[Thoracic sonography in infancy and childhood]

Multidetector CT in children: current concepts and dose reduction strategies

The recent technical development of multidetector CT (MDCT) has contributed to a substantial increase in its diagnostic applications and accuracy in children. A major drawback of MDCT is the use of ionising radiation with the risk of inducing secondary cancer. Therefore, justification and optimisation of paediatric MDCT is of great importance in order to minimise these risks ("as low as reasonably achievable" principle). This review will focus on all technical and non-technical aspects relevant for paediatric MDCT optimisation and includes guidelines for radiation dose level-based CT protocols.

Ultrasound diagnosis of pneumonia in children

PURPOSE

This study was done to compare the diagnostic accuracy of ultrasound and chest X-ray (CXR) in children with suspected pneumonia.

MATERIALS AND METHODS

Seventy-nine children aged from 6 months to 16 years with clinical signs suggestive of pneumonia underwent lung ultrasound and CXR.

RESULTS

Lung ultrasound was positive for the diagnosis of pneumonia in 60 patients, whereas CXR was positive in 53. In four patients with negative CXR and positive ultrasound findings, pneumonia was confirmed by chest computed tomography (CT) (performed for recurrent pneumonia in the same location). In the other three patients with negative CXR and positive ultrasound findings, the clinical course was consistent with pneumonia.

CONCLUSIONS

Lung ultrasound is a simple and reliable tool that can be used by the clinician in the case of suspected pneumonia. It is as reliable as CXR, can be easily repeated at the patient's bedside and carries no risk of irradiation.

Ultrasound of the chest in children (mediastinum excluded)

Ultrasound (US) of the paediatric chest has become an established imaging tool that may supplement plain film findings helping to reduce or tailor other ionizing (sectional) imaging in a variety of paediatric conditions such as sequestration or pneumonia. US has been shown to offer valuable imaging alternatives, both reliably enabling diagnosis without need for ionising imaging such as in diaphragmatic palsy (traditionally diagnosed by fluoroscopy) and revealing additional information in patients with equivocal findings on radiographs or replacing follow-up examinations (for example, in pleural effusion). This review outlines the technical requisites for paediatric chest US applications and will discuss its diagnostic potential. Furthermore, it will consider US restrictions, mention some rare applications, and discuss the potential role of chest US in imaging algorithms of certain conditions.

Pediatric chest ultrasound

Ultrasound examination of the thorax can be quite rewarding in children, because their unique thoracic anatomy provides many acoustic windows into the chest. With only a modest effort, chest ultrasonography can provide many clinically relevant answers, without the radiation exposure from CT, or the need for sedation sometimes required for CT and MR imaging.