A Leone1, A Aulisa, C Perisano, T Re, M Galli. 1. Department of Bioimaging and Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, 00168, Rome, Italy.
Abstract
PURPOSE: To verify if a "two step" school-based scoliosis screening procedure could reduce childhood radiation exposure and, if so, to estimate the subsequent reduction in radiogenic cancer fatalities and in socio-economic burden. MATERIAL AND METHODS: Data from two different scoliosis screening programs (A and B) performed on a total of 8,995 children (age range 9-14) were examined. Children in program A (5,731 children) were screened using a "two-step" procedure in which school physicians performed the first clinical examination and uncertain cases were referred to an orthopaedist. The school physicians were previously instructed by orthopaedists in the recognition of a number of simple clinical signs. Children in program B (3,264 children) were screened using a "one-step" procedure in which the initial clinical examination was performed directly by an orthopedist. In both programs, suspected cases of scoliosis were then ascertained by the orthopaedist with Radiography. To evaluate the lifetime attributable risk of cancer mortality the guidelines of the International Commission on Radiological Protection Publication 60 were followed. The economic cost of the performed X-ray examination was calculated assuming the current National Health Service's reimbursement to hospitals of euro 35 per X-Ray exam. The statistic significance of the difference in these estimates between the two programs was assessed using the proportions z-test. The issues of the relative sensitivity and specificity of the two programs were also examined. RESULTS: In programs A and B, 86 (1.5 %) and 95 (2.91 %) X-ray examinations were performed respectively (z=4.452, p<0.001). Based on these observations, a screening of 10,000 children directly performed by orthopaedists would result in 291 X-ray exams (2.91 %). A screening of the same number of children using a two-step procedure would result in 150 X-ray exams (1.5 %), with a savings of euro 4,935 for the National Health Care System, a reduction of 0.283 Sv of collective dose, and an estimated 50% reduction in the number of radiogenic malignant tumours. CONCLUSIONS: Using a two-step scoliosis screening procedure provides reasonable sensitivity and specificity while reducing costs and radiation exposure to children.
PURPOSE: To verify if a "two step" school-based scoliosis screening procedure could reduce childhood radiation exposure and, if so, to estimate the subsequent reduction in radiogenic cancer fatalities and in socio-economic burden. MATERIAL AND METHODS: Data from two different scoliosis screening programs (A and B) performed on a total of 8,995 children (age range 9-14) were examined. Children in program A (5,731 children) were screened using a "two-step" procedure in which school physicians performed the first clinical examination and uncertain cases were referred to an orthopaedist. The school physicians were previously instructed by orthopaedists in the recognition of a number of simple clinical signs. Children in program B (3,264 children) were screened using a "one-step" procedure in which the initial clinical examination was performed directly by an orthopedist. In both programs, suspected cases of scoliosis were then ascertained by the orthopaedist with Radiography. To evaluate the lifetime attributable risk of cancer mortality the guidelines of the International Commission on Radiological Protection Publication 60 were followed. The economic cost of the performed X-ray examination was calculated assuming the current National Health Service's reimbursement to hospitals of euro 35 per X-Ray exam. The statistic significance of the difference in these estimates between the two programs was assessed using the proportions z-test. The issues of the relative sensitivity and specificity of the two programs were also examined. RESULTS: In programs A and B, 86 (1.5 %) and 95 (2.91 %) X-ray examinations were performed respectively (z=4.452, p<0.001). Based on these observations, a screening of 10,000 children directly performed by orthopaedists would result in 291 X-ray exams (2.91 %). A screening of the same number of children using a two-step procedure would result in 150 X-ray exams (1.5 %), with a savings of euro 4,935 for the National Health Care System, a reduction of 0.283 Sv of collective dose, and an estimated 50% reduction in the number of radiogenic malignant tumours. CONCLUSIONS: Using a two-step scoliosis screening procedure provides reasonable sensitivity and specificity while reducing costs and radiation exposure to children.
Authors: F Zurita Ortega; C Moreno Lorenzo; L Ruiz Rodríguez; A Martínez Martínez; A Zurita Ortega; A M Castro Sánchez Journal: An Pediatr (Barc) Date: 2008-10 Impact factor: 1.500
Authors: Stefano Negrini; Sabrina Donzelli; Angelo Gabriele Aulisa; Dariusz Czaprowski; Sanja Schreiber; Jean Claude de Mauroy; Helmut Diers; Theodoros B Grivas; Patrick Knott; Tomasz Kotwicki; Andrea Lebel; Cindy Marti; Toru Maruyama; Joe O'Brien; Nigel Price; Eric Parent; Manuel Rigo; Michele Romano; Luke Stikeleather; James Wynne; Fabio Zaina Journal: Scoliosis Spinal Disord Date: 2018-01-10
Authors: Angelo G Aulisa; Vincenzo Guzzanti; Emanuele Marzetti; Marco Giordano; Francesco Falciglia; Lorenzo Aulisa Journal: Scoliosis Date: 2014-04-23