Use of Artificial Intelligence in Radiology: Impact on Pediatric Patients, a White Paper From the ACR Pediatric AI Workgroup.

In this white paper, the ACR Pediatric AI Workgroup of the Commission on Informatics educates the radiology community about the health equity issue of the lack of pediatric artificial intelligence (AI), improves the understanding of relevant pediatric AI issues, and offers solutions to address the inadequacies in pediatric AI development. In short, the design, training, validation, and safe implementation of AI in children require careful and specific approaches that can be distinct from those used for adults. On the eve of widespread use of AI in imaging practice, the group invites the radiology community to align and join Image IntelliGently (www.

Perspective: Mandatory Radiology Education for Medical Students.

Radiology education of medical students is increasingly important given the intersection of radiology with virtually all medical specialties and integral role of imaging in modern patient care. Yet radiology education requirements in US medical schools are variable with only a minority of schools requiring a clerkship in radiology. When required, the radiology curriculum is often limited to anatomy courses in the preclinical years or partially incorporated into required core clerkships and often taught by nonradiologists.

Safety of gadoterate meglumine in children younger than 2 years of age.

Background: Few studies on the safety of gadolinium-based contrast agents have been performed in children with even fewer focusing on children younger than 2 years of age.

Objective: To assess the safety of gadoterate meglumine (Dotarem) in patients younger than 2 years of age by evaluating adverse events following contrast administration.

Materials And Methods: Pediatric patients younger than 2 years of age undergoing magnetic resonance imaging (MRI) with and without contrast were prospectively enrolled and received a weight-based intravenous dose of gadoterate meglumine (0.

Association between ventricular shunt catheter calcifications and the development of shunt fracture.

Background: Calcifications along ventricular catheters have been associated with shunt fractures although it is unknown whether their development predicts whether and when the shunts will fracture.

Objective: To determine whether extracranial calcifications found on a radiographic shunt series predicts whether a patient will experience a shunt catheter fracture or complication.

Materials And Methods: A retrospective review was performed of pediatric patients with a ventricular shunt placed before 18 years of age and radiographic shunt series.

Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease.

Background: While liver biopsy remains the gold standard, given the procedure risks and sampling errors, there is a need for reliable noninvasive biomarkers of hepatic fibrosis.

Objective: Determine the accuracy of two-dimensional shear wave elastography (2-D SWE) in predicting the histological severity of liver fibrosis in pediatric patients with known or suspected liver disease.

Materials And Methods: Subjects 0-18 years old with known or suspected liver disease and liver biopsy within 30 days (n=70) were included.

Changes in factors influencing fellowship choices among radiology residents from 2008 to 2018 and methods that may increase interest in the pediatric radiology subspecialty.

Background: Fewer residents are choosing a career in pediatric radiology, which is contributing to an ongoing shortage of pediatric radiologists.

Objective: To identify potential causes of reduced interest in pediatric radiology as a career given a projected worsening of a nationwide shortage of pediatric radiologists.

Materials And Methods: An online questionnaire using previously published questions was approved and distributed by the Program Directors in Diagnostic Radiology to diagnostic radiology residents on behalf of the Society for Pediatric Radiology (SPR).

Diagnostic accuracy of non-contrast magnetic resonance enterography in detecting active bowel inflammation in pediatric patients with diagnosed or suspected inflammatory bowel disease to determine necessity of gadolinium-based contrast agents.

Background: Pediatric patients with inflammatory bowel disease (IBD) are at increased risk of gadolinium deposition given the potential need for multiple contrast-enhanced magnetic resonance enterography (MRE) exams over their lifetime.

Objective: To determine whether gadolinium-based contrast agents are necessary in assessing active bowel inflammation on MRE in pediatric patients with known or suspected IBD.

Materials And Methods: We conducted a retrospective study of 77 patients (7-18 years; 68.

Solid tumor screening recommendations in trisomy 18.

The purpose of this study was to determine whether trisomy 18 patients are at an increased risk of tumor development and require formal tumor screening recommendations. A literature search of trisomy 18 patients with reports of tumors or malignancies, and compilation of all previously reported as well as new unreported cases was performed. 67 patients with trisomy 18 were found to have documented malignancies.

Pancreatic heterotopia in a neonatal abdominopelvic cyst.

