Marilyn J. Goske

Estimated pediatric radiation dose during CT

State-of-the-art CT scanners typically display two dose indices: CT dose index (CTDIvol [mGy]) and dose length product (DLP [mGy-cm]) based on one of two standard CTDI phantoms (16- or 32-cm diameter) used in the calculation of CTDIvol. CTDIvol represents the radiation produced by the CT scanner, not the radiation dose to an individual patient. Pediatric radiologists, aware of this discrepancy, have requested a method to estimate the CT patient dose based on the size of the pediatric patient or small adult. This paper describes the method developed by AAPM Task Group 204 to provide a better estimate of CT patient dose. These improved estimates of patient dose provide radiologists with a practical tool to better manage the radiation dose their patients receive. In the future, size-specific dose estimates (SSDE) received by the patient should be included in the patient’s electronic medical record to help radiologists better assess risk versus benefit for their patients.

The “circle sign”: a new sonographic sign of pneumatosis intestinalis – clinical, pathologic and experimental findings

Background. Pneumatosis intestinals (PI) represents gas in the bowel wall. The appearance of PI using high-resolution ultrasound (HRUS) has not been well described. Objective. The purpose of this report is to describe a new ultrasound sign of pneumatosis seen in three patients. This sign, called the “circle sign”, is indicative of bubbles of gas within the circumference of the bowel, producing an appearance of a continuous echogenic ring on ultrasound. Further studies of the sonographic characteristics of pneumatosis were performed with an in vitro model. Materials and methods. HRUS was performed prospectively in three patients demonstrating extensive PI radiographically. The appearance of the gas was characterized and the behavior of the intramural bubbles was studied when the bowel was compressed with the ultrasound transducer. Either CT scan or pathologic correlation was obtained in all patients. Experimental models of PI using air injected into the wall of sausage casing were developed. Results. The presence of echogenic gas bubbles within the circumference of the wall of the bowel seen with HRUS was shown to represent pneumatosis intestinalis at histologic examination or by CT scanning in the three study patients. In vitro studies confirmed the clinical impression that the use of compression is helpful in distinguishing intramural from intraluminal air. Conclusion. The presence of echogenic gas bubbles in the wall of the bowel, often seen as a circle within the circumference of the bowel, may be helpful in diagnosing PI on ultrasound using HRUS.

RADPED: an approach to teaching communication skills to radiology residents

Background: The Accreditation Council for Graduate Medical Education mandates that radiology residency programs teach communication skills to residents. Objective: The purpose of this paper is to present a mnemonic, RADPED, that can be used to enhance communication in the radiology setting. It reminds the resident of the salient points to address during an imaging encounter with pediatric patients and their families for the purpose of enhancing communication. Materials and methods: Recent history and research in medical communication are reviewed. Various communication guides used by primary care physicians, such as SEGUE, and the Kalamazoo consensus statement are discussed. This methodology was adapted into a format that could be used to teach communication skills to radiology residents in the context of an imaging encounter. Results: RADPED reminds the resident to establish rapport with the patient, ask questions as to why the patient and family are presenting for the study, discuss the exam, perform the procedure, use exam distractions, and discuss the results with the referring physician and family when appropriate. This guide is available with movie clips as part of an on-line pediatric radiology curriculum, http://www.pediatricradiology.clevelandclinic.org. Summary: This simple memory aid promotes the key points necessary to optimize the radiology resident’s encounter with pediatric patients and their families.

The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions

BackgroundCongenital heart disease (CHD) is a significant cause of morbidity and mortality in pediatric patients. Traditional teaching holds that specific types of CHD can be diagnosed on the chest radiograph (CXR) through pattern recognition.ObjectiveTo determine the accuracy of radiologists in detecting CHD on the CXR.Materials and methodsThis study was a blinded retrospective review of chest radiographs from 281 patients (<12 years) by five pediatric radiologists from three institutions. Thirteen groups were evaluated that included 12 categories of CHD and a control group of patients without heart disease. Radiographs were assessed for heart size, heart and mediastinal shape and vascularity. Clinical information, angiography, echocardiograms and surgery were used as the gold standard for definitive diagnosis.ResultsThe average accuracy of the five readers in distinguishing normal from CHD patients was 78% (range of 72% to 82%). The overall measure of accuracy in distinguishing specific congenital cardiac lesions among 13 groups of patients was 71% (range of 63% to 79%).ConclusionCXR alone is not diagnostic of specific cardiac lesions, with a low accuracy of only 71%. We believe that less emphasis should be placed on the use of radiographs alone in diagnosing specific congenital cardiac lesions.

Desmoplastic infantile ganglioglioma (DIG): cranial ultrasound findings.

Abstract Desmoplastic infantile ganglioglioma (DIG) is a rare brain tumor encountered in infants. In spite of its large size at presentation and occasional high mitotic activity on histopathology, the tumor has a good prognosis. A 7-month-old baby girl developed increasing head circumference. On ultrasound, a large multicystic mass was seen. We report the cranial ultrasound findings for the first time. Correlative imaging of this recently recognized entity is shown.

Pediatric radiologists: who we are and what we do

Background. There is a need for reliable monitoring of workforce trends in the field of pediatric radiology by the Society for Pediatric Radiology. In addition, the Society should periodically assess itself as to its mission and relevance to its members via membership surveys.¶Objective. The Membership Committee of the Society for Pediatric Radiology, 1999, conducted a 54-question survey to determine the makeup of its members, job profiles, satisfaction with services of the Society for Pediatric Radiology, and its official journal, Pediatric Radiology.¶Materials and methods. Seven hundred fifty surveys were given to active members of the Society for Pediatric Radiology in the United States and Canada. There were 275 surveys returned for an overall response of 37 %.¶Results. Mean age of members is 48 years with 99 % of respondents working. Membership is 34 % female and 66 % male. Women members of the Society are younger (45 vs 49 years, P = 0.0012) and work less hours (47.8 vs 51.0, P = 0.0135) than men. Fifty-seven percent of respondents practice in a freestanding childrens hospital, 29 % in a “childrens hospital within a hospital,” and 14 % are in community hospitals or an office-based practice. Eighty-two percent of the responding pediatric radiologists time is spent in performing examination on children, with only 18 % spent on adult work or administration. Forty-eight percent work at more than one office. Sixty-one percent worked evenings or weekends, excluding night call. Two hundred twenty-two of 275 respondents had received a Certificate of Added Qualification. The meeting “for CME credit” was considered the most important benefit of Society membership. Most respondents read select articles in Pediatric Radiology. There was sentiment to decrease esoteric case reports in favor of review articles. Only 19 % of respondents submitted their articles to Pediatric Radiology initially.¶Conclusion. Pediatric radiologists are a diverse membership with the common goal of advocating for healthcare and imaging in children. Survey information given to the leadership of the Society will help the organization remain responsive to its members.

Congenital solid neck mass: a unique presentation of Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) presenting in the neonatal period is very rare. In most cases, a self-limited cutaneous disease is the exclusive manifestation. We report an unusual case of neonatal LCH presenting with a large congenital solid neck mass without skin lesions. LCH should be considered in the differential diagnosis of solid masses in neonates and prompt physicians to search for visceral organ involvement.

Superficial venous thrombosis presenting as a painful popliteal fossa mass in a child

We report an unusual case of superficial venous thrombosis in a cyanotic 12‐year‐old child who had undergone recent appendectomy. Although compression, color Doppler, and duplex ultrasound techniques remain the keys to the diagnosis of venous thrombosis, SieScape sonography was beneficial in demonstrating the extent of the thrombi and their location along a superficial thrombosed vein.