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Kibrom BT, Manyazewal T, Demma BD, Feleke TH, Kabtimer AS, Ayele ND, Korsa EW, Hailu SS. Emerging technologies in pediatric radiology: current developments and future prospects. Pediatr Radiol 2024; 54:1428-1436. [PMID: 39012407 DOI: 10.1007/s00247-024-05997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
Radiological imaging is a crucial diagnostic tool for the pediatric population. However, it is associated with several unique challenges in this age group compared to adults. These challenges mainly come from the fact that children are not small-sized adults and differ in development, anatomy, physiology, and pathology compared to adults. This paper reviews relevant articles published between January 2015 and October 2023 to analyze challenges associated with imaging technologies currently used in pediatric radiology, emerging technologies, and their role in resolving the challenges and future prospects of pediatric radiology. In recent decades, imaging technologies have advanced rapidly, developing advanced ultrasound, computed tomography, magnetic resonance, nuclear imaging, teleradiology, artificial intelligence, machine learning, three-dimensional printing, radiomics, and radiogenomics, among many others. By prioritizing the unique needs of pediatric patients while developing such technologies, we can significantly alleviate the challenges faced in pediatric radiology.
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Affiliation(s)
- Bethlehem T Kibrom
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Biruk D Demma
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfahunegn H Feleke
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Potomac Urology Clinic, Alexandria, VA, USA
| | | | - Nitsuh D Ayele
- College of Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Eyasu W Korsa
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samuel S Hailu
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kafali SG, Bolster BD, Shih SF, Delgado TI, Deshpande V, Zhong X, Adamos TR, Ghahremani S, Calkins KL, Wu HH. Self-Gated Radial Free-Breathing Liver MR Elastography: Assessment of Technical Performance in Children at 3 T. J Magn Reson Imaging 2024. [PMID: 39036994 DOI: 10.1002/jmri.29541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Conventional liver magnetic resonance elastography (MRE) requires breath-holding (BH) to avoid motion artifacts, which is challenging for children. While radial free-breathing (FB)-MRE is an alternative for quantifying liver stiffness (LS), previous methods had limitations of long scan times, acquiring two slices in 5 minutes, and not resolving motion during reconstruction. PURPOSE To reduce FB-MRE scan time to 4 minutes for four slices and to investigate the impact of self-gated (SG) motion compensation on FB-MRE LS quantification in terms of agreement, intrasession repeatability, and technical quality compared to conventional BH-MRE. STUDY TYPE Prospective. POPULATION Twenty-six children without fibrosis (median age: 12.9 years, 15 females). FIELD STRENGTH/SEQUENCE 3 T; Cartesian gradient-echo (GRE) BH-MRE, research application radial GRE FB-MRE. ASSESSMENT Participants were scanned twice to measure repeatability, without moving the table or changing the participants' position. LS was measured in areas of the liver with numerical confidence ≥90%. Technical quality was examined using measurable liver area (%). STATISTICAL TESTS Agreement of LS between BH-MRE and FB-MRE was evaluated using Bland-Altman analysis for SG acceptance rates of 40%, 60%, 80%, and 100%. LS repeatability was assessed using within-subject coefficient of variation (wCV). The differences in LS and measurable liver area were examined using Kruskal-Wallis and Wilcoxon signed-rank tests. P < 0.05 was considered significant. RESULTS FB-MRE with 60% SG achieved the closest agreement with BH-MRE (mean difference 0.00 kPa). The LS ranged from 1.70 to 1.83 kPa with no significant differences between BH-MRE and FB-MRE with varying SG rates (P = 0.52). All tested methods produced repeatable LS with wCV from 4.4% to 6.5%. The median measurable liver area was smaller for FB-MRE (32%-45%) than that for BH-MRE (91%-93%) (P < 0.05). DATA CONCLUSION FB-MRE with 60% SG can quantify LS with close agreement and comparable repeatability with respect to BH-MRE in children. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Sevgi Gokce Kafali
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Bradley D Bolster
- US MR R&D Collaborations, Siemens Medical Solutions USA, Inc., Salt Lake City, Utah, USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Timoteo I Delgado
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Physics and Biology in Medicine Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vibhas Deshpande
- US MR R&D Collaborations, Siemens Medical Solutions USA, Inc., Austin, Texas, USA
| | - Xiaodong Zhong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
- Physics and Biology in Medicine Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Timothy R Adamos
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Shahnaz Ghahremani
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kara L Calkins
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Holden H Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
- Physics and Biology in Medicine Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Ożga J, Mężyk E, Kmiecik W, Wojciechowski W, Żuber Z. Magnetic resonance imaging of the musculoskeletal system in the diagnosis of rheumatic diseases in the pediatric population. Reumatologia 2024; 62:196-206. [PMID: 39055724 PMCID: PMC11267661 DOI: 10.5114/reum/190262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Magnetic resonance imaging (MRI) of the musculoskeletal system is an examination increasingly performed for suspected juvenile idiopathic arthritis, chronic nonbacterial osteomyelitis and juvenile idiopathic inflammatory myopathies, as well as other rheumatic diseases of developmental age. T1-, T2- and PD-weighted with or without fat suppression or short tau inversion recovery/turbo inversion recovery magnitude (STIR/TIRM) sequences and post-contrast sequences are evaluated to diagnose pathological changes in the synovial membrane, subchondral bone marrow and surrounding soft tissues. Magnetic resonance imaging allows detection of synovitis, tenosynovitis, bursitis, and enthesitis as well as bone marrow edema and soft tissue edema. Several pediatric-specific MRI scoring systems have been developed and validated to standardize and facilitate the assessment of the extent of the inflammatory process and disease activity in MRI. Early detection of inflammatory changes allows the inclusion of comprehensive pharmacotherapy giving the possibility of permanent remission and objective measurement of the effectiveness of treatment.
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Affiliation(s)
- Joanna Ożga
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Poland
- Clinical Department of Pediatrics and Rheumatology, St. Louis Regional Specialised Children's Hospital, Krakow, Poland
| | - Elżbieta Mężyk
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Poland
- Clinical Department of Pediatrics and Rheumatology, St. Louis Regional Specialised Children's Hospital, Krakow, Poland
| | - Wojciech Kmiecik
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Poland
- Clinical Department of Pediatrics and Rheumatology, St. Louis Regional Specialised Children's Hospital, Krakow, Poland
| | - Wadim Wojciechowski
- Clinical Department of Pediatrics and Rheumatology, St. Louis Regional Specialised Children's Hospital, Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Poland
- Clinical Department of Pediatrics and Rheumatology, St. Louis Regional Specialised Children's Hospital, Krakow, Poland
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Anupindi SA, Dillman JR. Body MRI in pediatrics: where we are and what the future holds. Pediatr Radiol 2024:10.1007/s00247-024-05984-8. [PMID: 38981906 DOI: 10.1007/s00247-024-05984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
Body magnetic resonance imaging (MRI) is increasingly used for disease diagnosis, characterization, and monitoring in children of all ages. MRI has numerous advantages when compared to other imaging modalities, including a lack of ionizing radiation, superior soft tissue image contrast, and ability to provide objective, quantitative assessments. As MRI continues to evolve, pediatric body MRI examinations of the future will certainly be different than our current and past protocols. In this review article, we will discuss the present and likely future states of pediatric body MRI, including the increasing application of quantitative MRI methods, faster imaging techniques and implementation of abbreviated targeted protocols, and the growing use of artificial intelligence methods.
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Affiliation(s)
- Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Ozdemir S, Ayyildiz TK. The effect of video-based education program applied before children's pediatric Magnetic Resonance Imaging (MRI) on anxiety in Turkey: A randomized controlled study. J Pediatr Nurs 2024; 77:e81-e89. [PMID: 38637174 DOI: 10.1016/j.pedn.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE This study is a randomized controlled trial conducted to examine the effects of a Turkish video-based education program on scanned image quality and child and parent anxiety during Magnetic Resonance Imaging (MRI). DESIGN AND METHODS The study was conducted with 66 children aged between 4 and 15 years at Zonguldak Bulent Ecevit University Health Practice and Research Hospital, between January 2019 and December 2019. A video-based educational program was applied to an intervention group before MRI. RESULTS The video-based education program reduced children's anxiety and fear (p < 0.001). The study also showed a significant reduction in parental stress (p < 0.001). The image quality in the intervention group was better than that in the control group (control group: 3.24 ± 1.20; intervention group: 4.18 ± 0.81) (p = 0.001). Significantly fewer children refused to enter the MRI room in the intervention group than in the control group (p < 0.05). CONCLUSION Child-friendly and video-based educational programs can be organized for children and parents in diagnostic and treatment procedures for children in hospitals. PRACTICE IMPLICATIONS MRI scans can be uncomfortable for children and require transport to a better-equipped hospital for sedation. They can also cause financial loss for children and their parents and disrupt facility workflow. An educational program to adjust the children and their families will improve the scanning process and its success rate.
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Affiliation(s)
- Sumeyye Ozdemir
- Zonguldak Bülent Ecevit University, Health Sciences Institute, Department of Pediatric Nursing, Zonguldak, Turkey.
| | - Tulay Kuzlu Ayyildiz
- Zonguldak Bülent Ecevit University, Faculty of Health Sciences, Department of Nursing, Zonguldak, Turkey
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Mio M, Tabata N, Toyofuku T, Nakamura H. [Reduction of Motion Artifacts in Liver MRI Using Deep Learning with High-pass Filtering]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:510-518. [PMID: 38462509 DOI: 10.6009/jjrt.2024-1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE To investigate whether deep learning with high-pass filtering can be used to effectively reduce motion artifacts in magnetic resonance (MR) images of the liver. METHODS The subjects were 69 patients who underwent liver MR examination at our hospital. Simulated motion artifact images (SMAIs) were created from non-artifact images (NAIs) and used for deep learning. Structural similarity index measure (SSIM) and contrast ratio (CR) were used to verify the effect of reducing motion artifacts in motion artifact reduction image (MARI) output from the obtained deep learning model. In the visual assessment, reduction of motion artifacts and image sharpness were evaluated between motion artifact images (MAIs) and MARIs. RESULTS The SSIM values were 0.882 on the MARIs and 0.869 on the SMAIs. There was no statistically significant difference in CR between NAIs and MARIs. The visual assessment showed that MARIs had reduced motion artifacts and improved sharpness compared to MAIs. CONCLUSION The learning model in this study is indicated to be reduced motion artifacts without decreasing the sharpness of liver MR images.
