Pediatric Medical Imaging Research Articles

Paediatric medical imaging in Ireland- challenges, training, and the use of distraction techniques

The National Model of Care for Paediatric Healthcare Services, published in 2016, aims to ensure high-quality care for children across Ireland. However, with few exceptions, radiology departments in general hospitals “lack the necessary physical infrastructure, facilities, and staff training required for paediatrics.” These deficiencies can adversely affect a patient's behaviour and emotions, exacerbating fear of the healthcare system. This study sought to identify the challenges faced by radiographers in Ireland during paediatric imaging, with a focus on post-qualification training and the use of distraction techniques. A cross-sectional, qualitative online survey was conducted via Microsoft Forms, comprising 37 close-ended and eight open-ended questions on paediatric training, challenges, and distraction use. Ninety-six participants were recruited through snowball sampling from 26 hospitals and private clinics across Ireland. Only a small proportion of radiographers (n = 25, 26%) undertook post-qualification training in paediatric imaging, and many reported inadequate educational opportunities (n = 52, 60%). Patient cooperation (n = 45, 52%) and toddlers (n = 75, 90%) were identified as the most challenging aspect and age group, respectively. While distraction is commonly employed (n = 79, 91%), radiology departments often provide insufficient equipment (n = 65, 76%). The lack of equipment and training highlights the need for improvement in paediatric medical imaging services. The development of new training courses and distraction tools may enhance practice, ensuring the provision of high-quality paediatric care. Expanding radiographer training and implementing distraction tools may help paediatric patients better cope with the anxiety and stress associated with healthcare settings.

Benchmarking non-attendance patterns in paediatric medical imaging: A retrospective cohort study spotlighting First Nations children

IntroductionNon-attendance at Medical Imaging (MI) appointments can result in inefficiencies in healthcare resource allocation, increased financial burdens, and lead to potential barriers to effective healthcare delivery. We evaluated factors associated with non-attendance of MI appointments for children including variables: gender; age groups; residential postcodes; Indigenous status; appointment dates; appointment reminders and socio-economic status. MethodRetrospective cohort study of children with scheduled MI appointments at a Tertiary paediatric hospital in Australia, between January and December 2022. Data were extracted from the Radiology Information System and integrated with socio-economic census data through linking with postcode. Chi-squared, and logistic regression analysis were performed to identify significant predictors of non-attendance. ResultsOut of 17,962 scheduled outpatient appointments, 6.2 % did not attend. Males were less likely to attend than females (7.3 % vs. 5.8 %; p < 0.001). Older children had the highest frequency of non-attendance (p < 0.001). First Nations identified children had a higher likelihood of non-attendance at 14.5 % compared to non-First Nations at 5.8 %, and the odds ratio (OR) of First Nation children not attending was 2.54 (CI 2.13–3.03; p < 0.001) higher than non-First Nations children. Children from areas of disadvantage were less likely to attend (p < 0.001). Bone mineral densitometry had the highest odds of non-attendance (19.4 % of bookings) compared to other imaging modalities (p < 0.001). ConclusionThe following characteristics were associated with non-attendance: older male gender, residing in areas of socio-economic disadvantage, or identifying as First Nations Australians. By reviewing these findings with the cultural and professional experience of our Indigenous co-author, we have identified some strategies for improving attendance amongst First Nations children. Implications for practiceFactors associated with non-attendance, or “missed opportunities for care”, provide opportunities for intervention to improve attendance for vulnerable groups of children who require medical imaging.

Australian student radiographers’ experiences and perspectives in general paediatric medical imaging examinations

