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Objectives: To retrospectively evaluate all cone-beam computed tomography (CBCT) scans acquired from 2017 to 2022 in a Swiss university dental clinic with particular emphasis on radiation protection aspects. Material and methods: Radiological databases at the dental clinic of the University of Bern, Switzerland, were explored using a self-developed search algorithm. Data of all acquired CBCT from 01.01.2017 to 27.06.2022 were screened. Exposure parameters (exposure time, exposure angle, milliampere (mA), kilovoltage (kV), field of view (FOV) size), dose area product (DAP), age, and sex of the patient were recorded anonymously. The collected data were analyzed mainly descriptively. Correlations measured the statistical relationships between the variables. Results: A total of 10,348 CBCT datasets were analyzed. Patient age ranged from 5 to 96 years (mean: 49.4 years, SD: 21.6 years). The number of CBCTs in patients under 25 years was around 20% each year. In total, 10,313 (99.7%) CBCTs were acquired in small to medium FOV (FOV up to 10 cm of height), and 35 (0.3%) in large FOV (height > 10 cm). DAPs of small FOVs were 518.3 ± 233.2 mGycm2 (mean ± SD), of medium FOV 1233 ± 502.2 mGycm2, and of large FOV 2189 ± 368.7 mGycm2. DAP (ρ = 0.4048, p < 0.0001) and kV (ρ = 0.0210, p = 0.0327) correlated positively with age. Reduced scan angle correlated with young age (rpb 0.2729, p < 0.001). mA did not correlate with age (p = 0.3685). Conclusions: This study demonstrates that certain well-known radiation protection aspects as the reduction of FOV, mA, kV, and scan angle were only partly considered. Clinical relevance: Known radiation protection aspects, especially in young patients, should be fully applied in regular clinical practice. [ABSTRACT FROM AUTHOR]

Scatter radiation from portable and pediatric X-rays could pose a risk to radiographers, nearby patients, and caretakers. We aim to evaluate the spatial scatter radiation distribution to the radiographers, nearby patients, and caretakers during common projections in portable and pediatric X-rays. We evaluated the three-dimensional scatter dose profiles of four and three commonly used portable and pediatric X-ray projections, respectively, by anthropomorphic phantoms and scatter probes. For portable X-ray, the AP abdomen had the highest scatter radiation dose recorded. Radiographer scatter radiation doses were 177 ± 8 nGy (longest cord extension) and 14 ± 0 nGy (hiding behind the portable X-ray machine). Nearby patient scatter radiation doses were 3323 ± 28 nGy (40 cm bed distance), 1785 ± 50 nGy (80 cm bed distance), and 580 ± 42 nGy (160 cm bed distance). The AP chest and abdomen had the highest scatter radiation dose in pediatric X-rays. Caretaker scatter radiation doses were 33 ± 1 nGy (50 cm height) and 659 ± 7 nGy (140 cm height). Although the estimated lens doses were all within safe levels, the use of shielding and caution on dose estimation by inverse square law is suggested to achieve the ALARA principle and dose optimization. [ABSTRACT FROM AUTHOR]

The well‐referenced structural shielding design NCRP Report No. 147 uses workload information based on self‐reported film‐screen data from the AAPM Task Group 9 survey. The aim of this study was to assess the clinical workload distributions of modern digital radiography (DR) systems in general hospital and pediatric‐only practices. A retrospective analysis of DR imaging data on four radiographic systems in a hospital practice and two radiographic systems in a pediatric practice, through a custom clinical DICOM header analytics program. A total of 203, 294 exposures from the general hospital practice and 25,415 from the pediatric practice from 2019 and 2021 were included. Values for kVp, mAs, and detector type (wall bucky, table bucky, or free detector) were extracted. For each exam, mAs was accumulated in a kVp histogram with bins 5 kVp wide and further parsed by detector type. Total workload was calculated by summing all exposures, then normalized by the number of patients. The median (25th and 75th percentile) workload in the hospital practice was 0.43 (0.22, 1.13) mA‐min per patient, while the average was 1.36 ± 3.08. Pediatric data yielded a median (25th and 75th percentile) of 0.10 (0.05, 0.23) and an average of 0.29 ± 0.69 mA‐min per patient. Mean number of patients per week was 230 adult and 57 pediatric. Hospital workload data is approximately 44% less than the NCRP Report No. 147 value. [ABSTRACT FROM AUTHOR]

