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Scurvy, a disease caused by a severe lack of vitamin C in the diet, is most often associated with 17th-century sailors. Its 21st-century manifestation is a disease of the poor, sick, and those living in remote rural neighborhoods in which fresh, nutritious food is hard to come by. It is caused by a deficiency of Vitamin C and is rare in the United States. We describe the radiographic and MRI findings of a case of scurvy in a child with Noonan syndrome who is a "picky eater". MRI is rarely performed in scurvy as its radiographic findings are generally well known and sufficient for a diagnosis. However, due to the rarity of the disease in the US, MRI features of scurvy have been described in only a few case reports, to date. The rarity of this disease also causes scurvy to be kept lower, if at all in the differential diagnosis list.

Rationale and Objectives Education research has been undervalued in radiology, with few radiology journals having dedicated space for such research and barriers to production including dedicated time, resources, grant funding, and mentorship. As radiologists, we have an opportunity to study education in our unique learning environments and create more effective ways to teach that are grounded in established education theory, solid assessment methodologies, and a focus on merit as well as worth. Materials and Methods The growth of education research in our field requires a two-pronged approach; We must cultivate leaders in education research from within our specialty, and continue to submit high quality work to radiology journals to increase exposure of the reviewers and readership to education methodologies. Results We have created the first radiology education research fellowship to this end. This manuscript details the fellowship creation process, the first education research fellow experience, and in-depth analysis of the inaugural year via a qualitative program review. Conclusion We were successful in supporting an inaugural fellow in attaining the knowledge and skills to become a productive education researcher. Beyond this, the fellowship experience was a catalyst in developing her unique professional identity as an education master which will further raise the status of education research in pediatric radiology.

Recent literature has raised concerns about the sensitivity and accuracy of radiographs at diagnosing rib fractures. Studies have shown that chest computed tomography (CT) has far greater sensitivity at detecting rib fractures than radiographs. The purpose of this study was to evaluate the sensitivity of skeletal survey (SS) radiographs at diagnosis of rib fractures compared to CT in the pediatric population. This retrospective review included 57 patients who had undergone both a SS and a CT chest or CT chest/abdomen/pelvis within 30 days of each other for the indication of either non-accidental (NAT) or accidental trauma between 2009 and 2017. Images and reports were analyzed by a pediatric radiology fellow for presence/absence of fracture, evidence of healing and location of rib fracture, including rib level, location within the rib (anterior, lateral, and posterior), and side (right versus left). 225 rib fractures were identified in 25 patients on CT. 38 of those fractures were missed on the preceding SS, yielding a miss rate of 17%. Acute fractures were more likely to be missed than chronic or healing fractures (p ≤ 0.01). Location within the rib did not impact rib detection on radiographs. Left-sided rib fractures were not more common in NAT patients, compared to accidental trauma. SS miss approximately 17% of all rib fractures and CT is more sensitive modality in the detection of rib fractures, particularly acute rib fractures, regardless of location. Low-dose Chest CT could be a helpful modality in the work-up of NAT trauma.

Over the last decade, health care professionals in the field of radiology have experienced increasing rates of burnout. A study in 2017 showed high prevalence of burnout in pediatric radiology, and other studies have identified several drivers for burnout. An important factor in promoting wellness and mitigating burnout is leveraging diversity, equity and inclusion in the workplace. This manuscript highlights the importance of diversity in high-functioning teams as well as the critical role of equity and inclusion in the workplace to help create an organization where people belong and can effectively succeed.

Purpose This retrospective analysis aims to examine the effectiveness of the current chest imaging guidelines regarding COVID-19 positive pediatric patients on our study group of patients aged 0 to 18. Materials and methods We examined clinical and imaging data of 178 pediatric COVID-19 positive patients confirmed by PCR admitted to the Children's Hospital of Los Angeles between March 6, 2020 and June 23, 2020. Results Of 178 patients, only 46 (27%) patients underwent any form of chest imaging. Thirteen (28%) of 46 imaged patients had positive chest X-rays (CXR) or computed tomography (CT) chest findings, with 8 (62%) of the 13 patients suggesting pneumonia or multifocal pneumonia, 3 (23%) patients having acute respiratory distress syndrome, and 2 (15%) patients demonstrating left sided pleural effusions thought to be the result of ruptured appendicitis unrelated to their COVID-19 diagnosis. All but one patient had significant prior medical histories with an associated comorbid medical condition. Of the 46 imaged patients, 17 (37%) patients had a negative chest X-ray, and 15 (33%) patients had suggestive findings of viral etiology. 132 patients were not imaged. Conclusion Our study population corroborated current chest imaging guidelines in pediatric patients. Chest imaging modalities such as CXR and CT should be reserved for patients who are severely symptomatic and/or possess prior comorbidities such as immunosuppression, diabetes, asthma, obesity, or where other differential etiologies must be entertained.

Zellweger Syndrome (ZS) is a rare peroxisomal disorder also referred to as cerebrohepatorenal syndrome. ZS is an autosomal recessive disease often manifesting in the neonatal period with profound dysfunction of the central nervous system, liver and kidneys. Prenatal diagnosis of this syndrome is infrequent with imaging findings on fetal MRI rarely illustrated in the literature. This case highlights the pivotal role fetal MRI can play in identifying subtle features of the disease that are difficult to visualize on prenatal ultrasound. It is important for pediatric radiologists to be familiar with the most common imaging features of ZS on fetal MRI to expedite the diagnosis and help facilitate appropriate prenatal counseling.