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Affiliation(s)
- Motohira Mio
- Department of Radiology, Fukuoka University Chikushi Hospital
| | - Nariaki Tabata
- Department of Radiology, Fukuoka University Chikushi Hospital
| | - Tatsuo Toyofuku
- Department of Radiology, Fukuoka University Chikushi Hospital
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Kang SH, Lee Y. Motion Artifact Reduction Using U-Net Model with Three-Dimensional Simulation-Based Datasets for Brain Magnetic Resonance Images. Bioengineering (Basel) 2024; 11:227. [PMID: 38534500 DOI: 10.3390/bioengineering11030227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
This study aimed to remove motion artifacts from brain magnetic resonance (MR) images using a U-Net model. In addition, a simulation method was proposed to increase the size of the dataset required to train the U-Net model while avoiding the overfitting problem. The volume data were rotated and translated with random intensity and frequency, in three dimensions, and were iterated as the number of slices in the volume data. Then, for every slice, a portion of the motion-free k-space data was replaced with motion k-space data, respectively. In addition, based on the transposed k-space data, we acquired MR images with motion artifacts and residual maps and constructed datasets. For a quantitative evaluation, the root mean square error (RMSE), peak signal-to-noise ratio (PSNR), coefficient of correlation (CC), and universal image quality index (UQI) were measured. The U-Net models for motion artifact reduction with the residual map-based dataset showed the best performance across all evaluation factors. In particular, the RMSE, PSNR, CC, and UQI improved by approximately 5.35×, 1.51×, 1.12×, and 1.01×, respectively, and the U-Net model with the residual map-based dataset was compared with the direct images. In conclusion, our simulation-based dataset demonstrates that U-Net models can be effectively trained for motion artifact reduction.
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Affiliation(s)
- Seong-Hyeon Kang
- Department of Biomedical Engineering, Eulji University, Seongnam 13135, Republic of Korea
| | - Youngjin Lee
- Department of Radiological Science, Gachon University, Incheon 21936, Republic of Korea
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Greer MLC, Gee MS, Pace E, Sotardi S, Morin CE, Chavhan GB, Jaimes C. A survey of non-sedate practices when acquiring pediatric magnetic resonance imaging examinations. Pediatr Radiol 2024; 54:239-249. [PMID: 38112762 DOI: 10.1007/s00247-023-05828-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Improving access to magnetic resonance imaging (MRI) in childhood can be facilitated by making it faster and cheaper and reducing need for sedation or general anesthesia (GA) to mitigate motion. Some children achieve diagnostic quality MRI without GA through the use of non- practices fostering their cooperation and/or alleviating anxiety. Employed before and during MRI, these variably educate, distract, and/or desensitize patients to this environment. OBJECTIVE To assess current utilization of non-sedate practices in pediatric MRI, including variations in practice and outcomes. MATERIALS AND METHODS A survey-based study was conducted with 1372 surveys emailed to the Society for Pediatric Radiology members in February 2021, inviting one response per institution. RESULTS Responses from 50 unique institutions in nine countries revealed 49/50 (98%) sites used ≥ 1 non-sedate practice, 48/50 (96%) sites in infants < 6 months, and 11/50 (22%) for children aged 6 months to 3 years. Non-sedate practices per site averaged 4.5 (range 0-10), feed and swaddle used at 47/49 (96%) sites, and child life specialists at 35/49 (71%). Average success rates were moderate (> 50-75%) across all sites and high (> 75-100%) for 20% of sites, varying with specific techniques. Commonest barriers to use were scheduling conflicts and limited knowledge. CONCLUSION Non-sedate practice utilization in pediatric MRI was near-universal but widely variable across sites, ages, and locales, with room for broader adoption. Although on average non-sedate practice success rates were similar, the range in use and outcomes suggest a need for standardized implementation guidelines, including patient selection and outcome metrics, to optimize utilization and inform educational initiatives.
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Affiliation(s)
- Mary-Louise C Greer
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erika Pace
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, England, UK
| | - Susan Sotardi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Govind B Chavhan
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Deng X, Zhuang D, Liu J, Su C, Huang X. Application of intelligent pacifying strategy information system in reducing short-duration MRI sedation rate in children. Sci Rep 2023; 13:19003. [PMID: 37923781 PMCID: PMC10624830 DOI: 10.1038/s41598-023-44049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/03/2023] [Indexed: 11/06/2023] Open
Abstract
Exploring and analyzing the effectiveness of an intelligent pacifying strategy information system based on assisted decision-making in reducing the sedation rate of children in short-duration magnetic resonance scans. A total of 125 children aged 3-5 years who underwent MRI scans at a children's hospital from July to December 2021 participated in this study, during which 62 children were assigned to a control group from July to September, and 63 children were assigned to an intervention group from October to December. In the intervention group, the pacifier used the intelligent pacifying strategy information system based on assisted decision-making to assess children's temperament, and utilization of a system-generated pacification plan according to assessment results. In the control group, the pacification plan was formulated by the pacifier based on their own experience and discussion with families of the participating children. The success rate of pacification, duration of pacification, and image quality of the two groups were compare. Compared with the control group, the intervention group had a higher success rate of pacification and lower duration of pacification, with statistically significant differences (P < 0.05). There was no difference in image quality between the two groups (P > 0.05). The intelligent pacifying strategy information system can help reduce the use of the sedative drugs in children aged 3-5 years who underwent a short-duration MRI scan.
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Affiliation(s)
- Xiaofang Deng
- Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, China
| | - Deyi Zhuang
- Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, China
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, China
| | - Jungang Liu
- Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, China
| | - Cuimin Su
- Jinjiang Municipal Hospital, Jinjiang, China
| | - Xianghui Huang
- Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, China.
- Fujian Key Laboratory of Neonatal Diseases, Xiamen, China.
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Jablonska PA, Parent A, La Macchia N, Chan HH, Filleti M, Ramotar M, Cho YB, Braganza M, Badzynski A, Laperriere N, Conrad T, Tsang DS, Shultz D, Santiago A, Irish JC, Millar BA, Tadic T, Berlin A. A total inverse planning paradigm: Prospective clinical trial evaluating the performance of a novel MR-based 3D-printed head immobilization device. Clin Transl Radiat Oncol 2023; 42:100663. [PMID: 37587925 PMCID: PMC10425893 DOI: 10.1016/j.ctro.2023.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/25/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Background and purpose Brain radiotherapy (cnsRT) requires reproducible positioning and immobilization, attained through redundant dedicated imaging studies and a bespoke moulding session to create a thermoplastic mask (T-mask). Innovative approaches may improve the value of care. We prospectively deployed and assessed the performance of a patient-specific 3D-printed mask (3Dp-mask), generated solely from MR imaging, to replicate a reproducible positioning and tolerable immobilization for patients undergoing cnsRT. Material and methods Patients undergoing LINAC-based cnsRT (primary tumors or resected metastases) were enrolled into two arms: control (T-mask) and investigational (3Dp-mask). For the latter, an in-house designed 3Dp-mask was generated from MR images to recreate the head positioning during MR acquisition and allow coupling with the LINAC tabletop. Differences in inter-fraction motion were compared between both arms. Tolerability was assessed using patient-reported questionnaires at various time points. Results Between January 2020 - July 2022, forty patients were enrolled (20 per arm). All participants completed the prescribed cnsRT and study evaluations. Average 3Dp-mask design and printing completion time was 36 h:50 min (range 12 h:56 min - 42 h:01 min). Inter-fraction motion analyses showed three-axis displacements comparable to the acceptable tolerance for the current standard-of-care. No differences in patient-reported tolerability were seen at baseline. During the last week of cnsRT, 3Dp-mask resulted in significantly lower facial and cervical discomfort and patients subjectively reported less pressure and confinement sensation when compared to the T-mask. No adverse events were observed. Conclusion The proposed total inverse planning paradigm using a 3D-printed immobilization device is feasible and renders comparable inter-fraction performance while offering a better patient experience, potentially improving cnsRT workflows and its cost-effectiveness.
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Affiliation(s)
- Paola Anna Jablonska
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Department of Radiation Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Amy Parent
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Nancy La Macchia
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Harley H.L. Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Matthew Filleti
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Matthew Ramotar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Young-Bin Cho
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Maria Braganza
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Adam Badzynski
- Cancer Digital Intelligence Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Tatiana Conrad
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Derek S. Tsang
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - David Shultz
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Anna Santiago
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Jonathan C. Irish
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
- Department of Otolaryngology – Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Barbara-Ann Millar
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
| | - Tony Tadic
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, Ontario M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
- Cancer Digital Intelligence Program, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 7th Floor, Toronto, Ontario M5G 1Z5, Canada
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11
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Chen JV, Zapala MA, Zhou A, Vu N, Meyer L, Smith MD, Kelleher C, Glenn OA, Courtier J, Li Y. Factors and Labor Cost Savings Associated with Successful Pediatric Imaging without Anesthesia: a Single-Institution Study. Acad Radiol 2023; 30:1979-1988. [PMID: 36641347 DOI: 10.1016/j.acra.2022.12.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/13/2022] [Accepted: 12/25/2022] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES In pediatric imaging, sedation is often necessary to obtain diagnostic quality imaging. We aim to quantify patient and imaging-specific factors associated with successful pediatric scans without anesthesia and to evaluate labor cost savings associated with our institutional Scan Without Anesthesia Program (SWAP). MATERIALS AND METHODS Patients who participated in SWAP between 2019-2022 were identified. Chart review was conducted to obtain sociodemographic and clinical information. Radiology database was used to obtain scan duration, modality/body part of examination, and administration of contrast. Mann-Whitney U and Chi-Square tests were used for univariate analysis of factors associated with success. Multivariate logistic regression was used to evaluate independent contributions to success. Associated hospital labor cost savings were estimated using salary information obtained through publicly available resources. RESULTS Of 731 patients, 698 had successful and 33 had unsuccessful scans (95% success rate). In univariate analysis, older age, female sex, absence of developmental delay, and administration of contrast were significantly associated with successful scans. Multivariate analyses revealed that older age, female sex, and absence of developmental delay were significant independent factors lending toward success. Imaging-related factors were not associated with outcome in multivariate analysis. Estimated labor cost savings were $139,367.80 per year for the medical center. CONCLUSION SWAP had an overall success rate of 95%. Older age, absence of developmental delay, and female sex were independently significantly associated with successful outcome. Cost analysis reveals substantial labor cost savings to the institution compared with imaging under anesthesia.