Purpose: Dose Area Product (DAP) is a quantity for radiation risk assessment in diagnostic X-ray tests. Children's tissues are up to 10 times more sensitive to radiation than adults, and life expectancy is higher in children than adults, as well as a higher risk of hematopoietic and mass malignancies in them. Therefore, this study aimed to measure DAP values for X-ray fields adjusted by Birjand radio-technologists in chest X-rays of children under 12 years of age. Materials and Methods: 233 children from Birjand University hospitals who performed chest X-rays were included in the study. To collect data related to DAP, the DAP meter model KermaX plus SDP was used. It should be noted that no intervention was performed in the patient's imaging method and at the time of radiation and measurement of the DAP values, there was no need for the patient's presence. In the end, the measured DAP values were compared with DAP values of other studies. Data were analyzed using SPSS software version 22 at 5% error level using Anova, t-test, and Pearson correlation tests. Results: Out of 233 patients who were included in the study, 134 males (57.5%) and 99 females (42.5%) participated in the study, it should be noted that there was no significant difference between the mean of DAP in male and female (p=0.52). In our study, the average DAP was 5.78 ± 3.54 μGy.m2 and DAP values in the range of 0.55 μGy.m2 to 15.54 μGy.m2 that were higher than the average of other studies and there was a significant difference. There was a direct relationship between radiation field dimensions and DAP values so that as the dimensions of the radiation field increase, the DAP value increases. There was a significant difference between the mean DAP of the lowest and the highest age groups, lowest and the highest age groups, and lowest and the highest height groups of patients. Conclusion: In our study, it was observed that there is a significant relationship between patients' weight, age, and height, radiation field dimensions with DAP values. The amount of DAP in the present study was significantly higher than in other studies. The most important effective parameter in DAP is the radiation field size and if sufficient optimization is done in imaging parameters (kVp, mAS, field size), the DAP values will be greatly reduced.

Background: It is not uncommon to hit children in Nigeria, hence there is an increased possibility of encountering children with non-accidental injury (NAI). Radiographers are one of the first-line caregivers in a hospital setting, hence it is important that they are able to identify and act appropriately in cases of suspected NAI in children Objective: The objective of this study was to establish Nigerian radiographers’ awareness and role both before and after identifying NAI in children. Materials and Methods: This was a descriptive cross-sectional survey that assessed radiographers’ awareness and role in identifying NAI in children. A Google Form link was distributed through various Nigerian radiographers’ WhatsApp groups, inviting interested radiographers to participate in the survey. Data were analyzed by using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented by using tables and charts. Results: Ninety-eight radiographers working across the federation participated in the online survey. A total of 53.1% of the respondents clearly understood what NAI meant, whereas 59.2% never participated in the imaging of a child for NAI investigation. Only 12.3% were confident that they were very competent in identifying radiological signs of NAI in children. Conclusion: Although most radiographers understand what NAI means, very few agree that they have been formally trained in pediatric imaging, hence they lack the expertise in acting appropriately in cases of suspected NAI in children. The radiographers strongly believe that they would benefit from proper training to handle cases of NAI in children.

Purpose To determine whether radiologic technologists are manipulating projections to lower patient dose in routine pediatric radiography examinations. Methods Using a descriptive survey approach, members from the American Society of Radiologic Technologists with a primary registration in radiography were randomly selected and invited to share their experiences using alternative projections during routine pediatric radiography examinations. Results For this study, 404 completed responses were analyzed. More than half of the participants (67.6%) strongly agreed or somewhat agreed that the use of alternative projections can reduce pediatric dose during routine radiography examinations, and more than half (61.3%) strongly agreed, agreed, or somewhat agreed that the use of alternative projections is beneficial for dose reduction. Incidentally, the most common response from participants regarding their use of alternative projections during routine pediatric radiography examinations was occasionally or sometimes. Nearly three-fourths of the participants strongly agreed that radiation protection guidelines are important to follow during routine pediatric radiography examinations. Although many radiologic technologists in this sample felt proficient using alternative projections during pediatric procedures, they also believed additional training in such methods would be beneficial. Discussion Most institutions have imaging protocols in place; however, the use of alternative methods of projection during routine pediatric radiography examinations might heighten current radiation protection guidelines, leading to protocol changes to reduce dose and improve the overall wellbeing of pediatric patients. Furthermore, recent recommendations in the field of medical imaging regarding patient shielding practices might deem positioning to be a more important method for dose reduction. Consultations from radiologists might be necessary to ensure that image quality is sufficient and diagnostic detail is not compromised. Additional training specific to using alternative projections during routine pediatric radiography examinations also might be warranted. Conclusion Current practices do not suggest alternative methods of projection are applied regularly during routine pediatric radiography examinations. Considerations should be made to allow technologists to manipulate projections when permitted. [ABSTRACT FROM AUTHOR]

Introduction: Pediatrics is a vast field with many facets. The importance of having dedicated specialists trained in the treatment and care of pediatric patients has long been recognized. It is necessary to determine if the profession of radiography is making similar progress in improving on the pediatric radiography services offered in the country. Objective: The objective of this study was to establish if there was a perceived need for specialized pediatric radiographic education in Nigeria. Subjects and Methods: This was a descriptive cross-sectional survey, which accessed radiographers′ take on the need for specialized education in pediatric imaging. A Google Form link was distributed through various Nigerian radiographers′ WhatsApp groups, inviting interested radiographers to participate in stating their opinions on the need for specialized pediatric radiographic education in the country and other related questions. Data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented using tables and charts. Results: Seventy-six radiographers working in 25 states across the federation participated in the online survey. A total of 90.8% of the respondents stated there was a need for specialized radiographic education in pediatric imaging, and 64.5% felt that this education or training opportunities for radiographers was inadequate. Only 43.4% were comfortable performing pediatric imaging. Conclusion: Majority of the radiography departments in Nigeria do not have dedicated equipment or staff for pediatric radiography. Undergoing specialized pediatric imaging training will benefit radiographers who are keen on improving the radiography services offered to pediatric patients.

