Scanning In Children Research Articles

Bone Microarchitecture Assessed by Trabecular Bone Score Is Independent of Mobility Level or Height in Pediatric Patients with Cerebral Palsy.

Bone strength and fracture risk do not only depend on bone density, but also on bone structure. The trabecular bone score (TBS) evaluates homogeneity of bone microarchitecture indirectly by measuring gray-level variations of two-dimensional (2D) DXA images. Although TBS is well-established for adults, there have been only few publications in pediatrics. In this monocentric retrospective analysis, we investigated TBS in children and adolescents with cerebral palsy (CP), a patient group vulnerable to low bone mineral mass due to impaired mobility. The influence of different parameters on TBS and areal BMD (aBMD) were evaluated, as well as the relationship between TBS and aBMD. We compared TBS values of our study population to a reference population. A total of 472 lumbar spine-dual-energy X-ray absorptiometry (LS-DXA) scans of children and adolescents with CP (205 female), aged between 4 and 18 years, were analyzed. The DXA-scans were part of the routine examination. The children had no records of fractures or specific bone diseases. Our study population with CP had similar TBS as the reference population. TBS did not increase with age until an inflection point at 10 years in females, and 12 years in males. Girls had significantly higher TBS than boys (p = .049) and pubertal girls aged 8 to 13 years had significantly higher TBS than prepubertal girls (p = .009). TBS standard deviation score for age (SDS-TBS) and aBMD Z-scores correlated weakly (p < .001; R = 0.276 [males], R = 0.284 [females]). Other than for aBMD Z-scores, SDS-TBS was not influenced by age-adjusted height Z-scores and there was no significant difference in SDS-TBS when grouped by mobility levels, using the Gross Motor Function Classification System (GMFCS). Our results indicate that children with CP have a similar homogeneous distribution of trabecular microarchitecture as controls. Puberty initiation appears to be essential for increase of TBS with age and for sex differences. TBS seems less influenced by body composition, height, and mobility than aBMD. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic head injuries

The aim of this study was to determine the potential impact of the Pediatric Emergency Care Applied Research Network (PECARN) rules on the CT rate in a large paediatric minor traumatic head injury (MTHI) cohort and compare this with current national Dutch guidelines. This was a planned sub-study of a prospective multicentre observational study that enrolled 1006 children younger than 18 years with MTHI. We calculated the number of recommended CT scans and described trauma-related CT scan abnormalities. The PECARN rules recommended a significantly lower percentage of CT scans in all age categories, namely 101/357 (28.3%) versus 164/357 (45.9%) (p < 0.001) in patients under 2 years of age and 148/623 (23.8%) versus 394/623 (63.2%) (p < 0,001) versus in patients 2 years and older.Conclusion: The projected CT rate can significantly be reduced if the PECARN rules are applied. We therefore advocate that the PECARN guidelines are also implemented in The Netherlands.What is Known:• To guide clinicians whether to perform a CT scan in children with a minor traumatic head injury (MTHI) clinical decision rules has been developed.• The overall CT scan rate in adherence with the Dutch MTHI guidelines is 44%.What is New:• The projected CT rate can significantly be reduced in a Dutch cohort of MTHI if the PECARN rules are applied.• The Dutch national guidelines for MTHI can safely be replaced by the PECARN rules.

Utilization of CT imaging in minor pediatric head, thoracic, and abdominal trauma in the United States

BackgroundLiberal use of CT scanning in children with blunt trauma risks unnecessary radiation exposure and cost. Recent literature questions the utility of whole-body CT in stable children without clinical evidence of significant injury, but this is often done based on injury mechanism. The purpose of this study is to quantify the utilization of CT scans of the head, chest, abdomen, and pelvis based on injury severity in these body regions and to assess the impact of American College of Surgeons (ACS) pediatric trauma center designation on CT utilization in children with minor or no injuries. MethodsWe queried the National Trauma Databank for 2014, 2015, and 2016 to identify all patients 14 years and younger. Using Abbreviated Injury Scale (AIS) score as a proxy for injury severity, we analyzed the number of head, thoracic, and abdominal CT scans done for patients at low levels of injury severity (AIS 0–2) in each of these body regions and according to trauma center level designation (ACS I, II, III, standalone pediatric I or II, and non ACS accredited). ResultsOf 257,661 children who were entered into the database for any reason, overall CT utilization was 20% for head, 5% for the chest and 9% for the abdomen and pelvis. Children with no injuries or minimal injury to the head were scanned 7% and 46% of the time, respectively, for the chest 3% and 13% and for the abdomen 6% and 30%. For all body regions and all levels of injury severity, level 1 stand-alone pediatric centers displayed significantly lower CT utilization rates than others. ConclusionCT scan rates for children with minimal or no injuries to the head, chest, abdomen and pelvis are significant. Level 1 stand-alone pediatric trauma centers are least likely to perform these studies. Widespread education and acceptance of clinical guidelines for imaging in stable patients throughout trauma systems could alleviate this disparity. Level of evidenceLevel III retrospective comparative study

