CT Scans In Children Research Articles

Optimal Chest Compression Point During Pediatric Resuscitation: Implications for Pediatric Resuscitation Practice by CT Scans.

Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure. Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020. Single-center pediatric department in a German University Hospital. Imaging data were obtained from 290 patients of 3-16 years old. None. We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth. In this study of thoracic CT scans in children 3-16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults-6 cm limit-may be chosen.

Chest CT Scan Findings in Children with COVID-19: A Systematic Review.

To gather, summarize, and appraise the available evidence on: 1) the accuracy of chest CT scan in diagnosing COVID-19 among children, and 2) the characteristic chest CT scan findings associated with COVID-19 pneumonia in children. We comprehensively searched databases (MEDLINE, COCHRANE), clinical trial registries, bibliographic lists of selected studies, and unpublished data for relevant studies. Guide questions from the Painless Evidence Based Medicine and the National Institutes of Health Quality Assessment Tools were used to assess study quality. A poor quality study showed 86.0% (95% CI 73.8, 93.0) sensitivity and 75.9% (95% CI 67.1, 83.0) specificity of chest CT scan in diagnosing COVID-19 in children. Thirty-nine observational studies describing chest CT scan in children with COVID-19 showed abnormal findings in 717 of 1028 study subjects. Common chest CT scan findings in this population include: 1) ground glass opacities, patchy shadows, and consolidation, 2) lower lobe involvement, and 3) unilateral lung lesions. Studies which investigate the accuracy of chest CT scan in the diagnosis of COVID-19 in children are limited by heterogeneous populations and small sample sizes. While chest CT scan findings such as patchy shadows, ground glass opacities, and consolidation are common in children with COVID-19, these may be similar to the imaging findings of other respiratory viral illnesses.

The Clinical, Etiological, and Demographic Profile of Children Aged 1 to 14 Years with Seizures Attending a Tertiary Care Hospital in Gwalior District, India: A Cross-Sectional Study

Purpose: The clinical profile of seizures among children exhibits ethnic and geographical variations. The objective of this study was to examine the clinical, etiological, and demographic profiles of childhood seizures.Methods: This was a hospital-based, cross-sectional study. Data were collected on the socio-demographic profile, details of the clinical presentation of seizure episodes, past history of meningitis, and neuroimaging (i.e., computed tomography [CT] scans), as well as the history of risk factors. Numbers, percentages, the chi-square test, and the Fisher exact test statistic were calculated. A P value of <0.05 was considered significant.Results: This study included 102 patients, of whom 82 experienced generalized tonic-clonic seizures (GTCS) and the remaining 20 had focal seizures. The most common age at presentation was between 1 and 4 years (55.9%). Approximately 70.0% of the children experienced postictal confusion and drowsiness, 38.2% had fever or sleep deprivation, and 25.5% suffered from headaches or vomiting. Postictal confusion and drowsiness were significantly more prevalent in children with GTCS (76.8%) compared to those with focal seizures (45.0%). Cerebral edema was the most common abnormality detected on CT scans in children with GTCS (n=6). Conclusion: Younger age, neonatal brain insult, and family history were found to be associated with a higher risk of seizure episodes. Postictal confusion and drowsiness were identified as the most common clinical features. Postictal confusion and drowsiness were significantly more prevalent in GTCS compared to focal seizures. Cerebral edema was the most common abnormality observed in GTCS on CT neuroimaging.

Should the Radiologist Always Request a Blood Test Before an Emergency CT Scan in Children.

Renal failure is relatively common in children presenting to the emergency department, suggesting that the assumption of normal renal function is not always valid. Although some computed tomography (CT) scans necessitate the use of intravenous contrast, one should probably consider whether a blood test is necessary to assess the patient's renal function and possibly consider other imaging modalities before proceeding. With no pediatric-specific guidelines and no validated pediatric prevention strategies, further research is needed to establish clear recommendations for contrast-enhanced exams in stable and unstable pediatric patients with unknown renal function.

RSSA Conference: Radiation Exposure from Repeated CT Scans in Children: A Quantitative Analysis.

