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Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, Moreno JA, Dias MS, Christian CW, Nelson MD, Silvera VM, Palasis S, Raissaki M, Rossi A, Offiah AC. Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 2018; 48:1048-1065. [PMID: 29796797 DOI: 10.1007/s00247-018-4149-1] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/22/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.
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Slovis TL, Levin TL, Joshi A. Walter E. Berdon, MD (1930-2017). Pediatr Radiol 2017; 47:1697-1699. [PMID: 28951941 DOI: 10.1007/s00247-017-3985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blumfield E, Moore MM, Drake MK, Goodman TR, Lewis KN, Meyer LT, Ngo TD, Sammet C, Stanescu AL, Swenson DW, Slovis TL, Iyer RS. Survey of gadolinium-based contrast agent utilization among the members of the Society for Pediatric Radiology: a Quality and Safety Committee report. Pediatr Radiol 2017; 47:665-673. [PMID: 28283728 DOI: 10.1007/s00247-017-3807-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/06/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gadolinium-based contrast agents (GBCAs) have been used for magnetic resonance (MR) imaging over the last three decades. Recent reports demonstrated gadolinium retention in patients' brains following intravenous administration. Since gadolinium is a highly toxic heavy metal, there is a potential for adverse effects from prolonged retention or deposition, particularly in children. For this reason, the Society (SPR) for Pediatric Radiology Quality and Safety committee conducted a survey to evaluate the current status of GBCAs usage among pediatric radiologists. OBJECTIVE To assess the usage of GBCAs among SPR members. MATERIALS AND METHODS An online 15-question survey was distributed to SPR members. Survey questions pertained to the type of GBCAs used, protocoling workflow, requirement of renal function or pregnancy tests, and various clinical indications for contrast-enhanced MRI examinations. RESULTS A total of 163 survey responses were compiled (11.1% of survey invitations), the majority of these from academic institutions in the United States. Ninety-four percent reported that MR studies are always or usually protocoled by pediatric radiologists. The most common GBCA utilized by survey respondents were Eovist (60.7%), Ablavar (45.4%), Gadovist (38.7%), Magnevist (34.4%) and Dotarem (32.5%). For several clinical indications, survey responses regarding GBCA administration were concordant with American College of Radiology (ACR) Appropriateness Criteria, including seizures, headache and osteomyelitis. For other indications, including growth hormone deficiency and suspected vascular ring, survey responses revealed potential overutilization of GBCAs when compared to ACR recommendations. CONCLUSION Survey results demonstrate that GBCAs are administered judiciously in children, yet there is an opportunity to improve their utilization with the goal of reducing potential future adverse effects.
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Offiah AC, Servaes S, Adamsbaum CS, Argyropoulou MI, Halliday KE, Jaspan T, Owens CM, Raissaki M, Rosendahl K, Stoodley N, Van Rijn RR, Callahan MJ, Chung T, Donaldson JS, Jaramillo D, Slovis TL, Strouse PJ. Initial response of the European Society of Paediatric Radiology and Society for Pediatric Radiology to the Swedish Agency for Health Technology Assessment and Assessment of Social Services' document on the triad of shaken baby syndrome. Pediatr Radiol 2017; 47:369-371. [PMID: 28233046 DOI: 10.1007/s00247-017-3808-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
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Slovis TL, Strouse PJ, Strauss KJ. Radiation Exposure in Imaging of Suspected Child Abuse: Benefits versus Risks. J Pediatr 2015; 167:963-8. [PMID: 26354874 DOI: 10.1016/j.jpeds.2015.07.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/29/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
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Zidan M, Thomas RL, Slovis TL. What you need to know about statistics, part II: reliability of diagnostic and screening tests. Pediatr Radiol 2015; 45:317-28. [PMID: 25726014 DOI: 10.1007/s00247-014-2944-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/13/2014] [Accepted: 02/19/2014] [Indexed: 02/02/2023]
Abstract
The foundation for the usefulness of any diagnostic test should be that it is both reliable and accurate in its clinical diagnosis. In this article we present the second of a two-part series on validity and reliability, discussing the assessment of reliability among raters of diagnostic tests and between diagnostics tests themselves. To examine reproducibility (reliability) among raters of diagnostic tests we present the calculation of two statistical procedures: (1) the kappa coefficient statistic when presented with categorical data for the presence or absence of a clinical diagnosis and (2) the intraclass correlation coefficient (ICC) for continuously scaled data among raters. The accuracy among diagnostic tests (i.e. their interchangeability) can be evaluated by application of (1) a Bland-Altman plot procedure (with its 95% limits of agreement) and (2) the Passing-Bablok regression procedure (for the identification and evaluation of systematic and proportional differences). When deciding whether to select a diagnostic test one must evaluate its ability to provide more precise information than a gold standard test, and whether in clinical practice it would be more beneficial for patients to adopt it.