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Affiliation(s)
- Joshua Vic Chen
- School of Medicine, University of California, San Francisco, CA
| | - Matthew A Zapala
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Alice Zhou
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Nola Vu
- School of Public Health, University of California, Berkeley, CA
| | - Lauren Meyer
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Mikaela Demartini Smith
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Chloe Kelleher
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Orit A Glenn
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Jesse Courtier
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628.
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12
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Alkhulaifat D, Rafful P, Khalkhali V, Welsh M, Sotardi ST. Implications of Pediatric Artificial Intelligence Challenges for Artificial Intelligence Education and Curriculum Development. J Am Coll Radiol 2023; 20:724-729. [PMID: 37352995 DOI: 10.1016/j.jacr.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 06/25/2023]
Abstract
Several radiology artificial intelligence (AI) courses are offered by a variety of institutions and educators. The major radiology societies have developed AI curricula focused on basic AI principles and practices. However, a specific AI curriculum focused on pediatric radiology is needed to offer targeted education material on AI model development and performance evaluation. There are inherent differences between pediatric and adult practice patterns, which may hinder the application of adult AI models in pediatric cohorts. Such differences include the different imaging modality utilization, imaging acquisition parameters, lower radiation doses, the rapid growth of children and changes in their body composition, and the presence of unique pathologies and diseases, which differ in prevalence from adults. Thus, to enhance radiologists' knowledge of the applications of AI models in pediatric patients, curricula should be structured keeping in mind the unique pediatric setting and its challenges, along with methods to overcome these challenges, and pediatric-specific data governance and ethical considerations. In this report, the authors highlight the salient aspects of pediatric radiology that are necessary for AI education in the pediatric setting, including the challenges for research investigation and clinical implementation.
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Affiliation(s)
- Dana Alkhulaifat
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Patricia Rafful
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vahid Khalkhali
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Welsh
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan T Sotardi
- Director, CHOP Radiology Informatics and Artificial Intelligence, Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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13
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Juvenile idiopathic arthritis of the knee: is contrast needed to score disease activity when using an augmented MRI protocol comprising PD-weighted sequences? Eur Radiol 2022; 33:3775-3784. [PMID: 36472701 PMCID: PMC10121492 DOI: 10.1007/s00330-022-09292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Objective
To compare unenhanced versus enhanced knee joint magnetic resonance imaging (MRI) to assess disease activity of juvenile idiopathic arthritis (JIA).
Methods
Fifty-three knee joint MRI examinations were performed on a 3-Tesla system in 27 patients (age: 11.40 ± 3.61 years; 21 females, 6 males). MRI protocols comprised PD-weighted sequences in addition to the widely used standard protocol. JIA subgroups comprised oligoarticular arthritis (n = 16), extended oligoarthritis (n = 6), rheumatoid factor-negative polyarticular arthritis (n = 3), enthesitis-related arthritis (n = 1), and psoriatic arthritis (n = 1). MR images were retrospectively analyzed by 3 experienced radiologists in two readings, using JAMRIS (juvenile arthritis MRI scoring) system and a modified IPSG (international prophylaxis study group) classification. In the first reading session, only unenhanced MR images were evaluated. In a second reading session, all images before and after contrast medium application were included. In order to avoid bias, an interval of at least 2 weeks was set between the two readings. The clinical JADAS10 (juvenile arthritis disease activity score) was calculated including clinical assessment and laboratory workup and correlated with MRI scores. Statistical analysis comprised Pearson’s correlation for correlating two scoring results of unenhanced and the enhanced MRI, intra-class correlation coefficient (ICC) for inter- and intra-reader agreement. Diagnostic accuracy was calculated using ROC (receiver operating characteristics) curve analysis.
Results
Inter-reader agreement determined by ICC for unenhanced and enhanced MRI scores for IPSG was moderate (0.65, 95% CI 0.51–0.76, and 0.62, 95% CI 0.48–0.75) and high for JAMRIS (0.83, 95% CI 0.75–0.89, and 0.82, 95% CI 0.74–0.89). Intra-reader agreement was good to very good for JAMRIS (0.85 95% CI 0.81–0.88, 0.87 95% CI 0.83–0.89 and 0.96 95% CI 0.92–0.98) and IPSG (0.76 95% CI 0.62–0.86, 0.86 95% CI 0.77–0.92 and 0.92 95% CI 0.86–0.96). Scores of unenhanced MRI correlated with contrast-enhanced MRI: JAMRIS (r = 0.97, R2 = 0.93, p < 0.01), modified IPSG (r = 0.95, R2 = 0.91, p < 0.01). When using JADAS10 as a reference standard, moderate accuracy for both unenhanced and enhanced MRI scores was noted: JAMRIS (AUC = 0.68, 95% CI 0.51–0.85, and AUC = 0.66, 95% 0.49–0.82), IPSG score (AUC = 0.68, 95% 0.50–0.86, and AUC = 0.61, 95% 0.41–0.81).
Conclusions
Our results suggest that contrast agent application could be omitted in JIA patients with an augmented knee MRI protocol comprising PD-weighted sequence.
Key Points
• Unenhanced MRI can detect disease activity of the knee joint in patients with JIA with equally high accuracy compared to contrast-enhanced MRI.
• The intra- and inter-reader agreement was high for unenhanced and enhanced MRI JAMRIS scores, which indicate relatively good applicability of the scoring system, even for less experienced readers.
• When using the clinical JADAS10 as a reference standard for the detection of disease activity, moderate accuracy for both unenhanced and enhanced MRI scores, both JAMRIS and IPSG, was noted, which might be caused by the fact that the majority of patients had either no or minimal clinical disease activity.
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14
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Utilization of neonatal sedation and anesthesia: an SPR survey. Pediatr Radiol 2022; 52:2630-2635. [PMID: 35767032 DOI: 10.1007/s00247-022-05423-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/18/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is little data regarding the use of sedation and anesthesia for neonatal imaging, with practice patterns varying widely across institutions. OBJECTIVE To understand the current utilization of sedation and anesthesia for neonatal imaging, and review the current literature and recommendations. MATERIALS AND METHODS One thousand, two hundred twenty-six questionnaire invitations were emailed to North American physician members of the Society for Pediatric Radiology using the Survey Monkey platform. Descriptive statistical analysis of the responses was performed. RESULTS The final results represented 59 institutions from 26 U.S. states, the District of Columbia and three Canadian provinces. Discrepant responses from institutions with multiple respondents (13 out of 59 institutions) were prevalent in multiple categories. Of the 80 total respondents, slightly more than half (56%) were associated with children's hospitals and 44% with the pediatric division of an adult radiology department. Most radiologists (70%) were cognizant of the neonatal sedation policies in their departments. A majority (89%) acknowledged awareness of neurotoxicity concerns in the literature and agreed with the validity of these concerns. In neonates undergoing magnetic resonance imaging (MRI), 46% of respondents reported attempting feed and bundle in all patients and an additional 46% attempt on a case-by-case basis, with most (35%) using a single swaddling attempt before sedation. Sedation was most often used for neonatal interventional procedures (93%) followed by MR (85%), nuclear medicine (48%) and computed tomography (31%). More than half of respondents (63%) reported an average success rate of greater than 50% when using neonatal sedation for MR. CONCLUSION Current practice patterns, policies and understanding of the use of sedation and anesthesia for neonatal imaging vary widely across institutions in North America, and even among radiologists from the same institution. Our survey highlights the need for improved awareness, education, and standardization at both the institutional level and the societal level. Awareness of the potential for anesthetic neurotoxicity and success of non-pharmacologic approaches to neonatal imaging is crucial, along with education of health care personnel, systematic approaches to quality control and improvement, and integration of evidence-based protocols into clinical practice.
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15
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Wong BJ, Lee RJ, Saragossi J, Post SG, Glaubach T. Inpatient Care Team Views on Child Life Services: A Scoping Review. Hosp Pediatr 2022; 12:e400-e415. [PMID: 36239095 DOI: 10.1542/hpeds.2022-006651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
CONTEXT The utilization of Child Life Services is influenced by interprofessional collaboration and perceptions of other members of the medical team. OBJECTIVES To summarize studies which address pediatric health care team perspectives on Child Life Services and their utilization in the hospital setting. DATA SOURCES A comprehensive literature search was conducted with controlled vocabularies and key terms in MEDLINE, Embase, CINAHL, PsycInfo, and Web of Science. STUDY SELECTION Primary studies published before November 2021 were screened using a predetermined set of inclusion and exclusion criteria. DATA CHARTING Data charting was performed by 2 independent reviewers. Data extracted include baseline study characteristics, common themes, main outcomes, strengths, and limitations. Because this is not a systematic review, data from included studies was not quantitatively analyzed, but carefully summarized in the manner of a standard scoping review. RESULTS Nine studies met criteria for inclusion. Common qualitative themes on certified child life specialists include: (1) their broad responsibilities, (2) their positive impact on patients and families, (3) challenges with interprofessional collaboration and integration, and (4) the value of educating others on their roles and responsibilities. CONCLUSIONS Medical subject headings, controlled vocabulary, or other standardized subject headings that index literature on Child Life Services is limited. However, the existing body of literature supports the positive impact certified child life specialists have on patients and families, despite challenges with complete integration into the interdisciplinary care team. Additional research is required to fully understand and overcome these challenges in continued efforts to further drive patient and family-centered care.