Pancreatic heterotopia is a rare congenital anomaly more commonly incidentally found in adults. While intra-abdominal cysts found on prenatal imaging are not uncommon, we examine a case of pancreatic heterotopia presenting in an abdominopelvic cyst on prenatal imaging. At birth, the neonate was found to have hypoglycemia unresponsive to treatment that resolved after cyst resection.

Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation.

Background: Pediatric trauma patients transferred to pediatric trauma centers (PTCs) often have imaging at the originating hospital (OH). The increased use of computed tomography (CT) raises concerns about malignancy risk from ionizing radiation leading many PTCs to adopt radiation dose reduction strategies. We hypothesized that pediatric trauma patients are exposed to excess radiation from imaging before transfer.

Fetal and neonatal presentation of OEIS complex.

OEIS complex is a rare entity comprising a combination of omphalocele, exstrophy of the cloaca, imperforate anus, and spinal defects. We present a case that demonstrates the imaging features of OEIS complex, which also has the rare diagnosis of a terminal myelocystocele, across multiple imaging modalities both prenatally and postnatally. A prenatal diagnosis of OEIS complex allowed for appropriate planned multidisciplinary management of this patient.

Management and outcomes of traumatic hemothorax in children.

Background: Adult guidelines for the management of traumatic hemothorax are well established; however, there have been no similar studies conducted in the pediatric population. The purpose of our study was to assess the management and outcomes of children with traumatic hemothorax.

Materials And Methods: Following Institutional Review Board approval, we conducted a retrospective cross-sectional study of all trauma patients diagnosed with a hemothorax at a Level-1 pediatric trauma center from 2007 to 2012.

Phosphaturic mesenchymal tumor of the tibia with oncogenic osteomalacia in a teenager.

Phosphaturic mesenchymal tumor is an uncommon cause of a paraneoplastic syndrome that can be associated with osteogenic osteomalacia. This tumor most commonly occurs in middle-aged men and women. We report a rare case of a phosphaturic mesenchymal tumor in a 16-year-old girl with multiple fractures as a result of severe osteoporosis.

Rhabdoid tumor: an aggressive renal medullary tumor of childhood.

We present a case of a renal rhabdoid tumor in a 2-month-old girl. Rhabdoid tumors are rare primary renal tumors in children, but they have characteristic features--medullary sinus invasion and subcapsular fluid collections--which enable a specific diagnosis. The classic imaging characteristics of this tumor compared to other more common primary pediatric renal tumors will be reviewed.

Intrarenal neuroblastoma with pulmonary metastases mimicking a Wilms tumor.

Primary intrarenal neuroblastoma is extremely rare and is a mimic of Wilms tumor. We present a case of a renal mass in a 14month old male with lung metastases at the initial presentation. This was thought to represent a Wilms tumor.

Extracardiac applications of MR blood pool contrast agent in children.

Magnetic resonance (MR) angiography has significantly reduced the need for diagnostic conventional angiography and is preferred over CT angiography in children because of its lack of ionizing radiation. The availability of gadofosveset trisodium (the only clinically approved blood pool MR contrast agent) has led to an increase in applications of MR for vascular imaging and an improvement in diagnostic quality of MR angiography. Gadofosveset is a gadolinium-based contrast agent that binds reversibly to albumin, resulting in increased paramagnetic effect and longer intravascular residence.

Neurofibromatosis 1 vasculopathy manifesting as a peripheral aneurysm in an adolescent.

Arterial vasculopathy is a well-recognized but uncommon manifestation of neurofibromatosis type 1 (NF-1). It can manifest as stenoses, aneurysms or arteriovenous malformations. NF-1 vasculopathy typically involves the aorta, visceral arteries or carotid-vertebral circulation.

Thymoma with osseous metaplasia in an adolescent.

A 13-year-old girl was incidentally found to have a partially calcified anterior mediastinal mass during the work-up for a left humeral lesion. The resected specimen demonstrated a lymphocyte predominant World Health Organization type B1 thymoma with nodules of metaplastic bone consistent with osseous metaplasia. In addition, she had multiple osteochondromas, a periosteal chondroma of the humerus, a metaplastic osseous pseudotumor of the thigh, and other benign-appearing sclerotic foci, all manifestations of what is likely an autosomal dominant disorder.