Search

CEEPUS – Central European Exchange Program for University Studies – is the biggest regional academic exchange program in Europe, currently comprising 15 countries. CEEPUS awards mobility grants to students and teachers, mostly in the framework of networks. From a much-doubted bold experiment, CEEPUS has evolved into a best practice example and has more than fulfilled its original expectations. As CEEPUS III is to expire on April 30, 2025, the discussion is on whether and in which form a possible CEEPUS IV shall be developed.

Introduction. Previous studies suggested that effects of the surfactant administration in preterm infants with respiratory distress syndrome cannot be followed by lung ultrasound (L-US). Objective. The aim of the paper is to evaluate the surfactant replacement therapy effects using a new, proposed grading system for L-US findings. Methods. We report the series of 12 preterm infants with clinical and radiographic signs of respiratory distress syndrome, in whom L-US examinations were performed prior to, and within the first 24 hours after surfactant administration. To evaluate the surfactant replacement therapy effects, we proposed a new grading system (1 to 6) for L-US findings at each examined lung area, based on the presence of normal finding, the amount of B-lines and subpleural consolidations. Results. All preterm infants had an improvement of L-US findings from one to four grades observed within the first 24 hours after surfactant administration, which has not been previously reported. The improvement of L-US findings was most commonly observed in anterior lung areas. Conclusion. L-US might enable an early detection of the surfactant replacement therapy effects. Further prospective studies are necessary to define the role of L-US in this field.

Unfortunately, errors and mistakes are part of life. Errors and mistakes can harm patients and incur unplanned costs. Errors may arise from various sources, which may be classified as systematic, latent, or active. Intrinsic and extrinsic factors also contribute to incorrect decisions. In addition to cognitive biases, our personality, socialization, personal chronobiology, and way of thinking (heuristic versus analytical) are influencing factors. Factors such as overload from private situations, long commuting times, and the complex environment of information technology must also be considered. The objective of this paper is to define and classify errors and mistakes in radiology, to discuss the influencing factors, and to present strategies for prevention. Hierarchical responsibilities and team "well-being" are also discussed., (© 2024. The Author(s).)

Children are more sensitive to ionizing radiation than adults. Even though the risk is very low, exposure from radiological examinations can possibly cause them long-term side effects. Recent large epidemiological studies involving children and young adults have added evidence suggesting that even small doses of radiation, such as those from computed tomography scans, might slightly increase the risk of developing cancer later in life. Therefore, even though radiologic studies are essential for an accurate diagnosis and management of various conditions, it is crucial to minimize radiation exposure. This article addresses radiation protection for children in the medical use of ionizing radiation and it is set in the context of the European legislative framework regarding radiation protection. It advocates for a holistic approach to paediatric radiological tests. This approach includes the key principles of radiation protection, such as the justification of imaging procedures supported by referral guidelines, as well as the optimization of techniques (according to the ALARA principle) and effective communication with parents about the benefits and the risks of radiologic procedures. Protecting children from unnecessary radiation is not only a technical challenge, but also a moral obligation and a legal requirement., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Common disorders of the gastrointestinal (GI) tract, such as gastroesophageal reflux/disease (GER/D) and constipation, are frequent causes for seeking medical support in infants. Diagnostic workup must ensure that diagnosed diseases are responsible for such complaints, thus enabling appropriate therapy. In this context assessment consists of clinical examination, functional tests, and imaging, which should be done in a staged manner. Close cooperation between clinicians and clinical radiologists enables optimal diagnostics, thus forming the basis for appropriate therapy., (© 2023. The Author(s).)

