Janet L. Strife

Systemic hypertension secondary to peripheral vascular anomalies in patients with Williams syndrome.

ng/ml , n = 20). Although whole blood serotonin concentrations may decrease with increasing age, 1~ values in patient 1 were also elevated compared with those in an age-matched normal pediatric population we are studying (values to be reported elsewhere). Elevated serotonin levels in children with Williams syndrome adds to the growing list of disorders that have evidence of central nervous system serotonergic dysfunction? In summary, medical, developmental, and psychologic data have been described in two children with Williams syndrome and autism. The documentation and comparison of specific abnormalities in autistic Children with different associated organic conditions may help to delineate the neurobiologic cause of both the behavioral phenotype and the underlying genetic conditions.

Diseases Associated with Childhood Obesity

OBJECTIVE Radiologists can play an active role in childrens health by increasing awareness of diseases associated with obesity. This article reviews key imaging findings in obesity-related diseases, current issues in imaging obese children, and treatment strategies. CONCLUSION There has been a well-documented pediatric obesity epidemic and a dramatic increase in clinical diseases associated with it. These serious health consequences affect nearly every organ system. Despite the increasing prevalence of obesity and the associated health hazards, pediatric obesity as a diagnosis is often overlooked by health care providers.

Sleep Fluoroscopy for Localization of Upper Airway Obstruction in Children

The management of children with upper airway obstruction (UAO) in whom previous airway surgeries or concomitant craniofacial or neuromuscular abnormalities exist is complicated by potential obstruction at multiple sites. Sleep fluoroscopy (SF) provides adynamic representation of relative degrees of obstruction at multiple levels of the pediatric airway. Fifty-five SF studies were performed on 50 infants and children to localize obstructive sites. Correlation was assessed with findings on direct laryngoscopy and bronchoscopy under spontaneous ventilation. In 24 (44%), endoscopic and SF findings correlated exactly. The SF studies identified a site of UAO in 11 patients with normal findings on endoscopic examination and multiple sites of UAO in 16 others. Two thirds of these occurred at the hypopharynx and tongue base. The SF studies failed to detect 5 airway abnormalities in 4 patients. The sensitivity of SF for endoscopically verified laryngotracheal lesions was lowest for glottic (67%) and subglottic (70%) locations and higher for tracheal (92%) and supraglottic (100%) sites. Sleep fluoroscopy altered the course of treatment in 26 (52%) children. It appears to be a valuable adjunct to endoscopy in the identification and management of pediatric UAO when hypopharyngeal collapse or multiple levels of obstruction are suspected.

Is the frontal radiograph alone sufficient to evaluate for pneumonia in children

BackgroundIn our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed.ObjectiveTo determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children.Materials and methodsThree radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs. A majority interpretation of at least two radiologists for the frontal views alone was compared with majority interpretation of the frontal and lateral combined views for the radiographic diagnosis of pneumonia. “Pneumonia” was defined as a focus of streaky or confluent lung opacity.ResultsFor the radiographic diagnosis of pneumonia, the sensitivity and specificity of the frontal view alone were 85% and 98%, respectively. For the confluent lobar type of pneumonia, the sensitivity and specificity increased to 100%.ConclusionWhen the frontal view alone yields a diagnosis of confluent lobar pneumonia, this is highly reliable. However, nonlobar types of infiltrates will be underdiagnosed in 15% of patients using the frontal view alone. The clinical impact of these radiographically underdiagnosed pneumonias needs to be assessed prior to implementing the practice of using only frontal radiographs for diagnosing pneumonia.

A multihospital survey of radiation exposure and image quality in pediatric fluoroscopy

Background. Traditionally, pediatric radiologists have been advocates of fluoroscopy systems that provide diagnostic images at the lowest possible radiation dose to the pediatric patient. Manufacturers of fluoroscopic equipment vary as to their claims of “low radiation“ exposures.¶Objectives. To obtain comparative data on radiation exposure and image quality from four pediatric hospitals, across variants of fluoroscopic equipment (such as pulsed versus continuous fluoroscopy).¶Materials and methods. Images were acquired from phantoms that simulated the size of a 3-year-old child. Phantom results, both stationary and rotating dynamic, were evaluated for radiation exposure and for image resolution of high- and low-contrast objects.¶Results. Radiation exposure from the four fluoro units varied widely; the lowest-dose selectable fluoro mode produced exposures varying between 34 and 590 mrads/min among the four fluoro units, and the highest-dose selectable fluoro mode produced 540–2230 mrads/min. The lowest radiation exposures were produced by pulsed fluoro units, and the very lowest radiation exposure was produced by a fluoroscope that had been especially optimized for pediatric imaging. There was only a small variation in image quality among the hospitals for visualization of stationary objects. A wide variability was noted for detection of objects on the moving phantom.¶Conclusions. The variability in the number of detected objects was considerably smaller than the variability in radiation exposure. Pulsed fluoroscopy provides improved resolution for moving objects. Optimization of one hospitals fluoroscope especially for pediatric imaging produced the best ratio of image quality to radiation exposure.