The use of diagnostic reference levels (DRLs) is currently recommended, and dose evaluation is considered to be important for establishing a Japanese radiological protection system in radiological medicine. Children, in particular, are sensitive to radiation, and their exposure levels must be taken into account. The DRL for the entrance surface dose (ESD) used in pediatric chest X-ray examinations in Japan is 0.2 mGy. However, the bodies of infants and young children show major changes with rapidly developing organs. Thus, the possibility that organ development may also be affected by radiation exposure should be taken into account. Therefore, radiological technologists must be conservative in setting radiographic conditions for pediatric examinations. The objective of this study was to evaluate the doses used in pediatric chest X-ray examinations at our hospital and compare them with the current DRLs, considering the assumption that setting conditions individually for different ages and subject thicknesses and performing more detailed dose evaluations will help reduce radiation exposure. The study was carried out to estimate the ESDs in 163 pediatric patients who underwent frontal or lateral chest X-ray examinations at our hospital. All doses were lower than 0.2 mGy, the dose recommended in the Japanese DRLs 2015. The doses showed a strong correlation with age, but a weaker correlation with subject thickness. These results suggest that instead of considering a common DRL for all children, the DRL should be evaluated on the basis of age. [ABSTRACT FROM AUTHOR]

Purpose To examine recent radiologic science graduates' perceptions of pediatric radiography training and provide educators with information regarding the delivery of pediatric education in entry-level radiography programs. Methods Radiologic technologists with fewer than 24 months of experience who, at the time, were American Society of Radiologic Technologists (ASRT) members in the Graduate Bridge membership level were asked to complete an original survey that was created using a cross-sectional research design. The survey asked questions about their pediatric radiography education experience, level of training, level of agreement regarding various techniques and challenges associated with pediatric radiography, and demographic information. Results A total of 280 responses was analyzed for this study. The majority (151, 53.9%) of the participants were satisfied or very satisfied with the training and education they received in their respective radiography programs to perform imaging studies on pediatric patients. However, 149 (53.2%) of the participants strongly agreed that more curricula and training specific to pediatric radiography would benefit future students. Discussion Opportunities for additional education might include providing more training on using Pigg-O-Stats and other immobilization devices, catheterizing pediatric patients for voiding cystourethrograms, and communicating effectively with pediatric patients and their family members. Moreover, providing students with clinical experiences to gain confidence in pediatric radiography at a dedicated pediatric facility should be considered. Conclusion Although most entry-level radiographers in this study considered their preparation for pediatric imaging satisfactory, they also strongly believed that additional pediatric-specific training would benefit future radiographers. Radiography educators should consider various opportunities to enhance the pediatric imaging curriculum and encourage or require clinical rotations in pediatric facilities. Further research that addresses educators' perceptions of pediatric radiography instruction might be warranted. [ABSTRACT FROM AUTHOR]

The thoracic region in pediatric patients poses unique diagnostic and interventional challenges, necessitating specialized approaches in radiological imaging and procedures. This review provides an overview of the key considerations, techniques, and clinical significance in the field of pediatric thoracic radiology and interventions. We discuss the importance of age-appropriate imaging modalities and the application of advanced technologies in assessing a wide range of thoracic conditions in children, including congenital anomalies, infections, neoplasms, and trauma. Furthermore, we highlight the evolving role of minimally invasive interventional procedures in the management of pediatric thoracic disorders. As the understanding of pediatric thoracic pathology continues to expand, this review aims to guide healthcare professionals, radiologists, and pediatricians in delivering optimal care to children with thoracic concerns., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish Society of Cardiovascular Surgery.)

Purpose The purpose of this study is to report the number of children from a total population of children with cerebral palsy (CP) in Scotland who had a displaced or dislocated hip at first registration in a national surveillance programme. Methods Migration percentage (MP), laterality, Gross Motor Function Classification System (GMFCS) level, CP subtype, distribution of CP and age were analyzed in 1171 children. Relative risk was calculated with 95% confidence intervals. Hip displacement and dislocation were defined as a MP of 40 to 99 and > 100 respectively. Results Radiographs were available from the first assessment of 1171 children out of 1933 children registered on the system. In all, 2.5% of children had either one or both hips dislocated (29/1171) and dislocation only occurred in children of GMFCS levels IV and V. A total of 10% of children had a MP 40 to 99 in one or both hips (117/1171). An increasing GMFCS level was strongly associated with an abnormal MP. Hip dislocation was unusual in patients under the age of seven years. A MP of 40 to 99 was not seen in children with isolated dystonia. Displacement was more frequent in children with bilateral involvement and dislocation was only seen in spastic and mixed tone groups. Conclusion This data gives an overview of the number of CP children who have hip displacement/dislocation in Scotland and who will possibly require surgery. [ABSTRACT FROM AUTHOR]