Purpose To evaluate how the COVID-19 pandemic affected the imaging utilization patterns for non-COVID-19-related illness in a pediatric emergency department (ED). Methods We retrospectively reviewed radiology reports for ultrasound, CT, MRI, and fluoroscopy studies performed at a pediatric ED in April from 2017 to 2021, excluding studies for respiratory symptoms and trauma. Radiology reports and medical records were reviewed to determine if patients had a positive radiology diagnosis, the type of diagnosis, and whether it required hospital admission. Results from during the pandemic were compared to predicted rates based on pre-pandemic years. Results A total of 2198 imaging studies were included. During the COVID-19 pandemic, fewer ED imaging studies were performed compared to predicted. The decrease was greater in April 2020 (RR = 0.56, p

Purpose We aimed to compare COVID-19 imaging findings of young adults (19–35 years of age) with those of children (0–18 years) and to correlate imaging findings of young adults with their laboratory tests. Materials and methods This retrospective study included Real Time-Polymerase Chain Reaction (RT-PCR) confirmed 130 young adults (mean age: 28.39 ± 4.77; 65 male, 65 female) and 36 children (mean age: 12.41 ± 4.51; 17 male, 19 female), between March and June 2020. COVID-19 related imaging findings on chest CT were examined in young adults and compared with children by the Mann-Whitney U, and Chi-square or Fisher's exact test. Laboratory examinations of young adults were assessed in terms of correlation with radiological findings by the Spearman's correlation analysis. Results Bilateral multiple distributions (p = 0.014), subpleural involvement, and pleural thickening (p = 0.004), GGOs with internal consolidations were more frequent in adults (p = 0.009). Infiltrations were significantly larger than 20 mm in young adults (p = 0.011). The rates of feeding vessel sign, vascular enlargement, and halo sign were significantly higher in young adults (p

Contrast-enhanced ultrasound (CEUS) has been increasingly used in pediatric radiology practice worldwide. For nearly two decades, CEUS applications have been performed with the off-label use of gas-containing second-generation ultrasound contrast agents (UCAs). Since 2016, the United States Food and Drug Administration (FDA) has approved the UCA Lumason for three pediatric indications: the evaluation of focal liver lesions and echocardiography via intravenous administration and the assessment of vesicoureteral reflux via intravesical application (contrast-enhanced voiding urosonography, ceVUS). Prior to the FDA approval of Lumason, numerous studies with the use of second-generation UCAs had been conducted in adults and children. Comprehensive protocols for clinical safety evaluations have demonstrated the highly favorable safety profile of UCA for intravenous, intravesical and other intracavitary uses. The safety data on CEUS continue to accumulate as this imaging modality is increasingly utilized in clinical settings worldwide. As of August 2021, 57 pediatric-only original research studies encompassing a total of 4,518 children with 4,906 intravenous CEUS examinations had been published. As in adults, there were a few adverse events; the majority of these were non-serious, although very rarely serious anaphylactic reactions were reported. In the published pediatric-only intravenous CEUS studies included in our analysis, the overall incidence rate of serious adverse events was 0.22% (10/4,518) of children and 0.20% (10/4,906) of all CEUS examinations. Non-serious adverse events from the intravenous CEUS were observed in 1.20% (54/4,518) of children and 1.10% (54/4,906) of CEUS examinations. During the same time period, 31 studies with the intravesical use of UCA were conducted in 12,362 children. A few non-serious adverse events were encountered (0.31%; 38/12,362), but these were most likely attributable to the bladder catheterization rather than the UCA. Other developing clinical applications of UCA in children, including intracavitary and intralymphatic, are ongoing. To date, no serious adverse events have been reported with these applications. This article reviews the existing pediatric CEUS literature and provides an overview of safety-related information reported from UCA uses in children.

To estimate the effectiveness and efficiency of chest CT in children based on the suspected diagnosis in relation to the number of positive, negative, and inconclusive CT results.In this monocentric retrospective study at a university hospital with a division of pediatric radiology, 2019 chest CT examinations (973 patients; median age: 10.5 years; range: 2 days to 17.9 years) were analyzed with regards to clinical data, including the referring department, primary questions or suspected diagnosis, and CT findings. It was identified if the clinical question was answered, whether the suspected diagnosis was confirmed or ruled out, and if additional findings (clinically significant or minor) were detected.The largest clinical subgroup was the hematooncological subgroup (n = 987), with frequent questions for inflammation/pneumonia (66 % in this subgroup). Overall, CT provided conclusive results in 97.6 % of all scans. In 1380 scans (70 %), the suspected diagnosis was confirmed. In 406/2019 cases (20 %), the CT scan was negative also in terms of an additional finding. In 8 of 9 clinical categories, the proportion of positive results was over 50 %. There were predominantly negative results (110/179; 61 %) in pre-stem cell transplant evaluation. In the subgroup of trauma management, 81/144 exams (57 %) showed positive results, including combined injuries (n = 23). 222/396 (56 %) of all additional findings were estimated to be clinically significant.In a specialized center, the effectiveness of pediatric chest CT was excellent when counting the conclusive results. However, to improve efficiency, the clinical evaluation before imaging appears crucial to prevent unnecessary CT examinations.· Pediatric chest CT in specialized centers has a high diagnostic value.. · CT identifies relevant changes besides the working hypothesis in clinically complex situations.. · Pre-CT clinical evaluation is crucial, especially in the context of suspected pneumonia..· Esser M, Tsiflikas I, Kraus MS et al. Effectiveness of Chest CT in Children: CT Findings in Relation to the Clinical Question. Fortschr Röntgenstr 2022; 194: 281 - 290.ZIEL: Abschätzung der klinischen Wertigkeit der Thorax-CT bei Kindern auf Grundlage der Verdachtsdiagnose und positiven, negativen und inkonklusiven CT-Befunde.In dieser retrospektiven monozentrischen Studie an einer Universitätsklinik mit Abteilung für Kinderradiologie wurden 2019 Thorax-CTs (973 Patienten; Altersmedian 10,5 Jahre; Spannweite: 2 Tage bis 17,9 Jahre) hinsichtlich klinischer Daten analysiert, einschließlich Zuweiserinformationen, primärer Fragestellungen oder Verdachtsdiagnosen und CT-Befunde. Es wurde festgehalten, ob die klinische Fragestellung beantwortet wurde, ob die Verdachtsdiagnose bestätigt oder ausgeschlossen wurde und ob Nebenbefunde (klinisch signifikant oder irrelevant) festgestellt wurden.Die größte klinische Untergruppe bestand aus hämatoonkologischen Fällen (n = 987) mit häufiger Fragestellung eines pulmonalen Infektfokus (66 % in dieser Gruppe). Insgesamt lieferte die CT in 97,6 % aller CTs konklusive Resultate. In 1380 CTs (70 %) wurde die Verdachtsdiagnose bestätigt. In 406/2019 Fällen (20 %) wurde weder ein primärer Befund noch ein Nebenbefund festgestellt. In 8 von 9 klinischen Kategorien war der Anteil der positiven Ergebnisse über 50 %. Vorwiegend negative Ergebnisse (110/179; 61 %) traten bei Patienten vor Stammzelltransplantation auf. In der Gruppe der Traumapatienten lieferten 81/144 der Untersuchungen (57 %) positive Ergebnisse, einschließlich mehrerer kombinierter Verletzungen (n = 23). 222/396 aller Nebenbefunde (56 %) wurden als klinisch relevant eingestuft.Die pädiatrische Thorax-CT in spezialisierten Zentren hat eine hohe diagnostische Aussagekraft im Hinblick auf konklusive Untersuchungsergebnisse. Zur Verbesserung der Effizienz der Methode und Prävention unnötiger CT-Untersuchungen ist die klinische Beurteilung prä-CT entscheidend.· Die pädiatrische Thorax-CT in spezialisierten Zentren hat eine hohe diagnostische Aussagekraft.. · Die CT kann in klinisch komplexen Situationen relevante Veränderungen neben der Arbeitshypothese erkennen.. · Die klinische Beurteilung prä-CT ist unentbehrlich, insbesondere bei Verdacht auf eine Pneumonie..

