Search

Background In 2008, there were no pediatric radiologists in Ethiopia, a country of 100 million people. The radiology residency programs lacked training in pediatric imaging acquisition and interpretation. Objective We established an accredited local pediatric radiology fellowship program in Ethiopia. Methods With assistance from US faculty from the Children's Hospital of Philadelphia, Ethiopian radiologists created a 2-year fellowship training program in a university-based Ethiopian radiology residency program that incorporated formal lectures and seminars, case tutorials, journal clubs, teleradiological conferences, paper presentations, and online courses from collaborating institutions. Formal accreditation of the program was achieved from the university, and core values were established to ensure sustainability and self-sufficiency. The Ethiopian institution provided funding for the fellows, and US faculty volunteered their time. Results In 2015, 2 radiologists were recruited to the new fellowship; after graduation in 2017, they formed the first pediatric radiology section at the Ethiopian institution. Three new fellows were recruited in 2019, and the program is now self-sustaining. Pediatric imaging training has also been added to the radiology residency. Conclusions Establishing a pediatric radiology fellowship in a country with high need but little existing faculty expertise is feasible through outreach efforts.

BACKGROUND: Most congenital anomalies of the urinary tract present with hydronephrosis. Some are physiological while others pathological. Ultrasound, micturating cyst urethrography, dynamic renal scintigraphy, intravenous urography, dynamic and static magnetic resonance urography are used for examination. Currently, renal arterial Doppler resistance index is used as complimentary mechanism. This study assesses our experience in resistive index measurement in differentiating obstructive from non-obstructive hydronephrosis in children.METHODS: A cross-sectional study of forty-two infants and children (

Ultrasound (US) is used in the initial evaluation and surveillance of urinary tract dilation in children. Urinary tract dilation is diagnosed in 1–2% of all pregnancies during routine prenatal sonography with technological advances in US imaging. Urinary tract dilation classification systems, including the 2014 multidisciplinary consensus, assess anterior–posterior renal pelvic diameter and calyceal dilation. There is no consensus regarding optimal patient positioning — supine versus prone — during US assessment of urinary tract dilation. We performed this study to determine whether there is a significant difference in the measurement of the anterior–posterior renal pelvic diameter, presence of calyceal dilation, or resulting urinary tract dilation consensus score obtained between supine and prone positions. Two raters retrospectively reviewed renal bladder US exams of children with urinary tract dilation of one or both kidneys. We included technically adequate US examinations of orthotopic kidneys that were imaged in both supine and prone positions; we excluded children with renal anomalies or prior surgery. Anterior–posterior renal pelvic diameter measurements as well as central and peripheral calyceal dilation were documented in both supine and prone positions. A postnatal urinary tract dilation consensus score was assigned to each kidney based only on these features. Urinary tract dilation in either the supine or prone position was performed in 146 kidneys (69 right, 77 left) in 89 children. Median age was 0.26 years (interquartile ratio [IQR] 0.08–0.61 years). Female-to-male ratio was 1:3 (21/89). The interclass correlations of the anterior–posterior renal pelvic diameter were 0.88 and 0.87 in the supine and prone positions, respectively, without significant differences (P=0.1). When comparing all kidneys together, the mean anterior–posterior renal pelvic diameter was 7.1 mm (95% confidence interval [CI] 6.4–7.8) in supine and 7.9 (95% CI 7.1–8.7) in prone, with a mean difference between the measurements of 0.83 mm (95% CI 0.3–1.4; P=0.16). Central calyceal and peripheral calyceal dilation were more commonly found in the prone position versus the supine position in both kidneys. Central calyceal dilation was observed in 15 cases in the prone but not in the supine position. In one kidney, it was seen only in the supine but not in the prone position. Overall the urinary tract dilation score differed between positions in 10.3% (15/146) of cases, most of them (14/15) with a higher score in prone compared to the supine position. Scanning in prone position tends to more frequently show calyceal dilation and a greater size of the anterior–posterior renal pelvic diameter, resulting in higher urinary tract dilation classification scores, with almost perfect interobserver agreement.

