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Choosing Wisely Canada

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

X-rays are only indicated if there is pain in the malleolar zone, bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps immediately after the trauma and in the emergency department.

Choosing Wisely Canada

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

Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is nearly as good in experienced hands. Since ultrasound will reduce radiation exposure, ultrasound is the preferred initial 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.

Choosing Wisely Canada

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

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.

Choosing Wisely Canada

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

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 ...

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 ...