Background The coronavirus disease 2019 (COVID-19) pandemic has heightened existing gender differences in academic productivity in medicine. There have been discrepant repercussions for women in academics due to the pandemic, including fewer publications, potentially impacting academic advancement. Objective To evaluate trends over time in the gender of authors of manuscripts submitted to Pediatric Radiology. Materials and methods This retrospective review of unsolicited manuscripts submitted to Pediatric Radiology from January 2017 to December 2020 included only submissions from North America. For each submission, genders of the first, last (senior) and corresponding authors were inferred by inspection or confirmed by internet search. Chi-square and Fisher exact tests were used to compare authorship gender proportions. Quarterly comparisons between 2019 and 2020 were performed to assess for differences during the COVID-19 pandemic. Results Between 2017 and 2020, 1,018 manuscripts were submitted. There was no significant difference in female authorship over time (P > 0.05 for first, last and corresponding authors), but there was an increase in female first authorship (38.6% in 2017, 43.2% in 2020). The frequencies of female first (P = 0.03) and last (P = 0.01) authors were significantly higher for educational manuscripts (reviews and pictorial essays) versus other manuscript types. Manuscript submissions increased in the second quarter of 2020; however, there was a statistically significant decrease in last authorship by women during this period (P = 0.02). Conclusion Female authorship of manuscripts submitted to Pediatric Radiology has remained relatively stable between 2017 and 2020. During the early phase (March–May 2020) of the COVID-19 pandemic, female last authorship was significantly lower versus the previous year.

Background Since coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020, many authors have noted the collateral damage on non-COVID-19-related illnesses. These indirect effects of the pandemic have resulted in people presenting later and with more severe stages of disease, even if their diagnoses are not directly related to SARS-CoV-2, the virus that causes COVID-19. Objective We studied these indirect effects of COVID-19 on the imaging workup and outcomes for pediatric patients at our center who had acute appendicitis during the pandemic. Materials and methods We performed a retrospective review of cases in children ≤18 years who were evaluated for acute appendicitis during the same period, March 1 to May 31, in both 2019 and 2020. We compared demographic and clinical data as well as surgical and pathological findings, and we graded imaging findings according to severity. Differences in patient outcomes were assessed using the Wilcoxon rank sum test and the Pearson chi-square test. Results The total number of pediatric patients evaluated with imaging for acute appendicitis dropped by 43% between 2019 and 2020 (298 vs. 169), but the total number of children treated remained similar (59 vs. 51). There was proportionate use of US and CT in each timeframe but a higher percentage of positive imaging findings in 2020 (50/169, 29.6% vs. 56/298, 18.7% in 2019, P=0.04). There were more imaging examinations with features of complicated appendicitis among positive cases (9/51, 18% vs. 5/59, 8% in 2019, P=0.08) and more pathologically proven perforated cases during the pandemic (14/51, 27% vs. 6/59, 10% in 2019, P=0.11), although these results did not reach statistical significance. There were no changes in surgical management, vital signs, laboratory values, length of stay or complication rates. Conclusion There was a large drop in the number of pediatric patients imaged for acute appendicitis during the acute phase of the COVID-19 pandemic despite similar numbers of patients treated. The utilization trends of US vs. CT remained stable between time periods. The differences in imaging findings and perforation rates were less pronounced compared to other published studies.

BackgroundChildren are frequently referred to the pediatric radiology department due to complaints related to the urinary tract.Main bodyWe aimed to describe common clinical scenarios in paediatric urology practice and their recommended imaging diagnostic algorithms. Practical imaging approach to following common clinical scenarios and the common radiological findings are discussed: (A) perinatal urinary tract dilatation and other congenital anomalies; (B) recurrent urinary tract infection; (C) enuresis and daytime urinary incontinence; (D) abdominal masses; (E) flank pain; (F) hematuria; (G) trauma; (H) nonpalpable testis, ambiguous genitalia and common urogenital sinus anomalies; and I) renovascular hypertensionConclusionsImaging investigations should be tailored according to the clinical presentation in a stepwise approach aiming for optimum patients’ care.