IntroductionPaediatric patients differ from adult patients with respect to anatomy, examination factors, behaviour, and intellectual development, requiring dedicated specialised knowledge and expertise. In the absence of a formal dedicated paediatric medical imaging subspecialty, this study undertook to understand student radiographers' experiences and perspectives on paediatric medical imaging. MethodsThe study entailed a descriptive cross-sectional survey design entailed a 51-item closed and open-ended response questionnaire using a total sampling method. Data were collected from both under- and postgraduate student radiographers who undertook clinical placement. Data interpretation and analysis involved statistical analysis of close-ended questions and thematic analysis of open-ended questions. ResultsThe overall response rate was 70%. Most participants acknowledged the importance of dedicated paediatric content as well as the theory content covered. The shortcoming in pre-placement practical component was overcome through varied approaches like observations and attempting through supervision whilst experiencing uncertainty, anxiety and felt unfair to risk the patient. As reported in literature like their qualified counterparts expressed similar challenges in technique adaptation, styles of interactions in gaining cooperation from both the children and parents. They also felt paediatric content and the practicals should be embedded throughout the course offering to not compromise the day-to-day service delivery. ConclusionsThe study findings iterate the importance paediatric imaging in the service delivery context. The importance of undertaking these examinations reliant on experiential learning is insufficient to bridge the gap of preparation prior to placement. Implications for practiceCollaborative academic and clinical radiography education will ensure that radiography students’ dedicated specialised paediatric imaging knowledge and experience are enhanced.

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis.

Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)-virtual reality (VR-MRI) and a certified Child Life Program (CLP). A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs. VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged fromCAN$190.69to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91-$426.64) to CAN$3843.41 (CAN$3196.59-$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20-$188.76) to CAN$283.85 (CAN$283.71-$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient. While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes of pediatric patients scheduled for MRI at their facilities.

Effective doses for common paediatric diagnostic general radiography examinations at a major Australian paediatric hospital and the communication of associated radiation risks.

Health professionals in paediatric medical imaging are routinely required to communicate radiation risks to carers and patients. Effective dose alone cannot be used to specify and communicate the radiation risk for an individual as risks are dependent on many factors including age and patient sex. In this study, we estimated typical effective doses for 20 commonly performed paediatric general radiography examinations using the weight-based imaging protocols employed at a major Australian specialist paediatric hospital. Effective doses were used to estimate and categorise associated age-based stochastic risks with commonly used risk terminology to facilitate communication of risk. Paediatric protocols for common general radiography examinations and World Health Organization 50th percentile weight-for-age data for females and males aged up to 18 years were used to estimate typical effective doses using Monte Carlo software and lifetime risk of cancer incidence using published data. Results were used to determine standardised levels of risk using the Calman risk model. Effective doses, corresponding lifetime risk of cancer incidence and level of risk category from 20 general radiography examinations for paediatric patients were calculated and presented for ease of communication. Doses ranged from <0.001 mSv (negligible risk) to 1.6 mSv (low risk). Typical effective doses from common paediatric general radiography examinations, the associated lifetime risk of cancer incidence and level of risk have been established for our institution. This can be used to convey risks to health professionals, patients and carers in ways that are easy to understand and compare with other everyday risks.

Development of a Super-Resolution Scheme for Pediatric Magnetic Resonance Brain Imaging Through Convolutional Neural Networks

Pediatric medical imaging represents a real challenge for physicians, as children who are patients often move during the examination, and it causes the appearance of different artifacts in the images. Thus, it is not possible to obtain good quality images for this target population limiting the possibility of evaluation and diagnosis in certain pathological conditions. Specifically, magnetic resonance imaging (MRI) is a technique that requires long acquisition times and, therefore, demands the use of sedation or general anesthesia to avoid the movement of the patient, which is really damaging in this specific population. Because ALARA (as low as reasonably achievable) principles should be considered for all imaging studies, one of the most important reasons for establishing novel MRI imaging protocols is to avoid the harmful effects of anesthesia/sedation. In this context, ground-breaking concepts and novel technologies, such as artificial intelligence, can help to find a solution to these challenges while helping in the search for underlying disease mechanisms. The use of new MRI protocols and new image acquisition and/or pre-processing techniques can aid in the development of neuroimaging studies for children evaluation, and their translation to pediatric populations. In this paper, a novel super-resolution method based on a convolutional neural network (CNN) in two and three dimensions to automatically increase the resolution of pediatric brain MRI acquired in a reduced time scheme is proposed. Low resolution images have been generated from an original high resolution dataset and used as the input of the CNN, while several scaling factors have been assessed separately. Apart from a healthy dataset, we also tested our model with pathological pediatric MRI, and it successfully recovers the original image quality in both visual and quantitative ways, even for available examples of dysplasia lesions. We hope then to establish the basis for developing an innovative free-sedation protocol in pediatric anatomical MRI acquisition.