Early markers of cystic fibrosis structural lung disease: follow-up of the ACFBAL cohort.

Little is known about early predictors of later cystic fibrosis (CF) structural lung disease. This study examined early predictors of progressive structural lung abnormalities in children who completed the Australasian CF Bronchoalveolar Lavage (ACFBAL) clinical trial at age 5-years and participated in an observational follow-up study (CF-FAB).Eight Australian and New Zealand CF centres participated in CF-FAB and provided follow-up chest computed-tomography (CT) scans for children who had completed the ACFBAL study with baseline scans at age 5-years. CT scans were annotated using PRAGMA-CF scoring. Ordinal regression analysis and linear regression were used to investigate associations between PRAGMA-CF (Perth-Rotterdam Annotated Grid Morphometric Analysis for CF) outcomes at follow-up and variables measured during the ACFBAL study.99 out of 157 ACFBAL children (mean±sd age 13±1.5 years) participated in the CF-FAB study. The probability of bronchiectasis at follow-up increased with airway disease severity on the baseline CT scan. In multiple regression (retaining factors at p<0.05) the extent of bronchiectasis at follow-up was associated with baseline atelectasis (OR 7.2, 95% CI 2.4-22; p≤ 0.001), bronchoalveolar lavage (BAL) log2 interleukin (IL)-8 (OR 1.2, 95% CI 1.05-1.5; p=0.010) and body mass index z-score (OR 0.49, 95% CI 0.24-1.00; p=0.05) at age 5 years. Percentage trapped air at follow-up was associated with BAL log2 IL-8 (coefficient 1.3, 95% CI 0.57-2.1; p<0.001) at age 5 years.The extent of airway disease, atelectasis, airway inflammation and poor nutritional status in early childhood are risk factors for progressive structural lung disease in adolescence.

Reproducibility of foot dimensions measured from 3-dimensional foot scans in children and adolescents with Down syndrome

BackgroundChildren and adolescents with Down syndrome have a distinctive foot shape (such as wide and flat feet) that often leads to difficulty with footwear fitting. 3-dimensional (3D) scanning can accurately measure the foot dimensions of individuals with Down syndrome, which may assist shoe fit. However, the reproducibility of measuring foot dimensions using 3D scans in children and adolescents with Down syndrome is unknown. The aim of this study was to determine the intra- and inter-rater reproducibility of measuring foot dimensions of children and adolescents with Down syndrome using 3D scanning.Methods3D foot scans of 30 participants with Down syndrome aged 5 to 17 years were obtained using the FotoScan 3D scanner. Foot dimensions assessed were foot length, ball of foot length, outside ball of foot length, diagonal foot width, horizontal foot width, heel width, ball girth, instep girth, first and fifth toe height, and instep height. Additionally, the Wesjflog Index and forefoot shape were determined. Measurements were completed by two raters independently on two separate occasions, 2 weeks apart. Intra- and inter-rater reliability were assessed using intra-class coefficients (ICCs) and Gwet’s AC1 statistics with 95% confidence intervals. Agreement was determined by calculating limits of agreement (LOA) and percentage agreement.ResultsEighteen participants were female and 12 were male (mean age 10.6 [3.9] years). Intra-rater reproducibility (ICCs ranged from 0.74 to 0.99, 95% LOA from − 13.7 mm to 16.3 mm) and inter-rater reproducibility (ICCs ranging from 0.73 to 0.99, 95% LOA from − 18.8 mm to 12.7 mm) was good to excellent, although some measurements (ball of foot length, outside ball of foot length, heel width and girth measurements) displayed wider LOAs indicating relatively poorer agreement. Forefoot shape displayed substantial to almost perfect reliability (Gwet’s AC1 0.68 to 0.85) and percentage agreement ranged from 73 to 87%, indicating acceptable agreement.ConclusionsThe measurement of specific foot dimensions of children and adolescents with Down syndrome using 3D scans is reproducible. Findings of this study may be used to support future research measuring specific foot dimensions of children and adolescents with Down syndrome using 3D foot scans.