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Affiliation(s)
| | | | | | - Stephen G Post
- Center for Medical Humanities, Compassionate Care, and Bioethics
| | - Taly Glaubach
- Renaissance School of Medicine
- Stony Brook Children's Hospital, Stony Brook University, Stony Brook, New York
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16
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Gallo-Bernal S, Bedoya MA, Gee MS, Jaimes C. Pediatric magnetic resonance imaging: faster is better. Pediatr Radiol 2022:10.1007/s00247-022-05529-x. [PMID: 36261512 DOI: 10.1007/s00247-022-05529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) has emerged as the preferred imaging modality for evaluating a wide range of pediatric medical conditions. Nevertheless, the long acquisition times associated with this technique can limit its widespread use in young children, resulting in motion-degraded or non-diagnostic studies. As a result, sedation or general anesthesia is often necessary to obtain diagnostic images, which has implications for the safety profile of MRI, the cost of the exam and the radiology department's clinical workflow. Over the last decade, several techniques have been developed to increase the speed of MRI, including parallel imaging, single-shot acquisition, controlled aliasing techniques, compressed sensing and artificial-intelligence-based reconstructions. These are advantageous because shorter examinations decrease the need for sedation and the severity of motion artifacts, increase scanner throughput, and improve system efficiency. In this review we discuss a framework for image acceleration in children that includes the synergistic use of state-of-the-art MRI hardware and optimized pulse sequences. The discussion is framed within the context of pediatric radiology and incorporates the authors' experience in deploying these techniques in routine clinical practice.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - M Alejandra Bedoya
- Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA.
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17
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Sbaraglia F, Spinazzola G, Adduci A, Continolo N, De Riso M, Ferrone G, Festa R, Garra R, Tosi F, Rossi M. Children and neonates anesthesia in magnetic resonance environment in Italy: an active call survey. BMC Anesthesiol 2022; 22:279. [PMID: 36056321 PMCID: PMC9438255 DOI: 10.1186/s12871-022-01821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pediatric anesthesia care in the Magnetic Resonance Imaging is a challenge for clinicians. The recent debate about the role of anesthetic agent on neural development, encouraged an evaluation of their actual activity in this environment. In this active call survey, the authors sought to delineate the Italian situation regarding national centers, staff involved, monitoring tools available and sedation techniques. Methods A complete sample of all national centers performing almost a pediatric discharge in the 2014 was obtained from Health Ministry registers. All Institutions were contacted for a prospective phone investigation and a three-section survey was fill out with the Physician in charge. A descriptive and exploratory analyzes about the organization setting of the Centers were performed. Results Among 876 Institution screened, only 106 (37%) met minimal criteria for inclusion. Children are managed by anesthesiologists in the 95% of cases, while neonates in the 54%. A dedicated nurse is present in 74% of centers. While a pulse oximetry is present in 100% of centers, the rate of prevalence of other monitoring is lower. A specific MRI-compatible ventilator is available in the 95% of Centers, but many tools are not equally homogenously distributed. Pharmacological approach is preferred in pediatric age (98%), but its use for newborns is reduced to 43%. Conclusions We found significant heterogeneity in the daily clinical practice of sedation in MRI. Our results could be a starting point to evaluate the further evolution of approach to children and neonates in magnetic resonance setting. Trial registration ClinicalTrials.gov identifier: NCT04775641. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01821-3.
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Affiliation(s)
- Fabio Sbaraglia
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Giorgia Spinazzola
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Alessia Adduci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Nicola Continolo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Mariella De Riso
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Giuliano Ferrone
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Rossano Festa
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Rossella Garra
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Federica Tosi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Marco Rossi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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18
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Free-breathing magnetic resonance imaging with radial k-space sampling for neonates and infants to reduce anesthesia. Pediatr Radiol 2022; 52:1326-1337. [PMID: 35169882 DOI: 10.1007/s00247-022-05298-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/17/2021] [Accepted: 01/20/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Conventional chest and abdominal MRI require breath-holds to reduce motion artifacts. Neonates and infants require general anesthesia with intubation to enable breath-held acquisitions. OBJECTIVE We aimed to validate a free-breathing approach to reduce general anesthesia using a motion-insensitive radial acquisition with respiratory gating. MATERIALS AND METHODS We retrospectively enrolled children <3 years old who were referred for MRI of the chest or abdomen. They were divided into two groups according to MRI protocol: (1) breath-held scans under general anesthesia with T2-weighted single-shot fast spin-echo (SSFSE) and contrast-enhanced T1-weighted modified Dixon, and (2) free-breathing scans using radial sequences (T2-W MultiVane XD and contrast-enhanced T1-W three-dimensional [3-D] Vane XD). Two readers graded image quality and motion artifacts. RESULTS We included 23 studies in the free-breathing cohort and 22 in the breath-hold cohort. The overall imaging scores for the free-breathing radial T2-W sequence were similar to the scores for the breath-held T2-W SSFSE sequence (chest, 3.6 vs. 3.2, P=0.07; abdomen, 3.9 vs. 3.7, P=0.66). The free-breathing 3-D radial T1-W sequence also had image quality scores that were similar to the breath-held T1-W sequence (chest, 4.0 vs. 3.0, P=0.06; abdomen, 3.7 vs. 3.9, P=0.15). Increased motion was seen in the abdomen on the radial T2-W sequence (P<0.001), but increased motion was not different in the chest (P=0.73) or in contrast-enhanced T1-W sequences (chest, P=0.39; abdomen, P=0.15). The mean total sequence time was longer in free-breathing compared to breath-held exams (P<0.01); however, this did not translate to longer overall exam times (P=0.94). CONCLUSION Motion-insensitive radial sequences used for infants and neonates were of similar image quality to breath-held sequences and had decreased sedation and intubation.
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19
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Let's Play the fMRI-Advantages of Gamified Paradigm in Examining the Motor Cortex of Young Children. J Clin Med 2022; 11:jcm11102929. [PMID: 35629053 PMCID: PMC9145096 DOI: 10.3390/jcm11102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Performing functional magnetic resonance imaging (fMRI) examination is difficult when a child needs to stay awake and cooperate. Many techniques help to prepare them for the study but without modification of the examination protocol. The objective of this research was to prepare a gamified motor paradigm (“computer game”) that will improve the fMRI examination of young children. Methods: After preparing a dedicated application the fMRI examination was performed on 60 healthy children (10 girls and 10 boys in each age group of 4, 5, and 6 years old). Each child performed the gamified and a standard motor paradigm, both based on squeezing a rubber bulb. The effectiveness of squeezing were compared. Results: With the application of the gamified paradigm children completed significantly more active blocks (3.3 ± 1.4) than for the standard paradigm (2.2 ± 1.6) (p < 0.0001). In mixed-effects Poisson regression, age (IRR = 1.9; 95%CI: 1.5−2.5) and application of gamified paradigm (IRR = 5.6; 95%CI: 1.1−28.0) were significantly associated with more completed blocks. Conclusions: The gamified motor paradigm performed better than a standard paradigm in the fMRI examination of children between 4 and 6 years old. It allowed a significant increase in the number of completed active blocks and also better squeezing effectiveness in each block.
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20
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Conklin J, Tabari A, Longo MGF, Cobos CJ, Setsompop K, Cauley SF, Kirsch JE, Huang SY, Rapalino O, Gee MS, Caruso PJ. Evaluation of highly accelerated wave controlled aliasing in parallel imaging (Wave-CAIPI) susceptibility-weighted imaging in the non-sedated pediatric setting: a pilot study. Pediatr Radiol 2022; 52:1115-1124. [PMID: 35119490 DOI: 10.1007/s00247-021-05273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Susceptibility-weighted imaging (SWI) is highly sensitive for intracranial hemorrhagic and mineralized lesions but is associated with long scan times. Wave controlled aliasing in parallel imaging (Wave-CAIPI) enables greater acceleration factors and might facilitate broader application of SWI, especially in motion-prone populations. OBJECTIVE To compare highly accelerated Wave-CAIPI SWI to standard SWI in the non-sedated pediatric outpatient setting, with respect to the following variables: estimated scan time, image noise, artifacts, visualization of normal anatomy and visualization of pathology. MATERIALS AND METHODS Twenty-eight children (11 girls, 17 boys; mean age ± standard deviation [SD] = 128.3±62 months) underwent 3-tesla (T) brain MRI, including standard three-dimensional (3-D) SWI sequence followed by a highly accelerated Wave-CAIPI SWI sequence for each subject. We rated all studies using a predefined 5-point scale and used the Wilcoxon signed rank test to assess the difference for each variable between sequences. RESULTS Wave-CAIPI SWI provided a 78% and 67% reduction in estimated scan time using the 32- and 20-channel coils, respectively, corresponding to estimated scan time reductions of 3.5 min and 3 min, respectively. All 28 children were imaged without anesthesia. Inter-reader agreement ranged from fair to substantial (k=0.67 for evaluation of pathology, 0.55 for anatomical contrast, 0.3 for central noise, and 0.71 for artifacts). Image noise was rated higher in the central brain with wave SWI (P<0.01), but not in the peripheral brain. There was no significant difference in the visualization of normal anatomical structures and visualization of pathology between the standard and wave SWI sequences (P=0.77 and P=0.79, respectively). CONCLUSION Highly accelerated Wave-CAIPI SWI of the brain can provide similar image quality to standard SWI, with estimated scan time reduction of 3-3.5 min depending on the radiofrequency coil used, with fewer motion artifacts, at a cost of mild but perceptibly increased noise in the central brain.
