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Cone-beam computed tomography-assisted percutaneous gastrostomy tube insertion in children with challenging anatomy. Pediatr Radiol 2023; 53:963-970. [PMID: 36720724 DOI: 10.1007/s00247-023-05593-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: 10/06/2022] [Revised: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required. OBJECTIVE To describe our experience using cone-beam computed tomography (CT)-assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy. MATERIALS AND METHODS A retrospective review was performed in children who underwent cone-beam CT-assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used. RESULTS Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96 min (range 50-131 min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6 mGy (average 26.2 mGy, median 24.9 mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27). CONCLUSION This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.
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Adjunctive techniques for percutaneous enteral access in children: a pictorial review. Pediatr Radiol 2023; 53:324-331. [PMID: 36104540 DOI: 10.1007/s00247-022-05473-w] [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: 03/01/2022] [Revised: 06/13/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Primary percutaneous gastrostomy and gastrojejunostomy tube placements are fundamental procedures performed in pediatric interventional radiology, with both antegrade and retrograde techniques described. In pediatric patients, however, challenges may arise due to smaller patient size and anatomical variations. Several adjunctive techniques may facilitate safe percutaneous access in the setting of a limited percutaneous gastric access window. These include the intra-procedural use of cone beam computed tomography (CT), percutaneous needle decompression in the setting of distended air-filled bowel interposed between the stomach and abdominal wall, post-pyloric balloon occlusion to facilitate gastric distension, ultrasound-guided gastric puncture, and intra-gastric contrast-enhanced ultrasound (ceUS) to define the relationship of the gastric wall and the anterior abdominal wall. Adjunctive techniques may increase successful primary percutaneous gastroenteric tube placement and may improve operator confidence in safe placement.
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3
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Steiniger B, Lechel U, Reichenbach JR, Fiebich M, Aschenbach R, Schegerer A, Waginger M, Bobeva A, Teichgräber U, Mentzel HJ. In vitro measurements of radiation exposure with different modalities (computed tomography, cone beam computed tomography) for imaging the petrous bone with a pediatric anthropomorphic phantom. Pediatr Radiol 2022; 52:1125-1133. [PMID: 35460347 PMCID: PMC9107409 DOI: 10.1007/s00247-022-05308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/02/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various imaging modalities, such as multi-detector computed tomography (CT) and cone beam CT are commonly used in infants for the diagnosis of hearing loss and surgical planning of implantation hearing aid devices, with differing results. OBJECTIVE We compared three different imaging modalities available in our institution, including a high-class CT scanner, a mid-class CT scanner and an angiography system with a cone beam CT option, for image quality and radiation exposure in a phantom study. MATERIALS AND METHODS While scanning an anthropomorphic phantom imitating a 1-year-old child with vendor-provided routine protocols, organ doses, surface doses and effective doses were determined for these three modalities with thermoluminescent dosimeters. The image quality was evaluated using the signal difference to noise ratio (SDNR) and the spatial resolution of a line-pair insert in the phantom head. The dose efficiency, defined as the ratio of SDNR and effective dose, was also compared. RESULTS The organ and surface doses were lowest with the high-class CT protocol, but the image quality was the worst. Image quality was best with the cone beam CT protocol, which, however, had the highest radiation exposure in this study, whereas the mid-class CT was in between. CONCLUSION Based on our results, high-end CT should be used for surgical planning because it has the lowest dose, while the image quality is still sufficient for this purpose. However, if highest image quality is needed and required, e.g., by ENT surgeons, the other modalities should be considered.
