ACR Appropriateness Criteria® Urinary Tract Infection-Child: 2023 Update.

Urinary tract infection (UTI) is a frequent infection in childhood. The diagnosis is usually made by history and physical examination and confirmed by urine analysis. Cystitis is infection or inflammation confined to the bladder, whereas pyelonephritis is infection or inflammation of kidneys.

Imaging of pediatric pancreas tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper.

Primary pancreatic tumors in children are rare with an overall age-adjusted incidence of 0.018 new cases per 100,000 pediatric patients. The most prevalent histologic type is the solid pseudopapillary neoplasm, followed by pancreatoblastoma.

ACR Appropriateness Criteria® Crohn Disease-Child.

Crohn disease is an inflammatory condition of the gastrointestinal tract with episodes of exacerbation and remission occurring in children, adolescents, and adults. Crohn disease diagnosis and treatment depend upon a combination of clinical, laboratory, endoscopic, histological, and imaging findings. Appropriate use of imaging provides critical information in the settings of diagnosis, assessment of acute symptoms, disease surveillance, and therapy monitoring.

ACR Appropriateness Criteria® Osteomyelitis or Septic Arthritis-Child (Excluding Axial Skeleton).

Imaging plays an integral role in the evaluation of suspected musculoskeletal infections in children, not only in the accurate identification of infection such as osteomyelitis or septic arthritis, but also in guiding management. Various diagnostic modalities serve different purposes in the assessment of suspected pediatric musculoskeletal infections. The purpose of this document is to provide imaging guidance in the most frequently encountered clinical scenarios in which osteomyelitis and/or septic arthritis are suspected, outside of the axial skeleton.

ACR Appropriateness Criteria® Vomiting in Infants.

Vomiting in infants under the age of 3 months is one of the most common reasons for parents to seek care from their doctor or present to an emergency room. The imaging workup that ensues is dependent on several factors: age at onset, days versus weeks after birth, quality of emesis, bilious or nonbilious vomiting, and the initial findings on plain radiograph, suspected proximal versus distal bowel obstruction. The purpose of these guidelines is to inform the clinician, based on current evidence, what is the next highest yield and most appropriate imaging study to pursue a diagnosis.

ACR Appropriateness Criteria® Antenatal Hydronephrosis-Infant.

Antenatal hydronephrosis is the most frequent urinary tract anomaly detected on prenatal ultrasonography. It occurs approximately twice as often in males as in females. Most antenatal hydronephrosis is transient with little long-term significance, and few children with antenatal hydronephrosis will have significant obstruction, develop symptoms or complications, and require surgery.

ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child.

Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula.

Advances in Diagnostic Imaging in Pediatric Gastroenterology.

Purpose Of Review: The purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research.

Recent Findings: New magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis.

Spaced radiology: encouraging durable memory using spaced testing in pediatric radiology.

Applied memory research in the field of cognitive and educational psychology has generated a large body of data to support the use of spacing and testing to promote long-term or durable memory. Despite the consensus of this scientific community, most learners, including radiology residents, do not utilize these tools for learning new information. We present a discussion of these parallel and synergistic learning techniques and their incorporation into a software platform, called Spaced Radiology, which we created for teaching radiology residents.

ACR Appropriateness Criteria Developmental Dysplasia of the Hip-Child.

Developmental dysplasia of the hip (DDH) is the most common hip pathology in infants. Although its exact pathophysiology remains incompletely understood, its long-term prognosis depends not only on the severity of the dysphasia, but also on the timely implementation of appropriate treatment. Unrecognized and untreated hip subluxations and dislocations inevitably lead to early joint degeneration while overtreatment can produce iatrogenic complications, including avascular necrosis of the femoral head.

Use of Eovist in Pediatric Patients: Pearls and Pitfalls.

Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts.

Cerebral autoregulation in premature infants during the first 96 hours of life and relationship to adverse outcomes.

Objective: To test the hypothesis that impaired cerebral autoregulation (ICA) increases the susceptibility of premature infants to adverse outcomes, we determined the relationship of ICA and cerebral reactivity (CR) measured in the first 96 hours of life to the outcome of grade 3 or 4 intraventricular haemorrhage (IVH) and/or death within 1 month.