Introduction: Cranial CT scans are associated with radiation exposure to the eye lens, which is a particularly radiosensitive organ. Children are more vulnerable to radiation than adults. Therefore, it is essential to use the available dose reduction techniques to minimize radiation exposure. According to the European Consensus on patient contact shielding by the IRCP from 2021, shielding is not recommended in most body areas anymore. This study aims to evaluate whether bismuth shielding as well as its combination with other dose-saving technologies could still be useful. Methods: Cranial CT scans of a pediatric anthropomorphic phantom were performed on two up-to-date MDCT scanners. Eye lens dose measurements were performed using thermoluminescent dosimeters. Furthermore, the impact of BS and of the additional placement of standoff foam between the patient and BS on image quality was also assessed. Results: Bismuth shielding showed a significant lens dose reduction in both CT scanners (GE: 41.50 ± 4.04%, p < 0.001; Siemens: 29.75 ± 6.55%, p = 0.00). When combined with AEC, the dose was lowered even more (GE: 60.75 ± 3.30%, p < 0.001; Siemens: 41.25 ± 8.02%, p = 0.00). The highest eye dose reduction was achieved using BS + AEC + OBTCM (GE: 71.25 ± 2.98%, p < 0.001; Siemens: 58.75 ± 5.85%, p < 0.001). BS caused increased image noise in the orbital region, which could be mitigated by foam placement. Eye shielding had no effect on the image noise in the cranium. Conclusions: The use of BS in cranial CT can lead to a significant dose reduction, which can be further enhanced by its combination with other modern dose reduction methods. BS causes increase in image noise in the orbital region but not in the cranium. The additional use of standoff foam reduces image noise in the orbital region.

Paediatric computed tomography (CT) imaging has always been associated with challenges. Although the technical background of CT imaging is complex, it is worth considering the baseline aspects of radiation exposure to prevent unwanted excess radiation in paediatric patients. In this review, we discuss the most relevant factors influencing radiation exposure, and provide a simplified and practical approach to optimise paediatric CT., (© 2022. The Author(s).)

It is an indisputable dogma in extremity radiography to acquire x-ray studies in at least two complementary projections, which is also true for distal radius fractures in children. However, there is cautious hope that computer vision could enable breaking with this tradition in minor injuries, clinically lacking malalignment. We trained three different state-of-the-art convolutional neural networks (CNNs) on a dataset of 2,474 images: 1,237 images were posteroanterior (PA) pediatric wrist radiographs containing isolated distal radius torus fractures, and 1,237 images were normal controls without fractures. The task was to classify images into fractured and non-fractured. In total, 200 previously unseen images (100 per class) served as test set. CNN predictions reached area under the curves (AUCs) up to 98% [95% confidence interval (CI) 96.6%-99.5%], consistently exceeding human expert ratings (mean AUC 93.5%, 95% CI 89.9%-97.2%). Following training on larger data sets CNNs might be able to effectively rule out the presence of a distal radius fracture, enabling to consider foregoing the yet inevitable lateral projection in children. Built into the radiography workflow, such an algorithm could contribute to radiation hygiene and patient comfort., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Janisch, Apfaltrer, Hržić, Castellani, Mittl, Singer, Lindbichler, Pilhatsch, Sorantin and Tschauner.)

Objective: Balloon kyphoplasty with polymethylmethacrylate (PMMA) represents the standard procedure for the treatment of thoracic and lumbar type A compression fractures. However, an increased degeneration in adjacent intervertebral disks following PMMA kyphoplasty has been demonstrated in elderly patients. Calcium phosphate cement (CPC) appears to be superior to PMMA for the intravertebral stabilization in younger patients. It remains unkown whether CPC kyphoplasty causes degeneration of adjacent disks in adolescents., Design: Seven adolescents with thoracolumbar spine fractures underwent kyphoplasty at a mean age of 14.5 years (range 10-18). At a mean follow-up of 3.7 years (range 1 to 4.8) postoperatively, 3.0 Tesla magnetic resonance imaging (MRI) of the spine was performed to assess intervertebral disk degeneration by quantitative T2 relaxation maps and subjective ratings using modified Pfirrmann scores. A total of 56 intervertebral disks was analyzed. Initial computed tomography (CT) examinations served as basis to assess the severity of adjacent endplate injuries in terms of articular step-offs., Results: Initial imaging detected 18 thoracolumbar vertebral body fractures of which 9 were treated with CPC kyphoplasty. Quantitative follow-up MRI revealed signs of degeneration in 10 (17.9%) of the examined 56 intervertebral disks, 7 of them adjacent to a previously fractured vertebral body. Signs of disk degeneration were significantly higher in caudal endplates with articular step-offs larger than 5 mm compared to fractured vertebral bodies without endplate step-offs., Conclusions: Quantitative MRI follow-ups did not suggest CPC-related intervertebral disk degradations following thoracolumbar kyphoplasty in adolescents, but indicated disk alterations correlating to adjacent endplate fracture severity.

