Manrita Sidhu

Clinical and radiographic findings in children with spontaneous lymphatic malformation regression

Objective Evaluate clinical and radiographic characteristics of spontaneously regressing lymphatic malformations (“lesions”). Subjects and Methods Retrospective review of 104 consecutive patients with cervicofacial lesions, with 1-year follow-up. Data collected: patients age; lesion stage, location, radiographic characteristics; treatment. Data analysis using descriptive and Fischer exact tests. Results Spontaneously regressing lesions were identified in 13 of 104 (12.5%) patients. Five of 13 had in utero lesions, which persisted at birth; presenting age in the remaining eight patients was 2 to 138 months. Lesions regressed within 2 to 7 months. Lesion stage: I (7 of 13), II (2 of 13), III (4 of 13). Lesion location: left neck (9 of 13), right neck (4 of 13), posterior neck (10 of 13). All 13 resolving lesions were macrocystic with fewer than five septations in 11 of 13. Comparison of a resolving lesion cohort with a nonresolving lesion cohort demonstrated that disappearing lesions are more likely to have fewer than five septae and to be macrocystic (P < 0.05). Treatment was none in seven of 13, antibiotics in four of 13, and redundant skin excision in two of 13. Conclusion Spontaneous lesion regression can occur, and these lesions have distinct features. Lesions with these characteristics can be observed.

Image Gently, Step Lightly: Increasing Radiation Dose Awareness in Pediatric Interventions through an International Social Marketing Campaign

In the past several decades, advances in imaging and interventional techniques have been accompanied by an increase in medical radiation dose to the public. Radiation exposure is even more important in children, who are more sensitive to radiation and have a longer lifespan during which effects may manifest. To address radiation safety in pediatric computed tomography, in 2008 the Alliance for Radiation Safety in Pediatric Imaging launched an international social marketing campaign entitled Image Gently. This article describes the next phase of the Image Gently campaign, entitled Step Lightly, which focuses on radiation safety in pediatric interventional radiology.

Ultrasound-guided Endovenous Diode Laser in the Treatment of Congenital Venous Malformations: Preliminary Experience

The authors present their experience in treating congenital venous malformations with ultrasound (US)-guided endovenous diode laser. Six patients underwent treatment of eight venous malformations for complaints including pain, activity limitation, or cosmetic defect. At a mean follow-up interval of 14.5 months, all had either resolution of (five patients) or marked decrease in (one patient) pain, allowing them to resume previously limited activities. There were no instances of nerve damage or skin necrosis. One patient had a self-limited mucosal tongue base ulcer. In this small series of patients, endovenous laser treatment of venous malformations was effective during short-term follow-up.

Image Gently, Step Lightly: Promoting Radiation Safety in Pediatric Interventional Radiology

OBJECTIVE The Image Gently, Step Lightly campaign is an education and awareness campaign focusing on radiation safety in pediatric interventional radiology. To promote radiation safety by standardizing workflow and encouraging team responsibility, the campaign Website includes a procedural checklist that the medical team may use to review radiation safety steps before each pediatric interventional procedure. CONCLUSION Use of this checklist can be an effective tool in the ongoing effort to maximize radiation safety during interventional procedures.

Image Gently, Step Lightly: increasing radiation dose awareness in pediatric interventional radiology

Children and radiation safetyThe National Council on Radiation Protection and Mea-surement reported in March 2009 that radiation dose to theUnited States population had risen sevenfold since the early1980s. CT and nuclear medicine are the two largestcontributors to medical radiation, with fluoroscopic expo-sure during interventional procedures the third largestcontributor, accounting for 7% of the total medical radiationdose to the U.S. public [1]. The readers of PediatricRadiology are well aware of the risks of unnecessary andexcessive medical radiation to our pediatric patients. Whilechildren undergo interventional procedures less commonlythan adults, the use of interventional radiology (IR) inpediatric care is increasing, and some more complexprocedures can result in long fluoroscopic times. Further,children with chronic illnesses may undergo many IRprocedures, and receive a higher cumulative dose fromrepeated exposures [2–6]. Just as with CT, it is our re-sponsibility to actively promote radiation protection duringIR cases. The Image Gently, Step Lightly campaign is a neweffort of the Alliance for Radiation Safety in PediatricImaging. Using the information provided on the website(www.imagegently.com), interventional radiologists canaccess valuable educational tools to help minimize radiationdose to themselves, to their medical colleagues in the IRsuite, and most importantly, to their pediatric patients.Pediatric interventional radiology and Image GentlyThe field of pediatric interventional radiology has devel-oped a more focused identity in the last 5 years as a resultof growth into a critical mass of practitioners and increasing