The calcification of ligamentum arteriosum occurs after the normal closure of the ductus arteriosus. Foreign body ingestion is a common event in the pediatric age, and it is frequently addressed in the Emergency Room. We report a case of foreign body in a patient with unknown calcification of the ligamentum arteriosum. His parents noted blood in the saliva, but he had no symptoms indicative of an acute clinical situation. The CT showed a hyperdense object in the aorto-pulmonary window with features compatible with a metallic object. The child underwent surgery, during which a calcified ligamentum arteriosum was found and no foreign body. This phenomenon has been described to be better identified using multi-section CT scans than X-Rays.

The diagnosis and treatment of pediatric intrathoracic lymphatic-venous malformations (LVM) can be complex due to their rarity, variable presentation and confusing nomenclature in the literature. The International Society for the Study of Vascular Anomalies (ISSVA) has recently (2018) updated their classification to help guide the correct diagnosis, nomenclature and management of such cases. We present the case of a 12-month-old Caucasian female with a lymph-venous malformation (LVM) classified in the updated ISSVA classification as a combined vascular malformation (CLVM) defined as two or more vascular malformations found in one lesion, associated with an underlying “malformation of an individual named vessel”. The patient presented with tachypnea, tachycardia and fever. While all the previous cases underwent surgical treatment, our patient was successfully treated with rapamycin and sclerotherapy. Appropriate imaging can aid in the diagnosis of vascular anomalies and in the proper ISSVA classification, saving the patient the need for a biopsy and allow for proper referral to Multidisciplinary Vascular Anomalies centers. The accurate classification can identify cases that can be treated through Interventional Radiology with sclerosing agents and medical therapy as opposed to surgery.

Thoracic ultrasound is radiation-free, easily available, portable modality with added advantage of real-time assessment. It is useful in mediastinal lesions and peripheral lung, pleural and chest wall masses. Not only is it a valuable modality in differentiating solid from cystic lesion, it can also depict internal architecture without the use of contrast material. The added advantages of its use in children are the lack of ionizing radiation, and no need for sedation or general anesthesia in most cases. Although it has its limitations with a longer learning curve, it can act as a second-line modality to chest radiograph and adjunctive modality to CT in cases of a thoracic mass in a child.

Background Missed appointments can have an adverse impact on health outcomes by delaying appropriate imaging, which can be critical in influencing treatment decisions. Objective To assess for socioeconomic and imaging exam factors associated with missed appointments among children scheduled for diagnostic imaging. Materials and methods We retrospectively analyzed children (21 days (OR=3.7; 95% CI=2.9–4.8). The use of radiation, intravenous contrast agent or sedation was not associated with increased likelihood of missed appointments. Conclusion Expanding our knowledge of how different socioeconomic and imaging-related factors influence missed appointments among children can serve as a foundational step to better understand existing and emerging disparities and inform strategies to advance health equity efforts in radiology.

Artificial intelligence (AI) is a broad and complicated concept that has begun to affect many areas of medicine, perhaps none so much as radiology. While pediatric radiology has been less affected than other radiology subspecialties, there are some well-developed and some nascent applications within the field. This review focuses on the use of AI within pediatric radiology for image interpretation, with descriptive summaries of the literature to date. We highlight common features that enable successful application of the technology, along with some of the limitations that can inhibit the development of this field. We present some ideas for further research in this area and challenges that must be overcome, with an understanding that technology often advances in unpredictable ways.

Work-related stress and burnout were documented to be high among pediatric radiologists prior to the coronavirus disease 2019 (COVID-19) pandemic. New challenges arose from the COVID-19 pandemic, potentially introducing new stressors and anxieties. To evaluate potential sources of stress and anxiety for pediatric radiology faculty during the early phase of the COVID-19 pandemic. We conducted a survey of attending physician members of the Society for Pediatric Radiology in North America from April 27, 2020, to May 22, 2020. The response rate was 21% (251/1,206). Survey questions included demographic information and questions regarding working remotely, personal protective equipment, redeployment, personal wellness, wellness resources and financial concerns. A psychometrician reviewed the questions to ensure minimal risk of misinterpretation. Median age of respondents was 48 years (range 33–70 years) with median number of years in practice of 14 (range 1–45 years). Fifty-three percent of respondents were women and 46% were men. Because of an increase in remote work, 69% of respondents endorsed feeling more isolated from a lack of regular interaction with colleagues. Fifty-three percent of respondents indicated that it is challenging to work remotely while overseeing home schooling for children. In comparison to men, women reported overall higher work-related stress and anxiety (P=0.02), higher feelings of guilt from radiology staff (i.e. technologists and nurses) being more exposed to COVID-19 (P=0.02) and higher levels of stress providing for dependents (P=0.04). Most respondents thought that departmental leadership was effective and respondents were not concerned about meeting financial obligations or job loss. The early phase of the COVID-19 pandemic caused additional stress and anxiety for pediatric radiology faculty and disproportionally affected women. Given the continuously evolving state of the COVID-19 pandemic, these results could aid in planning and implementation of future strategies to combat burnout in radiology. Specific attention should be directed to different stressors experienced by female versus male radiologists, especially in regard to dependent care.