Background: Whole-body magnetic resonance imaging (MRI) is an evolving and increasingly powerful imaging tool with a variety of applications in the pediatric patient population. Variability exists among radiology practices in how this MRI tool is used and how it is performed.Objective: Our objective was to gain an improved understanding of technical and utilization practices in pediatric whole-body MRI across North America by exploring indications for exam performance, determining referral patterns, and assessing technical protocols and procedures.Materials and methods: A 19-question survey was generated in Survey Monkey and distributed in 2016 to the Society for Pediatric Radiology membership. The survey asked questions that included practice type, imaging modality preferences for diseases commonly evaluated with whole-body MRI, MRI field strength and sequence selection, and billing practices.Results: Data were obtained from 62 unique responses to the survey, representing 471 physicians. The majority (93%) practice in an academic institution or private practice with academic affiliation and most practices have utilized whole-body MRI for less than 6 years. Whole-body MRI is performed in pediatric patients 0 to 18 years of age, and was the preferred imaging modality for diagnosis/staging/follow-up in neurofibromatosis, type 1 (75%), chronic recurrent multifocal osteomyelitis (CRMO) (74%), cancer predisposition syndromes (75%), vasculopathies (50%) and disseminated/multifocal infection (49%). The most commonly utilized sequences are coronal short tau inversion recovery (STIR) (90%), coronal T1 with or without fat saturation (65%), and axial diffusion-weighted imaging (DWI) (48%). No preference was shown for either 1.5-T or 3-T systems. Wide variability was seen in preference for billing code utilization, though the majority use chest/abdomen/pelvis (57%) or unlisted MRI (37%) codes.Conclusion: Radiology practitioners - represented by the Society for Pediatric Radiology pediatric radiologists - are using whole-body MRI in the imaging care of pediatric patients for a variety of indications. Survey results reveal some variability in exam utilization and technical performance practices among those pediatric radiologists who perform whole-body MRI. [ABSTRACT FROM AUTHOR]

When children around 2 years of age show leg bowing and diseases are ruled out based on radiographic findings without conducting blood tests, they are classified as "physiologic" genu varum. Since whether or not physiologic genu varum is associated with bone metabolism is unclear, this study was conducted to clarify the association between genu varum and bone metabolism in children. Thirty-five pediatric patients with genu varm who visited our out-patient clinic were enrolled. While two of the 35 children had nutritional rickets, showing abnormalities on both blood test (ALP, ≥1000 IU/L; iPTH, >65 pg/mL and 25(OH)D, ≤20 ng/mL) and radiographs (such as cupping, fraying or splaying), five of 35 children showed abnormalities on blood tests but not radiographs. While metaphyseal-diaphyseal angle (MDA) correlated with serum 25-hydroxy vitamin D (r = -0.35, p = 0.04) and magnesium (r = -0.36, p = 0.04), MDA and femorotibial angle (FTA) correlated with alkaline phosphatase (r = 0.43, p = 0.01 and r = 0.51, p = 0.006, respectively). A ridge regression analysis adjusted for age and body mass index indicated that ALP was associated with MDA and FTA. A logistic regression analysis adjusted for age and BMI indicated that higher ALP influenced an MDA >11°, which indicates the risk for the progression of genu varum (odds ratio 1.002, 95% confidence interval 1.0003-1.003, p = 0.021). The higher ALP (+100 IU), the higher risk of an MDA >11° (odds ratio 1.22). In conclusion, genu varum is associated with the alkaline phosphatase level regardless of the presence of radiographic abnormalities in the growth plate in children. [ABSTRACT FROM AUTHOR]