Joint Quality Improvement Guidelines for Pediatric Arterial Access and Arteriography: From the Societies of Interventional Radiology and Pediatric Radiology

Manraj K. S. Heran & Francis Marshalleck & Michael Temple & Clement J. Grassi & Bairbre Connolly & Richard B. Towbin & Kevin M. Baskin & Josee Dubois & Mark J. Hogan & Sanjoy Kundu & Donald L. Miller & Derek J. Roebuck & Steven C. Rose & David Sacks & Manrita Sidhu & Michael J. Wallace & Darryl A. Zuckerman & John F. Cardella & Society of Interventional Radiology Standards of Practice Committee and Society of Pediatric Radiology Interventional Radiology Committee

Multidetector CT angiography of pediatric vascular malformations and hemangiomas: utility of 3-D reformatting in differential diagnosis

Background: Vascular malformations can be difficult to diagnose and classify. Accurate classification is important because treatments and prognosis vary based on the type of lesion. Diagnosis is based on a combination of clinical features with a variety of imaging techniques, including US, MRI/MRA, CT, and conventional angiography. Objective: We hypothesized that imaging features seen on 3-D reformatted images obtained with multidetector CT angiography (CTA) would aid in differential diagnosis of types of vascular anomalies. Materials and methods: We retrospectively reviewed CT scans of 11 patients with vascular lesions and pathologically proven diagnoses in which 3-D reformatting was obtained.Results: The 3-D images accurately diagnosed hemangiomas and lymphangiomas in all cases, in contrast to diagnosis by clinical criteria and planar CT, which was difficult or inaccurate. The 3-D CTA did not aid in the distinction between venous malformations and arteriovenous malformations (AVM), which appeared similar. Conclusions: Our preliminary observations suggest that volume-rendered reformatting is helpful in categorizing clinically significant vascular head and neck lesions, resulting in more diagnostic value than planar CT imaging alone. In particular, 3-D CTA might allow accurate differentiation of hemangiomas from AVM, and of lymphangiomas from other types of lesions, which was, in our series, not possible using clinical examination or conventional planar CT angiography.

Image gently 5 years later: What goals remain to be accomplished in radiation protection for children?

477 to house these materials for download by parents, medical professionals, government agencies, and health care organizations worldwide. The brochures empower parents with basic information about their child’s examination and afford them the opportunity to ask questions before the imaging test. This process of informed decision making provides the underpinning for a partnership between caregivers and family, which is encouraged by the Institute of Medicine [3] as a fundamental aspect of medical professionalism.

Pediatric interventional radiology workforce survey summary

This report summarizes the results of a workforce survey of pediatric interventional radiology (PIR) performed by the 2005 SPR Vascular Interventional Radiology (VIR) Committee. Detailed results, discussion and proposed solutions to the challenges reported will be presented in a subsequent article. A link to an online survey was sent to all known pediatric interventionalists and to the members of the Society of Chairpersons of Radiology in Children’s Hospitals (SCORCH). The survey was announced at the 48th Annual SPR in New Orleans and was open from 18 February 2005 until 18 May 2005. The survey was sent to a maximum of 77 potentially different sites and there were 41 responses. Therefore, the response rate was at least 53%. Due to the anonymity of the survey, the exact response rate cannot be calculated. Out of 41 responses, 38 sites reported having an active PIR service. These 38 responses form the basis of the remainder of this report. The original question is stated or paraphrased and the responses are listed below it. In the instances when not all sites answered a question, the number of responses is noted in parentheses.

Joint quality improvement guidelines for pediatric arterial access and arteriography: From the Societies of Interventional Radiology and Pediatric Radiology

Manraj K. S. Heran & Francis Marshalleck & Michael Temple & Clement J. Grassi & Bairbre Connolly & Richard B. Towbin & Kevin M. Baskin & Josee Dubois & Mark J. Hogan & Sanjoy Kundu & Donald L. Miller & Derek J. Roebuck & Steven C. Rose & David Sacks & Manrita Sidhu & Michael J. Wallace & Darryl A. Zuckerman & John F. Cardella & Society of Interventional Radiology Standards of Practice Committee and Society of Pediatric Radiology Interventional Radiology Committee