Purpose Children with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability due to development of unbalanced muscular strength. Our major goal in this study is to compare the accuracy of physical examination and ultrasonography (US) in determination of glenohumeral instability in infants with BPBI compared with magnetic resonance imaging (MRI) as a gold standard, and to investigate the role and value of US as a screening modality for assessing glenohumeral instability. Methods Forty-two consecutive patients (mean age, 2.3±0.8 months) with BPBI were enrolled into this prospective study. Patients were followed up with physical examination and US with dynamic evaluation in 4-6 weeks intervals. Patients who developed glenohumeral instability based on physical examination and/or US (n=21) underwent MRI. Glenohumeral instability was defined as alpha angle >30° and percentage of posterior humeral head displacement >50%. Diagnostic accuracy of physical examination and US was calculated and quantitative parameters were compared with Wilcoxon test. Results Glenohumeral instability was confirmed with MRI in 15 of 21 patients. Accuracy and sensitivity of physical examination and US were 47%, 66% and 100%, 100%, respectively in determination of glenohumeral instability. No significant difference was found for the alpha angle (p = 0.173) but the percentage of posterior humeral head displacement was statistically significant between US and MRI (p = 0.028). Conclusion Our results indicate that US with dynamic evaluation is a good alternative for MRI in assessment of glenohumeral instability in infants with BPBI, since it is highly accurate and specific, and quantitative measurements used for glenohumeral instability were comparable to MRI. US can be used as a screening method to assess glenohumeral instability in infants with BPBI.

Urinary bladder hemangiomas are a rare cause of gross hematuria in young patients. Multimodality imaging with ultrasound, computed tomography, and magnetic resonance imaging help define the site and extent of hemangioma. We describe a case of an otherwise healthy 9-year-old male presenting with recurrent gross hematuria. The initial US did not demonstrate a bladder mass, but subsequent cystoscopies showed progressive enlargement of an extensive sessile and partially pedunculated vascular mass. Imaging with ultrasound, computed tomography, and magnetic resonance imaging persistently demonstrated a hypervascular bladder mass without extravesical extension. Ultimately, biopsy of the mass made the diagnosis of bladder hemangioma.

There have been rapid advances in artificial intelligence (AI) technology in recent years, and the field of diagnostic imaging is no exception. Just as digital technology revolutionized how radiology is practiced, so these new technologies also appear poised to bring sweeping change. As AI tools make the transition from the theoretical to the everyday, important decisions need to be made about how they will be applied and what their role will be in the practice of radiology. Pediatric radiology presents distinct challenges and opportunities for the application of these tools, and in this article we discuss some of these, specifically as they relate to the prediction, identification and investigation of child abuse.

Pediatric radiologists have the professional and ethical duty to assist, inform and educate the legal system in regard to matters involving medical imaging in children. These guidelines, drafted by the Society for Pediatric Radiology Ethics Committee and approved by the Society for Pediatric Radiology Board of Directors, provide recommendations for expert legal testimony in pediatric radiology and codify minimal ethical norms for the pediatric radiology expert witness in legal proceedings.

The use of sedation and general anesthesia has facilitated the significant growth of MRI use among children over the last years. While sedation and general anesthesia are considered to be relatively safe, their use poses potential risks in the short term and in the long term. This manuscript reviews the reasons why MRI examinations require sedation and general anesthesia more commonly in the pediatric population, summarizes the safety profile of sedation and general anesthesia, and discusses an amalgam of strategies that can be implemented and can ultimately lead to the optimization of sedation and general anesthesia care within pediatric radiology departments.

Fellows begin MRI training with variable experience and expertise. To better serve patients, pediatric radiology fellows should gain competence in MRI that enables seamless transition to independent practice. We implemented a needs assessment survey and conducted a focus group discussion to identify knowledge gaps and inform creation of a curriculum for pediatric body MRI. We electronically distributed a comprehensive anonymous needs assessment survey in October 2016 to current fellows and recent (

The value of obtaining second-opinion interpretations by specialty radiologists has been established. In pediatric radiology, this has primarily been explored in general terms, comparing tertiary pediatric radiologists' interpretations to referral reads. In adults, second reads by subspecialty radiologists have been shown to yield changes in patient management, including in neuroradiology, musculoskeletal radiology and oncological radiology. Here, we examine second-opinion reads by pediatric radiologists by reviewing the pediatric and adult subspecialty literature. We also present our experience in providing subspecialty outside reads, summarizing lessons learned in implementing a system for outside interpretations into a pediatric radiology practice.

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.

There are few data describing practice patterns related to the use of sedation/anesthesia for diagnostic imaging in pediatric radiology departments. To understand current practice patterns related to imaging with sedation/anesthesia in pediatric radiology departments based on a survey of the Society of Chiefs of Radiology at Children’s Hospitals (SCORCH) in conjunction with the American College of Radiology’s Pediatric Imaging Sedation and Anesthesia Committee. A multi-question survey related to imaging with sedation/anesthesia in pediatric radiology departments was distributed to SCORCH member institutions in January 2019. A single reminder email was sent. Descriptive statistical analyses were performed. Of the 84 pediatric radiology departments, 23 (27%) completed the survey. Fifty-seven percent of the respondents self-identified as academic/university-affiliated and 13% as a division/section in an adult radiology department. Imaging sedation (excluding general anesthesia) is commonly performed by pediatric anesthesiologists (76%) and intensive care unit physicians (intensivists, 48%); only 14% of departments expect their pediatric radiologists to supervise imaging sedation. Ninety-six percent of departments use child life specialists for patient preparation. Seventy percent of departments have preparatory resources available on a website, including simulation videos (26%) and audio clips (17%). Nearly half (48%) of the departments have a mock scanner to aid in patient preparation. Imaging sedation/anesthesia is most often scheduled at the request of ordering clinicians (65%), while 57% of departments allow schedulers to place patients into imaging sedation/anesthesia slots based on specified criteria. Imaging sedation/anesthesia practice patterns vary among pediatric radiology departments, and understanding current approaches can help with standardization and practice improvement.