Comparative analysis of computed tomography scan and flexible bronchoscopy in the evaluation of suspected foreign body aspiration in children and the role of later in its removal

Background: Foreign body aspiration (FBA) in children is considered one of the most important diagnostic and therapeutic challenges for physicians. Often there is no history of aspiration of foreign body in this population and these children present with a wide range of nonspecific signs and symptoms. The objective of the study was to study the diagnostic utility of chest computed tomography (CT) scan in children with suspected FBA in comparison to flexible bronchoscopy (FB) and the role of later as a therapeutic tool in the removal of airway foreign bodies. Methods: This was a prospective observational study conducted from January 2015 to August 2019. Children admitted for persistent respiratory symptoms underwent CT chest and FB for confirmation of the diagnosis and retrieval of the foreign body if present. Results: A total of 101 patients of both genders were enrolled in the study. Fifty-three participants were boys and 48 were girls. FBA was diagnosed in 53 patients on chest CT. On FB, FBA was confirmed in 55 patients. The sensitivity and specificity of chest CT in our study were 85% and 87% respectively. In 25 of these patients, removal was successfully done by the FB. Conclusion: We conclude that a Chest CT scan is inferior to FB in the diagnosis of suspected trachea-bronchial foreign bodies in children. FB as a therapeutic tool has an excellent safety record in the retrieval of airway foreign bodies in this population.

2582 Diagnosis of Meckel's Diverticulum With Double Balloon Enteroscopy

INTRODUCTION: Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal (GI) tract, present in 2-4% of the population. Typically, it presents as GI bleeding and is usually diagnosed in childhood. However, some patients may remain asymptomatic through adulthood or present later in life with complications. We describe an unusual case of an adult male presenting with abdominal pain and maroon stools, who underwent an extensive workup and was eventually diagnosed with MD only after a double-balloon enteroscopy (DBE). CASE DESCRIPTION/METHODS: A 29-year-old male with no significant medical history, presented with epigastric pain and melena for 2 days. He was initially hemodynamically stable with an admission hemoglobin of 8 g/dL. During his hospitalization, he passed intermittent maroon blood clots resulting in a hemoglobin drop to 6 g/dL, requiring 4 units of pRBCs. He had an extensive diagnostic workup including an EGD, colonoscopy, Meckel's scan, CT angiogram &amp; push enteroscopy, which did not reveal a source of bleeding. Finally, a video capsule endoscopy showed active bleeding at 67% small bowel transit time. An anterograde DBE was then performed which showed no evidence of bleeding. Afterward, a retrograde DBE revealed a single bleeding diverticulum in the mid-ileum. The area was tattooed, and general surgery performed a laparoscopic small bowel resection of the Meckel's diverticulum. Pathology of the resected specimen was consistent with Meckel's diverticulum. The patient has remained asymptomatic since the surgery. DISCUSSION: We report the case of a young adult patient who presented with typical symptoms of Meckel's diverticulum but negative diagnostic examination with common practice Meckel's workup. A diagnosis was made only after the use of DBE after symptoms persisted, which calls to question whether certain imaging modalities are superior in adult-onset Meckel's than in the pediatric population in detecting MD. The sensitivity and specificity of Meckel's scan in children is 85% and 95%, respectively, but decreases to 62.5% and 9% in adults. A retrospective case-series found that DBE had a significantly higher mean diagnostic accuracy of 85.0% for MD compared to 21.4% for Meckel's scan. Mean diagnostic accuracies of other tests were as follows: VCE (36%), CT (32%), and angiography (10%). We suggest utilizing DBE much earlier in the diagnostic workup, in conjunction with capsule endoscopy, to better optimize diagnostic yield.

Correlation between pre-operative CT findings and intra-operative features in pediatric cholesteatoma: a retrospective study on 26 patients.