Purpose Ghost artifacts are a major contributor to degradation of spinal cord diffusion tensor images. A multi-stage post-processing pipeline was designed, implemented and validated to automatically remove ghost artifacts arising from reduced field of view diffusion tensor imaging (DTI) of the pediatric spinal cord. Method A total of 12 pediatric subjects including 7 healthy subjects (mean age = 11.34 years) with no evidence of spinal cord injury or pathology and 5 patients (mean age = 10.96 years) with cervical spinal cord injury were studied. Ghost/true cords, labeled as region of interests (ROIs), in non-diffusion weighted b0 images were segmented automatically using mathematical morphological processing. Initially, 21 texture features were extracted from each segmented ROI including 5 first-order features based on the histogram of the image (mean, variance, skewness, kurtosis and entropy) and 16s-order feature vector elements, incorporating four statistical measures (contrast, correlation, homogeneity and energy) calculated from co-occurrence matrices in directions of 0°, 45°, 90° and 135°. Next, ten features with a high value of mutual information (MI) relative to the pre-defined target class and within the features were selected as final features which were input to a trained classifier (adaptive neuro-fuzzy interface system) to separate the true cord from the ghost cord. Results The implemented pipeline was successfully able to separate the ghost artifacts from true cord structures. The results obtained from the classifier showed a sensitivity of 91%, specificity of 79%, and accuracy of 84% in separating the true cord from ghost artifacts. Conclusion The results show that the proposed method is promising for the automatic detection of ghost cords present in DTI images of the spinal cord. This step is crucial towards development of accurate, automatic DTI spinal cord post processing pipelines. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study.Objective: To determine the prevalence of loss in fixed segment alignment after surgical correction of adult spinal deformity (ASD) and identify associated risk factors.Summary Of Background Data: Altered fixed segment alignment influences global spinal alignment; however, associated risk factors have not been determined.Methods: Data of 63 patients with ASD (55 females; mean age, 68.0 yrs), who underwent corrective fusion from the lower thoracic spine to the pelvis and completed the 2-year follow up, were retrospectively analyzed. Change in alignment early postoperatively and at 2 years postoperatively was evaluated using the fixed segmental angle (FSA) and fixed vertebral angle (FVA). The predictive value of the following parameters was evaluated: age, sex, body mass index (BMI), high grade osteotomy, rod material, screw loosening, spinopelvic parameters [T1 pelvic angle (TPA), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), and proximal junctional kyphosis (PJA), and Oswestry Disability Index (ODI) scores].Results: Change of 2.4° in FSA and -3.1° in FVA were identified 2 years postoperatively, with higher intrarater and interrater reliability for FSA. Based on minimal detectable change in FSA, patients were classified into two groups: (+) loss (ΔFSA >3°) and (-) loss (ΔFSA ≤3°). Correction loss occurred in 17 patients; these patients had a greater BMI, higher rate of high-grade osteotomies, commercially pure titanium (CP) rods implanted, screw loosening, higher preoperative and postoperative TPA, and higher TPA, SVA, and PT after 2 years, than patients without correction loss.Conclusion: The loss of sagittal fixed segment alignment was relatively high at 27%. Greater BMI, high-grade osteotomies, CP rod use, and sagittal malalignment were associated with correction loss after ASD surgery.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Study Design: Reproducibility of measurements.Objective: This study investigates the reliability and standard error of measurement of spine and thoracic height radiographic measurements in patients with early onset scoliosis (EOS).Summary Of Background Data: Spine and thoracic height radiographic measurements are often used as a surrogate for pulmonary development in patients with EOS. There is limited literature validating the reliability of spine and thoracic height measurements in the EOS population.Methods: Using pilot data, we determined measuring 49 unique radiographs would provide 80% power to obtain a 95% confidence interval (CI) width of 0.05 for the interclass correlation coefficients (ICCs). A random sampling strategy, stratified by underlying diagnosis from the Classification of Early Onset Scoliosis (C-EOS), was used to distribute the diagnoses in the study sample. Two attending pediatric spine surgeons, two pediatric orthopedic fellows, and two research assistants measured coronal spine (T1-S1) and thoracic (T1-T12) height on digital radiographs using imaging software (Surgimap; Nemaris, Inc, New York) on two separate occasions at least 3 weeks apart. Order of images was randomized for the second iteration. Linear mixed model regression analyses were used to estimate interrater and intrarater reliability.Results: The study sample included subjects (N = 48) with idiopathic (N = 17, 35%), congenital (N = 16, 33%, 1 patient excluded), neuromuscular (N = 11, 23%), and syndromic (N = 4, 8%) scoliosis. Overall interrater reliability estimates for spine height (ICC: 0.894, 95% CI: 0.847-0.932) and thoracic height (ICC: 0.890, 95% CI: 0.844-0.929) were excellent. Intrarater reliability estimates for spine height (ICC: 0.906, 95% CI: 0.830-0.943) and thoracic height (ICC: 0.898, 95% CI: 0.817-0.938) were also excellent.Conclusion: There is excellent interrater and intrarater reliability for radiographic measurements of spine and thoracic height in the EOS population at our institution.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

The objectives of this study are to describe the radiologic abnormalities detected on chest computed tomography (CT) of children suffering from tuberculosis and identify in which asymptomatic children, with positive tuberculin skin test and normal chest radiography, CT has the highest diagnostic yield using a low radiation dose protocol. The most common finding on CT in cases of tuberculosis is lymphadenopathy with necrotic appearance. In asymptomatic children with positive tuberculin skin test and normal chest radiography, CT had higher diagnostic yield in children younger than 5 years, modifying the therapeutic approach in a high percentage of cases. Reduction kilovoltage (kV) and milliamperage (mA) protocols significantly decrease the radiation dose, keeping sufficient diagnostic quality. [ABSTRACT FROM AUTHOR]

Many orthopedic articles describe advances in surgical techniques and implants used in pediatric scoliosis surgery. However, even though postoperative spine imaging constitutes a large portion of outpatient musculoskeletal pediatric radiology, few, if any, radiology articles discuss this topic. There has been interval advancement over the last decades of the orthopedic procedures used in the treatment of spinal scoliosis in adolescents with idiopathic scoliosis. The goal of treatment in these patients is to stop the progression of the curve by blocking the spinal growth and correcting the deformity as much as possible. To that end, the authors in this paper discuss postoperative imaging findings of Harrington rods, Luque rods, Luque-Galveston implants and segmental spinal fusion systems. Regarding early onset scoliosis, the guiding principles used for adolescent idiopathic scoliosis do not apply to a growing spine because they would impede lung development. As a result, other devices have been developed to correct the curve and to allow spinal growth. These include spine-based growing rods, vertically expandable prosthetic titanium rods (requiring repetitive surgeries) and magnetically controlled growing rods (with a magnetic locking/unlocking system). Other more recent systems are Shilla and thoracoscopic anterior vertebral body tethering, which allow guided growth of the spine without repetitive interventions. In this paper, we review the radiologic appearances of different orthopedic implants and techniques used to treat adolescent idiopathic scoliosis and early onset scoliosis. Moreover, we present the imaging findings of the most frequent postoperative complications. [ABSTRACT FROM AUTHOR]