Bassett’s ligament is an accessory fascicle of the anterior inferior tibiofibular ligament. The prevalence, normal thickness and clinical implications of a thickened ligament have not been described in the pediatric radiology literature. The purpose of this study was to determine the prevalence and thickness of Bassett’s ligament in pediatric patients with magnetic resonance imaging (MRI) findings of lateral talar osteochondral lesions, medial talar osteochondral lesions and posterior ankle impingement, to compare these measurements with normal MRIs, and to compare the reproducibility of these measurements. This is a retrospective study of pediatric ankle MRIs with four cohorts containing 21 patients each. All MRIs were retrospectively reviewed by a pediatric musculoskeletal radiologist and a pediatric radiology fellow. The prevalence of Bassett’s ligament and its axial thickness were obtained for each cohort with repeat measurements for intra-observer and interobserver variability. Average thickness and standard deviation of Bassett’s ligament were calculated. The prevalence of Bassett’s ligament and its thickness in each cohort were (mean±standard deviation): lateral osteochondral lesions, 71% (15/21), 1.9±0.5 mm; medial osteochondral lesions, 52% (11/21), 1.4±0.2 mm; posterior impingement, 52% (11/21), 1.3±0.2 mm; and normal ankle examinations, 71% (15/21), 1.5±0.4 mm. The thickness of Bassett’s ligament was increased in the lateral talar osteochondral lesion group when compared to normal (P=0.02), while thickness in the medial osteochondral lesion and posterior impingement groups was not significant when compared to normal. The repeat measurements showed no significant difference in intra-observer and interobserver variability. Bassett’s ligament is a normal structure in children. Thickening of Bassett’s ligament is seen with lateral osteochondral lesions and may be an indirect sign of anterolateral tibiotalar capsule injury.

Approximately 13,500 children each year are treated for non-powder gun injuries of which approximately one-quarter of these injuries are puncture wounds. Although rare, vascular migration of the bullet or pellet (otherwise known as the “wandering bullet”) may result in downstream organ damage secondary to vascular or venous occlusion, most commonly travelling anterograde and lodging within the lung venous system. Interestingly, we present a case of a 12-year-old female who was shot in the neck with a compressed-air gun loaded with ball-bearing pellets. Eventual retrograde vascular migration of the ball-bearing pellet from the right internal jugular vein to the hepatic vein caused hepatic venous occlusion and congestion. It is important for radiologists to remember the possibility of retrograde travel of bullets and pellets, and radiographs should be scrutinized for foreign bodies present in areas other than the region of injury. Bullet retrieval is determined by clinical evaluation and necessity, and if indicated, endovascular, percutaneous retrieval, or surgical exploration may be considered.

Value to pediatric radiologists Older radiologists, who compose approximately 7% of the radiology workforce [[1]], generally do not want to continue to work late or overnight shifts and would like to work fewer or no weekend days Traditionally, academic radiology departments are staffed by full-time faculty who provide clinical service and resident/student teaching while pursuing academic and research goals necessary for advancement and promotion During a 6-month period (September 2019 to February 2020), three senior diagnostic pediatric radiologists and one senior pediatric interventional radiologist participated in a per diem employment arrangement The total combined salary cost for the three per diem diagnostic radiologists for this period was 38% lower than the total compensation of one typical FTE body radiologist, while the total RVUs generated was only 8 3% lower than the typical FTE radiologist [Extracted from the article] Copyright of Pediatric Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The field of radiology has benefited greatly from the technological boom that has brought greater precision, efficiency and utilization amid an exponential growth in medical science. The downside is that the same technology that has allowed the field to grow is contributing to an erosion of interpersonal communication and connection with patients and referring physicians. Remote reading has displaced us from the communal reading room, where much interaction and teaching used to take place. The “invisible” radiologist must transcend these barriers in order to preserve and strengthen the role of radiology in medical care. With modest adaptation, radiologists can regain their identity as consultants, where they have the greatest chance to show their value and thwart the drive toward commoditization.

Senior pediatric radiologists who have spent a major portion of their careers interpreting conventional film-screen radiographic studies have collected a wealth of hard-copy teaching material that is at risk of becoming obsolete. The teaching value and usefulness of analog film teaching files can be preserved using available hardware and standard software. The final product can be made available in a high-quality digital format to students, trainees and faculty without complicated search-and-retrieval methodology. This paper describes a relatively simple and low-cost procedure to preserve and use this source of wisdom and experience. It also emphasizes the role that such a resource can play as part of a comprehensive educational program.

There is increasing emphasis on improving the patient experience with a shift to patient- and family-centered care throughout all areas of health care. In 2013, the American College of Radiology launched Imaging 3.0, an initiative aimed at encouraging and enabling radiologists to work on culture change to increase focus on appropriateness, efficiency, quality, safety and patient satisfaction. Many groups have subsequently used these and other tools to improve the overall patient experience, focusing on the entire imaging journey to include initial order placement, registration in the department, image acquisition, departure from the department, and how and when the patient and family receive the imaging results. In our department we have used multiple strategies and have applied quality-improvement methods and patient/family-centered care models to improve quality, safety and the patient experience. Most of these efforts have included team members across the department, including radiologists, technologists, quality-improvement personnel, managers and nurses. In addition, for the last 12 years, a key member of these teams has been our patient and family advocate (PFA). We describe the important role that a PFA can play in improving the patient and family experience in pediatric radiology.

Pediatric radiology departments rely heavily on a dedicated, efficient and collaborative multi-disciplinary health care team to provide efficient service and quality care to patients and families. Certified child life specialists are an essential part of this multi-disciplinary team. The main goal of the child life specialists is to improve the overall experience for patients and families. In addition, child life specialists, working in collaboration with the medical care team, help decrease the need for general anesthesia by providing patient pain management, distraction and coping techniques. These interventions result in improved patient safety, increased departmental efficiency and increased revenue. The role of child life specialists extends into the exam room, where their interventions help decrease procedure times and improve imaging quality. In this article, the authors discuss the key role of child life specialists in a pediatric radiology department and provide examples of how child life can impact patient safety, patient and family satisfaction, and operational efficiency.

While patient and family-centered care (PFCC) is currently a hot topic in medicine, it has long been a specific focus of pediatrics. The concept of PFCC includes a change in culture where physicians and patients move away from paternalism and instead view patients and families as partners in care. Although there are many ways in which adult-focused radiologists can learn from pediatric radiologists as leaders in PFCC, there remain many opportunities for improvement for all radiologists.