To assess the predictive value of pre-operative CT imaging in pediatric patients affected by cholesteatoma of the middle ear, comparing pre-operative CT findings to intra-operative features. A retrospective study was performed on a population of 26 pediatric patients who underwent tympanoplasty for middle ear cholesteatoma at the Otorhinolaryngology Departments of Verona and Modena University Hospitals between December 2011 and June 2018. Comparison between pre-operative CT images and intra-operative findings (assessed from video recording) was made focusing on the involvement of specific structures: ossicular chain, tegmen tympani, labyrinthine fistula, facial nerve, and temporal bone involvement. CT sensitivity, specificity, positive and negative predictive values were calculated. Overall, 28 surgical procedures were evaluated. No statistically significant differences were encountered between CT images and intra-operatory findings regarding the selected parameters. Based on our study, pre-operative temporal bone CT scan is a valuable tool for the assessment of pediatric patient candidates for cholesteatoma surgery given the absence of statistically significant differences between radiologic and intra-operative findings. The present findings might support the indication to routinely perform temporal bone CT scan in children with cholesteatoma as part of pre-surgical plan. III.

Bone mineral density and vitamin D status in children with remission phase of steroid-sensitive nephrotic syndrome.

Children with idiopathic nephrotic syndrome are primarily treated with glucocorticoids (GCs), but long-term GC use can lead to undesired side effects. We investigated the bone mineral density (BMD) and 25-hydroxyvitamin D (25-OH D) levels in children with the remission phase of steroid-sensitive nephrotic syndrome (SSNS). This study included 32 patients with SSNS who had not received GC treatment in the last 6 months and a control group of 20 healthy children. Serum levels of calcium, phosphate, alkaline phosphatase, 25-(OH)D, and parathyroid hormone (PTH) were measured. BMD was determined in the lumbar spinal region using dual-energy X-ray absorptiometry (DEXA). Serum 25-(OH)D levels were lower in the SSNS patients than in the healthy children (P <0.05), with 22 patients (68.8%) having Z-scores <-1. The Z-scores were positively correlated with 25-(OH)D levels (r = 0.424, P <0.05). PTH levels were higher in patients with osteoporosis than in patients with Z-scores ≥-1 (P <0.05). Bone mineral content and BMD were positively correlated with the age of diagnosis (P <0.01). Receiver-operating characteristic curve analysis showed that the cutoff value of 25-(OH)D levels for predicting low BMD was 14.67 ng/mL with a sensitivity of 90% and a specificity of 64%. The area under the curve (AUC ± standard error) was 0.868 ± 0.064 (95% confidence interval: 0.742-0.994, P = 0.001). Decreased 25-(OH)D levels and the negative effects of long-term GC treatment on BMD persist in SSNS remission phase. Levels of 25-(OH)D <14.67 ng/mL could predict abnormal DEXA scans in children with SSNS remission phase.

Evaluation of 3 T lung magnetic resonance imaging in children with allergic bronchopulmonary aspergillosis: Pilot study

ObjectiveTo evaluate the diagnostic performance of 3 T lung magnetic resonance imaging (MRI) in children with allergic bronchopulmonary aspergillosis (ABPA). Materials and methodsThis study protocol was approved by the institutional ethics committee. From October 2015 to January 2018, we prospectively evaluated twenty-seven consecutive children with ABPA. The diagnosis of ABPA was made on the ISHAM-ABPA working group criteria. High resolution computed tomography (HRCT) and 3 T MRI of the chest was performed on the same day. Bronchiectasis, consolidation, nodules, and mucus impaction were assessed in all segments. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI were calculated using HRCT findings as the reference standard. Interobserver agreement was calculated using the kappa statistic. ResultsThe mean age of the patients was 9.89 years (range: 5–16 years). There were 20 males and 7 females. The sensitivity, specificity, PPV, and NPV for bronchiectasis was 68%, 100%, 100% and 71.43% respectively. The sensitivity, specificity, PPV, and NPV for consolidation was 80%, 100%, 100% and 96% respectively. For detection of nodules, the sensitivity, specificity, PPV, and NPV was 75%, 100%, 100% and 88.46% respectively. There was 100% sensitivity, specificity, PPV and NPV for mucus impaction. There was a high degree of interobserver agreement for MRI findings (k = 0.9–1) as well as agreement (k = 0.7–1) between CT and MRI for all the four findings. ConclusionWith the currently available routine MR sequences, MRI demonstrates high specificity but less sensitivity and negative predictive value to HRCT scan in children with ABPA. Newer MR sequences need to be explored and validated to enhance the potential of lung MRI in ABPA.