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Affiliation(s)
- John Conklin
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Azadeh Tabari
- Harvard Medical School, Boston, MA, USA. .,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Maria Gabriela Figueiro Longo
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes Cobos
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Kawin Setsompop
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Stephen F Cauley
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - John E Kirsch
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Susie Yi Huang
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Otto Rapalino
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Paul J Caruso
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
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21
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Moore MM, Gee MS, Iyer RS, Chan SS, Ayers TD, Bardo DME, Chandra T, Cooper ML, Dotson JL, Gadepalli SK, Gill AE, Levin TL, Nadel HR, Schooler GR, Shet NS, Squires JH, Trout AT, Wall JJ, Rigsby CK. ACR Appropriateness Criteria® Crohn Disease-Child. J Am Coll Radiol 2022; 19:S19-S36. [PMID: 35550801 DOI: 10.1016/j.jacr.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Crohn disease is an inflammatory condition of the gastrointestinal tract with episodes of exacerbation and remission occurring in children, adolescents, and adults. Crohn disease diagnosis and treatment depend upon a combination of clinical, laboratory, endoscopic, histological, and imaging findings. Appropriate use of imaging provides critical information in the settings of diagnosis, assessment of acute symptoms, disease surveillance, and therapy monitoring. Four variants are discussed. The first variant discusses the initial imaging for suspected Crohn disease before established diagnosis. The second variant pertains to appropriateness of imaging modalities during suspected acute exacerbation. The third variant is a substantial discussion of recommendations related to disease surveillance and monitoring of Crohn disease. Finally, panel recommendations and discussion of perianal fistulizing disease imaging completes the document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Michael M Moore
- Co-Director, Division of Radiology Innovation and Value Enhancement, Penn State Health Children's Hospital, Hershey, Pennsylvania.
| | - Michael S Gee
- Research Author, Deputy Chair of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Travis D Ayers
- Medical Director of Inflammatory Bowel Disease, Arkansas Children's Hospital, Little Rock, Arkansas; North American Society for Pediatric Gastroenterology, Hepatology & Nutrition
| | - Dianna M E Bardo
- Vice Chair of Radiology-Quality & Safety, Phoenix Children's Hospital, Phoenix, Arizona
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-Director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Matthew L Cooper
- Pediatric Radiology Division Chief and Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - Jennifer L Dotson
- Co-Director of the Center for Pediatric and Adolescent IBD, Nationwide Children's Hospital, Columbus, Ohio; American Academy of Pediatrics
| | - Samir K Gadepalli
- Surgical Director for Pediatric IBD, Director of Clinical Research for Pediatric Surgery, and Associate Program Director for Pediatric Surgery Fellowship, University of Michigan, Ann Arbor, Michigan; American Pediatric Surgical Association
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | | | - Narendra S Shet
- Children's National Hospital, Washington, District of Columbia
| | - Judy H Squires
- Chief of Ultrasound and Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew T Trout
- Director of Clinical Research for Radiology and Director of Nuclear Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Vice-Chair-JRCNMT
| | - Jessica J Wall
- Associate Medical Director of Pediatric Transport, UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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22
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Xu L, Herrington J, Cahill K, Risacher S, Gee MS. Strategies to optimize a pediatric magnetic resonance imaging service. Pediatr Radiol 2022; 52:152-157. [PMID: 33856504 PMCID: PMC8047568 DOI: 10.1007/s00247-021-05059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
A pediatric MRI service is a vital component of a successful radiology department. Building an efficient and effective pediatric MRI service is a multifaceted process that requires detailed planning for considerations related to finance, operations, quality and safety, and process improvement. These are compounded by the unique challenges of caring for pediatric patients, particularly in the setting of the recent coronavirus disease 2019 (COVID-19) pandemic. In addition to material resources, a successful pediatric MRI service depends on a collaborative team consisting of radiologists, physicists, technologists, nurses and vendor specialists, among others, to identify and resolve challenges and to strive for continued improvement. This article provides an overview of the factors involved in both starting and optimizing a pediatric MRI service, including commonly encountered obstacles and some proposed solutions to address them.
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Affiliation(s)
- Limin Xu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA
| | - Jeremy Herrington
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA
| | - Kellie Cahill
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA
| | - Seretha Risacher
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
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23
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Harrington SG, Jaimes C, Weagle KM, Greer MLC, Gee MS. Strategies to perform magnetic resonance imaging in infants and young children without sedation. Pediatr Radiol 2022; 52:374-381. [PMID: 33830290 PMCID: PMC8027290 DOI: 10.1007/s00247-021-05062-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/25/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
Given the increasing use of MRI in the pediatric population, the need for sedation in MRI performed in young children is a topic of growing importance. Although sedation is generally tolerated well by children, the financial and operational impacts of anesthesia on MRI workflow, as well as potential adverse effects of anesthetic medications, highlight the need to perform MRI in children without sedation whenever possible. This review focuses on current techniques to facilitate non-sedation MRI in children, including exam preparation with MRI simulation; asleep but not sedated techniques; awake and relaxed techniques using certified child life specialists, animal-assisted therapy, a child-friendly environment and in-scan entertainment; and non-sedated MRI protocol modifications such as shorter scan time, prioritizing sequences, reducing motion artifact, noise reduction, limiting use of gadolinium, employing an open MRI and modifying protocols.
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Affiliation(s)
- Samantha G Harrington
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | | | - Kathryn M Weagle
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
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24
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Bardo DME, Rubert N. Radial sequences and compressed sensing in pediatric body magnetic resonance imaging. Pediatr Radiol 2022; 52:382-390. [PMID: 34009408 DOI: 10.1007/s00247-021-05097-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 12/28/2022]
Abstract
Magnetic resonance imaging (MRI) is often an ideal imaging modality for children of any age for any anatomy and for many pathologies. MRI sequences can be prescribed to produce high-resolution images of anatomical structures, characterize tissue composition, and detect physiological states and organ function. Shortening imaging sequences in any manner possible has been a topic of research and development in MRI since its emergence. Selection of imaging sequence parameters influences more than just the appearance and signal qualities of the imaged tissues; these details along with spatial encoding and data readout steps determine the time it takes to acquire an image. As each piece of image data is acquired and encoded with spatial and temporal information it is stored in k-space. As k-space is filled, either completely or partially, a diagnostic image or physiological data can be reconstructed. Shortening the length of time required for the readout step by efficiently filling k-space using compressed sensing and radial techniques is the subject of this manuscript.
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Affiliation(s)
- Dianna M E Bardo
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
| | - Nicholas Rubert
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
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25
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Goetstouwers S, Kempink D, The B, Eygendaal D, van Oirschot B, van Bergen CJA. Three-dimensional printing in paediatric orthopaedic surgery. World J Orthop 2022; 13:1-10. [PMID: 35096533 PMCID: PMC8771415 DOI: 10.5312/wjo.v13.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/29/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional (3D) printing is a rapidly evolving and promising field to improve outcomes of orthopaedic surgery. The use of patient-specific 3D-printed models is specifically interesting in paediatric orthopaedic surgery, as limb deformity corrections often require an individual 3D treatment. In this editorial, various operative applications of 3D printing in paediatric orthopaedic surgery are discussed. The technical aspects and the imaging acquisition with computed tomography and magnetic resonance imaging are outlined. Next, there is a focus on the intraoperative applications of 3D printing during paediatric orthopaedic surgical procedures. An overview of various upper and lower limb deformities in paediatrics is given, in which 3D printing is already implemented, including post-traumatic forearm corrections and proximal femoral osteotomies. The use of patient-specific instrumentation (PSI) or guiding templates during the surgical procedure shows to be promising in reducing operation time, intraoperative haemorrhage and radiation exposure. Moreover, 3D-printed models for the use of PSI or patient-specific navigation templates are promising in improving the accuracy of complex limb deformity surgery in children. Lastly, the future of 3D printing in paediatric orthopaedics extends beyond the intraoperative applications; various other medical applications include 3D casting and prosthetic limb replacement. In conclusion, 3D printing opportunities are numerous, and the fast developments are exciting, but more evidence is required to prove its superiority over conventional paediatric orthopaedic surgery.
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Affiliation(s)
- Sven Goetstouwers
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam 3015GD, South-Holland, Netherlands
| | - Dagmar Kempink
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam 3015GD, South-Holland, Netherlands
| | - Bertram The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda 4818CK, North-Brabant, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam 3015GD, South-Holland, Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda 4818CK, North-Brabant, Netherlands
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26
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Henry D, Fulton R, Maclaren J, Aksoy M, Bammer R, Kyme A. Optimizing a Feature-Based Motion Tracking System for Prospective Head Motion Estimation in MRI and PET/MRI. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2022. [DOI: 10.1109/trpms.2021.3063260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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27
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Callahan MJ, Cravero JP. Should I irradiate with computed tomography or sedate for magnetic resonance imaging? Pediatr Radiol 2022; 52:340-344. [PMID: 33710404 PMCID: PMC7952501 DOI: 10.1007/s00247-021-04984-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/03/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
In the context of pediatric cross-sectional imaging, the risk of ionizing radiation for CT and the potential adverse effects associated with sedation/anesthesia for MRI continue to provoke lively discussions in the pediatric literature and lay press. This is particularly true for issues relating to the risks of ionizing radiation for CT, which has been a topic of discussion for nearly two decades. In addition to understanding these potential risks and the importance of minimizing individual pediatric patient exposure to ionizing radiation, it is equally important for radiologists to be able to frame these risks with respect to the potential for adverse outcomes associated with the use of anesthesia for cross-sectional imaging in the pediatric population. Notably, before such risks can be estimated and compared, one should always consider the potential utility of each imaging modality for a given diagnosis. If one cross-sectional imaging modality is likely to be far superior to the other for a specific clinical question, every effort must be made to safely image the child, even if sedation/anesthesia is required.
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Affiliation(s)
- Michael J Callahan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Joseph P Cravero
- Department of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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28
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Kafali SG, Armstrong T, Shih SF, Kim GJ, Holtrop JL, Venick RS, Ghahremani S, Bolster BD, Hillenbrand CM, Calkins KL, Wu HH. Free-breathing radial magnetic resonance elastography of the liver in children at 3 T: a pilot study. Pediatr Radiol 2022; 52:1314-1325. [PMID: 35366073 PMCID: PMC9192470 DOI: 10.1007/s00247-022-05297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic resonance (MR) elastography of the liver measures hepatic stiffness, which correlates with the histopathological staging of liver fibrosis. Conventional Cartesian gradient-echo (GRE) MR elastography requires breath-holding, which is challenging for children. Non-Cartesian radial free-breathing MR elastography is a potential solution to this problem. OBJECTIVE To investigate radial free-breathing MR elastography for measuring hepatic stiffness in children. MATERIALS AND METHODS In this prospective pilot study, 14 healthy children and 9 children with liver disease were scanned at 3 T using 2-D Cartesian GRE breath-hold MR elastography (22 s/slice) and 2-D radial GRE free-breathing MR elastography (163 s/slice). Each sequence was acquired twice. Agreement in the stiffness measurements was evaluated using Lin's concordance correlation coefficient (CCC) and within-subject mean difference. The repeatability was assessed using the within-subject coefficient of variation and intraclass correlation coefficient (ICC). RESULTS Fourteen healthy children and seven children with liver disease completed the study. Median (±interquartile range) normalized measurable liver areas were 62.6% (±26.4%) and 44.1% (±39.6%) for scan 1, and 60.3% (±21.8%) and 43.9% (±44.2%) for scan 2, for Cartesian and radial techniques, respectively. Hepatic stiffness from the Cartesian and radial techniques had close agreement with CCC of 0.89 and 0.94, and mean difference of 0.03 kPa and -0.01 kPa, for scans 1 and 2. Cartesian and radial techniques achieved similar repeatability with within-subject coefficient of variation=1.9% and 3.4%, and ICC=0.93 and 0.92, respectively. CONCLUSION In this pilot study, radial free-breathing MR elastography was repeatable and in agreement with Cartesian breath-hold MR elastography in children.