The use of artificial intelligence (AI) in image analysis is an intensively debated topic in the radiology community these days. AI computer vision algorithms typically rely on large-scale image databases, annotated by specialists. Developing and maintaining them is time-consuming, thus, the involvement of non-experts into the workflow of annotation should be considered. We assessed the learning rate of inexperienced evaluators regarding correct labeling of pediatric wrist fractures on digital radiographs. Students with and without a medical background labeled wrist fractures with bounding boxes in 7,000 radiographs over ten days. Pediatric radiologists regularly discussed their mistakes. We found F1 scores-as a measure for detection rate-to increase substantially under specialist feedback (mean 0.61±0.19 at day 1 to 0.97±0.02 at day 10, p<0.001), but not the Intersection over Union as a parameter for labeling precision (mean 0.27±0.29 at day 1 to 0.53±0.25 at day 10, p<0.001). The times needed to correct the students decreased significantly (mean 22.7±6.3 seconds per image at day 1 to 8.9±1.2 seconds at day 10, p<0.001) and were substantially lower as annotated by the radiologists alone. In conclusion our data showed, that the involvement of undergraduated students into annotation of pediatric wrist radiographs enables a substantial time saving for specialists, therefore, it should be considered., Competing Interests: The authors have declared that no competing interests exist.

In medicine, particularly in radiology, there are great expectations in artificial intelligence (AI), which can "see" more than human radiologists in regard to, for example, tumor size, shape, morphology, texture and kinetics - thus enabling better care by earlier detection or more precise reports. Another point is that AI can handle large data sets in high-dimensional spaces. But it should not be forgotten that AI is only as good as the training samples available, which should ideally be numerous enough to cover all variants. On the other hand, the main feature of human intelligence is content knowledge and the ability to find near-optimal solutions. The purpose of this paper is to review the current complexity of radiology working places, to describe their advantages and shortcomings. Further, we give an AI overview of the different types and features as used so far. We also touch on the differences between AI and human intelligence in problem-solving. We present a new AI type, labeled "explainable AI," which should enable a balance/cooperation between AI and human intelligence - thus bringing both worlds in compliance with legal requirements. For support of (pediatric) radiologists, we propose the creation of an AI assistant that augments radiologists and keeps their brain free for generic tasks., (© 2021. The Author(s).)

Objective: This study investigates the development of the thoracic cross-section at the nipple line level during the early stages of life. Unlike the descriptive awareness regarding chest development course, there exist no quantitative references concerning shape, circumference and possible dependencies to age, gender or body weight. The proposed mathematical relations are expected to help create guidelines for more realistic modelling and potential detection of abnormalities. One potential application is lung electrical impedance tomography (EIT) monitoring where accurate chest models are crucial in both extracting reliable parameters for regional ventilation function and design of EIT belts. Despite their importance, such reference data is not readily available for the younger age range due to insufficient data amid the regulations of neonatal imaging., Results: Chest circumference shows the highest correlation to body weight following the relation [Formula: see text] where x is the body weight in grams and f(x) is the chest circumference in cm at the nipple line level. No statistically significant difference in chest circumference between genders was detected. However, the shape indicated signs of both age and gender dependencies with on average boys developing a more rectangular shape than girls from the age of 1 years and 9 months., (© 2022. The Author(s).)

Digital radiography is widely available and the standard modality in trauma imaging, often enabling to diagnose pediatric wrist fractures. However, image interpretation requires time-consuming specialized training. Due to astonishing progress in computer vision algorithms, automated fracture detection has become a topic of research interest. This paper presents the GRAZPEDWRI-DX dataset containing annotated pediatric trauma wrist radiographs of 6,091 patients, treated at the Department for Pediatric Surgery of the University Hospital Graz between 2008 and 2018. A total number of 10,643 studies (20,327 images) are made available, typically covering posteroanterior and lateral projections. The dataset is annotated with 74,459 image tags and features 67,771 labeled objects. We de-identified all radiographs and converted the DICOM pixel data to 16-Bit grayscale PNG images. The filenames and the accompanying text files provide basic patient information (age, sex). Several pediatric radiologists annotated dataset images by placing lines, bounding boxes, or polygons to mark pathologies like fractures or periosteal reactions. They also tagged general image characteristics. This dataset is publicly available to encourage computer vision research., (© 2022. The Author(s).)