A local study on diagnostic reference levels estimation for children computed tomography

Introduction: The Diagnostic reference levels (DRLs) play a critical role in the optimization of radiation dose especially, in some conditions like pediatrics. They are useful indicators by which the radiologists can be aware of delivered excess radiation doses to the patients, and take corrective actions if necessary. In order to meet some requirements for establishing the national computed tomography DRLs tables, much studies are needed all around the country. Materials and Methods: All active computed tomography (CT) scanners in public and private centers in Tehran were identified and checked for quality assurance and control certification. Eleven centers were chosen to be studied according to CT examination frequencies. Weighted CT dose index (CTDIw) and dose length product (DLP) for head, sinus, chest and abdomen/pelvis scans of children were obtained from scanner’s operator consoles and classified into four groups based on their ages (A; <1 year, B; 1-5 years, C; 5-10 years and D; 10-15 years). The 3rd quartiles of CTDIw were considered as DRLs and compared with the reported European Union (EU) and United Kingdom (UK) ones. Results: DRLs for head, sinus, chest and abdomen/pelvis scans were found to be 86.76, 31.33, 6.33, 7.65 mGy; 43.38, 31.33, 6.33, 7.65 mGy; 43, 31.33, 6.33, 7.65 mGy and 44.53, 31.33, 6.33, 7.65 mGy in the four groups (A-D) respectively. They are lower than the reported DRLs in EU and UK. Conclusion: There are variations in the radiation dose between the CT centers and identical scanners indicating the necessity for dose optimization. The data reported in this study can be remarkably useful in this concern.

General anesthesia / sedation requirement influences the way MRI brain scans are ordered in a tertiary pediatric hospital.

MRI guidelines have been created to help clinicians order scans appropriately. Some scans in children are carried out under general anesthesia (GA) / sedation. To evaluate if the requirement for GA/sedation influences the way MRI brain scans are ordered. Retrospective. Children with MRI brain scans in 2015 to 2017. 3T, 1.5T. Institutional Review Board approval for waiver of consent was obtained. Clinical MRI brain reports for children were classified into whether they conformed to the American College of Radiology (ACR) 2013 guidelines by research assistants under supervision of a pediatric radiologist. Scans were sorted into those with normal brains or abnormality. The statistical difference between groups was assessed using t-test for continuous variables and chi-square test for categorical variables with IBM SPSS 19. Of the total 1893 MRI scans, 431 were performed under GA and six under sedation. Of the 431 cases performed under GA/sedation, 383 (87.6%) were ordered according to guidelines. Of the 1456 cases that did not require GA/sedation, 710 (48.8%) conformed to guidelines. The percentage of scans ordered according to guidelines was 38.8% higher in those who had scans performed under GA/sedation (P < 0.001). MRI scans were normal in 635 (58.0%) out of the 1093 cases ordered according to guidelines and normal in 638 (79.8%) out of the 800 cases that did not follow guidelines. Scans not ordered according to guidelines had higher proportion of normal scans (21.8%) compared with those ordered according to guidelines (P < 0.001). Higher adherence to imaging guidelines is seen in younger patients who were exposed to the risks of GA/sedation for the MRI. Scans not adhering to guidelines had a higher percentage of having no brain abnormality detected. 3 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e250-e255.

The White Blood Cell Count to Hemoglobin Level Ratio is Correlated with the Presence of Cortical Defects on DMSA Renal Scans in Children with Febrile Urinary Tract Infection

The White Blood Cell Count to Hemoglobin Level Ratio is Correlated with the Presence of Cortical Defects on DMSA Renal Scans in Children with Febrile Urinary Tract Infection