The objective of the present study was to validate the use of web-based tutorials to teach technical skills in pediatric ultrasound.A series of 10 video tutorials, each of which was less than 10 minutes long, was created to improve the education of radiology trainees in terms of their ultrasound technique. Pediatric radiology fellow trainees from our institution in the United States and radiology resident trainees from our partner institution in Ethiopia were invited to participate in the study. Validation of the video tutorials was performed using two learning modules that focused on the renal bladder and the right upper quadrant (RUQ). Pretest and posttest skill and confidence assessments were also conducted. After watching the tutorials, the trainees completed questionnaires that assessed the reach, appeal, and learning effectiveness of the modules.Ten fellow trainees and eight resident trainees participated in the study. The fellows were invited to evaluate both the RUQ and the renal bladder learning modules, whereas the residents evaluated the RUQ module only. Before reviewing the RUQ module, the fellows had performed a median of four RUQ ultrasound examinations, whereas the residents had performed a median of 400 RUQ ultrasound examinations. After the trainees viewed the learning module, the median skills test scores of the fellows increased from 20 to 37.5 (highest possible score, 45) (p0.01), and those of the residents increased from 38 to 40 (highest possible score, 40) (p = 0.04). With a total possible score of 15, the median confidence score improved from 8 to 11 for fellows (p0.01) and from 13.5 to 14.5 for residents (p = 0.04). After the fellows viewed the renal bladder learning module, their median skills test scores increased from 20 to 37.5 (highest possible score, 40) (p0.01), and their median confidence score increased from 8.5 to 11 (highest possible score, 15) (p = 0.01). Trainees gave the tutorials positive ratings overall.Radiology fellow trainees and resident trainees with disparate backgrounds in ultrasound showed significant improvement in their technical skills in pediatric ultrasound and confidence after viewing the tutorials. The web-based design of the tutorials allows integration of international pediatric radiology training communities.

Introduction: Abdominal masses in pediatric patients are common findings& may be caused by congenital anomalies, tumors, trauma, infection or abscess, or by organ enlargement. Imaging modality choice is a core issue in the evaluation of pediatric patients.Objective-: The objective of this study is to compare and examine the correlation of B-mode US diagnosis with that of pathological diagnosis of pediatric abdominal masses (PAMs).Methods: A retrospective study conducted on 83 (47 male, 36 female) pediatric abdominal masses (PAM) casesadmitted to TASH, pediatric surgical ward to study the US patterns of PAMs withpathologic correlation to see diagnosis sensitivity of US.Results: All the 83 patients had US evaluation, 42(50.6%) of them had both US & biopsy diagnoses, 60(72.3%) have US & FNAC result, 44(53%) had both US & IVP study, 10(12%) had both US & CT study, 8(9.6%) had both CT & Biopsy, 27(32.1%) had IVP & Biopsy results. When US diagnosis was compared with the final diagnosis, 31 of the 42 cases (74%) including cystic abdominal masses had similar diagnosis with the biopsy. From the 20 case with final diagnosis of wilm’s tumor (WT), 17(85%) were correctly diagnosed by ultrasound as WT. that showed US sensitivity to be high for WT in particular than PAMs as a whole. When the FNAC, U/S & Biopsy cross tabulation was analyzed, only13 of the 25 cases (52%) of FNAC results matched the biopsy diagnosis but 19 of 25 cases (76%) of U/S diagnosis matched the results of the final diagnosis, making U/S more sensitive than FNAC in the diagnosis of PAMs in our study. Conclusion: - In addition to describing the location, size & consistency of the PAMs, US was shown to give exact diagnosis in a good percentage of patients in this study. US has far better sensitivity (76% to 52%) in diagnosing PAMs as a whole compared to the FNAC results in the study. So, Ultrasound scanning is a noninvasive method of visualizing th cross sectional anatomic relation of PAMs with a good sensitivity in the diagnosis of the different PAMs which make it especially valuable in pediatric patients, where prompt diagnosis and treatment are essential & radiation exposure risk is a concern.