Background: Mesenteric lymphatic malformations (LMs) represent rare congenital anomalies that can include chylous or nonchylous content. The pathologic mechanisms explaining this phenomenon are poorly understood and not yet described. Furthermore, the current management approach does not consider the contents of the mesenteric LMs. In the present study, we have defined the relationship between the lymphatic mesenteric cyst content and the histologic evidence of LMs within the bowel wall., Methods: We retrospectively investigated all patients with mesenteric LMs treated surgically at our department from 1999 to 2018., Results: A total of 11 patients (6 girls and 5 boys) were included in our analysis. Seven patients had presented with LMs located in the jejunal mesentery, three in the ileocecal region, and only one in the mesocolon transversum and omentum. Of the 11 children, 7 had had LMs with nonchylous content and 4 had presented with chylous content LMs. Intestinal resection was performed in all 4 patients with chylous content LMs and 4 patients with nonchylous content LMs. Histopathologic evaluation of the surgical specimens determined that only the LMs with chylous content displayed malformed lymphatic channels throughout the bowel wall. The resected small bowel of four patients with nonchylous content showed no LM extension throughout the intestinal wall., Conclusions: LMs with chylous content seem to develop from malformed lymphatic channels within the bowel wall. In such cases, segmental intestinal resection is mandatory. In contrast, mesenteric LMs with nonchylous content can potentially be treated without bowel resection if the blood supply can be preserved. This finding is, to the best of our knowledge, reported in the present study for the first time., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Lung ultrasound (LUS) is now widely used in the diagnosis and monitor of neonatal lung diseases. Nevertheless, in the published literatures, the LUS images may display a significant variation in technical execution, while scanning parameters may influence diagnostic accuracy. The inter- and intra-observer reliabilities of ultrasound exam have been extensively studied in general and in LUS. As expected, the reliability declines in the hands of novices when they perform the point-of-care ultrasound (POC US). Consequently, having appropriate guidelines regarding to technical aspects of neonatal LUS exam is very important especially because diagnosis is mainly based on interpretation of artifacts produced by the pleural line and the lungs. The present work aimed to create an instrument operation specification and parameter setting guidelines for neonatal LUS. Technical aspects and scanning parameter settings that allow for standardization in obtaining LUS images include (1) select a high-end equipment with high-frequency linear array transducer (12-14 MHz). (2) Choose preset suitable for lung examination or small organs. (3) Keep the probe perpendicular to the ribs or parallel to the intercostal space. (4) Set the scanning depth at 4-5 cm. (5) Set 1-2 focal zones and adjust them close to the pleural line. (6) Use fundamental frequency with speckle reduction 2-3 or similar techniques. (7) Turn off spatial compounding imaging. (8) Adjust the time-gain compensation to get uniform image from the near-to far-field.

Cause determination is challenging in fever or inflammation of unknown origin (FUO/IUO) despite today's diagnostic modalities. We evaluated the value of F-18 FDG PET/CT in an unselected patient collective. This retrospective nonrandomized single-center study enrolled 300 male and female patients with FUO/IUO. PET/CT findings were compared with final clinical outcomes to determine the sensitivity, specificity, clinical significance, etiological distribution of final diagnoses, impact on treatment, role of white-blood cell count (WBC), and C-reactive protein (CRP). In 54.0% (162/300) PET/CT was the decisive exanimation for establishing the final diagnosis, in 13.3% (40/300) the findings were equivocal and indecisive, in 3.3% (10/300) PET/CT findings were false positive, while in 29.3% (88/300) a normal F-18 FDG pattern was present. Statistical analysis showed a sensitivity of 80.2% and a specificity of 89.8% for the contribution of PET/CT to the final diagnosis. CRP levels and WBC were not associated with PET/CT outcome. PET/CT let to new treatment in 24.0% (72/300), treatment change in 18.0% (54/300), no treatment change in 49.6% (149/300), and in 8.3% (25/300) no data was available. Our study demonstrates the utility of F-18 FDG PET/CT for source finding in FUO/IUO if other diagnostic tools fail., (© 2022. The Author(s).)