Diagnosis of a Bleeding Meckelʼs in an Adult with a Negative Meckelʼs Scan

Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract, occurring in 2% of the general population. Most diagnosis of MD are made in childhood. However, some patients may remain asymptomatic through adulthood or present later in life with complications such as anemia due to ileal ulceration. Strictures occur in MD due to secretion of hydrochloric acid and pepsin by heterotopic gastric tissue. We describe a case of an adult male presenting with abdominal pain and anemia who was diagnosed initially with small bowel ulceration consistent with Crohn's disease. However, he was eventually diagnosed with MD after surgical exploration. This case illustrates the difficulty in diagnosing MD in adults by standard imaging or endoscopy. A 45 year-old South Asian man without significant PMH presented to clinic with a one-year history of progressive anemia associated with fatigue and abdominal pain. Initial evaluation included an upper endoscopy and colonoscopy. A video capsule endoscopy (VCE) study revealed an inflammatory stricture in the distal ileum concerning for IBD. Retrograde DBE defined two ulcerated stenotic strictures located in the mid-ileum immediately adjacent to a diverticulum. Biopsies of the two strictures and diverticulum were suggestive of Crohn's disease. A Meckel's scan was performed and negative. Surgical resection of the diseased segment of bowel was consistent with a MD which was confirmed by histology. Meckel's diverticulum (MD) is primary diagnosed in childhood by 99mTc nuclear imaging or Meckel's scan (MS). The sensitivity and specificity of this scan in children is 85% and 95%, respectively, but falls to 62.5% and 9% in adults. This discrepancy may be related to a decline in heterotopic gastric mucosa with age in symptomatic MD. A case series evaluating an incidental MD in 311 patients found no presence of heterotrophic (ie. gastric and pancreatic) mucosa. One retrospective case-series found that DBE had a significantly higher diagnostic accuracy 85.0% (61.1%-96.0%) for MD than MS 21.4% (5.7%-51.2%) in the adult population with a (P = 0.001). However, DBE is not available in all centers. This same study also reported the diagnostic accuracy of other modalities for MD including small-bowel follow through (63%),VCE (36%),CT (32%), and angiography (0%). In cases in which a MD is suspected but evaluation by imaging and VCE are inconclusive, referral for DBE should be considered.1986_A Figure 1. Mid-ileum Stricture1986_B Figure 2. Stricture adjacent to Large Diverticulum1986_C Figure 3. Histopathology adapted from Fujita, Naoyuki

Maturation of pelvic ossification centers on computed tomography in normal children.

The pelvis is composed of three paired primary ossification centers: the pubis, the ischium and the ilium. During maturation, multiple secondary ossification centers can be seen in the synchondroses between these bones and in the pelvic apophyses. The fragmented appearance of these centers can be confused with pathology. To examine development of pelvic ossification centers by CT and determine normal appearance throughout childhood. Three pediatric radiologists reviewed 325 pelvic CT scans in children and young adults 5-18years old and graded 6 pelvic ossification centers to evaluate maturational changes in critical structures. Rate and progression of ossification and age at complete fusion vary with gender at the different ossification centers in the growing pelvis. Knowledge of the normal CT appearance of ossification centers throughout childhood is important to differentiate the normal appearance from pathology.

Using a motion-tracking device to facilitate motion control in children with ASD for neuroimaging

ABSTRACTPurpose: Conducting neurological scans of children with disabilities is difficult because participants exhibit excessive motion. We examined whether a motion-tracking system that combined real-time visual feedback with positive reinforcement and shaping could facilitate motion control in two children with autism spectrum disorder.Methods: Using a modified changing criterion design, we evaluated whether the intervention could facilitate decreases in the participants’ range of motion and increases in duration of motion control in a mock scanner.Results: Participants restricted head motion to increasingly smaller distance windows for 2 min. Once participants limited head displacement to 3 mm for 2 min, duration of motion control increased to a range of 7–20 min. Summary-level data from the actual scan suggests increases in motion control generalized outside of the intervention context.Conclusion: This study adds to the limited research on the use of behavioral interventions to increase motion control for neuroimaging in children with disabilities.

OA078] The acceptable quality doses (AQDs) in children undergoing CT examinations in Hamad medical corporation hospitals in Qatar

Purpose The main purpose of this work is to estimate the acceptable quality doses (AQDs) resulting from various protocols for children undergoing CT examinations in Hamad Medical Corporation hospitals in Qatar. Methods This method has been introduced recently [ https://www.ncbi.nlm.nih.gov/pubmed/25430807 ] and it takes into account all three important parameters; image quality, dose and patient’s age. About 100 cases of pediatric patients (up to 15 y of age) have been studied for CT examination of Head, Chest and Abdomen. All Images were assessed for image quality according to scoring criteria; 1, 2, 3 and 4 corresponding to bad, not acceptable, acceptable, and higher than necessary quality, respectively. Only images with acceptable quality (score of 3) were selected and grouped into four age groups, 1–5, >5–10 and >10–15 y. The median values for CTDIVol and DLP were determined as the AQD. Results The initial results are shown in the table below. Head Chest Abdomen CTDIvol (mGy) DLP (mGy.cm) CTDIvol (mGy) DLP (mGy.cm) CTDIvol (mGy) DLP (mGy.cm) 17.2 234 0.6 13 2.4 108 >1–5 y 20.0 419 1.5 31 2.8 84 >5–10 y 20.7 513 2.2 61 3 125 10–15 y 21.8 427 3.7 109 6.4 277 CTDIvol and DLP for CT scans of children for images of acceptable quality. Conclusions The concept of AQD allowed orientation of radiologists in image quality assessment and its documentation. Further, integration of image quality scoring with dose resulted in detection of situations with higher-than-necessary image quality and awareness and detection of opportunities for optimization.