Challenges and Opportunities in Restructuring Radiology Residencies: The APDR Residency Restructuring Committee Report

Changes to the ABR certification process are imminent, with a core examination after 36 months of training and a certifying examination 15 months after the completion of training replacing the current examination structure for residents entering training in July 2010 and beyond. The Residency Restructuring Committee of the Association of Program Directors in Radiology was developed to analyze the challenges and opportunities of these upcoming changes and provide recommendations to programs. The guidelines included in this article represent a summary of the work of this committee to date.

Spiral CT versus MRI in neonatal airway evaluation.

Magnetic resonance imaging has become the standard means of imaging pediatric airway obstruction due to vascular anomalies. However, magnetic resonance imaging requires a long acquisition time and is prone to motion artifacts. The development of spiral or helical computed tomography provides an alternative imaging modality for evaluating pediatric airway obstruction. We present the case of a neonate with a double aortic arch which initially was not identified on magnetic resonance imaging but was visualized with spiral computed tomography. If suspicion of an intra-thoracic abnormality is high, spiral computed tomography may be a useful adjunct or replacement to magnetic resonance imaging.

The American Board of Radiology perspective on maintenance of certification: Part IV - Practice quality improvement in diagnostic radiology

1All authors: The American Board of Radiology, 5441 E Williams Blvd., Tucson, AZ 85711. Address correspondence to J. L. Strife. he American public expects safe, predictable, high-quality care and assumes that physicians work to remain current and competent. The American Board of Radiology (ABR) encourages each board-certified diagnostic radiologist to understand his or her professional responsibilities and to participate in continuous quality improvement and lifelong learning. In the United States health care system, quality of care, medical error reduction, and patient safety represent continuing themes that dominate public concern [1–3]. Maintenance of Certification (MOC), the overarching program of the American Board of Medical Specialties (ABMS) and its member boards, is the response of U.S. physicians to address these concerns [4–8]. Although advances in medical science, technology, and biomedical research continue to accelerate, other barriers prevent rapid dissemination and adoption of evidence-based, recommended care [9]. A RAND Corporation study has estimated that only 50–54% of the care Americans receive is care that has been recommended on the basis of evidence-based medical literature [3]. Much of what radiologists do is not evidence based [10]. Outcomes and costs to diagnose and treat specific diseases vary widely among physicians, hospitals, health care providers, and regions of the country [10]. To address challenges in the medical system and the public’s concerns, the ABMS, composed of 24 member boards representing all medical subspecialties in the United States, mandated in March 2000 that each board initiate specialty-specific MOC programs [4–8]. Diplomates are no longer granted lifetime certification but rather must demonstrate evidence of professionalism, continuing medical education and knowledge, as well as a commitment to practice improvement. The MOC program, including “Part IV: Practice Quality Improvement,” for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. There are four component parts to the MOC process: “Part I: Professional Standing,” “Part II: Lifelong Learning and Periodic Self-Assessment,” “Part III, Cognitive Expertise,” and “Part IV: Evaluation of Practice Performance” [11–15]. The ABR program for self-evaluation of practice performance is linked to a process of continuing quality improvement and is titled “Practice Quality Improvement” (PQI).

Esophageal edema as a predictor of unsuccessful balloon extraction of esophageal foreign body

In 1966 Bigler described a method for extraction of impacted foreign bodies with the use of a Foley catheter [1]. Using this method several investigators have reported a success rate of up to 95% [2, 3]. We wish to report a patient group in which catheter extraction of esophageal foreign bodies was less successful, and a radiographic sign which appears to be predictive of an unsuccessful foreign body removal.

Radiographic evaluation of the neonate with congenital heart disease.

Remarkable advances in pediatric cardiology have been spurred by the explosion of technologies both in interventional and surgical techniques and the ability to manipulate the genome of experimental animals. After a brief discussion concerning the striking advances in the molecular understanding of congenital heart disease, this article focuses on clues to the diagnosis of congenital heart disease and on chest radiography and common, specific lesions of the neonate such as hypoplastic left heart, transposition of the great vessels, and severe tetralogy of Fallot. The impact of treatment protocols involving interventional cardiology in the neonate also are discussed.