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Thomas RL, Zidan MA, Slovis TL. What you need to know about statistics Part I: validity of diagnostic and screening tests. Pediatr Radiol 2015; 45:146-52. [PMID: 25636704 DOI: 10.1007/s00247-014-2882-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/16/2013] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Abstract
The intent of this manuscript is to provide guidance and support to clinicians and investigators for reporting the results of screening and diagnostic tests. This article is the first of two parts addressing statistics in imaging research. In this part validity measures are discussed. In part II reliability measures will be discussed. In discussing validity, the following concepts will be introduced: (1) functions of diagnostic tests, (2) statistical characteristics of diagnostic tests and application of validity measures, (3) power and sample size for testing the sensitivity and specificity of the diagnostic test, (4) statistical versus clinical significance and (5) characteristics of a useful diagnostic test.
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Hintz SR, Barnes PD, Bulas D, Slovis TL, Finer NN, Wrage LA, Das A, Tyson JE, Stevenson DK, Carlo WA, Walsh MC, Laptook AR, Yoder BA, Van Meurs KP, Faix RG, Rich W, Newman NS, Cheng H, Heyne RJ, Vohr BR, Acarregui MJ, Vaucher YE, Pappas A, Peralta-Carcelen M, Wilson-Costello DE, Evans PW, Goldstein RF, Myers GJ, Poindexter BB, McGowan EC, Adams-Chapman I, Fuller J, Higgins RD. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015; 135:e32-42. [PMID: 25554820 PMCID: PMC4279063 DOI: 10.1542/peds.2014-0898] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age. METHODS Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors. RESULTS Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes. CONCLUSIONS Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.
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Offiah AC, Andronikou S, Avni F, Daltro P, Donnelly LF, Jaramillo D, Kim IO, Nievelstein RAJ, Owens CM, Slovis TL, van Rijn R, Lee EY. Expert opinion: what are the greatest challenges and barriers to applying evidence-based and practical approaches to preclinical and clinical research in the field of pediatric radiology? Pediatr Radiol 2014; 44:1209-12. [PMID: 25246190 DOI: 10.1007/s00247-014-3047-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/12/2014] [Indexed: 11/24/2022]
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Dunoski B, Slovis TL. Update in pediatric imaging. Adv Pediatr 2014; 61:75-125. [PMID: 25037125 DOI: 10.1016/j.yapd.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mody SS, Slovis TL. Craniosynostosis--another look. Pediatr Radiol 2013; 43:657-8. [PMID: 23584206 DOI: 10.1007/s00247-013-2689-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/21/2013] [Indexed: 10/27/2022]
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Slovis TL, Frush DP, Goske MJ. An amazing accomplishment--CT manufacturers deserve our thanks. Pediatr Radiol 2013; 43:132-4. [PMID: 23224138 DOI: 10.1007/s00247-012-2562-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 10/25/2012] [Indexed: 11/26/2022]
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Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P, Berrington de Gonzalez A. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin 2012; 62:75-100. [PMID: 22307864 PMCID: PMC3548988 DOI: 10.3322/caac.21132] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The 600% increase in medical radiation exposure to the US population since 1980 has provided immense benefit, but increased potential future cancer risks to patients. Most of the increase is from diagnostic radiologic procedures. The objectives of this review are to summarize epidemiologic data on cancer risks associated with diagnostic procedures, describe how exposures from recent diagnostic procedures relate to radiation levels linked with cancer occurrence, and propose a framework of strategies to reduce radiation from diagnostic imaging in patients. We briefly review radiation dose definitions, mechanisms of radiation carcinogenesis, key epidemiologic studies of medical and other radiation sources and cancer risks, and dose trends from diagnostic procedures. We describe cancer risks from experimental studies, future projected risks from current imaging procedures, and the potential for higher risks in genetically susceptible populations. To reduce future projected cancers from diagnostic procedures, we advocate the widespread use of evidence-based appropriateness criteria for decisions about imaging procedures; oversight of equipment to deliver reliably the minimum radiation required to attain clinical objectives; development of electronic lifetime records of imaging procedures for patients and their physicians; and commitment by medical training programs, professional societies, and radiation protection organizations to educate all stakeholders in reducing radiation from diagnostic procedures.