As a specialty, radiology has spent much of the last two decades implementing information systems that improve departmental efficiency and the ordering provider's access to information. While our patients have realized benefits such as improved access to care and reduced turnaround times, there has been little focus on using these information systems to improve patient engagement. In the last decade, society has shifted. Now, consumers in every industry expect to be able to use technology to help them accomplish different tasks from scheduling to communicating. Medicine, in general, has been slow to respond to the concept of the patient as a consumer. In this manuscript we describe some of the informatics efforts we have employed in our department to improve patient engagement. We present these initiatives, corresponding to each aspect of the radiology value stream, from the patient's point of view.

This case demonstrates the importance of considering septic pulmonary embolism (SPE) on the differential for chest pain in the pediatric population, especially in patients with a history of skin and soft tissue infection. The adolescent patient in this report, with a history of axillary hidradenitis suppurativa complicated by methicillin-resistant Staphylococcus aureus (MRSA) superinfection and recent completion of a 3-month course of doxycycline, presented with isolated focal chest pain in the absence of other infectious or respiratory signs or symptoms. Initial pulmonary imaging revealed multiple bilateral wedge-shaped nodules. Three specialty teams were consulted in the patient's evaluation, resulting in biopsy of a suspicious lesion that confirmed the diagnosis of MRSA SPE. Following a course of targeted antibiotic therapy, the patient's chest pain resolved and imaging findings improved. Insights gleaned from the workup of this patient are useful in formulating a framework for recognition of SPE in children presenting with chest pain, and also highlight the importance of considering insidious SPE presentation in the setting of antibiotic pretreatment.

Rationale: The International Atomic Energy Agency (IAEA) instituted a Coordinated Research Project (CRP) on the “Evaluation and Optimization of Pediatric Imaging” addressing the lack of consistency in this field. The purpose was to develop and test an optimization schema for the practices of pediatric radiology and nuclear medicine. Methods: A 5-step optimization schema was developed. Once a protocol optimization is identified, the steps are: 1) identification of the imaging situation, 2) collection of administered activity data and evaluation of the diagnostic image quality at baseline, 3) comparison of baseline administered activity data to published standards or other benchmarks, 4) identification of intervention, if necessary, 5) implementation of intervention and evaluation. Results: Within the CRP, two institutes considered optimization projects regarding nuclear medicine. In this work, renal imaging using 99mTc-DMSA projects are presented as examples. Site 1 acquired their standard 300-s static 99mTc-DMSA studies as 5-frame dynamic studies in 29 children. Frames were added to simulate different levels of administered activity. Image quality was subjectively judged on a 3-point Likert scale. A 30% reduction in administered activity with increased imaging duration (350-s) across all age groups was shown to be acceptable. This reduction was implemented and evaluated in 31 subsequent children yielding administered activities significantly lower than baseline (mean relative difference of 30% (age group 0-5 y), 37% (5-10 y) and 38% (10-15 y)). Site 2 performed a phantom study to determine the impact of lowering administered activity on image noise, indicating that administered activities could be significantly lowered if longer imaging times were used. This led to a 50-70% reduction from baseline with no loss in image quality. Conclusion: A dose optimization approach was applied successfully for several procedures commonly performed in pediatric nuclear medicine. Results are reported for renal cortical imaging using 99mTc-DMSA, leading to significant reductions in administered activity (and thus radiation dose). This optimization schema can be successfully implemented by nuclear medicine clinics seeking to improve their approach to imaging children.

Common cause analysis of hospital safety events that involve radiology can identify opportunities to improve quality of care and patient safety. To study the most frequent system failures as well as key activities and processes identified in safety events in an academic children’s hospital that underwent root cause analysis and in which radiology was determined to play a contributing role. All safety events involving diagnostic or interventional radiology from April 2013 to November 2018, for which the hospital patient safety department conducted root cause analysis, were retrospectively analyzed. Pareto charts were constructed to identify the most frequent modalities, system failure modes, key processes and key activities. In 19 safety events, 64 sequential interactions were attributed to the radiology department by the patient safety department. Five of these safety events were secondary to diagnostic errors. Interventional radiology, radiography and diagnostic fluoroscopy accounted for 89.5% of the modalities in these safety events. Culture and process accounted for 55% of the system failure modes. The three most common key processes involved in these sequential interactions were diagnostic (39.1%) and procedural services (25%), followed by coordinating care and services (18.8%). The two most common key activities were interpreting/analyzing (21.9%) and coordinating activities (15.6%). Proposing and implementing solutions based on the analysis of a single safety event may not be a robust strategy for process improvement. Common cause analyses of safety events allow for a more robust understanding of system failures and have the potential to generate more specific process improvement strategies to prevent the reoccurrence of similar errors. Our analysis demonstrated that the most common system failure modes in safety events attributed to radiology were culture and process. However, the generalizability of these findings is limited given our small sample size. Aligning with other children’s hospitals to use standard safety event terminology and shared databases will likely lead to greater clarity on radiology’s direct and indirect contributions to patient harm.