Advances in pediatric medical imaging: A review of radiation exposure reduction techniques

Medical imaging has become essential for the diagnosis and management of diseases, providing a range of techniques for obtaining images of internal organs and tissues of the human body. Advances in these imaging techniques have been rapid, leading to a concomitant increase in the use of these techniques for the diagnosis and monitoring of a range of diseases in both adults and children. Healthcare professionals increasingly rely on medical imaging to identify acute diseases, guide planning and treatment during surgical procedures, and monitor the progress of treatment. In particular, imaging plays a critical role in determining the effectiveness of treatment, and is required to determine the extent and spread of bone and soft tissue tumors prior to biopsy or surgical treatment. The use of medical imaging in a growing number of children, particularly in diagnostic radiology, has raised concerns in recent years that the corresponding exposure to ionizing radiation in children is high. Radiation exposure and risks in children underlie concerns about the effective dose to patients of known and potential carcinogenic effects. In general, these concerns center around two groups of techniques: computed tomography (CT) and interventional endoscopic examinations.

Pediatric effective dose assessment for routine computed tomography examinations in Tehran, Iran.

Background:The purpose of this study is to evaluate the effective dose (ED) for computed tomography (CT) examination in different age groups and medical exposure in pediatric imaging centers in Tehran, Iran.Methods:Imaging data were collected from 532 pediatric patients from four age groups subjected to three prevalent procedures. National Cancer Institute CT (NCICT) software was used to calculate the ED value.Results:The mean ED values were 1.60, 4.16, and 10.56 mSv for patients' procedures of head, chest, and abdomen–pelvis, respectively. This study showed a significant difference of ED value among five pediatric medical imaging centers (P < 0.05). In head, chest, and abdomen–pelvis exams, a reduction in ED was evident with decreasing patients' age.Conclusion:As there were significant differences among ED values in five pediatric medical imaging centers, optimizing this value is necessary to decrease this variation. For head CT in infants and also abdomen–pelvis, further reduction in radiation exposure is required.

Ensuring Adequate Development and Appropriate Use of Artificial Intelligence in Pediatric Medical Imaging

Of over 100 FDA-cleared artificial intelligence (AI) tools for triage, detection, or diagnosis in medical imaging, only one is cleared for use in children. Thus, children may be unable to benefit from the advances that AI provides to adults. Furthermore, dataset demographics are frequently absent from the publicly available FDA documents, and it is not apparent that the software is unsuitable for use in pediatric patients. Herein, recommendations for change are proposed.

Comparing a Virtual Reality-Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial.

BackgroundThe experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed.ObjectiveThis study aims to compare the effectiveness of a virtual reality (VR)—based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers’ reported anxiety, procedural data, caregiver usability, child satisfaction, and fun.MethodsThis unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers’ reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales).ResultsA total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children’s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37).ConclusionsDigital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting.Trial RegistrationClinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382

Lifetime attributable cancer risk related to prevalent CT scan procedures in pediatric medical imaging centers

Purpose Evaluation of the organ dose in pediatric patients up to 15 years old and Estimation of lifetime attributable risk (LAR) of cancer incidence in pediatric computed tomography procedures. Materials and methods Data from 532 patients below 15 years old was collected and they were categorized into four age groups of <1, 1–5, 5–10, and 10–15 years old. NCICT software was used to calculate the organ dose, and LAR of cancer incidence has been estimated according to the BEIR VII report. Results The highest median dose in all age groups was related to eye lens (head scan), thyroid (chest scan), and colon (abdomen-pelvic scan). The highest average LAR of cancer incidence was observed for breast cancer and colon cancer following a chest CT scan of the youngest group (<1-year-olds) [68.23 per 100,000] and abdomen-pelvic scans of the oldest group (10- to 15-year-olds) [57.30 per 100,000]. Conclusion This study shows that the average LAR is higher in females and it decreases with age in both genders. Although CT scan has an indispensable application in diagnosis, the patient dose should be taken into account before any examination specifically in pediatric patients.

PEDIATRIC REGIONAL DRL ASSESSMENT IN COMMON CT EXAMINATIONS FOR MEDICAL EXPOSURE OPTIMIZATION IN TEHRAN, IRAN.

