference in these estimates between the two programs was assessed using the proportions z-test. The issues of the relative sensitivity and specificity of the two programs were also examined.
In programs A and B, 86 (1.5 %) and 95 (2.91 %) X-ray examinations were performed respectively (z=4.452, p<0.001). Based on these observations, a screening of 10,000 children directly performed by orthopaedists would result in 291 X-ray exams (2.91 %). A screening of the same number of children using a two-step procedure would result in 150 X-ray exams (1.5 %), with a savings of euro 4,935 for the National Health Care System, a reduction of 0.283 Sv of collective dose, and an estimated 50% reduction in the number of radiogenic malignant tumours.
Using a two-step scoliosis screening procedure provides reasonable sensitivity and specificity while reducing costs and radiation exposure to children.
验证“两步法”学校脊柱侧凸筛查程序是否能降低儿童的辐射暴露，并在此基础上，估算随后降低的放射性癌症死亡率和社会经济负担。
对两个不同的脊柱侧凸筛查项目（A 和 B）共 8995 名儿童（年龄 9-14 岁）的数据进行了检查。项目 A（5731 名儿童）采用“两步法”进行筛查，校医进行初步临床检查，对不确定的病例则转诊给矫形外科医生。校医在识别一些简单的临床体征方面，曾接受过矫形外科医生的指导。项目 B（3264 名儿童）采用“一步法”进行筛查，即直接由矫形外科医生进行初始临床检查。在这两个项目中，疑似脊柱侧凸的病例随后由矫形外科医生用 X 光检查进行确认。为评估终生归因于癌症死亡率的风险，遵循了国际辐射防护委员会第 60 号出版物的指南。假设当前国民保健制度向医院报销每例 X 光检查 35 欧元，计算了所进行 X 光检查的经济成本。使用比例 z 检验评估两个方案之间这些估计值差异的统计学意义。还检查了两个方案的相对灵敏度和特异性问题。
在项目 A 和 B 中，分别进行了 86（1.5%）和 95（2.91%）次 X 光检查（z=4.452，p<0.001）。基于这些观察结果，如果直接由矫形外科医生对 10000 名儿童进行筛查，将进行 291 次 X 光检查（2.91%）。对相同数量的儿童进行两步筛查，将进行 150 次 X 光检查（1.5%），这可为国家卫生保健系统节省 4935 欧元，降低集体剂量 0.283Sv，并估计降低 50%的放射性恶性肿瘤数量。
使用两步法脊柱侧凸筛查程序可提供合理的灵敏度和特异性，同时降低儿童的成本和辐射暴露。
