John F. de Campo

Computed tomographic assessment of vertebral bone mineral in childhood

Quantitative computed tomography (QCT) was used to assess trabecular bone mineral concentration in the vertebrae of 132 children, 45 with suspected disorder of bone mineralisation, 54 with thalassaemia and 37 controls. The range for bone mineral concentration in controls, expressed as equivalent K2HPO4 concentrations, was 90–190 mg cm−3. Abnormally low values were seen in all untreated children with idiopathic juvenile osteoporosis, 3/9 steroid recipients, and three patients with osteogenesis imperfecta. Abnormally high values were seen in 10/14 chronic renal failure patients. Comparison of the single and dual-energy methods showed that the single energy method, which has a lower radiation dose and is less prone to error from movement artifact, is satisfactory in most paediatric applications.Quantitative computed tomography (QCT) was used to assess trabecular bone mineral concentration in the vertebrae of 132 children, 45 with suspected disorder of bone mineralisation, 54 with thalassaemia and 37 controls. The range for bone mineral concentration in controls, expressed as equivalent K2HPO4 concentrations, was 90–190 mg cm−3. Abnormally low values were seen in all untreated children with idiopathic juvenile osteoporosis, 3/9 steroid recipients, and three patients with osteogenesis imperfecta. Abnormally high values were seen in 10/14 chronic renal failure patients. Comparison of the single and dual-energy methods showed that the single energy method, which has a lower radiation dose and is less prone to error from movement artifact, is satisfactory in most paediatric applications.

Radiological evidence of bowel obstruction in intussusception

Several criteria have been proposed to identify patients likely to be at risk from barium reduction of intussusception, those with a high probability of having a pathological lead point, and those in whom an enema is unlikely to be successful. Signs of peritonitis and septicaemia are regarded as absolute contraindications to attempted barium reduction of intussusception, but as yet the radiological appearance of small bowel obstruction per se has not been substantiated as a contraindication. The presence of small bowel obstruction indicates that therapeutic reduction is less likely to be successful than in patients with normal or nonspecific plain radiographs (31% vs 57%) but is not in itself an indication that the examination would be unsafe. Patients with small bowel obstruction are acceptable risks for safe and successful therapeutic enemas, provided there is no clinical evidence of gangrenous bowel.

Allergic reaction following micturating cystourethrography

Adverse reactions associated with the parenteral use of contrast agents are widely recognized, but reactions to contrast agents used in micturating cystourethrography (MCU) are much less common, although absorption of contrast media through intact bladder mucosa has been documented. A significant adverse reaction to ionic contrast material used for MCU in which neither reflux nor traumatic urethral catheterization could be implicated is presented. This case illustrates that significant reactions can occur during MCU and appropriate resuscitation facilities must be available. In a patient with a history of reaction to IV contrast media, the need for MCU should be reviewed and consideration given to nuclear medicine MCU. If a radiologic MCU is needed, consideration should be given to performing it in the hospital, with nonionic contrast media and steroid premedication.

Whither RANZCR: Making a good college great: Wither RAMZCR: Making a good college great

I am often asked why I volunteered to stand for the Royal Australian and New Zealand College of Radologists (RANZCR) Board. The simple answer is years of frustration. We have much to be proud of, and we have many dedicated volunteer members to thank for their tireless personal contributions over decades. Our training programmes are developing well. The changes to a board structure were bold, timely and well led. It will enable a focus on absolute priorities. Early steps towards international partnerships, redevelopment of our journal and commencement of a quality programme are to be applauded. We should recognise that radiation oncologists have been generally more successful in their advocacy and academic roles. In asserting that we need to do better is not to diminish in any way the achievements of all those who have led us to this point. Nevertheless, I was frustrated by the lack of member services and benefits. Frustrated by poor government engagement for sustainable funding, and equitable geographic access to radiology and radiation oncology services. Frustrated by the lack of active development of academic radiology and radiation oncology. Frustrated by the lack of a benchmark continuing professional development (CPD) programme. Frustrated by the slow development of the benefits from international partnerships. Frustrated by the lack of support for members to provide better, safer and appropriate radiation oncology and imaging services. I was also frustrated by our lack of focus on health outcomes more generally. We maintain our objective is the ‘. . . betterment of our peoples’. We have much to do if we are to achieve this objective. Consider how we compare with the leadership shown by other Colleges on the National Surgical Death Audits, National Bowel Cancer Screening and National Rare Disease Register. Frustrated for a decade by the lack of leadership in radiation safety. As recently as 2013, we have steadfastly avoided providing any numeric data on the risks of malignancy from CT to members and patients. To have clinical credibility we must take a leadership position on the use of CT, given that in young people CT causes about one potentially avoidable cancer a week in Australia alone. Frustrated by our partnership with Australian Diagnostic Imaging Association (ADIA). The results of ADIA participation speak for themselves! Governments speak the language of patient outcomes, access to services and efficiency. This is our language too, but not the approach of the ADIA membership generally. We should separate from ADIA, ASAP. Our relevance to government must be built on clinical evidence. Frustrated by the poor advocacy for migrant members. Do we really support the policy of members who are citizens with RANZCR being confined to areas of need? In short, if membership were not compulsory, how many members would we have? How long will it be bs_bs_banner Journal of Medical Imaging and Radiation Oncology 58 (2014) 46–47

Imaging of liver tumours in childhood

Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdominal mass, imaging (in consultation with a paediatric surgeon) aims to confirm the intrahepatic site, determine its likely resectability, exclude metastatic abdominal disease, and characterise the mass. The imaging in 44 patients with primary liver tumour over a 33-year period was reviewed and correlated with surgical/pathological findings. Characterising hepatic masses with ultrasound, computed tomography, nuclear medicine, and angiography is less important than determining its resectability and alerting the surgeon to vascular anomalies and the presence of metastatic disease. We conclude that a chest X-ray and ultrasound study are the primary methods for evaluation of a child with suspected hepatic mass. With careful attention to technique, the mass can be evaluated and an assessment made of tumour resectability preoperatively. Based on this review, we propose a schema for the initial evaluation of suspected hepatic masses in children.