The main purpose of this pilot study was to assess the regional diagnostic reference level (RDRL) of computed tomography (CT) examinations to optimise medical exposure in five pediatric medical imaging centers in Tehran, Iran where the most frequent CT examinations were investigated. For each patient, CT volume dose indexes (CTDIvol) and dose length product (DLP) in each group were recorded and their third quartile was calculated and set as RDRL. Pediatrics were divided into four age groups (<1; 1-5; 5-10 and 10-15years). Then, the third quartile values for head, chest and abdomen-pelvic CTs were, respectively, calculated for each group in terms of CTDIvol: 21.3, 24.4, 24.2 and 36.3mGy; 2.9, 3.2, 3.7 and 5.7mGy; 3.7, 5.7, 6.3 and 6.8mGy; and in terms of DLP: 322.2, 390.1, 424.9 and 694.1mGy.cm; 53.1, 115.2, 145.3 and 167.6mGy.cm and 128.7, 317.7, 460.2 and 813.8mGy.cm. Finally, RDRLs were compared with other countries and preceding data in Iran. As a result, CTDIVOL values were lower than other national and international studies except for chest and abdomen-pelvic values obtained in Europe. Moreover, this matter applied to DLP so that other formerly reported values were higher than the present study but European values for chest and abdomen-pelvic scans and also Tehran studies conducted in 2012. Variation of scan parameters (tube voltage (kVp), tube current (mAs) and scan length), CTDIvol and DLP of different procedures among different age groups were statistically significant (P-value <0.05). The variations in dose between CT departments as well as between identical scanners suggest a large potential for optimization of examinations relative to which this study provides helpful data.

A clinical audit of anatomical side marker use in a pediatric medical imaging department: A quantitative and qualitative investigation.

BackgroundThe presence of a radiopaque or digital anatomical side marker (ASM) is an important diagnostic feature on radiographs and should be a routine feature on every radiographic image. Despite its importance, research has indicated numerous instances where ASMs were absent which have the potential to lead to adverse events. To date, few studies have systematically examined the use of ASMs in clinical practice and explored medical imaging professionals’ perspectives on ASM use. This research aimed to address this knowledge gap.MethodsThis investigation was conducted in two stages. Stage 1 involved a retrospective clinical audit of 421 randomly selected radiographs within 12-months at a pediatric medical imaging department. The data were analyzed for overall presence and type of marker use. Stage 2 comprised of semi-structured interviews with 11 radiographers to garner their perspectives on ASM use, and barriers and enablers to their use in clinical practice. The interviews were transcribed verbatim and thematically analyzed.ResultsThe overall presence of ASMs (radiopaque and digital) was observed on 99 per cent of radiographs. There was a noticeable shift towards the use of digital (78.8 per cent) compared to radiopaque ASMs (20.2 per cent), highlighting the growing trend towards using ASM in post-processing. A handful of images (N = 4) did not include any ASMs. Semi-structured interviews revealed multifaceted barriers (time, infection precautions, and patient factors) and few enablers (professionalism, legal requirement) for ASM use.ConclusionThis investigation, informed by quantitative and qualitative research paradigms, has shed new light on an important area of radiography practice. While missing ASMs were a small feature, there continue to remain opportunities where best practice standards can be improved. The increasing use of digital ASMs potentially highlights a shift in clinical practice standards.

Australasian radiographers’ choices of immobilisation strategies for paediatric radiological examinations

IntroductionImmobilisation may be necessary to ensure patient safety and examination success in paediatric medical imaging. Little guidance exists regarding the selection of different immobilisation methods. The purpose of this study was to explore radiographers’ selection of immobilisation methods in paediatric medical imaging and the influences on their choices. MethodsEthical approval was obtained. A mixed methods approach consisting of online questionnaire distribution followed by individual interviews was used to explore Australasian radiographers' self-reported patterns of immobilisation use and the underlying reasons and beliefs. Quantitative data were described using frequency data, with a Fisher's Exact test used to determine any association between demographic variables and immobilisation methods. Qualitative data were evaluated using content analysis. ResultsSixty-five radiographers returned completed questionnaires, with seven participating in interviews. Psychological immobilisation methods were preferred to minimise patient pain and distress, but physical methods were considered more effective, with parental holding the most likely method to be used (63/65, 96.9%). Participants assumed certain methods to be more appropriate based on patient age and examination type, but adapted their choices based on many other factors, seeking to provide personalised care. Further training was strongly desired (48/64, 75.0%). Participants disagreed on whether introducing written guidance would be beneficial (33/62, 53.2%). ConclusionChoosing an immobilisation method appears to be a case-by-case activity requiring critical assessment of multiple factors in order to balance patient care with examination success. Implications for practiceImprovements in quality and quantity of education are recommended to enhance radiographers’ ability to make choices based on all relevant factors.

