Pediatric Musculoskeletal Imaging Guidelines, Pediatric Musculoskeletal Imaging Age Considerations

Many conditions affecting the musculoskeletal system in the pediatric population are different diagnoses than those occurring in the adult population. For those diseases which occur in both pediatric and adult populations, minor differences may exist in management due to patient age, comorbidities, and differences in disease natural history between children and adults. Patients age < 18 years old should be imaged according to the pediatric musculoskeletal imaging guidelines, and patients age ? 18 years should be imaged according to the Musculoskeletal Imaging Guidelines, except where directed otherwise by a specific guideline section. Pediatric musculoskeletal imaging appropriate clinical evaluation and conservative treatment, A recent (within 60 days) face-to-face evaluation including a detailed history, physical examination, appropriate laboratory studies, and basic imaging such as plain radiography or ultrasound should be performed prior to considering advanced imaging, unless the patient is undergoing guideline-supported scheduled follow-up imaging evaluation. Plain X-ray should be done prior to advanced imaging for musculoskeletal conditions to rule out those situations that do not require advanced imaging, such as osteoarthritis, acute/healing fracture, osteomyelitis, and tumors of bone amenable to biopsy or radiation therapy (in known metastatic disease), etc. Even in soft tissue masses, plain X-rays are helpful in evaluating for calcium/bony deposits, e.g. myositis ossificans and invasion of bone. Provider-directed conservative care may include any or all of the following: R.I.C.E (rest, ice, compression, and elevation), NSAIDs (non-steroidal anti-inflammatory drugs), narcotic and non-narcotic analgesic medications, oral or injectable corticosteroids, viscosupplementation injections, a provider-directed home exercise program, cross-training, physical medicine, or immobilization by splinting/casting/bracing. These guidelines are based upon using advanced imaging to answer specific clinical questions that will affect patient management. Imaging is not indicated if the results will not affect patient management decisions. Standard medical practice would dictate continuing conservative therapy prior to advanced imaging in patients who are improving on current treatment programs. Repeat imaging studies of the same body area are not necessary solely for return-to-play decisions. Unless otherwise stated in a specific guideline section, repeat imaging stud