CHOOSING WISELY CANADA
5 things
radiologists and patients should question
By the Canadian Association of Radiologists *
1
Don’t do imaging for lower-back pain unless red flags are present.
Red flags include suspected epidural abscess or hematoma
presenting with acute pain, but no neurological symptoms
(urgent imaging is required); suspected cancer; suspected
infection; cauda equina syndrome; severe or progressive
neurologic deficit; and suspected compression fracture. In
patients with suspected uncomplicated herniated disc or
spinal stenosis, imaging is only indicated after at least a sixweek trial of conservative management and if symptoms
are severe enough that surgery is being considered.
2
Don’t do imaging for minor head trauma
unless red flags are present.
Red flags include Glasgow Coma Scale (GCS) less than 13;
GCS less than 15 at 2 hours post-injury; a patient aged 65
years or older; obvious open skull fracture; suspected open
or depressed skull fracture; any sign of basilar skull fracture
(e.g., hemotympanum, raccoon eyes, Battle’s Sign, CSF otorhinorrhea); retrograde amnesia to the event lasting 30 minutes or longer after the event; “dangerous” mechanism (e.g.,
pedestrian struck by motor vehicle, occupant ejected from
motor vehicle, or fall from higher than 3 feet or down more
than 5 stairs); and coumadin-use or bleeding disorder.
3
Don’t do imaging for uncomplicated headache unless red flags are present.
Red flags include recent onset, rapidly increasing frequency
and severity of headache; headache causing the patient to
wake from sleep; associated dizziness, lack of coordination,
tingling or numbness, new neurologic deficit; and new onset of a headache in a patient with a history of cancer or
immunodeficiency.
4
Don’t do computed tomography (CT) for
the evaluation of suspected appendicitis
in children until after ultrasound has been
considered as an option.
Although CT is accurate in ѡ