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Affiliation(s)
- Beatrice Steiniger
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, Jena, 07747, Germany.
| | - Ursula Lechel
- MB3 External and Internal Dosimetry and Biokinetics, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Martin Fiebich
- Department LSE, Technische Hochschule Mittelhessen, Gießen, Germany
| | - Rene Aschenbach
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, Jena, 07747, Germany
| | - Alexander Schegerer
- MB3 External and Internal Dosimetry and Biokinetics, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Matthias Waginger
- Section Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Anelyia Bobeva
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, Jena, 07747, Germany
| | - Ulf Teichgräber
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, Jena, 07747, Germany
| | - Hans-Joachim Mentzel
- Section Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
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Percutaneous Core Needle Biopsy: Considerations in the Pediatric Patient. Tech Vasc Interv Radiol 2021; 24:100779. [PMID: 34895707 DOI: 10.1016/j.tvir.2021.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Image-guided percutaneous biopsy is the cornerstone of solid tissue diagnosis. The ability to safely sample tissue in locations that previously required surgery or necessitated empiric therapy has allowed for more personalized treatment options, as well as more rapid development of novel therapeutics. In children, these same advantages are accompanied by a smaller margin for error and rapidly expanding indications. The intent of this review is to outline the role of image-guided biopsy in the management of childhood disease, how this role is changing, and the practical aspects of managing and performing pediatric biopsies.
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5
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Crowley JJ, Cahill AM. Society of Interventional Radiology Guidelines and Statements Division 2020 Year-End Document Review. J Vasc Interv Radiol 2021; 32:918.e1-918.e4. [PMID: 34051989 DOI: 10.1016/j.jvir.2021.01.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- John J Crowley
- Departments of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
| | - Anne Marie Cahill
- Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
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Facchini G, Ceccarelli L, Tomà P, Bartoloni A. Recent Imaging Advancements for Lung Metastases in Children with Sarcoma. Curr Med Imaging 2021; 17:236-243. [PMID: 33371858 DOI: 10.2174/1573405616666201228125657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
In children and adolescents affected by musculoskeletal sarcomas (both soft tissue and bone sarcomas), the presence of lung metastases is a frequent complication, that should be known since the patient's prognosis, as management, and treatment depend on it. During the staging phase, the detection of lung metastases should be sensitive and specific, and it should be carried out by minimizing the radiation exposure. To deal with this problem, imaging has reached important goals in recent years, thanks to the development of cone-beam CT or low-dose computed tomography, with some new iterative reconstruction methods, such as Veo and ASIR. Imaging is also fundamental for the possibility to perform lung biopsies under CT guidance, with less morbidity, less time-consumption, and shorter recovery time, compared to surgical biopsies.Moreover, important results have also been demonstrated in the treatment of lung metastases, due to the improvement of new mini-invasive image-guided percutaneous thermal ablation procedures, which proved to be safe and effective also in young patients.
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Affiliation(s)
- Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Ospedale Pediatrico Bambino Gesu, Rome, Italy
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Durand R, Cahill AM, Shellikeri S, Acord M. Postpyloric Balloon Occlusion to Increase Technical Success during Pediatric Percutaneous Gastrostomy/Gastrojejunostomy Tube Placement. J Vasc Interv Radiol 2020; 31:1139-1142.e1. [PMID: 32534976 DOI: 10.1016/j.jvir.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
Abstract
Gastric distension through insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement; however, poor or incomplete gastric distention can occur, despite the use of glucagon, and lead to rapid egress of air from the stomach into the duodenum. This report describes the adjunctive technique using postpyloric balloon occlusion in 29 patients to maximize gastric insufflation during G/GJ tube placement after failure of conventional methods. Balloon occlusion was successful in salvaging 23 of 29 (79.3%) of G/GJ tube placements without any complications.
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Affiliation(s)
- Rachelle Durand
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Anne Marie Cahill
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Sphoorti Shellikeri
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Michael Acord
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
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Murphy CM, Ramoso LR, Monroe EJ. XperCT Sharpening Reconstruction for Cone-Beam Computed Tomography Guided Lung and Bone Interventions. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1705265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractC-arm cone-beam computed tomography (CBCT) is a valuable tool for three-dimensional navigation and mapping in the interventional radiology suite owing to its flexible gantry positioning, real-time three-dimensional volume acquisition, and reduced contrast and radiation use. Reports of CBCT-guided bone and lung interventions are relatively infrequent, however, possibly due in part to the lack of dedicated bone and lung reconstruction algorithms and concerns regarding insufficient lesion conspicuity. Two cases of an ad hoc intraprocedural CBCT sharpening reconstruction are presented in this article.