A 4-year-old boy presented with swelling over the inferior tip of the scapula and an unclear history. Initial radiographic findings were concerning for an aggressive lesion. This case highlights how a multimodality imaging approach was used to relieve uncertainty by diagnosing a paediatric bowing type fracture of the scapular tip. [ABSTRACT FROM AUTHOR]

Background: Commercially available 3D multi-echo Dixon (mDixon) sequences provide parametric maps of liver T2*, obviating manual curve fitting that is often required with conventional gradient recalled echo (GRE)-based multi-echo relaxometry, potentially simplifying clinical work flow.Objective: The purpose of our study was to compare T2* values generated by a 3D mDixon sequence to values generated by GRE-based T2* relaxometry with manual curve fitting in a pediatric and young adult population.Materials and Methods: We reviewed clinical MRI exams performed at 1.5T for liver iron content estimation between February 2015 and June 2016 that included both mDixon and multi-echo GRE pulse sequences. We obtained mean T2* measurements based on each sequence by drawing regions of interest on each of four axial slices through the mid-liver. We compared mDixon-based and GRE-based T2* measurements using paired t-tests and assessed agreement using single-measure intra-class correlation coefficients and Bland-Altman difference plots.Results: One hundred nine patients met inclusion criteria (site 1=82; site 2=27). Mean age was 12.4±5.8 years, and 42 subjects (39%) were female. There was no statistically significant difference in mean T2* values for the two sequences (pooled means: 11.7±11.0 [GRE] vs. 11.7±10.9 ms [mDixon]; P=0.93). There was excellent absolute agreement between sequences (intraclass correlation coefficient [ICC]=0.98 for patients at both sites, confidence interval [CI]: 0.97-0.98 with mean bias of 0.0 ms [-4.2 ms to +4.2 ms]).Conclusion: 3D mDixon is accurate for measuring liver T2* and can likely replace 2D GRE-based relaxometry. [ABSTRACT FROM AUTHOR]

Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine age-related, infratentorial changes in T relaxation times during infancy and childhood using routine MRI data at 3 Tesla. Methods: One hundred patients (0-199 months) without signal abnormalities on conventional MRI were retrospectively selected from our pool of pediatric MRI examinations. T maps based on our routinely acquired triple-echo turbo spin-echo (TSE) sequence were created. Based on their clinical symptoms, the children were divided into 43 controls and 57 diseased children with different clinical diseases. T relaxation times were measured in 15 infratentorial brain regions (medullary pyramid, ventral and dorsal pons, middle cerebellar peduncle, dentate nucleus, medial and lateral cerebellar hemisphere each on both sides, and in the cerebellar vermis) investigating age-related changes. Secondly, this study examined whether those changes in T values differed between healthy and diseased children. Results: Age significantly reduced T relaxation time in all infratentorial brain regions ( p < 0.05). With increasing age, the T relaxation times decreased continuously, faster in the first 9 months and slower thereafter. Overall, controls did not differ significantly from diseased children ( p > 0.05) apart from the dentate nucleus and cerebellar hemispheres in terms of rapid decline (larger in controls) and the right dorsal pons and left pyramid in terms of slow decline (larger in diseased children). In both groups, the later slow decline was almost negligible. Conclusions: Using T maps, it was possible to determine age-related T relaxation times in the different infratentorial brain regions in this preliminary study. Between neurologically healthy controls and diseased children, no significant differences in T relaxation times could be found overall in the studied regions. [ABSTRACT FROM AUTHOR]