The purpose of this study is to determine the normal ranges of radioulnar (i.e. medial-lateral) finger deviations during growth. We retrospectively measured radioulnar interphalangeal joint angles in 6236 properly aligned thumbs and fingers in trauma radiographs of 4720 patients aged 0 to 19 years. The mean interphalangeal joint angle of the thumb was 0.2° (standard deviation 1.5°). The average proximal interphalangeal joint angles were ulnar deviation of 2.5° (1.7°) for the index, ulnar deviation 1.7° (1.5°) for the middle, radial deviation 1.3° (1.8°) for the ring, radial deviation 2.0° (2.8°) for the little fingers. The distal interphalangeal joint angles were ulnar deviation of 2.5° (1.7°), ulnar deviation 2.1° (1.7°), radial deviation 2.1° (1.7°), radial deviation 5.1° (2.8°) from index to the little fingers. Thumbs were typically straight, whereas the index and middle fingers deviated ulnarly, and ring and little fingers radially. There were no relevant differences in sex or laterality.

This paper presents a new method for selecting a patient specific forward model to compensate for anatomical variations in electrical impedance tomography (EIT) monitoring of neonates. The method uses a combination of shape sensors and absolute reconstruction. It takes advantage of a probabilistic approach which automatically selects the best estimated forward model fit from pre-stored library models. Absolute/static image reconstruction is performed as the core of the posterior probability calculations. The validity and reliability of the algorithm in detecting a suitable model in the presence of measurement noise is studied with simulated and measured data from 11 patients. The paper also demonstrates the potential improvements on the clinical parameters extracted from EIT images by considering a unique case study with a neonate patient undergoing computed tomography imaging as clinical indication prior to EIT monitoring. Two well-known image reconstruction techniques, namely GREIT and tSVD, are implemented to create the final tidal images. The impacts of appropriate model selection on the clinical extracted parameters such as center of ventilation and silent spaces are investigated. The results show significant improvements to the final reconstructed images and more importantly to the clinical EIT parameters extracted from the images that are crucial for decision-making and further interventions.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background and Objectives: Computer-aided diagnosis relies on machine learning algorithms that require filtered and preprocessed data as the input. Aligning the image in the desired direction is an additional manual step in post-processing, commonly overlooked due to workload issues. Several state-of-the-art approaches for fracture detection and disease-struck region segmentation benefit from correctly oriented images, thus requiring such preprocessing of X-ray images. Furthermore, it is desirable to have archived studies in a standardized format. Radiograph hanging protocols also differ from case to case, which means that images are not always aligned and oriented correctly. As a solution, the paper proposes XAOM, an X-ray Alignment and Orientation Method for images from 21 different body regions., Methods: Typically, other methods are crafted for this purpose to suit a specific body region and form of usage. In contrast, the method proposed in this paper is comprehensive and easily tuned to align and orient X-ray images of any body region. XAOM consists of two stages. For the first stage of the method, aligning X-ray images, we experimented with the following approaches: Hough transform, Fast line detection algorithm, and Principal Component Analysis method. For the second stage, we have experimented with the adaptations of several well known convolutional neural network topologies for correctly predicting image orientation: LeNet5, AlexNet, VGG16, VGG19, and ResNet50., Results: In the first stage, the PCA-based approach performed best. The average difference between the angle detected by the algorithm and the angle marked by the experts on the test set containing 200 pediatric X-ray images was 1.65 ∘ , while the median value was 0.11 ∘ . In the second stage, the VGG16-based network topology achieved the best accuracy of 0.993 on a test set containing 4,221 images., Conclusion: XAOM is highly accurate at aligning and orienting pediatric X-ray images of 21 common body regions according to a set standard. The proposed method is also robust and can be easily adjusted to the different alignment and rotation criteria., Availability: The Python source code of the best performing implementation of XAOM is publicly available at https://github.com/fhrzic/XAOM., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.