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Affiliation(s)
- Christopher M. Murphy
- Division of Interventional Radiology, Department of Radiology, Seattle Children’s Hospital, Seattle, Washington, United States
| | - L. Ray Ramoso
- Division of Interventional Radiology, Department of Radiology, Seattle Children’s Hospital, Seattle, Washington, United States
| | - Eric J. Monroe
- Division of Interventional Radiology, Department of Radiology, Seattle Children’s Hospital, Seattle, Washington, United States
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Shkumat NA, Brashdi YA, Volodina S, Parra D, Connolly BL. Dosimetric Feasibility of Cone-Beam CT in Pediatric Image-Guided Retrograde Gastrostomy Tube Insertions. Can Assoc Radiol J 2020; 71:68-74. [DOI: 10.1177/0846537119885680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Cone-beam computed tomography (CBCT) in interventional radiology allows volumetric imaging with open patient access. This work aimed to assess radiation dose metrics of CBCT in simulated image-guided retrograde gastrostomy (IGRG) tube insertions in pediatric anthropomorphic phantoms and to compare them to measured radiation dose metrics obtained using fluoroscopy during clinical IGRG tube insertions in children. Methods: Radiation dose indices obtained from radiation dose structured reports of fluoroscopic IGRG tube insertions were retrospectively evaluated in a consecutive cohort of 30 children. Dose indices were fractionated into 3 clinical stages for each procedure ( planning, insertion, and confirmation). These 3 stages in 30 patients (3 × 30 = 90 patient stages) were compared to dose indices measured from 4 CBCT acquisition protocols acquired in pediatric phantoms. Results: The mean proportion of radiation dose during planning, insertion, and confirmation was 35%, 38% and 27%, with mean reference-point air kerma (range) measured to be 1.0 (0.02-6.0) mGy, 0.9 (0.03-4.1) mGy, and 0.7 (0.04-3.7) mGy, respectively. Cone-beam computed tomography dose varied greatly depending on technical parameters and protocol selection, ranging from 0.7 to 39.3 mGy. In 19% of patient stages, the most dose-sparing CBCT protocol evaluated on phantoms delivered less radiation than the radiation dose indices recorded from patient’s fluoroscopy. Conclusions: From a dosimetric perspective, radiation delivered in CBCT can vary widely, yet can be appreciably low. With appropriate CBCT protocol selection, the radiation dose delivered may be sufficiently low to warrant consideration for use, if clinically needed during difficult IGRG tube insertions, and satisfy the interventionalist’s benefit–risk assessment.
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Affiliation(s)
- Nicholas A. Shkumat
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Yahya Al Brashdi
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sabina Volodina
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dimitri Parra
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Bairbre L. Connolly
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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10
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Shah JH, Whitmore MJ. Interventional Radiology's Role in the Treatment of Pediatric Thoracic Disease. Semin Roentgenol 2019; 54:395-406. [PMID: 31706372 DOI: 10.1053/j.ro.2019.06.009] [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]
Affiliation(s)
- Jay H Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA; Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
| | - Morgan J Whitmore
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
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11
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Volders D, Heran MKS. A novel percutaneous approach to retrieve an ingested extra-esophageal foreign body. Pediatr Radiol 2019; 49:1234-1237. [PMID: 31101958 DOI: 10.1007/s00247-019-04416-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 12/25/2022]
Abstract
We report a case of an 8-year-old boy who presented to our emergency department with progressive onset of dysphagia and odynophagia after eating barbecued steak that evening. Radiographs revealed a metal bristle from a barbecue brush at the level of the proximal esophagus. The otolaryngologist attempted to retrieve this bristle using flexible esophagoscopy, but unfortunately it pushed the bristle extra-esophageal. In order to avoid major open surgery with associated morbidity, a novel percutaneous image-guided minimally invasive percutaneous approach was used to successfully retrieve the bristle.