Background: This study investigated the frequency of pediatric patients undergoing multiple CT examinations during the last five years that lead to high cumulative effective dose (CED) and determined their age distribution. Method: This retrospectively reviewed data on pediatric CT exams performed from 2018 to 2023 using radiology archives of King Abdulaziz University Hospital Jeddah, Saudi Arabia. Result: A total of 2758 scans (representing 875 pediatric patients) performed in the past 5 years were included in this study. The mean and range of the DLP (mGy.cm) per procedure were 378(310-3986) for age group 0 to 5, 516 (129-4572) for age groups 6 to 10, and 572 (160-6474) for ages 11 to 15. The maximum number of repeats was 26 CT exams conducted from May 2020 to December 2022. Conclusion: Repeats were carried out frequently and pediatric doses varied up to 30 times for the same CT procedure. There is a crucial need for exposure reduction among pediatric patients and the use of dose-tracking software, with alert levels to reduce unnecessary repeats.

Dual-layer spectral CT improves the image quality of cerebral unenhanced CT scan in children

PurposeTo evaluate the image quality and determine the optimal energies of virtual monoenergetic imaging (VMI) in unenhanced pediatric cerebral scans by dual-layer spectral detector computed tomography (DLCT). MethodsFifty-three consecutive unenhanced cerebral scans by a DLCT scanner in children (age ≤ 12 years) were retrospectively analyzed. Conventional images (CI) and VMIs were reconstructed. The gray matter (GM) and white matter (WM) noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), posterior fossa, and subcalvarial artifac tindex (PFAI, SAI) were calculated. Two radiologists independently determined the image quality using a 5-point Likert-type scale based on GM − WM differentiation (GWMA), subcalvarialspace (SAA), beam hardening artifacts in the posterior fossa (PFAA), and the overall diagnostic quality. The student t-test and Wilcoxon test were used to determining the statistical significance. ResultsCompared with CI, superior noise were observed in VMI at low keV levels and were lowest at 100 keV (P < 0.001); the SNR and CNR were significantly higher at the 45 keV to 75 keV levels (all Ps of <0.005). The best GWMA were noticed at the 50 keV level compared to other keV levels (all P < 0.05). The optimal SAA and PFAA were found at 100 keV, respectively. The assessment of overall diagnostic quality was the best at 50 keV (P < 0.013 to < 0.001). ConclusionsThe VMI scan significantly improved the quality of pediatric cerebral images compared with those from CI. The optimal energy level for the brainparenchyma was 50 keV while those for subcalvarial space and posterior fossa were 100 keV.

CT Scanning in Children in a Country with Limited Resources (Burkina Faso)

CT Scanning in Children in a Country with Limited Resources (Burkina Faso)

The feasibility of ct scanning in children with a positive recombinant tuberculosis allergen test

The problem of substantiating the use of diagnostic methods using ionizing radiation in children remains topical, and the importance of the problem grows every year. Special attention should be paid to this issue in children’s TB. Thirty-three children suspected of TB were monitored for tubercular recombinant allergen (ATP). The study showed that the diagnosis made by the clinicians and the computed tomography (CT) data in children with modified ATP samples have no reliable influence (p=0.89; Fisher criterion=0.11). Diagnosis of TB was more dependent on clinical, laboratory, radiological, and historical data combined, and often CT had no effect on patient management. The rationale for applying CT in children with modified ATP responses should be corrected and applied on strict grounds to maintain radiation safety.

Comparison of metabolic tumour volume with Standardised Uptake Value (SUV) in F18 FDG pet CT scan in children with Hodgkin lymphoma

Comparison of metabolic tumour volume with Standardised Uptake Value (SUV) in F18 FDG pet CT scan in children with Hodgkin lymphoma

