Purpose or Case Report: The Choosing Wisely initiative, led by the American Board of Internal Medicine (ABIM) Foundation in collaboration with over 80 medical societies and organizations, was launched in 2012 in the United States and Canada. Choosing Wisely is a response to the estimation that roughly 20% of current medical tests and therapies lack justification, provide no value, and may pose risks. The American Academy of Pediatrics (AAP) became a participant in Choosing Wisely from the start, resulting in 16 pediatric specialty-specific lists designed to assist AAP members in responsible healthcare resource management. While pediatric radiology did not develop its own list, imaging recommendations were included on fully half of the published AAP/Choosing Wisely lists.
Methods & Materials: We systematically evaluated every recommendation from the Choosing Wisely initiative within the AAP. Lists were accessed on the AAP website and we included every recommendation pertaining to radiology.
Results: Eight of the 16 published lists (50%) included imaging recommendations – Cardiology and Cardiac Surgery, Endocrinology, Neonatal Perinatal Medicine, Neurological Surgery, Orthopedics, Pediatric Emergency Medicine, Surgery, and Urology – with a combined total of 21 such recommendations. Two recommendations from cardiology were excluded because they pertained to echocardiography, for a total of 19 recommendations and 7 specialties included. The recommendations encompassed various radiological techniques, including 2 for ultrasound, 5 for radiographs, 3 for CT scans, 1 for MRI, 2 for either CT or MRI scans, and 5 advised against obtaining imaging. Most of the recommendations (12 of 19) applied to children of all ages, six targeted infants, and one specifically preterm neonates.
Conclusions: The Choosing Wisely initiative encourages evidence-based dialogue on the avoidance of unnecessary medical tests, treatments, and procedures. These radiology-related recommendations provide important insights into some of the common imaging tests deemed unnecessary or potentially harmful by our clinical colleagues.