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Should We Abstain from Routine Use of Radiologic Imaging in Fitness to Dive Assessments? A call for action.

Authors:           1.         prof. Peter Lindholm, plindholm@health.ucsd.edu

Dept of Emergency Medicine, Division of Hyperbaric Medicine, University of California San Diego, USA.

Dept of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

                        2.         dr. Thijs Wingelaar, tt.wingelaar@mindef.nl (corresponding author)

Royal Netherlands Diving and Submarine Medical Center, Den Helder, the Netherlands.

 

This article calls for a critical reevaluation of routine radiologic imaging, particularly chest X-rays (CXR) and chest computed tomography (CT), in fitness-to-dive assessments for occupational, military, and commercial divers. While these assessments aim to prevent diving incidents by identifying medical risks, the frequent inclusion of radiologic imaging for asymptomatic divers raises concerns due to limited sensitivity and specificity, incidental findings, and potential disqualification without clear evidence of increased diving-related risk. The authors advocate for a community-driven consensus to establish evidence-based guidelines and address the necessity of routine imaging in this context.

Key points

  • -  The article questions the routine use of radiologic imaging, such as chest X-rays (CXR) and computed tomography (CT), in fitness-to-dive assessments, particularly for asymptomatic divers without disease risk.

  • -  The paper highlights the limitations of radiologic imaging in healthy populations, including the potential for incidental findings that may lead to unnecessary disqualifications and increased costs without proven benefits in preventing diving-related incidents.

  • -  The authors advocate for a community-driven consensus to establish evidence-based guidelines on imaging in diver assessments, urging colleagues to contribute data and opinions to address this issue comprehensively.