Paediatric population neuroimaging is an emerging field that falls at the intersection between developmental neuroscience and epidemiology. A key feature of population neuroimaging studies involves large-scale recruitment that is representative of the general population. One successful approach for population neuroimaging is to embed neuroimaging studies within large epidemiological cohorts. The Generation R Study is a large, prospective population-based birth-cohort in which nearly 10,000 pregnant mothers were recruited between 2002 and 2006 with repeated measurements in the children and their parents over time. Magnetic resonance imaging was included in 2009 with the scanning of 1070 6-to-9-year-old children. The second neuroimaging wave was initiated in April 2013 with a total of 4245 visiting the MRI suite and 4087 9-to-11-year-old children being scanned. The sequences included high-resolution structural MRI, 35-direction diffusion weighted imaging, and a 6 min and 2 s resting-state functional MRI scan. The goal of this paper is to provide an overview of the imaging protocol and the overlap between the neuroimaging data and metadata. We conclude by providing a brief overview of results from our first wave of neuroimaging, which highlights a diverse array of questions that can be addressed by merging the fields of developmental neuroscience and epidemiology. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to obtain lower airway dimensions in children by means of computed tomography (CT). Methods: Chest CT scans from 195 pediatric patients (118 boys/77 girls) aged 0.04-15.99 years were analyzed. Tracheal and bronchial lengths, anterior-posterior and lateral diameters, as well as cross-sectional area were assessed at the following levels: mid trachea, right proximal and distal bronchus, proximal bronchus intermedius, and left proximal and distal bronchus. Mediastinal angles of tracheal bifurcation were measured. Data were analyzed by means of linear and polynomial regression plots. Results: The strongest correlations were found between tracheal and bronchial diameters and age as well as between tracheal and bronchial lengths and body length. All measured airway parameters correlated poorly to body weight. Bronchial angles revealed no association with patient's age, body length, or weight. Conclusion: This comprehensive anatomical database of lower airway dimensions demonstrates that tracheal and bronchial diameters correlate better to age, and that tracheal and bronchial length correlate better to body length. All measured airway parameters correlated poorly to body weight. [ABSTRACT FROM AUTHOR]

National guidance from the United Kingdom and the United States on community-acquired pneumonia in children states that chest radiographs are not recommended routinely in uncomplicated cases. The main reason in the ambulatory setting is that there is no evidence of a substantial impact on clinical outcomes. However clinical practice and adherence to guidance is multifactorial and includes the clinical context (developed vs. developing world), the confidence of the attending physician, the changing incidence of complications (according to the success of immunisation programs), the availability of alternative imaging (and its relationship to perceived risks of radiation) and the reliability of the interpretation of imaging. In practice, chest radiographs are performed frequently for suspected pneumonia in children. Time pressures facing clinicians at the front line, difficulties in distinguishing which children require admission, restricted bed numbers for admissions, imaging-resource limitations, perceptions regarding risk from procedures, novel imaging modalities and the probability of other causes for the child's presentation all need to be factored into a guideline. Other drivers that often weigh in, depending on the setting, include cost-effectiveness and the fear of litigation. Not all guidelines designed for the developed world can therefore be applied to the developing world, and practice guidelines require regular review in the context of new information. In addition, radiologists must improve radiographic diagnosis of pneumonia, reach consensus on the interpretive terminology that clarifies their confidence regarding the presence of pneumonia and act to replace one imaging technique with another whenever there is proof of improved accuracy or reliability. [ABSTRACT FROM AUTHOR]

Objective: To evaluate trends and patterns in CT usage among children (aged 0-17 years) in The Netherlands during the period 1990-2012.Methods: Lists of electronically archived paediatric CT scans were requested from the Radiology Information Systems (RIS) of Dutch hospitals which reported >10 paediatric CT scans annually in a survey conducted in 2010. Data included patient identification, birth date, gender, scan date and body part scanned. For non-participating hospitals and for years prior to electronic archiving in some participating hospitals, data were imputed by calendar year and hospital type (academic, general with <500 beds, general with ≥ 500 beds).Results: Based on 236,066 CT scans among 146,368 patients performed between 1990 and 2012, estimated annual numbers of paediatric CT scans in The Netherlands increased from 7,731 in 1990 to 26,023 in 2012. More than 70 % of all scans were of the head and neck. During the last decade, substantial increases of more than 5 % per year were observed in general hospitals with fewer than 500 beds and among children aged 10 years or older.Conclusion: The estimated number of paediatric CT scans has more than tripled in The Netherlands during the last two decades.Key Points: • Paediatric CT in The Netherlands has tripled during the last two decades. • The number of paediatric CTs increased through 2012 in general hospitals. • Paediatric CTs continued to increase among children aged 10 years or older. [ABSTRACT FROM AUTHOR]

Purpose: Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically.Methods: A transversal cohort study was conducted at a level 1 trauma center in Germany (2008-2014). In a statistical pre hoc analysis, a sample size of 200 images of each standard radiograph was determined. The picture archiving and communication system (PACS) was searched for radiographic examinations in patients under 18 years.Results: The following fracture rates for the investigated 20 most common examinations were found: 70.5% clavicle, 54.5% forearm, 53% wrist, 41.5% elbow, 30.5% lower leg, 20% hand, 18.5% finger, 12.5% toe, 12% forefoot, 11.5% ankle, 9% shoulder, 6.5% patella, 5.5% foot, 4% knee, 2% conventional rib series, 1.5% lumbar spine, 1% Towne view, 0.5% skull, 0% cervical spine, and 0% odontoid. Differences in the mean age of analyzed pediatric trauma patients in correlation to different standard radiographs were found.Conclusions: In our study, a relevant amount of different standard radiographs revealed a low fracture rate. Therefore, indications for X-ray should be checked properly and alternative procedures should be discussed with the patient and the parents. Clinical decision rules should be developed and pathways have to be implemented to minimize radiation exposure, waiting time, and costs. [ABSTRACT FROM AUTHOR]