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Affiliation(s)
- Sevgi Gokce Kafali
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Tess Armstrong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Grace J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Joseph L. Holtrop
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Robert S. Venick
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Shahnaz Ghahremani
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | | | - Claudia M. Hillenbrand
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA ,Research Imaging NSW, University of New South Wales, Sydney, Australia
| | - Kara L. Calkins
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Holden H. Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
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29
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Comparison of ultrafast wave-controlled aliasing in parallel imaging (CAIPI) magnetization-prepared rapid acquisition gradient echo (MP-RAGE) and standard MP-RAGE in non-sedated children: initial clinical experience. Pediatr Radiol 2021; 51:2009-2017. [PMID: 34268599 DOI: 10.1007/s00247-021-05117-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/21/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fast magnetic resonance imaging (MRI) sequences are advantageous in pediatric imaging as they can lessen child discomfort, decrease motion artifact and improve scanner availability. OBJECTIVE To evaluate the feasibility of an ultrafast wave-CAIPI (controlled aliasing in parallel imaging) MP-RAGE (magnetization-prepared rapid gradient echo) sequence for brain imaging of awake pediatric patients. MATERIALS AND METHODS Each MRI included a standard MP-RAGE sequence and an ultrafast wave-MP-RAGE sequence. Two neuroradiologists evaluated both sequences in terms of artifacts, noise, anatomical contrast and pathological contrast. A predefined 5-point scale was used by two independent pediatric neuroradiologists. A Wilcoxon signed-rank test was used to evaluate the difference between sequences for each variable. RESULTS Twenty-four patients (14 males; mean age: 11.5±4.5 years, range: 1 month to 17.8 years) were included. Wave-CAIPI MP-RAGE provided a 77% reduction in scan time using a 32-channel coil and a 70% reduction using a 20-channel coil. Visualization of the pathology, artifacts and pathological enhancement (including parenchymal, leptomeningeal and dural enhancement) was not significantly different between standard MP-RAGE and wave-CAIPI MP-RAGE (all P>0.05). For central (P<0.001) and peripheral (P<0.001) noise, and the evaluation of the anatomical structures (P<0.001), the observers favored standard MP-RAGE over wave-CAIPI MP-RAGE. CONCLUSION Ultrafast brain imaging with wave-CAIPI MP-RAGE is feasible in awake pediatric patients, providing a substantial reduction in scan time at a cost of subjectively increased image noise.
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30
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Kurokawa T, Iba K, Hanaka M, Teramoto A, Emori M, Hayakawa H, Saito A, Takashima K, Yamashita T. Surgical Procedures Based on the Arthrographic Findings of the Fifth MTP Joint With Proximal Phalanx Duplication in Postaxial Polydactyly of the Foot. J Foot Ankle Surg 2021; 60:983-989. [PMID: 34006434 DOI: 10.1053/j.jfas.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023]
Abstract
Radiographic findings in several atypical cases of postaxial polydactyly of the foot do not provide sufficient information to assess the cartilaginous structures or duplicated digit connections at the MTP joint. The purpose of this study was to demonstrate the surgical procedures using arthrography for the cartilaginous structures of the MTP joint in postaxial polydactyly of the foot. We performed arthrography in 7 feet of 7 patients with postaxial polydactyly of the foot in which duplication of the proximal phalanx was observed at the fifth MTP joint on the basis of radiographic evaluation. The average age at surgery was 13.5 months and average duration of postsurgical follow-up was 36 months. Individual surgical procedures were confirmed or modified during the operation by reference to the arthrographic findings. Radiographic and arthrographic findings were assessed in relation to the findings from direct observation of the cartilaginous structures at surgery. Postoperative malalignment, functional disturbance and pain in the reconstructed toe were evaluated. The arthrographic findings provided different forms of cartilaginous structures that could be categorized in 4 types, and reflected the cartilaginous connection visualized at surgery that could not be detected on radiographs in each case. No cases revealed any deformities, functional disturbance, or pain in the reconstructed toe after surgery. The parents' evaluation in each case was "very satisfied" or "satisfied." The arthrographic findings provided additional information regarding variations in the cartilaginous structures of the fifth MTP joint and for determining individual surgical procedure for postaxial polydactyly of the foot.
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Affiliation(s)
- Takafumi Kurokawa
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Megumi Hanaka
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hikaru Hayakawa
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akira Saito
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kenichi Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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31
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Dillman JR, Gee MS, Ward CG, Drum ET, States LJ. Imaging sedation and anesthesia practice patterns in pediatric radiology departments - a survey of the Society of Chiefs of Radiology at Children's Hospitals (SCORCH). Pediatr Radiol 2021; 51:1497-1502. [PMID: 33606058 DOI: 10.1007/s00247-021-04996-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are few data describing practice patterns related to the use of sedation/anesthesia for diagnostic imaging in pediatric radiology departments. OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION Imaging sedation/anesthesia practice patterns vary among pediatric radiology departments, and understanding current approaches can help with standardization and practice improvement.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher G Ward
- Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth T Drum
- Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Jaimes C, Biaggotti D, Sreedher G, Chaturvedi A, Moore MM, Danehy AR. Magnetic resonance imaging in children with implants. Pediatr Radiol 2021; 51:748-759. [PMID: 33871727 DOI: 10.1007/s00247-021-04965-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/21/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022]
Abstract
As access to MRI in pediatrics increases, the radiologist needs to become acquainted with the basic principles of MRI safety. As part of the image acquisition, the static magnetic field, gradient system, and the radiofrequency transmit-receive coil interact with medical and non-medical implants and can result in serious injury. The main stage of risk triage is based on the determination of whether the implant is MRI-safe, conditional, unsafe or unknown. Guiding principles include the strict adherence to manufacturer specifications for MRI-conditional implants and the assumption that an unknown implant is MR-unsafe. In this article we review considerations for common medical implants encountered in pediatrics including ventriculoperitoneal shunts, orthopedic hardware, orthodontic hardware, pacemakers, vascular stents, vagal nerve stimulators and cochlear implants. Finally, we review a set of high-yield considerations, including the non-communicative patient (sedated or non-verbal), susceptibility artifacts from unclear source, and the approach to an unknown implant.
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Affiliation(s)
- Camilo Jaimes
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA.
| | - Diane Biaggotti
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | | | - Apeksha Chaturvedi
- Pediatric Radiology, University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Michael M Moore
- Pediatric Radiology, Milton S. Hershey Medical Center, Penn State University, Hershey, PA, USA
| | - Amy R Danehy
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA.,MRI Safety Committee, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Sreedher G, Ho ML, Smith M, Udayasankar UK, Risacher S, Rapalino O, Greer MLC, Doria AS, Gee MS. Magnetic resonance imaging quality control, quality assurance and quality improvement. Pediatr Radiol 2021; 51:698-708. [PMID: 33772641 DOI: 10.1007/s00247-021-05043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/22/2021] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
Quality in MR imaging is a comprehensive process that encompasses scanner performance, clinical processes for efficient scanning and reporting, as well as data-driven improvement involving measurement of key performance indicators. In this paper, the authors review this entire process. This article provides a framework for establishing a successful MR quality program. The collective experiences of the authors across a spectrum of pediatric hospitals is summarized here.
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Affiliation(s)
- Gayathri Sreedher
- Department of Radiology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Unni K Udayasankar
- Department of Medical Imaging, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Seretha Risacher
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Otto Rapalino
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
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Vriesman MH, de Jonge CS, Kuizenga-Wessel S, Adler B, Menys A, Nederveen AJ, Stoker J, Benninga MA, Di Lorenzo C. Simultaneous assessment of colon motility in children with functional constipation by cine-MRI and colonic manometry: a feasibility study. Eur Radiol Exp 2021; 5:8. [PMID: 33565002 PMCID: PMC7873179 DOI: 10.1186/s41747-021-00205-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/19/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Colonic manometry is the current reference standard for assessing colonic neuromuscular function in children with intractable functional constipation (FC). Recently, cine magnetic resonance imaging (cine-MRI) has been proposed as a non-invasive alternative. We compared colonic motility patterns on cine-MRI with those obtained by manometry in children, by stimulating high-amplitude propagating contractions (HAPCs) with bisacodyl under manometric control while simultaneously acquiring cine-MRI. METHODS After Institutional Review Board approval, adolescents with FC scheduled to undergo colonic manometry were included. A water-perfused 8-lumen catheter was used for colonic manometry recordings. After an intraluminal bisacodyl infusion, cine-MRI sequences of the descending colon were acquired for about 30 min simultaneously with colonic manometry. Manometry recordings were analysed for HAPCs. MRI images were processed with spatiotemporal motility MRI techniques. The anonymised motility results of both techniques were visually compared for the identification of HAPCs in the descending colon. RESULTS Data regarding six patients (three males) were analysed (median age 14 years, range 12-17). After bisacodyl infusion, three patients showed a total of eleven HAPCs with colonic manometry. Corresponding cine-MRI recorded high colonic activity during two of these HAPCs, minimal activity during seven HAPCs, while two HAPCs were not recorded. In two of three patients with absent HAPCs on manometry, colonic activity was recorded with cine-MRI. CONCLUSIONS Simultaneous acquisition of colonic cine-MRI and manometry in children with FC is feasible. Their motility results did not completely overlap in the identification of HAPCs. Research is needed to unravel the role of cine-MRI in this setting.