Evaluation of image quality, organ doses, effective dose, and cancer risk from pediatric brain CT scans

purposeThe present study was conducted to assess organ doses, effective dose, and image quality, and to estimate the risk of exposure-induced cancer death (REID) in pediatric brain computed tomography examinations. MethodsThis investigation was performed on 179 pediatric patients (99 men and 80 women) under 12 years old who underwent non-contrast brain CT scans. Patients were classified into four age groups of ≤ 1, 2–5, 6–9, and 10–12 years old. Organ doses and effective doses were calculated using the ImpactDose program. Cancer risk models presented in the BEIR VII report were used to estimate REID values. Image quality assessment in this study was performed by measuring image quality parameters such as noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). ResultsThe highest organ dose in all age groups belonged to the brain. The mean REID values were 12.34 per 100,000 males and 16.77 per 100,000 females. REID values decreased with the increasing age of patients in both genders and were higher for female children than male children. The mean SNR of gray matter, SNR of white matter, and CNR were 11.04, 10.5, and 2.31, respectively. ConclusionsAccording to the results of this study, brain CT scans in children are associated with an increased potential risk of cancer. Therefore, minimizing unnecessary radiation exposure in pediatric patients and using alternative imaging modalities are of particular importance. Moreover, optimizing the radiation parameters while maintaining the diagnostic image quality in children should be considered.

Clinical Question Influence on Radiation Dose of Cardiac CT Scan in Children.

Background: To assess the impact of different clinical questions on radiation doses acquired during cardiac computed tomography in children. Methods: A total of 116 children who underwent cardiac CT on a third-generation dual-source CT scanner were included. The clinical questions were divided into three main categories: the extent of scanning in the z-axis, coronary artery assessment and cardiac function assessment. Radiation dose values represented as a dose-length product (DLP) in mGy*cm were recorded from the CT scanner protocols. Results: There were significantly higher doses in cases with cardiac function assessment (median DLP 348 versus 59 mGy*cm, p < 0.01) and in cases with coronary artery assessment (median DLP 133 versus 71 mGy*cm, p < 0.01). Conclusion: The most important factor was the assessment of cardiac function, where the median radiation dose was 4.3× higher in patients with a request for cardiac function assessment. We strongly recommend that clinical requests for cardiac CT should be carefully considered in the paediatric population.

Epidemiology of Thyroid Cancer.

Epidemiology of Thyroid Cancer.

Automated segmentation of whole-body CT images for body composition analysis in pediatric patients using a deep neural network.

To develop an automatic segmentation algorithm using a deep neural network with transfer learning applicable to whole-body PET-CT images in children. For model development, we utilized transfer learning with a pre-trained model based on adult patients. We used CT images of 31 pediatric patients under 19 years of age (mean age, 9.6 years) who underwent PET-CT from institution #1 for transfer learning. Two radiologists manually labeled the skin, bone, muscle, abdominal visceral fat, subcutaneous fat, internal organs, and central nervous system in each CT slice and used these as references. For external validation, we collected 14 pediatric PET/CT scans from institution #2 (mean age, 9.1 years). The Dice similarity coefficients (DSCs), sensitivities, and precision were compared between the algorithms before and after transfer learning. In addition, we evaluated segmentation performance according to sex, age (≤ 8 vs. > 8 years), and body mass index (BMI, ≤ 20 vs. > 20 kg/m2). The algorithm after transfer learning showed better performance than the algorithm before transfer learning for all body compositions (p < 0.001). The average DSC, sensitivity, and precision of each algorithm before and after transfer learning were 98.23% and 99.28%, 98.16% and 99.28%, and 98.29% and 99.28%, respectively. The segmentation performance of the algorithm was generally not affected by age, sex, or BMI, except for precision in the body muscle compartment. The developed model with transfer learning enabled accurate and fully automated segmentation of multiple tissues on whole-body CT scans in children. • We utilized transfer learning with a pre-trained segmentation algorithm for adult to develop an algorithm for automated segmentation of pediatric whole-body CT. • This algorithm showed excellent performance and was not affected by sex, age, or body mass index, except for precision in body muscle.