Despite advances in non-invasive radiological techniques for the treatment of intussusception, management of the entity still remains exclusively surgical in many developing countries, including Ethiopia. Fluoroscopic units are rare or mostly dysfunctional. Ultrasound scanners are more commonly available. Ultrasound-guided hydrostatic reduction (USGHR) was recently introduced to the main referral hospital in Ethiopia, and subsequently has been adopted as the initial management option for intussusception. The aim of this study was to evaluate our experience with USGHR in Ethiopia and measure the impact on patient care. A prospective study was conducted between July 2014 and August 2015 on all pediatric patients, with US-confirmed intussusception, at the Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. All patients, excluding those with signs of peritonitis, bowel ischemia, or symptoms lasting longer than 4 days, were selected to undergo USGHR. A total of 53 children were diagnosed with intussusception, confirmed via ultrasound. Following exclusion criteria, USGHR was attempted in 47 of the patients. Forty-one of the 47 patients (87.2%) had successful reduction, resulting in a 77% overall rate of successful non-operative management in all patients with intussusception. The rate of operative reduction of intussusception decreased by 77% following the introduction of USGHR as the initial non-surgical intervention. Therefore, we believe USGHR should be fully implemented in our hospital, and recommend that this study serves as an example to other institutions in our country as well as in other developing countries facing similar challenges.

Four major factors necessitate the support for and advancement of pediatric imaging in Ethiopia. First, the demographics are loud and clear: 44% of the population is younger than 14 years and 60% is younger than 20 years. At the largest general referral hospital of the country, Tikur Anbessa Hospital in Addis Ababa, 47% of the patient population is children. Second, higher education in Ethiopia has witnessed historical undertakings through the establishment of more than 20 universities that have high need of well-trained professionals. Third, various medical specialties have already started or are in the process of establishing subspecialties like pediatric surgery, pediatric oncology and neonatology— specialties that necessitate dedicated pediatric imaging support. However, there is not a single pediatric radiologist in the country, which has an estimated population of 93 million. Fourth, there is a significant discrepancy with regard to the availability of radiologic equipment between the public and private sectors. The Faculty of Medicine of the Addis Ababa University, in Tikur Anbessa Hospital, which is a public entity, runs the only radiology residency program in the country. Currently, there is no MRI scanner at this facility. Thus graduates face major challenges when they go out to work in better-equipped public or private facilities. The Children’s Hospital of Philadelphia (CHOP) Pediatric Radiology Outreach Program in Ethiopia has made the commitment to lead the efforts to support pediatric radiology education in Ethiopia. Building on the training of local radiology academic faculty members through a pediatric radiology fellowship is likely to have a sustainable positive outcome. Thus efforts to implement pediatric radiology education need to consider residents, faculty members and practicing radiologists. The educational support is multifaceted and includes regular pediatric radiology visiting professorships, tele-radiology for teaching, provision of teaching cases and recorded pediatric radiology lectures, organization of an observership at our institution (supported through the Soroosh Mahboubi International Fund for Higher Education) and research mentorship. We conduct an annual pediatric radiology continuing education course in collaboration with the Radiological Society of Ethiopia to develop pediatric imaging in the country by focusing on practicing radiologists. We emphasize how to optimize and broaden the spectrum of ultrasound studies in children. There is scarcity of CTandMRI scanners in the teaching hospitals. In the private sector these modalities are more prevalent. We specifically address pediatric CT and MRI techniques, indications and interpretations to help close the existing knowledge gap. In conclusion, the vision of the CHOP international outreach program is that there will be increasing and appropriate emphasis of pediatric imaging in the radiology residency, supported by the first batch of graduating local pediatric radiologists.