Atom probe tomography and transmission electron microscopy are used to analyze magnetron-sputtered MoS2 films containing Ti and Au/Sb2O3 as a model system for tribological coatings. Transmission electron microscopy characterization showed that the Ti–MoS2 film is dense and featureless whereas Sb2O3/Au–MoS2 film is less dense and have columnar morphology. Three-dimensional atom probe reconstructions revealed that the Ti–MoS2 films have a homogeneous composition and contain about 15 at.% Ti, which is uniformly distributed throughout the MoS2 matrix without any evidence of Ti precipitation. Sb2O3/Au–MoS2 films also showed homogeneous distribution of Sb2O3 throughout the MoS2 matrix and the presence of Au-rich precipitates. The complementary techniques of atom probe tomography and transmission electron microscopy indicate that Ti and Sb2O3 incorporation in the deposition of MoS2 produces amorphous microstructures, whereas the addition of Au forms nano-sized and well-dispersed precipitates. [ABSTRACT FROM PUBLISHER]

A pilot study was carried out involving six radiology centres across the state of Tasmania, Australia, with two main goals. First, to compare the choice of exposure factors used by each centre for four common paediatric projections of a 'standard' infant, 5-, 10- and 15-year-old patients. Second, to measure dose area product (DAP) at each radiology centre using the factors obtained and compare it against published diagnostic reference levels (DRLs). Significant variation was observed between the six radiology centres studied which has been attributed to the variability in exposure factors provided by the centres. Notably, the measured DAP values in the case of infant and 5-year-old patients were observed to be significantly lower than the published reference DAP DRLs. While significantly higher exposure factors have been observed for 15-year-old patients as illustrated in measured DAP values. [ABSTRACT FROM AUTHOR]

Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Colonic volvulus is rare in children and associated with colonic dysmotility. Diagnosis of colonic volvulus on radiographs in these patients can be challenging. The purpose of the study was to identify the accuracy of abdominal radiographs and findings suggestive of colonic volvulus.Materials and Methods: A retrospective (2003- 2014) study of all children with colonic volvulus proven surgically or endoscopically reviewed their medical charts for underlying disease and clinical presentation as well as their original radiograph reports. Two pediatric radiologists (reader 1 and reader 2) independently reviewed the radiographs. The kappa test was used to evaluate interobserver variability.Results: There were 19 cases of colonic volvulus in 18 patients (11 males) a mean age 14 years. Cecal volvulus was the most common finding at 14/19 cases (74%). Sixteen of 18 (89%) patients had neurological impairment and 10 of 18 (56%) had intestinal dysmotility. The most common presentation was abdominal distension (14/19 [74%]) and pain (11/19 [58%]). Colonic volvulus was diagnosed in only 7/16 (44%) of the abdominal radiographs. The specific finding of a coffee-bean sign was retrospectively observed only by reader 2 in two cases. Absence of rectal gas and focal colonic loop dilation were the most common findings by the readers (average 73.5% and 87%, respectively) with Kappa values of 0.3 and 0.38, respectively.Conclusion: Diagnosis of colonic volvulus in children can be challenging. Radiologists should be alerted to the possibility of colonic volvulus when there is focal colonic loop distention or absent rectal gas. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the results of an initiative aimed at improving the reasonable use of radiological examinations, ensuring their technical quality, implementing a radioprotection campaign that includes training of the professional team, and introducing the radioprotection card for children under 12 years old as a tool for parents and doctors to control children's exposure to radiation. Methods: The study was held in a health care insurance system covering 140,000 people. A radioprotection campaign was implemented according to Image Gently® protocols, ensuring the lowest dose of radiation and the quality of examinations, and the radioprotection card was implemented. To assess the effectiveness of these actions, the number of radiological examinations performed at the pediatric emergency room in a period of one year preceding the campaign was compared with the number of radiological examinations performed one year after the campaign. Results: The campaign was well accepted by all professionals, families, and patients involved. In the year following the implementation of radioprotection strategies, there was a 22% reduction of radiological examinations performed at the pediatric emergency room. There was also a 29% reduction in the request of two or more radiological examinations for the same child or examinations with two or more incidences. Conclusions: The campaign and the radioprotection card for children under 12 years old proved to be feasible strategies and correlated with a reduction in radiological examinations requested and performed at the pediatric emergency room. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the adequacy of x-ray beam collimation as a parameter for radiation protection in paediatric plain chest radiographs. METHOD: A total of 200 paediatric chest radiographs (= 18 years) were retrospectively assessed for good collimation practice as a means of radiation protection. Parameters assessed on the technique of collimation were the presence of silver lining as an evidence of x-ray beam collimation according to the European guideline on quality criteria for diagnostic radiographic images. RESULT: Of the 200 radiographs assessed for adequacy of x-ray beam collimation, 79.0% (n=158) showed evidence of adequate beam collimation white, 21.0% (n=42) were inadequately collimated. The results of the study showed adequate beam collimation practice in the Radiology department of the centre studied. CONCLUSION: The adequacy of x-ray beam collimation as parameter for radiation protection in paediatric plain chest radiographs was assessed. Majority of the paediatric plain chest radiographs were adequately collimated white some few radiographs reveal inadequacy of beam collimation. [ABSTRACT FROM AUTHOR]