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Affiliation(s)
- M H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - C S de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - S Kuizenga-Wessel
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Adler
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
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Abstract
BACKGROUND. Anesthetic exposure in children may impact long-term neurocognitive outcomes. Therefore, minimizing pediatric MRI scan time in children under anesthesia and the associated anesthetic exposure is necessary. OBJECTIVE. The purpose of this study was to evaluate pediatric MRI scan time as a predictor of total propofol dose, considering imaging and clinical characteristics as covariates. METHODS. Electronic health records were retrospectively searched to identify MRI examinations performed from 2016 to 2019 in patients 0-18 years old who received propofol anesthetic. Brain; brain and spine; brain and abdomen; and brain, head, and neck MRI examinations were included. Demographic, clinical, and imaging data were extracted for each examination, including anesthesia maintenance phase time, MRI scan time, and normalized propofol dose. MRI scan time and propofol dose were compared between groups using a t test. A multiple linear regression with backward selection (threshold, p < .05) was used to evaluate MRI scan time as a predictor of total propofol dose, adjusting for sex, age, time between scan and study end, body part, American Society of Anesthesiologists (ASA) classification, diagnosis, magnet strength, and IV contrast medium administration as covariates. RESULTS. A total of 501 examinations performed in 426 patients (172 girls, 254 boys; mean age, 6.55 ± 4.59 [SD] years) were included. Single body part examinations were shorter than multiple body part examinations (mean, 52.7 ± 18.4 vs 89.3 ± 26.4 minutes) and required less propofol (mean, 17.7 ± 5.7 vs 26.1 ± 7.7 mg/kg; all p < .001). Among single body part examinations, a higher ASA classification, oncologic diagnosis, 1.5-T magnet, and IV contrast medium administration were associated with longer MRI scan times (all p ≤ .009) and higher propofol exposure (all p ≤ .005). In multivariable analysis, greater propofol exposure was predicted by MRI scan time (mean dose per minute of examination, 0.178 mg/kg; 95% CI, 0.155-0.200; p < .001), multiple body part examination (p = .04), and IV contrast medium administration (p = .048); lower exposure was predicted by 3-T magnet (p = .04). CONCLUSION. Anesthetic exposure during pediatric MRI can be quantified and predicted based on imaging and clinical variables. CLINICAL IMPACT. This study serves as a valuable baseline for future efforts to reduce anesthetic doses and scan times in pediatric MRI.
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Wittenberg BM, Barnhart D. How are Certified Child Life Specialists perceived by healthcare professionals?: A call for interprofessional collaboration. J Interprof Care 2021:1-9. [PMID: 33472459 DOI: 10.1080/13561820.2020.1856053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
Certified child life specialists (CCLS) depend on collaboration with healthcare professionals for awareness of patient needs; however, historically other healthcare professionals misunderstand the CCLS role. The purpose of this study was to examine how healthcare professionals perceived the CCLS role and provide implications on the contribution of the CCLS to interprofessional collaboration (IPC). This study was a partial replication of two previous survey studies. Participants (N = 67) consisted of 26 child life and 42 other healthcare professionals who were employed at one freestanding children's hospital in the southern United States. Qualitative analyses revealed CCLS responsibilities could be explained with seven categories. Child life professionals were more likely to report CCLS responsibilities as providing patient support and family support and documenting psychosocial assessment and interventions in the medical record than other healthcare professionals. Child life and other healthcare professionals are mostly aligned in their perception of the CCLS role, specifically patient education, play, and normalization and development. Previous misconceptions about the CCLS role may be diminishing among other healthcare professionals; however, continued education about the CCLS role and communication with CCLSs would likely promote IPC.
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Affiliation(s)
| | - Dorothy Barnhart
- Child Life and Expressive Therapies Department, Children's Memorial Hermann Hospital, Houston, TX, USA
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Sotardi ST, Degnan AJ, Liu CA, Mecca PL, Serai SD, Smock RD, Victoria T, White AM. Establishing a magnetic resonance safety program. Pediatr Radiol 2021; 51:709-715. [PMID: 33871724 PMCID: PMC8054505 DOI: 10.1007/s00247-020-04910-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/03/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
Establishing a magnetic resonance (MR) safety program is crucial to ensuring the safe MR imaging of pediatric patients. The organizational structure includes a core safety council and broader safety committee comprising all key stakeholders. These groups work in synchrony to establish a strong culture of safety; create and maintain policies and procedures; implement device regulations for entry into the MR setting; construct MR safety zones; address intraoperative MR concerns; guarantee safe scanning parameters, including complying with specific absorption rate limitations; adhere to national regulatory body guidelines; and ensure appropriate communication among all parties in the MR environment. Perspectives on the duties of the safety council members provide important insight into the organization of program oversite. Ultimately, the collective dedication and vigilance of all MR staff are crucial to the success of a safety program.
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Affiliation(s)
- Susan T. Sotardi
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Andrew J. Degnan
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Chang Amber Liu
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA USA
| | - Patricia L. Mecca
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Suraj D. Serai
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - R. Daniel Smock
- Department of Radiology, Children’s Mercy Hospital, Kansas City, MO USA
| | - Teresa Victoria
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Ammie M. White
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
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Motion-corrected cardiac MRI is associated with decreased anesthesia exposure in children. Pediatr Radiol 2020; 50:1709-1716. [PMID: 32696111 PMCID: PMC8351617 DOI: 10.1007/s00247-020-04766-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/20/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The benefits of cardiac magnetic resonance imaging (MRI) in the pediatric population must be balanced with the risk and cost of anesthesia. Segmented imaging using multiple averages attempts to avoid breath-holds requiring general anesthesia; however, cardiorespiratory artifacts and prolonged scan times limit its use. Thus, breath-held imaging with general anesthesia is used in many pediatric centers. The advent of free-breathing, motion-corrected (MOCO) cines by real-time re-binned reconstruction offers reduced anesthesia exposure without compromising image quality. OBJECTIVE This study evaluates sedation utilization in our pediatric cardiac MR practice before and after clinical introduction of free-breathing MOCO imaging for cine and late gadolinium enhancement. MATERIALS AND METHODS In a retrospective study, patients referred for a clinical cardiac MR who would typically be offered sedation for their scan (n=295) were identified and divided into two eras, those scanned before the introduction of MOCO cine and late gadolinium enhancement sequences and those scanned following their introduction. Anesthesia use was compared across eras and disease-specific cohorts. RESULTS The incidence of non-sedation studies performed in children nearly tripled following the introduction of MOCO imaging (25% [pre-MOCO] to 69% [post-MOCO], P<0.01), with the greatest effect in patients with simple congenital heart disease. Eleven percent of the post-MOCO cohort comprised infants younger than 3 months of age who could forgo sedation with the combination of MOCO imaging and a "feed-and-bundle" positioning technique. CONCLUSION Implementation of cardiac MR with MOCO cine and late gadolinium enhancement imaging in a pediatric population is associated with significantly decreased sedation utilization.
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Kozak MF, Shariat M, Leiroz Ferreira Botelho Maisano Kozak AC, O'Connor Reyes RO, Caldas Pessoa Y, Oliveira Castro e Silva Sobral L, Afiune JY. Does sedation influence cardiac magnetic resonance duration for children? Clin Imaging 2020; 67:246-249. [DOI: 10.1016/j.clinimag.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022]
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The role of child life in pediatric radiology. Pediatr Radiol 2020; 50:1509-1513. [PMID: 32935242 DOI: 10.1007/s00247-020-04795-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
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.
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Mojtahed A, Gee MS, Yokoo T. Pearls and Pitfalls of Metabolic Liver Magnetic Resonance Imaging in the Pediatric Population. Semin Ultrasound CT MR 2020; 41:451-461. [DOI: 10.1053/j.sult.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Harrington SG, Johnson MK, Greer MLC, Gee MS. Pearls and Pitfalls in MR Enterography Interpretation for Pediatric Patients. Semin Ultrasound CT MR 2020; 41:462-471. [DOI: 10.1053/j.sult.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Whole-Body MRI Surveillance of Cancer Predisposition Syndromes: Current Best Practice Guidelines for Use, Performance, and Interpretation. AJR Am J Roentgenol 2020; 215:1002-1011. [PMID: 32809862 DOI: 10.2214/ajr.19.22399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE. Whole-body MRI is a valuable tool in the surveillance of cancer predisposition syndromes (CPSs). Because it allows wide-FOV imaging without ionizing radiation, whole-body MRI is ideal in pediatric patients, enabling efficient assessment of different organ systems for multifocal disease. This article summarizes the use of whole-body MRI in pediatric patients with CPSs for earlier detection of malignancy, provides evidence where available, and offers guidance where lacking because of the rarity of CPSs. Protocol modifications and technique performance in specific CPSs are also considered. CONCLUSION. Whole-body MRI is the preferred imaging modality for surveillance of pediatric patients with CPSs, and the growing literature supports its importance in presymptomatic cancer detection.
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Abstract
BACKGROUND. MRI use and the need for monitored anesthesia care (MAC) in children have increased. However, MAC is associated with examination delays, increased cost, and safety concerns. OBJECTIVE. The purpose of this study was to evaluate the success rate of nonsedated neuroradiologic MRI studies in children 1-7 years old and to investigate factors associated with success. METHODS. We retrospectively reviewed data from our institutional nonsedated MRI program. Inclusion criteria were outpatient nonsedated MRI referral, age 1-7 years old, and neuroradiologic indication. Exclusion criteria were MRI examinations for ventricular checks and contrast material use. Success was determined by reviewing the clinical MRI report. We recorded patient age and sex, type of MRI examination (brain, spine, craniospinal, head and neck, and brain with MRA), protocol length, presence of child life specialist, video goggle use, and MRI appointment time (routine daytime appointment or evening appointment). We used descriptive statistics to summarize patient demographics and clinical data and logistic regression models to evaluate predictors of success in the entire sample. Subset analyses were performed for children from 1 to < 3 years old and 3 to 7 years old. RESULTS. We analyzed 217 patients who underwent nonsedated MRI examinations (median age, 5.1 years). Overall success rate was 82.0% (n = 178). The success rates were 81.4% (n = 127) for brain, 90.3% (n = 28) for spine, 71.4% (n = 10) for craniospinal, 66.7% (n = 6) for head and neck, and 100% (n = 7) for brain with MRA. Age was significantly associated with success (odds ratio [OR], 1.33; p = .009). In children 1 to < 3 years old, none of the factors analyzed were significant predictors of success (all, p > .48). In children 3-7 years old, protocol duration (OR, 0.96; 95% CI, 0.93-0.99; p = .02) and video goggle use (OR, 6.38; 95% CI, 2.16-18.84; p = .001) were significantly associated with success. CONCLUSION. A multidisciplinary approach with age-appropriate resources enables a high success rate for nonsedated neuroradiologic MRI in children 1-7 years old. CLINICAL IMPACT. Using age as the primary criterion to determine the need for MAC may lead to overuse of these services. Dissemination of information regarding nonsedated MRI practice could reduce the rate of sedated MRI in young children.