Reducing the radiation exposure from CT scanning in children with shunts: a nationwide survey and a departmental CT protocol

Introduction: Low dose ionising radiation such as from CT scans carries a low but cumulative risk of cancer and children are particularly sensitive. Children with VP Shunts often undergo multiple CT scans. We developed a CT protocol with reduced radiation for paediatric patients with shunts and compared it with the current practice in the other neurosurgical units in the UK and ROI by conducting a nationwide survey.Methods: An email questionnaire was send to the superintendent radiographer in every Neurosurgical unit in the UK and the ROI.Results: The response rate was 70%. Only 5 (19%) of the responding units used a dedicated CT shunt protocol with reduced radiation. Radiation was reduced by lowering the tube current. In comparison, our protocol uses a combination of less tube current and fewer slices. This reduced the radiation exposure of a CT head significantly with sufficient image quality to make a diagnosis.Conclusion: Radiation from CT for paediatric shunt patients scans can and should be reduced. This can be achieved by using reduced radiation protocols. A national paediatric CT shunt protocol could lead to significant reduction in effective radiation dose.

Lung and airway shape in neuroendocrine cell hyperplasia of infancy.

Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare lung disease associated with significant air trapping. Although chest CT is crucial in establishing a diagnosis, CT and biopsy findings do not reveal airway abnormalities to explain the air trapping. We compared lung and airway morphology obtained from chest CT scans in children with NEHI and control children. In the children with NEHI, we explored relationships between lung and airway shape and lung function. We performed a retrospective review of children with NEHI who underwent clinical chest CT. We identified control children of similar size and age. We created lung masks and airway skeletons using semi-automated software and compared them using statistical shape modeling methods. Then we calculated a logistic regression model using lung and airway shape to differentiate NEHI from controls, and we compared shape model parameters to lung function measurements. Airway and lung shapes were statistically different between children with NEHI and controls. We noted a broad lung apex in the children with NEHI and a significantly increased apical anterior-posterior lung diameter. A logistic regression model including lung shape was 90% accurate in differentiating children with NEHI from controls. Correlation coefficients were significant between lung function values and lung and airway shape. Lung and airway shapes were different between children with NEHI and control children in this cohort. Children with NEHI had an increased anteroposterior diameter of their lungs that might be useful in the diagnostic criteria.

Analytical revisit to basics helps reduce unnecessary CT scan in children with abdominal trauma: A single institution experience

Introduction. CT scan is regarded as the investigation choice for accurate depiction of blunt abdominal injuries in children and is considered as an inevitable tool in the armamentarium of the clinician before deciding for conservative management of these children. However over dependence on CT scan puts the patient to many disadvantages.&#x0D; The aim of this study to devise stratification criteria for the children with blunt abdominal injury and advise CT scan to the children only who really require it.&#x0D; Material and methods. All the children with blunt abdominal injury were studied prospectively over a period of two years. These children underwent clinical, biochemical and ultrasonographic assessment at presentation followed by CT abdomen. Efficacy of predefined clinical, biochemical and ultrasonographic parameters was compared with CT scan to triage the children with intra abdominal injury.&#x0D; Results. A total of 84 children were registered in the study based on final diagnosis of presence or absence of intra abdominal injury the children were divided in two groups. These groups were then compared for various clinical, laboratory and ultrasonographic parameters to predict intra abdominal injury. The children having isolated abdominal injury, tenderness, raised AST, ALT and amylase and free fluid on ultrasonography were found to have more chances of intrabdominal injury (p &lt; 0.001). These parameters were the most sensitive parameters to predict intra abdominal injury and the cumulative sensitivity of these parameters was 99.7%. The CT abdomen was negative in 74.7% of the patients.&#x0D; Conclusion. Due to high negative rate of CT abdomen in children with abdominal trauma, its use as first line imaging investigation is questionable in all the children with abdominal trauma. We suggest that by utilizing clinical, biochemical and ultrasonographic parameters, the children at risk of intra abdominal injuries can identified with almost 100% accuracy mandating the use of CT scan only in these children.