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Choosing Wisely Canada

Canadian Association of Radiologists - Canadian Medical Association - University of Toronto

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 six-week trial of conservative management and if symptoms are severe enough that surgery is ...

Choosing Wisely Canada

Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto

Repair of minimally symptomatic inguinal hernias in adults can prevent potentially serious complications due to hernia incarceration. However, such repairs can also lead to complications such as infection, chronic inguinal pain and hernia recurrence which cumulatively approximate the risks of incarceration. Evidence shows that such hernias can also be managed with watchful waiting for up to 2 years after assessment, a choice that should be offered to appropriately selected persons.

Choosing Wisely Canada

Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto

Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is the preferred initial consideration for imaging examination in children. If the results of the ultrasound exam are equivocal, it may be followed by CT. This approach is cost-effective, reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specificity of 94 percent in experienced hands. Recognizing that expertise may vary, strategies including ...

Choosing Wisely Canada

Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto

Performing routine admission or preoperative chest X-rays is not recommended for ambulatory patients without specific reasons suggested by the history and/or physical examination findings. Only 2 percent of such images lead to a change in management. Obtaining a chest radiograph is reasonable if acute cardiopulmonary disease is suspected or there is a history of chronic stable cardiopulmonary diseases in patients older than age 70 who have not had chest radiography within six months.

Choosing Wisely Canada

Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto

Screening for colorectal cancer has been shown to reduce the mortality associated with this common disease; colonoscopy provides the opportunity to detect and remove adenomatous polyps, the precursor lesion to many cancers, thereby reducing the incidence of the disease later in life. However, screening and surveillance modalities are inappropriate when the risks exceed the benefit. The risk of colonoscopy increases with increasing age and comorbidities. The risk/benefit ratio of colorectal ...