Respiratory Manifestations of COVID-19 in Children: A Narrative Review

Background: Coronavirus disease 2019 (COVID‐19, the seventh coronavirus) is a new infectious disease that spread worldwide and rapidly became a pandemic. COVID‐19 is rare in children and often asymptomatic. The respiratory system is mainly involved in COVID-19 infection. Objectives: This study aimed to review respiratory manifestations in children with COVID-19. Methods: We searched for studies published from January 2020 to January 2021 in PubMed, Google Scholar, and Scopus in English. The search words were “2019-nCoV,” “novel coronavirus,” “COVID-19,” “SARS-CoV-2,” “severe acute respiratory syndrome coronavirus 2,” “children,” “child,” “infant,” “teenager,” “adolescent,” “pediatric,” and “neonate.” Results: Cough was a common symptom in our study (18.8%-100%, mean=64%). Pneumonia prevalence in children with COVID-19 is 11%-67% (mean=46%). Mild respiratory symptoms (14% - 60%) and severe respiratory distress syndromes (14%) were reported in some studies. Upper respiratory tract infection (URTI) was reported in 4 studies ranging from 11.1% to 34.4% (mean=24.1%). Ground-glass opacities (GGO) was reported in 12.2% to 81% of cases (mean=49.01%). Isolated consolidations were reported in 17% and 58% of patients in two studies. Enhanced lung texture was reported in 1.3% to 50% (mean=20.07%) of patients. Bilateral patchy shadowing was seen in 12.3% to 68% (mean=46.58%) of patients. Conclusions: Cough is the most common manifestation of respiratory system involvement in children with COVID-19. GGO and bilateral patchy involvement are the most common finding on lung CT scans in children with COVID-19.

How safe are CT scans in children?

How safe are CT scans in children?

The Pattern of CT Scan Use in the Diagnosis of Abdominal Pain in Children Presenting to the Emergency Department of a Tertiary Community Hospital.

Background and objectivePediatric populations are highly sensitive to ionizing radiations and, therefore, are more at risk of their harmful outcomes. Our study aimed to determine the percentage of children who underwent a CT scan after presenting to the ED with abdominal pain. The secondary aim was to determine the change in management related to the CT results. In addition, we also wanted to determine the predictors associated with the use of abdominal CT scans in the evaluation of children presenting to ED with abdominal pain as well as the predictors associated with positive CT scan results in children with abdominal pain.Materials and methodsWe retrospectively reviewed the medical records of children with abdominal pain seen in our ED from 01/01/2011 through 12/30/2012. Patients aged 4-18 years presenting with abdominal pain were identified from the medical records. Data on demographics, clinical characteristics, associated factors, CT use, CT findings, and change in management were collected. Data were analyzed using Chi-square (χ2) analysis and Student’s t-test.ResultsA total of 1,780 charts were reviewed and 1,272 children were included in the study. The mean age of the cohort was 12.6 ± 4.6 years; 62.6% were female and 68.7% were African American. Of note, 14% (181/1,272) of the study group had received a CT scan; change in medical management was noted in 34.8% (63/181) of the scanned patients. Predictors of CT use included older age (p<0.0001), male gender (p<0.0001), white race (p<0.0001), an attending without advanced training in pediatric emergencies (p=0.001), acute onset of symptoms (p<0.0001), higher pain score (p<0.0001), right lower quadrant pain (p<0.0001), abdominal wall rebound tenderness (p<0.0001), abdominal tenderness (p<0.0001), fever (p<0.0001), and absence of constipation (p=0.04). Positive CT scan results were predicted by the presence of fever (p=0.013), lack of constipation (p=0.025), and white race (p=0.022). A multivariate analysis could not be done because not all data were available for each patient.ConclusionThe use of the CT scan in children with abdominal pain affected the management in one out of three patients (34.8%). Fever, constipation, and white race were the factors associated with an increased likelihood of performing a CT scan and were also linked to positive results.

Epidemiological studies of CT scans and cancer risk: the state of the science.

