Selecting appropriate gastroenteric contrast media for diagnostic fluoroscopic imaging in infants and children: a practical approach.

In our experience, questions about the appropriate use of enteric contrast media for pediatric fluoroscopic studies are common. The purpose of this article is to provide a comprehensive review of enteric contrast media used for pediatric fluoroscopy, highlighting the routine use of these media at a large tertiary care pediatric teaching hospital.

Pediatric thoracic CT angiography at 70 kV: a phantom study to investigate the effects on image quality and radiation dose.

Background: Studies have demonstrated that 70-kilovolt (kV) imaging enhances the contrast of iodine, potentially affording a reduction in radiation dose while maintaining the contrast-to-noise ratio (CNR). There is a maximum amount of image noise beyond which increased contrast does not improve structure visualization. Thus, noise should be constrained during protocol optimization.

Size-based protocol optimization using automatic tube current modulation and automatic kV selection in computed tomography.

Size-based diagnostic reference ranges (DRRs) for contrast-enhanced pediatric abdominal computed tomography (CT) have been published in order to establish practical upper and lower limits of CTDI, DLP, and SSDE. Based on these DRRs, guidelines for establishing size-based SSDE target levels from the SSDE of a standard adult by applying a linear correction factor have been published and provide a great reference for dose optimization initiatives. The necessary step of designing manufacturer-specific CT protocols to achieve established SSDE targets is the responsibility of the Qualified Medical Physicist.

Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial gaussian noise--part 2, clinical outcomes.

OBJECTIVE. The purpose of this study was to determine the effect of a nominal 50% reduction in median absorbed radiation dose on sensitivity, specificity, and negative appendectomy rate of CT for acute appendicitis in children. MATERIALS AND METHODS.

Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial Gaussian noise--part 1, computer simulations.

Objective: The purpose of this study was to develop a departmental practice quality improvement project to systematically reduce CT doses for the evaluation of suspected pediatric appendicitis by introducing computer-generated gaussian noise.

Materials And Methods: Two hundred MDCT abdominopelvic examinations of patients younger than 20 years performed with girth-based scanning parameters for suspected appendicitis were reviewed. Two judges selected 45 examinations in which the diagnosis of appendicitis was excluded (14, appendix not visualized; 31, normal appendix visualized).

An electronic tool for systematic reporting of fractures on skeletal surveys in suspected child abuse: prototype development and physician feedback.

Objective: To describe a skeletal survey data entry and compilation tool and assess physician attitudes toward this reporting approach.

Background: Narrative skeletal survey reports are highly variable and prone to inconsistencies with potential adverse impact on patients.

Materials And Methods: The prototype skeletal survey data entry and compilation tool was developed and introduced into clinical practice at a large urban children's hospital.

Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse.

Objective: Previous studies have found that fractures involving the spine, hands, and feet are rare on skeletal surveys in cases of suspected child abuse, leading some authors to suggest eliminating these regions from the initial skeletal survey protocol. We assessed this recommendation by performing a historical review of these injuries in a pediatric population undergoing film screen-based radiographic skeletal surveys for suspected child abuse.

Materials And Methods: This cross-sectional retrospective study reviewed reports of initial skeletal surveys of all children younger than 2 years with suspected abuse imaged between April 1988 and December 2001.

Prevalence of the classic metaphyseal lesion in infants at low versus high risk for abuse.

Objective: The purpose of this article is to determine the relative likelihood of encountering a classic metaphyseal lesion in infants at low and high risk for abuse.

Materials And Methods: This 10-year retrospective study compared the prevalence of the classic metaphyseal lesion on high-detail American College of Radiology-standardized skeletal surveys in infants at low and high risk for abuse. Low-risk infants met all of the following criteria: skull fracture without significant intracranial injury on CT, history of a fall, and no other social risk factors for abuse.

Patient size measured on CT images as a function of age at a tertiary care children's hospital.

Objective: The purpose of our study was to measure patient size on CT images as a function of age at a large tertiary care children's hospital to develop current patient size data for modeling optimal x-ray exposure factors in children.

Materials And Methods: Anteroposterior and transverse dimensions of the head, thorax, abdomen, and pelvis were measured on CT examinations of pediatric patients less than 21 years old performed between June and November 2007. Patients with diseases that could affect measurements were excluded.

Detection of simulated inflicted metaphyseal fractures in a fetal pig model: image optimization and dose reduction with computed radiography.

Purpose: To prospectively determine in a fetal pig model whether diagnostic performance comparable to that of high-detail screen-film imaging can be achieved with computed radiography for the detection of simulated classic metaphyseal lesions (CMLs), by using Faxitron digital images as the reference standard, and whether radiation dose reduction is possible.

Materials And Methods: This study was granted exempt status by the institutional review board and the animal care and use committee. Fractures simulating the CML were produced in distal femurs of 20 deceased fetal pigs.

Suspected infant abuse: radiographic skeletal survey practices in pediatric health care facilities.

Purpose: To determine current national radiographic skeletal survey imaging practices, including migration to digital technologies, for evaluation of suspected infant abuse.

Materials And Methods: Of 155 children's health care facilities in the United States in which radiographic skeletal surveys are performed for suspected infant (<1 year old) abuse, 137 (88.4%) agreed to complete a questionnaire.