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Abdominal Applications of Pediatric Body MR Angiography: Tailored Optimization for Successful Outcome. AJR Am J Roentgenol 2020; 215:206-214. [PMID: 32374667 DOI: 10.2214/ajr.19.22289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to summarize current common techniques and indications for pediatric abdominopelvic MR angiography and strategies for optimizing them to achieve successful outcomes. We also discuss newer MR angiography techniques, including whole-body imaging and blood pool contrast agents, as well as various approaches to reducing the need for anesthesia in pediatric MRI. CONCLUSION. Pediatric body vascular imaging presents a unique set of challenges that require a tailored approach. Emerging pediatric abdominopelvic MR angiography techniques hold promise for continued improvement in pediatric body MR angiography.
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Torres ER, Tumey TA, Dean DC, Kassahun-Yimer W, Lopez-Lambert ED, Hitchcock ME. Non-pharmacological strategies to obtain usable magnetic resonance images in non-sedated infants: Systematic review and meta-analysis. Int J Nurs Stud 2020; 106:103551. [PMID: 32294563 DOI: 10.1016/j.ijnurstu.2020.103551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although the use of sedation is commonly practiced to keep infants still while receiving magnetic resonance imaging, non-pharmacological strategies are a potential alternative. OBJECTIVES The purpose of this study was to determine the success rate of obtaining usable magnetic resonance images in infants with the sole use of non-pharmacological strategies. DESIGN Systematic literature review and meta-analysis SETTING: A search was conducted in PubMed, CINAHL and Cochrane Library. PARTICIPANTS Human infants from birth to 24 months of age who did not receive any sedation or anesthesia during magnetic resonance imaging METHOD: Articles that reported the success rate of obtaining usable images were included. RESULTS Of the 521 non-duplicate articles found, 58 articles were included in the systematic review with sample sizes ranging from 2-457, an average success rate of 87.8%, and an average scan time of 30 min. The most common non-pharmacological technique included feeding and swaddling infants before imaging to encourage infants to sleep during the scan. Meta-analysis performed on 53 articles comprising 3,410 infants found a success rate of 87%, but significant heterogeneity was found (I2 = 98.30%). It was more difficult to obtain usable images solely with non-pharmacological techniques if infants were critically ill or a structural magnetic resonance imaging of the brain was required. CONCLUSION Non-pharmacological techniques are effective for obtaining usable magnetic resonance imaging scans in most but not all infants. Tweetable abstract: Non-pharmacological techniques are effective for obtaining usable magnetic resonance imaging scans in most infants.
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Affiliation(s)
- Elisa R Torres
- School of Nursing, University of Mississippi Medical Center, 2500 North State Street, Jackson 39216, MS, United States.
| | - Tyler A Tumey
- Burrell College of Osteopathic Medicine, 3501 Arrowhead Dr Las Cruces, NM 88001, United States.
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison WI 53705, United States.
| | - Wondwosen Kassahun-Yimer
- Department of Data Science, University of Mississippi Medical Center, School of Population Health,2500 North State Street, Jackson, MS 39216, United States.
| | - Eloise D Lopez-Lambert
- School of Nursing, University of Mississippi Medical Center, 2500 North State Street, Jackson 39216, MS, United States
| | - Mary E Hitchcock
- Ebling Library, University of Wisconsin-Madison, 750 Highland Ave, Madison WI 53705, United States.
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Shen XX, Liu TT, Gao FS, Wu D, DU LZ, Ma XL. [Application of vacuum stretcher combined with feeding in cranial magnetic resonance imaging examination for neonates: a prospective randomized controlled study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:435-440. [PMID: 32434637 PMCID: PMC7389395 DOI: 10.7499/j.issn.1008-8830.2001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effect and safety of vacuum stretcher combined with feeding in cranial magnetic resonance imaging (MRI) examination for neonates. METHODS A prospective study was performed for the neonates with hyperbilirubinemia, with a gestational age of >34 weeks and stable vital signs, who needed cranial MRI examination and did not need oxygen inhalation hospitalized in the Department of Neonatology, Children's Hospital of Zhejiang University School of Medicine, from September to November, 2019. The neonates were randomly divided into a vacuum stretcher combined with feeding group and a conventional sedation group. Vital signs were monitored before, during, and after MRI examination. The success rate of MRI procedure was recorded. RESULTS A total of 80 neonates were enrolled in the study, with 40 neonates in the vacuum stretcher combined with feeding group and 40 in the conventional sedation group. The vacuum stretcher combined with feeding group had a significantly higher success rate of MRI procedure than the conventional sedation group (P<0.05). As for the neonates who underwent successful MRI examination, the fastest heart rate after examination in the vacuum stretcher combined with feeding group was significantly lower than that in the conventional sedation group (P<0.05), while there were no significant differences between the two groups in transcutaneous oxygen saturation, respiratory rate, and body temperature before and after MRI examination (P>0.05). No complications, such as apnea, acute allergic reactions, and malignant fever, were observed. CONCLUSIONS Vacuum stretcher combined with feeding can improve the success rate of MRI procedure and reduce the use of sedatives, and meanwhile, it does not increase related risks.
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Affiliation(s)
- Xiao-Xia Shen
- Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310051, China.
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Saade-Lemus S, Nevo E, Soliman I, Otero HJ, Magee RW, Drum ET, States LJ. Clinical pediatric positron emission tomography/magnetic resonance program: a guide to successful implementation. Pediatr Radiol 2020; 50:607-617. [PMID: 32076750 DOI: 10.1007/s00247-019-04578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022]
Abstract
Children with malignancies undergo recurrent imaging as part of tumor diagnosis, staging and therapy response assessment. Simultaneous positron emission tomography (PET) and magnetic resonance (MR) allows for decreased radiation exposure and acts as a one-stop shop for disease in which MR imaging is required. Nevertheless, PET/MR is still less readily available than PET/CT across institutions. This article serves as a guide to successful implementation of a clinical pediatric PET/MR program based on our extensive clinical experience. Challenges include making scanners more affordable and increasing patient throughput by decreasing total scan time. With improvements in workflow and robust acquisition protocols, PET/MR imaging is expected to play an increasingly important role in pediatric oncology.
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Affiliation(s)
- Sandra Saade-Lemus
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elad Nevo
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Iman Soliman
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ralph W Magee
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elizabeth T Drum
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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49
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Wedderburn CJ, Subramoney S, Yeung S, Fouche JP, Joshi SH, Narr KL, Rehman AM, Roos A, Ipser J, Robertson FC, Groenewold NA, Gibb DM, Zar HJ, Stein DJ, Donald KA. Neuroimaging young children and associations with neurocognitive development in a South African birth cohort study. Neuroimage 2020; 219:116846. [PMID: 32304884 PMCID: PMC7443699 DOI: 10.1016/j.neuroimage.2020.116846] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/14/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an indispensable tool for investigating brain development in young children and the neurobiological mechanisms underlying developmental risk and resilience. Sub-Saharan Africa has the highest proportion of children at risk of developmental delay worldwide, yet in this region there is very limited neuroimaging research focusing on the neurobiology of such impairment. Furthermore, paediatric MRI imaging is challenging in any setting due to motion sensitivity. Although sedation and anesthesia are routinely used in clinical practice to minimise movement in young children, this may not be ethical in the context of research. Our study aimed to investigate the feasibility of paediatric multimodal MRI at age 2–3 years without sedation, and to explore the relationship between cortical structure and neurocognitive development at this understudied age in a sub-Saharan African setting. A total of 239 children from the Drakenstein Child Health Study, a large observational South African birth cohort, were recruited for neuroimaging at 2–3 years of age. Scans were conducted during natural sleep utilising locally developed techniques. T1-MEMPRAGE and T2-weighted structural imaging, resting state functional MRI, diffusion tensor imaging and magnetic resonance spectroscopy sequences were included. Child neurodevelopment was assessed using the Bayley-III Scales of Infant and Toddler Development. Following 23 pilot scans, 216 children underwent scanning and T1-weighted images were obtained from 167/216 (77%) of children (median age 34.8 months). Furthermore, we found cortical surface area and thickness within frontal regions were associated with cognitive development, and in temporal and frontal regions with language development (beta coefficient ≥0.20). Overall, we demonstrate the feasibility of carrying out a neuroimaging study of young children during natural sleep in sub-Saharan Africa. Our findings indicate that dynamic morphological changes in heteromodal association regions are associated with cognitive and language development at this young age. These proof-of-concept analyses suggest similar links between the brain and cognition as prior literature from high income countries, enhancing understanding of the interplay between cortical structure and function during brain maturation. MRI data are challenging to acquire in the early years of life. Paediatric MRI without sedation is feasible in sub-Saharan Africa, with 77% success. The Drakenstein Child Health study has novel MRI data of South African children. Morphological features of the cortex associate with neurocognitive development. Structure-cognition relationships in heteromodal association regions at 2–3 years.
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Affiliation(s)
- Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK; Neuroscience Institute, University of Cape Town, South Africa.
| | - Sivenesi Subramoney
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | | | - Shantanu H Joshi
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA, USA
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA, USA
| | - Andrea M Rehman
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Annerine Roos
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa; SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Jonathan Ipser
- Neuroscience Institute, University of Cape Town, South Africa; Department of Psychiatry, University of Cape Town, South Africa
| | - Frances C Robertson
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa; Cape Universities Brain Imaging Centre (CUBIC), Cape Town, South Africa
| | - Nynke A Groenewold
- Neuroscience Institute, University of Cape Town, South Africa; Department of Psychiatry, University of Cape Town, South Africa
| | - Diana M Gibb
- MRC Clinical Trials Unit, University College, London, UK
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; SAMRC Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, South Africa; Department of Psychiatry, University of Cape Town, South Africa; SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa
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50
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Advantages of a T1-Weighted Gradient-Recalled Echo (GRE) Sequence With a Radial 3D Sampling Approach Versus 2D Turbo Spin-Echo and Cartesian 3D GRE Sequences in Head and Neck MRI. AJR Am J Roentgenol 2020; 214:747-753. [DOI: 10.2214/ajr.19.21579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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