Callahan Michael J, MacDougall Robert D, Bixby Sarah D, Voss Stephan D, Robertson Richard L, Cravero Joseph P
Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
Pediatr Radiol. 2018 Jan;48(1):21-30. doi: 10.1007/s00247-017-4023-6. Epub 2017 Nov 27.
In the context of health care, risk assessment is the identification, evaluation and estimation of risk related to a particular clinical situation or intervention compared to accepted medical practice standards. The goal of risk assessment is to determine an acceptable level of risk for a given clinical treatment or intervention in association with the provided clinical circumstances for a patient or group of patients. In spite of the inherent challenges related to risk assessment in pediatric cross-sectional imaging, the potential risks of ionizing radiation and sedation/anesthesia in the pediatric population are thought to be quite small. Nevertheless both issues continue to be topics of discussion concerning risk and generate significant anxiety and concern for patients, parents and practicing pediatricians. Recent advances in CT technology allow for more rapid imaging with substantially lower radiation exposures, obviating the need for anesthesia for many indications and potentially mitigating concerns related to radiation exposure. In this review, we compare and contrast the potential risks of CT without anesthesia against the potential risks of MRI with anesthesia, and discuss the implications of this analysis on exam selection, providing specific examples related to neuroblastoma surveillance imaging.
在医疗保健领域，风险评估是指与公认的医疗实践标准相比，识别、评估和估计与特定临床情况或干预措施相关的风险。风险评估的目标是结合为一名患者或一组患者提供的临床情况，确定给定临床治疗或干预措施可接受的风险水平。尽管儿科横断面成像中的风险评估存在固有挑战，但儿科人群中电离辐射和镇静/麻醉的潜在风险被认为相当小。然而，这两个问题仍然是有关风险的讨论话题，并给患者、家长和执业儿科医生带来极大的焦虑和担忧。CT技术的最新进展使得成像速度更快，辐射暴露大幅降低，从而无需因多种适应症进行麻醉，并有可能减轻对辐射暴露的担忧。在本综述中，我们比较并对比了无麻醉CT的潜在风险与有麻醉MRI的潜在风险，并讨论了该分析对检查选择的影响，提供了与神经母细胞瘤监测成像相关的具体示例。
