Imaging in pediatric patients: Time to think again about surveillance
Bibliographic record
Abstract
BACKGROUND: Despite concerns regarding ionizing radiation exposures from diagnostic imaging procedures in pediatric patients, many are deemed unavoidable or even mandated by treatment protocols. A prior review at our institution found patients with lymphoma had a higher median cumulative radiation exposure (191 mSv) versus other oncology subgroups (61 mSv). PURPOSE: Estimations of cumulative diagnostic radiation exposures were tabulated for 5 years from the first diagnostic scan for 30 consecutive lymphoma patients diagnosed in 2001. Each individual imaging procedure was reviewed and classified as protocol mandated or discretionary (for disease surveillance, good patient care or radiologist request). RESULTS: Almost all patients (28/29) received chemotherapy; one had surgery only. Individual cumulative radiation exposures ranged from 10 to 642 mSv. Over 5 years, 690 procedures were performed; 303 (44%) X-rays, 203 (29%) CTs, 157 (23%) radionucleotide, and 27 (4%) interventional procedures. Of these, 238 (34%) were protocol required and 452 (66%) discretionary (224 as part of good patient care for a co-morbid illness and 228 for evaluation of possible disease progression/surveillance). A total of 86/217 (40%) studies (including 43 CTs and 38 radionucleotide scans) were performed when the recurrence risk was low (>2 years off therapy). CONCLUSIONS: The majority of ionizing radiation procedures in this lymphoma cohort were discretionary. Given the excellent outcome of this group and the long-term risks; rational use of discretionary surveillance procedures is necessary. Guidelines for the appropriate use of surveillance imaging based on probability of risk recurrence must be developed in order to minimize ionizing radiation exposure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".