Purpose To systematically investigate the frequency and types of allegations related to radiology practice handled by the Dutch Medical Disciplinary Court in the past 10 years. Methods The Dutch Medical Disciplinary Court database was searched for verdicts concerning radiology practice between 2010 and 2019. The association between the number of verdicts and time (years) was assessed by Spearman’s rho. Other data were summarized using descriptive statistics. Results There were 48 verdicts (mean 4.8 per year). There was no significant association between the number of verdicts and time (Spearman’s rho p = 0.99). Most allegations were in breast imaging and musculoskeletal radiology (each 18.8%), followed by interventional radiology, head and neck imaging, and abdominal imaging (each 12.5%), neuroradiology and vascular imaging (each 10.4%), and chest imaging (4.2%). There were 46 allegations against radiologists (95.8%) and 2 against residents (4.2%). The most common allegation (37.5%) was error in diagnosis. In 20.8% of verdicts, the allegation was judged (partially) founded; disciplinary measures were warnings (n = 8) and reprimands (n = 2). An appeal was submitted by the patient in 11 cases and by the radiologist in 3 cases. All appeals by patients were rejected, whereas 2 of the 3 appeals by radiologists were granted and previously imposed disciplinary measures were reversed. Conclusion Allegations against radiologists at the Dutch Medical Disciplinary Court are relatively few, their number has remained stable over the past 10 years, and a minority were judged to be (partially) founded. We can learn from the cases presented in this article, which may improve patient care. Key Points • The frequency of allegations against radiologists at the Dutch Medical Disciplinary Court is relatively low and has not exhibited any temporal change over the past 10 years. • These allegations reflect patient dissatisfaction, but this infrequently equals malpractice. • Knowledge of the circumstances under which these allegations have arisen may improve patient care.

Burnout in medicine, and specifically radiology, has been receiving more attention. Little data-driven literature is available regarding risk factors/causes to ultimately help guide the development of potential solutions. To survey pediatric radiologists, a cohort with a documented high prevalence of burnout, and to understand the impact of clinical demands on nonclinical tasks and the implications of burnout on mental health. A survey of Society for Pediatric Radiology (SPR) North America attendings was performed regarding institutional factors contributing to burnout, including call burden, clinical demands, departmental support and administrative/academic tasks. Questions regarding mental health and wellness resources were also included. Generalized linear modeling assuming binomial distribution was used for analyses with SAS 9.4. The response rate was 305/1,282 (24%) with 53% of respondents female. Respondents reported that both the number and complexity of clinical cases have increased since they first started practice as an attending, while the time for interpretation has not changed, P

Objective It is currently unknown whether efforts in recent years to create equal opportunities for female faculty in academic medicine have succeeded. We looked at faculty members in academic pediatric radiology departments across the United States and Canada to assess for evidence of gender disparities and differences in academic performance between males and females. Methods The analysis included diagnostic radiology programs across the United States and Canada, as specified by the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA Online) and the Canadian Resident Matching Service website. The Scopus database was used to retrieve the H-index, number of publications, and number of citations for each faculty member. We examined the distribution of male and female faculty members across geographical regions, academic ranks, and leadership roles. Academic performance was also compared. Results Across all regions and academic ranks, disparities exist between the number of male and female faculty members. The greatest disparity was found amongst the professor rank, where more than 70% of positions were occupied by males. Female professors were found to demonstrate similar levels of academic performance compared to their male counterparts, although this parity was not observed amongst assistant and associate professors. Conclusion Women occupied almost half (46.6%) of the total academic pediatric radiology workforce, despite having been previously shown to make up only 21% of radiologists. However, gender disparities currently exist among academic pediatric radiology faculty, with a significantly higher percentage of men in pediatric radiology faculty positions. Women, however, currently occupy a greater percentage of leadership positions compared to men, even though the majority of senior academic ranks are held by men.

Mycobacterium tuberculosis is the leading cause of infectious disease-related death worldwide. However, it is less frequently encountered in developed countries, and 90% of cases are reported in adults, making it a less commonly encountered entity in pediatric radiology. The disease is treatable, but symptoms of renal disease are nonspecific and should be identified early. A high index of clinical suspicion and supportive imaging studies, particularly in immigrant or exposed children, is prudent to prevent irreversible organ damage. We report a rare case of a 16-year-old Mexican immigrant male who presented with chronic dysuria, urinary frequency, intermittent hematuria, hydronephrosis, ureteral stenosis, and evolving autonephrectomy secondary to renal M. tuberculosis. Keywords: Pediatric, Tuberculosis, Infectious disease, Genito-urinary

Das Strategiepapier der GPR zeigt Entwicklungsmöglichkeiten der Kinder- und Jugendradiologie als Querschnittsfach zwischen der Radiologie und der konservativen und operativen Kinder- und Jugendmedizin auf. Zitierweise

Pediatric residents exhibit knowledge gaps in appropriateness of imaging utilization. This study evaluates the value of radiologist-driven imaging education in a pediatric residency program. The primary goals of this educational program were to provide pediatric residents with resources such as the American College of Radiology Appropriateness Criteria, support optimal resource utilization and patient care, increase resident understanding of radiation risk, and determine the value of integrating radiologists into pediatric education. A needs assessment was performed in which the chief residents of a large pediatric program were surveyed. The consensus of chief residents was that a four-part lecture series delivered by a pediatric radiology fellow would be beneficial to the pediatric residents. Topics included general radiation risk as well as basic imaging topics in the chest, abdomen, neurological system, extremities and vasculature. Each lecture integrated appropriate ordering, ALARA (As Low As Reasonably Achievable)/Image Gently, and basic image interpretation. Residents were asked, using a Likert scale, to rate their understanding of radiation risk, the ACR Appropriateness Criteria, and other topics of interest before and after each lecture. Pediatric residents were given a 10-item quiz before and after the lecture series to assess their knowledge regarding the best test to order in clinical scenarios. The average pre-lecture score for knowledge of radiation risk was 3.27 (95% confidence interval [CI]: 3.02–3.51) out of 5, which improved to 4.27 (95% CI: 4.09–4.57) post-lecture. There was an increase in understanding of ACR appropriateness, with pre-lecture rating of knowledge increasing from 1.91 (95% CI 1.54–2.29) out of 5 to 3.61 (95% CI 3.33–3.90) post-lecture. The residents averaged 82.7% (95% CI 77.3%–88.1%) on the appropriateness pre-test and 93.8% (95% CI 90.3%–97.2%) on the post-test. Residents provided positive feedback upon conclusion of the program and reported a beneficial effect on their education. A radiologist-driven lecture series in a pediatric residency can improve resident understanding of appropriate ordering practices and radiation risk. Radiologist participation in pediatric residency training is well-received.