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Pediatric pneumonia: will lung ultrasound replace X-ray?

From the March 2018 issue of DOTmed HealthCare Business News magazine
Pneumonia is the leading infectious cause of death among children under 5 years of age. According to the United Nations Children’s Fund (UNICEF), it kills nearly 2,500 children per day and accounted for approximately 16 percent of the 5.6 million under-5 deaths in 2016.

Part of what makes pneumonia so deadly is that many countries don’t have sufficient access to the standard tool for diagnosing the condition – X-ray. In fact, the World Health Organization (WHO) estimates that two-thirds of the world’s population has no access to basic diagnostic imaging technology whatsoever.

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Fortunately, the recent emergence of highly portable and low-cost ultrasound systems is poised to turn the tide on those statistics – dramatically improve global access to imaging while also curbing pediatric pneumonia’s mortality rate.

“These places are too poor to be able to have a chest X-ray machine in place,” says Dr. James Tsung, associate professor in emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai Hospital. “But we have affordable ultrasound machines and that makes it feasible to bring ultrasound to places that never had any diagnostic imaging technology.”

In the U.S. and other industrialized countries, where access to X-ray is abundant, there are a different set of reasons why ultrasound is being turned to for diagnosing pediatric pneumonia. Efforts to limit dose exposure and curb costs throughout the health care ecosystem have made the non-ionizing modality an appealing alternative to radiography.

Pediatric patients are more radiosensitive than adults, meaning their cancer risk per unit dose of ionizing radiation is higher, according to the FDA. And although the dose exposure from X-ray is marginal, initiatives like Image Gently have made efforts to reduce or eliminate unnecessary radiation exposure a top priority in medical imaging, particularly where children are concerned.

A clinical comparison
While the cost and safety benefits of ultrasound are a given, the diagnostic value compared to chest X-ray for pediatric pneumonia requires scientific scrutiny. Tsung and his colleagues in the pediatric emergency department at Mount Sinai took it upon themselves to investigate the issue by conducting a randomized controlled trial comparing lung ultrasound to chest X-ray in 191 patients under 21 years old.

Each patient was randomly assigned to undergo a lung ultrasound exam or a chest X-ray exam followed by lung ultrasound. For the first group, if the physician needed further verification, then the patient also received a chest X-ray.
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