, 逗号有存在的必要吗？

Initial ultrasonography may be associated with lower cumulative radiation exposure than initial CT, without significant differences in missing, serious, or alternative diagnoses; adverse events; pain scores; return emergency department visits; or hospitalizations. It is reasonable to use ultrasonography as the initial imaging modality in suspected nephrolithiasis and to monitor known stones.

初始超声检查与比初始CT相比可能与更低的累积辐射暴露有关，在遗漏严重或可能的诊断、不良事件、疼痛评分、再次急诊或住院方面两者没有显著差异。超声检查作为疑似肾结石的初始影像学检查和监测已知结石是合理的。

理解的对吗？如果理解的正确，missing, serious, or alternative diagnoses中间的逗号有存在的必要吗？