Department of Urology, University of Michigan , Ann Arbor , Michigan.
Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor , Michigan.
J Urol. 2019 May;201(5):996-1004. doi: 10.1097/JU.0000000000000030.
The Image Gently® campaign was launched by several radiological societies in 2007 to promote safe imaging in children. A goal of the campaign was to reduce ionizing radiation exposure in children. Given the recurrent nature of kidney stones, affected children are at risk for unnecessary ionizing radiation exposure from computerized tomography. We sought to determine whether the Image Gently campaign led to a decrease in the use of computerized tomography for evaluating children with nephrolithiasis. We hypothesized that the campaign was the primary cause of a reduction in the use of computerized tomography.
We analyzed medical claims data from 2001 to 2015 identifying children with nephrolithiasis covered by the same commercial insurance provider. Using a difference in differences design, we estimated changes in computerized tomography use after the campaign started among patients less than 18 years old compared to a control group age 18 years or older with nephrolithiasis.
We identified 12,734 children and 787,720 adults diagnosed with nephrolithiasis. Before 2007 quarterly rates of computerized tomography use during a stone episode (per 1,000 patients) were increasing at a parallel rate in children and adults (5.1 in children vs 7.2 in adults, p = 0.123). After the Image Gently campaign started the use of computerized tomography decreased in both groups but at a slightly higher rate in adults (difference in differences 2.96, 95% CI 0.00 to 5.91, p = 0.050).
Although there has been a reduction in the use of computerized tomography among children with nephrolithiasis, given a similar trend seen in adults this change cannot be primarily attributed to the Image Gently campaign.
“Image Gently”运动由多个放射学学会于 2007 年发起，旨在促进儿童的安全成像。该运动的目标之一是减少儿童的电离辐射暴露。鉴于肾结石的反复发作，受影响的儿童有接受计算机断层扫描的不必要电离辐射暴露的风险。我们试图确定“Image Gently”运动是否导致儿童肾结石评估中计算机断层扫描的使用减少。我们假设该运动是计算机断层扫描使用减少的主要原因。
我们分析了 2001 年至 2015 年的医疗索赔数据，确定了由同一家商业保险公司承保的肾结石儿童。使用差异中的差异设计，我们估计在运动开始后，18 岁以下患者与 18 岁或以上肾结石患者相比，计算机断层扫描使用的变化。
我们确定了 12734 名儿童和 787720 名成人患有肾结石。在 2007 年之前，结石发作期间计算机断层扫描使用的季度率（每 1000 名患者）以平行的速度在儿童和成人中增加（儿童 5.1 例，成人 7.2 例，p = 0.123）。“Image Gently”运动开始后，两组患者的计算机断层扫描使用率均有所下降，但成人的下降速度略快（差异差异 2.96，95%置信区间 0.00 至 5.91，p = 0.050）。
尽管肾结石儿童的计算机断层扫描使用率有所下降，但鉴于成人中也出现了类似的趋势，这一变化不能主要归因于“Image Gently”运动。