Measurements of CTDI and DLP from CT image data for paediatrics radiological performance evaluation and dose optimisation in Ghana

Risk of developing cancer in paediatric patients is higher compared with adults and hence need for optimization strategies in paediatric medical imaging is very critical. The higher risk is attributable to the fact that children have developing organs and tissues which are more sensitive to the effects of radiation, and also they have longer life expectancy which allows more time for any harmful effects of radiation to manifest. Optimization of radiological protection is a means of adjusting imaging parameters and instituting protective measures such that required images are obtained with lowest possible radiation dose, and net benefit is maximized to maintain sufficient image quality for diagnostic purposes. Special consideration is given to the availability of dose reduction measures for paediatric imaging equipment. A unique aspect of paediatric imaging is with regards to the wide range in patient sizes and weights, therefore requiring special attention to optimization and modification of equipment, technique, and imaging parameters. Good radiographic technique for paediatrics include attention to patient positioning, field size and adequate collimation, use of protective shielding, optimization of exposure factors etc. In CT, dose reduction is optimized by the adjustment of scan parameters such as mA, kVp, and pitch in accordance with patient weight, age, region scanned, and study indication. Paediatric radiological imaging should therefore be performed by trained and experienced health personnel in the medical imaging department. The overall aim of the research was to enhance the capability of Ghana to improve the efficiency of existing modalities for paediatric medical imaging and to implement and enhance optimization techniques and methodologies for advanced paediatric medical imaging in CT. In addition to providing appropriate clinical recommendation for clinicians for dose management during CT scan. MVL DICOM application software was used to access image data during abdominal CT scan. Effective dose estimates were estimated as developed by ICRP 103 recommendations. The data collection was based on retrospective extraction of image data, using MVL platform where detailed information of the CTDIvol and DLP were available for recording. The weighted CTDI (CTDIW) was estimated by multiplying the volumetric CTDI (CTDIVOL) by the pitch factor. The effective dose was estimated by the product of the region-specific normalizing constant and the dose length product on each image. For image quality Signal to Noise Ratio was estimated and compare with effective dose for dose optimisation. In conclusion, the mean dose parameters exceeded the recommended dose parameter and hence an urgent need for an action to minimise radiation dose to paediatric patients.

Web-based online education of pediatric medical imaging: current situation and prospect

Web-based medical education has permeated into almost every corner of traditional medical teaching, persistently upgrading the medical teaching models and qualities, and network teaching has become the hot spot of modern education mode. Although the medical network education industry is in good shape, due to many factors, the development of pediatric imaging network education goes slowly. By comparing current situation of our and other countries' pediatric imaging websites, this study aims to reveal the deficiencies of domestic online teaching in pediatric imaging, and further, to probe the practical meaning and strategy in construction of pediatric imaging teaching website stations, so constructing our own website stations is beneficial for the development of pediatric imaging education of our country. Key words: Pediatrics; Medical imaging; Web-based teaching; Website construction

Discussion on the training mode of "5+3" professional degree of pediatric medical imaging

At present, the training of graduate students majoring in pediatric medical imaging is mainly based on the training mode of adult imaging, which has some problems such as the lack of pediatric specialty, the weakness of students' basic knowledge, the lack of perfect evaluation system, and students' relatively weak ability of innovation and scientific research. To solve above problems, in practice, we carry out the diversified curriculum by clinical department rotation to strengthen the clinical skill training and medical image basic knowledge, put the imaging diagnosis and clinical practice skills and clinical practice workload grading into the evaluation system, and strengthen the training of scientific research ability of medical imaging graduate students, so as to cultivate the high-level applied talents of modern medical imaging. Key words: Pediatric medical imaging; Professional degree graduates; Training mode