20 years ago, 3 manuscripts describing doses and potential cancer risks from CT scans in children raised awareness of a growing public health problem. We reviewed the epidemiological studies that were initiated in response to these concerns that assessed cancer risks from CT scans using medical record linkage. We evaluated the study methodology and findings and provide recommendations for optimal study design for new efforts. We identified 17 eligible studies; 13 with published risk estimates, and 4 in progress. There was wide variability in the study methodology, however, which made comparison of findings challenging. Key differences included whether the study focused on childhood or adulthood exposure, radiosensitive outcomes (e.g. leukemia, brain tumors) or all cancers, the exposure metrics (e.g. organ doses, effective dose or number of CTs) and control for biases (e.g. latency and exclusion periods and confounding by indication). We were able to compare results for the subset of studies that evaluated leukemia or brain tumors. There were eight studies of leukemia risk in relation to red bone marrow (RBM) dose, effective dose or number of CTs; seven reported a positive dose-response, which was statistically significant (p < 0.05) in four studies. Six of the seven studies of brain tumors also found a positive dose-response and in five, this was statistically significant. Mean RBM dose ranged from 6 to 12 mGy and mean brain dose from 18 to 43 mGy. In a meta-analysis of the studies of childhood exposure the summary ERR/100 mGy was 1.78 (95%CI: 0.01-3.53) for leukemia/myelodisplastic syndrome (n = 5 studies) and 0.80 (95%CI: 0.48-1.12) for brain tumors (n = 4 studies) (p-heterogeneity >0.4). Confounding by cancer pre-disposing conditions was unlikely in these five studies of leukemia. The summary risk estimate for brain tumors could be over estimated, however, due to reverse causation. In conclusion, there is growing evidence from epidemiological data that CT scans can cause cancer. The absolute risks to individual patients are, however, likely to be small. Ongoing large multicenter cohorts and future pooling efforts will provide more precise risk quantification.

Burkitt’s Lymphoma of Intestine Presenting as Ileocolic Intussusception

Burkitt lymphoma, as the most common non-Hodgkin Bcell lymphoma of childhood, is rarely detected in the gastrointestinal tract. Intussusception secondary to Burkitt’s lymphoma is an uncommon presentation. We describe an unusual case of intestinal Burkitt’s lymphoma in a four and the half-year-old girl who presented with intermittent colicky pain three times. Imaging studies were suggestive of intussusception. The patient was subjected to the surgery of bowel resection, which revealed a creamy-gray oval-shaped mass. Histopathology through immunohistochemistry study confirmed the Burkitt lymphoma. Owing to rather nonspecific clinical and radiological features, the preoperative diagnosis of Burkitt lymphoma remains a challenging task for pediatric surgeons and radiologists. Therefore, in case of any clinical suspicion, further examinations, such as CT scan in children are recommended.

Analysis of Surgical Guidance and Related Predictive Factors of Head CT Scan in Children with Mild Head Trauma

Analysis of Surgical Guidance and Related Predictive Factors of Head CT Scan in Children with Mild Head Trauma

Is the Iliac Cortical Density Similarly Positioned in the Developing Pediatric Pelvis?

The iliac cortical density (ICD) is a critical fluoroscopic landmark for pelvic percutaneous screw placement. Our purpose was to evaluate the ICD as a landmark in pediatrics and quantify the diameter of osseous pathways for 3 screw trajectories: iliosacral (IS) at S1 and transiliac-transsacral (TSTI) at S1 and S2. Two hundred sixty-seven consecutive pelvic CT scans in children 0-16 years of age were analyzed. ICD and S1 vertebral heights were measured at multiple regions along S1. Their height and corresponding ratios, as well as osseous screw corridor dimensions were compared between age groups and by the dysmorphic status. In the nondysmorphic pelvises, S1 height, ICD height, and the ICD to S1 height ratio increased across age groups for all locations (P < 0.001). All 3 screw pathway diameters increased with age (P < 0.001). In the dysmorphic group, there was no increase in ICD to S1 height ratio with age. Except for the age 0-2 group, the ICD to S1 height ratios were significantly larger in the nondysmorphic group. In the dysmorphic group, S1 TSTI pathway remained narrow with age, whereas IS at S1 and TSTI at S2 had a significant increased diameter with age (P < 0.001). The ICD is a useful fluoroscopic landmark for percutaneous screw placement in the pediatric pelvis. For nondysmorphic pelvises, the ICD to S1 height ratio, as well as osseous corridors for IS, TSTI at S1, and TSTI at S2 screw trajectories increase significantly with age. The margin for safe screw placement in S1 is smaller for younger and dysmorphic pelvises.