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Slovis TL. Where we were, what has changed, what needs doing: a decade of progress. Pediatr Radiol 2011; 41 Suppl 2:456-60. [PMID: 21847722 DOI: 10.1007/s00247-011-2104-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 02/17/2011] [Accepted: 02/25/2011] [Indexed: 01/21/2023]
Abstract
In the last decade, there has been recognition of the effects of low-dose radiation in children. A critical mass of scientists, health care providers and manufacturers of radiation-producing imaging equipment has come together to educate ordering physicians to request only indicated examinations and radiologists to achieve low-dose examinations with diagnostic images. The forces that caused these changes will be discussed.
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Slovis TL. Sedation and anesthesia issues in pediatric imaging. Pediatr Radiol 2011; 41 Suppl 2:514-6. [PMID: 21847732 DOI: 10.1007/s00247-011-2115-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/31/2011] [Accepted: 04/11/2011] [Indexed: 10/17/2022]
Abstract
Sedation and anesthesia for pediatric imaging departments has changed dramatically for the following reasons: (1) radiologists have stopped sedating patients; (2) the majority of sedations are not for CT (because of the speed of the procedure) but for MR, which lasts 45 min or greater; (3) a cadre of services--pediatricians, emergency medicine physicians, hospitalists and intensivists, as well as anesthesiologists--can provide the services. These changes have significantly influenced the type of agents utilized for sedation and anesthesia and, most important, have created operational issues for MR departments. Nevertheless, it is important for each imaging department to create a uniform approach to sedation, taking into account patient expectations, efficiency of through-put, facilities and personnel available, and institutional costs.
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Slovis TL, Campbell JB. R. Parker Allen, MD (March 13, 1919–October 1, 2010). Pediatr Radiol 2011; 41:1075-6. [PMID: 21938794 DOI: 10.1007/s00247-011-2162-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Slovis TL, Strauss KJ, Frush DP. How many strikes does it take till we are out? Pediatr Radiol 2011; 41:547-8. [PMID: 21491195 DOI: 10.1007/s00247-011-2016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 02/04/2011] [Indexed: 11/27/2022]
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Slovis TL. The pediatric radiologist approaching retirement. Pediatr Radiol 2010; 40:491-2. [PMID: 20225110 DOI: 10.1007/s00247-009-1523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Retirement can be defined as a new stage of an active lifestyle. It is a unique chapter in life that can be fun and rewarding, if steps are taken to plan the process. Key factors to take into consideration during this process are family, friends, finances, and professional interests. With proper planning, rather than withdrawing from an active life, retirees can embrace their new lifestyle with a fresh perspective.
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Voss SD, Reaman GH, Kaste SC, Slovis TL. The ALARA concept in pediatric oncology. Pediatr Radiol 2009; 39:1142-6. [PMID: 19789861 DOI: 10.1007/s00247-009-1404-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 08/26/2009] [Indexed: 11/25/2022]
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Chapman S, Slovis TL. Response to Galaznik, Cohen & Scheimberg, and Rorke-Adams & Christian. Pediatr Radiol 2009; 39:770-1. [PMID: 19565234 DOI: 10.1007/s00247-009-1298-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
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Slovis TL, Strouse PJ. Malrotation: some answers but more questions. Pediatr Radiol 2009; 39:315-6. [PMID: 19241072 DOI: 10.1007/s00247-009-1169-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 12/30/2022]
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Slovis TL, Chapman S. The pathophysiology does not denote the mechanism. Pediatr Radiol 2009; 39:197-8. [PMID: 19165475 DOI: 10.1007/s00247-008-1144-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 12/31/2008] [Indexed: 11/25/2022]
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