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Affiliation(s)
- David Volders
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Manraj K S Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada. .,Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Ave., Vancouver, BC, V5Z 1M9, Canada. .,Department of Radiology, British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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12
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Shivaram GM, Gill AE, Monroe EJ, Koo KSH, Hawkins CM. Cone-beam computed tomography guidance with navigational overlay for percutaneous lung nodule biopsy. Pediatr Radiol 2019; 49:327-331. [PMID: 30411171 DOI: 10.1007/s00247-018-4296-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cone-beam CT is increasingly used in pediatric interventional radiology procedures. However, the feasibility or safety of using this mode of imaging guidance for percutaneous lung nodule biopsy in children has not been assessed. OBJECTIVE To retrospectively evaluate safety and diagnostic accuracy of percutaneous lung nodule biopsy in people treated at a pediatric hospital using cone-beam CT with navigational overlay. MATERIALS AND METHODS Thirty-six consecutive patients from two large tertiary-care children's hospitals with lung nodules of 48 mm or smaller underwent percutaneous lung nodule biopsy using cone-beam CT with navigational overlay. We evaluated patient demographics, pre- and post-biopsy diagnoses, number of biopsy passes, complications, radiation exposure and technical success. RESULTS Percutaneous lung nodule biopsy was performed for 37 nodules in 36 patients (23 males, 13 females, median age 15.5 years, range 8 months to 23 years). One patient underwent biopsy of two nodules at a single procedure. Median patient weight was 55 kg (range 8-97 kg). Pre-biopsy diagnoses included metastatic sarcoma or other solid tumor (n=11), leukemia/lymphoma (n=13), infection (n=10), chronic granulomatous disease (n=2) and post-transplant lymphoproliferative disorder (PTLD; n=1). Mean number of passes was 5 (range 2-15). Mean pre-procedure international normalized ratio (INR) was 1.1 and platelet count 193 × 109/L. Diagnostic specimens were obtained in 32 of 36 patients (89%). Thirteen complications were encountered in 12 patients (33% of cohort), including 9 pneumothoraces (4 requiring chest tubes); 1 hemothorax, which required a chest tube; and 3 self-limited pulmonary hemorrhages. Mean and median radiation doses were as follows: fluoroscopy time 3 min and 2.4 min, dose-area product (DAP) (recorded in 31 patients) 23,402 Gy·cm2 and 12,453 Gy·cm2, and air kerma 88 mGy and 58 mGy. CONCLUSION Percutaneous lung nodule needle biopsy can be performed accurately using cone-beam CT with navigational overlay.
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Affiliation(s)
- Giridhar M Shivaram
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98145, USA.
| | - Anne Elizabeth Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric J Monroe
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98145, USA
| | - Kevin S H Koo
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98145, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Patel PA, Minhas K, Ang J, Stuart S, De Coppi P, Gnannt R. Non-vascular interventional radiology in the paediatric alimentary tract. Eur J Radiol 2019; 112:72-81. [PMID: 30777223 DOI: 10.1016/j.ejrad.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022]
Abstract
Paediatric interventional radiology is an evolving speciality which is able to offer numerous minimally invasive treatments for gastrointestinal tract pathologies. Here we describe interventions performed by paediatric interventional radiologists on the alimentary tract from the mouth to the rectum. The interventions include sclerotherapy, stricture management by dilation, stenting and adjunctive therapies such as Mitomycin C administration and enteral access for feeding, motility assessment and administration of enemas.
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Affiliation(s)
- Premal A Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Kishore Minhas
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Jestine Ang
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Sam Stuart
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Ralph Gnannt
- Bilddiagnostik, Paediatric Interventional Radiology, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
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Monroe EJ, Amlie-Lefond CM. Cone beam computed tomography-guided transpterygoidal aspiration of a carotid space abscess in Lemierre's syndrome. Radiol Case Rep 2018; 13:618-621. [PMID: 30042808 PMCID: PMC6054713 DOI: 10.1016/j.radcr.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/08/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eric J. Monroe
- Department of Radiology, Division of Interventional Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, M/S R-5417, Seattle, WA 98105, USA
- Corresponding author.
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