Introduction: Ewing sarcomas of the chest wall, historically known as "Askin tumors" represent highly aggressive pediatric malignancies with a reported 5-year survival ranging only between 40 and 60% in most studies. Multimodal oncological treatment according to specific Ewing sarcoma protocols and radical "en-bloc" resection with simultaneous chest wall repair are key factors for long-term survival. However, the surgical complexity depends on tumor location and volume and potential infiltrations into lung, pericardium, diaphragm, esophagus, spine and major vessels. Thus, the question arises, which surgical specialties should join their comprehensive skills when approaching a child with Ewing sarcoma of the chest wall. Patients and Methods: All pediatric patients with Ewing sarcomas of the chest wall treated between 1990 and 2020 were analyzed focusing on complete resection, chest wall reconstruction, surgical complications according to Clavien-Dindo (CD) and survival. Patients received neo-adjuvant chemotherapy according to the respective Ewing sarcoma protocols. Depending on tumor location and organ infiltration, a multi-disciplinary surgical team was orchestrated to perform radical en-bloc resection and simultaneous chest wall repair. Results: Thirteen consecutive patients (seven boys and six girls) were included. Median age at presentation was 10.9 years (range 2.2-21 years). Neo-adjuvant chemotherapy ( n = 13) and irradiation ( n = 3) achieved significant reduction of the median tumor volume (305.6 vs. 44 ml, p < 0.05). En-bloc resection and simultaneous chest wall reconstruction was achieved without major complications despite multi-organ involvement. Postoperatively, one patient with infiltration of the costovertebral joint and laminectomy required surgical re-intervention (CD IIIb). 11/13 patients were treated with clear resections margins (R1 resection in one patient with infiltration of the costovertebral joint and marginal resection <1 mm in one child with multiple pulmonary metastases). All patients underwent postoperative chemotherapy; irradiation was performed in four children. Two deaths occurred 18 months and 7.5 years after diagnosis, respectively. Median follow-up for the remaining patients was 8.8 years (range: 0.9-30.7 years). The 5-year survival rate was 89% and the overall survival 85%. Conclusion: EWING specific oncological treatment and multi-disciplinary surgery performing radical en-bloc resections and simultaneous chest wall repair contribute to an improved survival of children with Ewing sarcoma of the chest wall., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Basharkhah, Lackner, Karastaneva, Bergovec, Spendel, Castellani, Sorantin, Benesch, Liegl-Atzwanger, Smolle-Jüttner, Urban, Höllwarth, Singer and Till.)

Introduction: Novel dedicated extremity cone beam computed tomography (CBCT) devices, recently introduced to the market, raised attention as a possible alternative in advanced diagnostic pediatric trauma imaging, today usually performed by multidetector computed tomography (MDCT). This work aimed to compare image quality and radiation dose of CBCT and MDCT., Materials and Methods: Fifty-four CBCT-MDCT examination pairs, containing nine MDCTs acquired in parallel prospectively and 45 MDCTs matched in retrospect, were included in this study. Image quality was analyzed semi-objectively by measuring noise, contrast-to-noise ratio (CNR), and signal-to-noise ratios (SNR) and subjectively by performing image impression ratings. CT dose records were readout., Results: Image noise was significantly lower in CBCT compared with MDCT, both semi-objectively and subjectively (both p < 0.001). CNR and SNRs were also in favor of CBCT, though CBCT examinations exhibited significantly more beam hardening artifacts that diminished the advantages of the superior semi-objective image quality. These artifacts were believed to occur more often in children due to numerous bone-cartilage transitions in open growth plates and may have led to a better subjective diagnostic certainty rating (p = 0.001). Motion artifacts were infrequently, but exclusively observed in CBCT. CT dose index (CTDI vol ) was substantially lower in CBCT (p < 0.001)., Conclusion: Dedicated extremity CBCT could be an alternative low-dose modality in the diagnostic pathway of pediatric fractures. At lower doses compared with MDCT and commonly affected by beam hardening artifacts, semi-objective CBCT image quality parameters were generally better than in MDCT.

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

To obtain the highest diagnostic information with least side effects when performing thoracic CT angiography (CTA) is challenging in young children. The current study aims to compare three contrast agent (CA) injection protocols regarding image quality and CA characteristic: a standard CTA, a fixed-bolus delay protocol, and the "microbolus technique (MBT)" developed in our institution. Seventy chest CTA scans of patients (<2 years) were divided into three groups. MBT was applied in group I, the standard protocol in group II and a fixed bolus delay in group III. Objective image quality was assessed by measuring peak enhancement, image noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Two observers scored subjective image quality and artifacts. Significantly lower amounts of CA (mean ± SD) were used in the MBT group compared to Group II (9.0 ± 3.7 ml vs. 12.9 ± 4.5 ml). A lower, but still diagnostic (>400 HU) enhancement was registered in all major thoracic vessels in group I without significant differences regarding SNR and CNR in most regions (p < 0.05). The best scores for image quality and artifacts were reached in group I. All three chest CTA contrast injection protocols offered diagnostic vessel enhancement in young patients. MBT was associated with reduced image artifacts and less injected CA.