Immobilisation in Australian paediatric medical imaging: A pilot study

AimsThe primary aim of this study is to document the use of paediatric immobilisation techniques in medical imaging. Secondary aims are to investigate differences between current practice of paediatric and non-paediatric facilities and radiographer gender and to investigate immobilisation protocols. MethodsA SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) newsletter. Radiographer members of ASMIRT were invited to participate. Frequency percentage analysis was undertaken; as the 'frequency of immobilisation' response was on a Likert scale and the ages categorical, a Fisher's exact test could determine dependency. ResultsThe use of paediatric immobilisation techniques was determined to be related to age. The most commonly used technique in general X-ray was “other people”; in computed tomography, Velcro, verbal reminders and distraction techniques; and in magnetic resonance imaging, sedation and Velcro. A comparison of immobilisation techniques demonstrated that Velcro use in X-ray was dependent on facility (p = 0.017) with paediatric facilities using it up to 17 years. Immobilisation frequency was dependent in 13–17 years (p = 0.035) with paediatric facilities rarely immobilising and non-paediatric facilities never. No dependencies resulted upon comparing genders. Immobilisation frequency was not dependent between protocols or current practice. ConclusionThe use of paediatric immobilisation technique is related to age with “other people”, sedation, Velcro, verbal reminders and distraction techniques being regularly used. The dependency of Velcro use and immobilisation frequency in 13–17 years is for unknown reasons and further investigation is required. A larger study should be carried out to validate these findings.

Frequency of paediatric medical imaging examinations performed at a European teaching hospital over a 7-year period.

The aim of this retrospective cohort study was to gain an insight into frequencies by which a range of medical imaging (MI) examinations were performed on paediatric patients at the main acute general teaching hospital in Malta between 2008 and 2014. Frequency data of MI examinations performed on paediatric patients were retrospectively collected from relevant information systems. All data was coded accordingly to facilitate data analysis. A total of 95,805 MI examinations were performed on 39,707 unique paediatric patients (<18years) between 2008 and 2014. Overall, the total number of paediatric MI examinations performed decreased over time, with use varying depending on modality type and paediatric age. Coincidentally the use of ultrasound and MRI increased year after year. Some paediatric patients underwent at least three MI examinations involving the same anatomical region being scanned, and which may collectively contribute to effective doses exceeding 10mSv. Knowledge of how MI examinations are used within the paediatric population can help practices evaluate and address any trends highlighted for particular examinations or age category of paediatric patients. Furthermore, awareness of current trends of MI in children can be helpful for the planning of future paediatric radiology departments. • Medical imaging (MI) examinations are commonly performed in paediatric patients. • In 7years 95,805 examinations were performed on 39,707 paediatric patients. • Use of ultrasound and MRI in paediatric patients increased annually. • Highest frequency of MI examinations was observed in neonates/infants younger than 1year. • Awareness of MI utilisation patterns and trends can help inform practice.

Estimation of the Risk of Cancer Associated with Pediatric Cranial Computed Tomography

Background: The role of Computed Tomography (CT) in the medical diagnosis of diseases has greatly expanded, despite the potential risk of cancer following exposures to ionising radiation (XRay) from this modality. This risk is particularly of great concern in children, who are more radiosensitive and have many years to manifest radiation effect than adults. Aims: To estimate risk of cancer induction from Pediatric cranial CT. Materials and Methods: A total of 203 patients, who were referred from various pediatric clinics and wards for cranial CT in a teaching hospital in the South Western Nigeria between the year 2011 and 2013 were considered. All patients were grouped into four age (year) groups: less than 1, 1-5, 5-10 and 10-15. A mathematical method was used to estimate the risk of cancer from the Original Research Article Atalabi et al.; BJMMR, 9(10): 1-7, 2015; Article no.BJMMR.18079 2 effective dose(ED) calculated from volume computed tomography dose index (CTDIvol), dose length product (DLP) and standard conversion factor. Results: The range of CTDIvol (mGy) received by all patients was 10–250 mGy while majority of the patients received 50–100. The range of DLP (mGy.cm) received by all patients and majority of patients was 500–5000 and 2001–2500 respectively. The range of ED (mSv) received by all patients and majority of the patients was 1–25 and 5–10 respectively. The risk estimated with respect to patients’ age showed that patient in the age group 1–5 years have the highest risk of cancer induction while the risk based on gender showed no significant difference. Conclusion: Over 60% of pediatric patients received more than the recommended values of CTDIvol, DLP and ED from cranial CT. Urgent steps must be taken to ensure compliant with international recommended precautions for dose reduction in pediatric medical imaging.