Setting: Single-centre level IV neonatal intensive care unit.

Patients: Neonates 24-29 weeks' gestation less than 12 hours old with invasive blood pressure monitoring.

Is the Scout Out? The Utility of Scout Radiographs in the Pediatric Upper Gastrointestinal Examination.

Objective: The aim of the study is to demonstrate the scout radiograph does not change patient management, alter planning, or contribute to interpretation of the outpatient pediatric upper gastrointestinal fluoroscopic examination (UGI).

Methods: We retrospectively reviewed 197 outpatient pediatric UGIs performed over a 2-year period. We performed a chart review on all patients to evaluate for potentially clinically significant findings on the scout radiograph.

Pediatric Osteochondral Lesions.

Osteochondral lesions are common in children and may arise from a variety of etiologies. Although they most frequently occur in the knee, other joints may be involved including the ankle and elbow. We describe the typical imaging appearance of osteochondral lesions with a focus on radiographs and magnetic resonance imaging.

Postnatal MRI for CDH: A pictorial review of late-presenting and recurrent diaphragmatic defects.

Late-presenting or recurrent diaphragmatic defects can pose a diagnostic challenge due to varying clinical presentations. Current diagnostic approaches include plain film radiograph for initial assessment, with other imaging modalities such as fluoroscopy, ultrasound, CT and MRI mainly utilized for troubleshooting. As a radiation-free modality, MRI can provide a more definitive diagnosis in particular cases due to its ability to visualize discontinuity of the diaphragm, distinguishing it from eventration.

Enhancing the Imaging Experience for Pediatric Patients.

The University of Maryland Medical Center's goal was to improve the safety and comfort of pediatric imaging by enhancing the experience for children. Two pediatric radiologists and two child life specialists worked together to create a training program to help guide radiology technologists on how to approach and interact with children undergoing medical imaging. The results of surveys administered to technologists and parents or caregivers helped refine the strategy for both creating training sessions for technologists and reading materials for children and their parents to optimally prepare for the procedures.

Imaging of pediatric pancreatic neoplasms with radiologic-histopathologic correlation.

Objective: The purpose of this article is to describe the imaging features of pediatric pancreatic tumors with pathologic correlation. Epithelial and nonepithelial lesions are described. Pancreatic imaging protocols, clinical presentation, and management are also detailed.

Primary extraosseous Ewing sarcoma of the lung: Case report and literature review.

Ewing sarcoma is the second most common primary osseous malignancy in children and young adults. However, infrequently, it can arise outside the skeletal system; rarer still, it can originate within the lung parenchyma. In this case report, we describe such a case in a 23-year-old male.

Handoffs between radiologists and patients: threat or opportunity?

Radiologists, referring physicians, and patients all have certain legal rights regarding access to medical records, including imaging data. The degree of patient access is likely to increase with the growing adoption of patient portals and personal health records. In addition, referring physicians and radiologists have a collective responsibility to ensure that important findings are transferred appropriately between their practices.

Implementation of 24/7 radiology services in an academic medical centre level 1 trauma centre: impact on trauma resuscitation unit length of stay and economic benefit analysis.

Study Objective: To evaluate the impact of 24/7 radiology services on trauma resuscitation unit (TRU) length of stay (LOS) for patients with minor trauma and to analyse the economic benefits of such an impact from trauma centre perspective.

Methods: The study was HIPAA compliant and had IRB approval. Data were extracted from hospital and radiology information systems.

Continuing challenges in defining image quality.

To achieve significant dose reduction without compromising diagnostic efficacy, it is important to understand the effects of exposure reduction on image quality, a concept that is often mentioned but not well defined in the imaging literature. Studies to assess subjective image quality for digital radiography (DR) demonstrate wide variability among radiologists and technologists, resulting in substantial variability in the determination of acceptable image quality and optimal radiation exposure required to obtain a high-quality radiograph. In addition to improving detector technology and image processing techniques and tailoring exposure to the exam type and patient body habitus, it is possible to take advantage of informatics-based and psychoperceptual approaches.