Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community

Patient Safety and Radiation Exposure in Transcystic Laparoscopic Common Bile Duct Exploration: A CARES Working Group Multicenter Study

BACKGROUND

Treatment of choledocholithiasis with laparoscopic cholecystectomy (LC) and intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile duct exploration (LCBDE) is associated with fewer procedures and shorter length of stay (LOS) compared to preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC. Fluoroscopy is required for both LCBDE and ERCP but fluoroscopic time (FT) and radiation dose (RD) in LCBDE has not been studied.

METHODS

The Choledocholithiasis Alliance for Research, Education, and Surgery (CARES) Working Group conducted this retrospective study on pediatric patients with suspected choledocholithiasis who received IOC. Demographics, type of LCBDE, FT and RD during IOC ± LCBDE, were analyzed. Statistical analysis was completed using Microsoft Excel and R software.

RESULTS

From five centers, 157 patients were identified (79 without LCBDE, 78 with LCBDE). Wire access into the duodenum was successful in 67 patients (86%) and 64 patients (82%) had successful duct clearance. Median FT for all LCBDE cases was 3.3 min [1.6, 6.7] and RD was 59.8 mGy [30.1, 125.0] with no difference between successful and unsuccessful duct clearance (66.7 mGy [29.0, 115.0], 55.8 mGy [35.8, 154.1], respectfully; p = 0.51).

CONCLUSION

Although both ERCP and LCBDE approaches result in fluoroscopic radiation exposure, FT, and RD in LCBDE have not previously been studied and are inadequately described in ERCP. Limiting radiation exposure in children is essential and fluoroscopy stewardship is a key component of pediatric safety in LCBDE.

LEVEL OF EVIDENCE

Level III.

Parent's perceptions of paediatric care in two radiology departments within Johannesburg, South Africa

BACKGROUND

A referral to the Radiology department may be a very frightening, and at times a stressful experience for a child and their parents. The radiographer plays an important role as a healthcare professional to simultaneously produce high-quality diagnostic X-ray images and facilitate a high standard of care in a limited timeframe.

METHODS

The purpose of this qualitative, phenomenological study was thus to explore and describe parents' perceptions of paediatric care in two Radiology departments within Gauteng. A total of 12 semi-structured individual interviews were conducted with parents, until data saturation was achieved.

RESULTS

Braun and Clarke's six-step thematic analysis was used which unveiled three themes: 1) Recognition of overall positive, high standard of care received by paediatrics who underwent an X-ray examination 2) Limitations prohibiting a caring environment 3) The need for parent-centered paediatric care through the implementation of Family Centered Care (FCC).

CONCLUSION

Overall, there was positive feedback from the parents' perspectives and general satisfaction with the quality of care received by the child whilst in the Radiology department. Although there were some negative categories particularly referring to an unknown environment, parents overall appreciated the qualities of caring and effective communication that the radiographers displayed during their visit.

IMPLICATIONS FOR PRACTICE

The lack of literature regarding parents' perceptions of paediatric care within the context of radiography led to the current study. Recommendations for future best practice would be incorporating the concept of FCC within the curriculum of the radiography degree to improve overall patient and parent satisfaction.

Radiological imaging and interventional procedures of the thorax in children

The thoracic region in pediatric patients poses unique diagnostic and interventional challenges, necessitating specialized approaches in radiological imaging and procedures. This review provides an overview of the key considerations, techniques, and clinical significance in the field of pediatric thoracic radiology and interventions. We discuss the importance of age-appropriate imaging modalities and the application of advanced technologies in assessing a wide range of thoracic conditions in children, including congenital anomalies, infections, neoplasms, and trauma. Furthermore, we highlight the evolving role of minimally invasive interventional procedures in the management of pediatric thoracic disorders. As the understanding of pediatric thoracic pathology continues to expand, this review aims to guide healthcare professionals, radiologists, and pediatricians in delivering optimal care to children with thoracic concerns.

Use of Artificial Intelligence in Radiology: Impact on Pediatric Patients, a White Paper From the ACR Pediatric AI Workgroup

In this white paper, the ACR Pediatric AI Workgroup of the Commission on Informatics educates the radiology community about the health equity issue of the lack of pediatric artificial intelligence (AI), improves the understanding of relevant pediatric AI issues, and offers solutions to address the inadequacies in pediatric AI development. In short, the design, training, validation, and safe implementation of AI in children require careful and specific approaches that can be distinct from those used for adults. On the eve of widespread use of AI in imaging practice, the group invites the radiology community to align and join Image IntelliGently (www.imageintelligently.org) to ensure that the use of AI is safe, reliable, and effective for children.

The role of ultrasound in necrotizing enterocolitis

Ultrasound has proved to be a useful modality for enhancing the diagnostic accuracy of necrotizing enterocolitis and associated complications. The standard imaging algorithm for evaluating necrotizing enterocolitis includes radiographs and clinical symptoms, the combination of which constitutes the Bell criteria. Major limitations of using the Bell criteria for diagnosing and clinically managing necrotizing enterocolitis include low diagnostic accuracy of radiographs and nonspecific symptomatology of preterm infants. In this regard, US can offer additional insights into bowel health by helping to characterize bowel motility, echogenicity, thickness, pneumatosis and perfusion. Extramural findings such as portal venous gas, nature and extent of ascites, and pneumoperitoneum can also be assessed. Recently, contrast-enhanced US was explored in a case series of preterm bowel disease and its diagnostic utility warrants further investigation. This article reviews the US features of necrotizing enterocolitis and highlights the role of US as a complement to radiographs, as well as the emerging use of contrast-enhanced US in necrotizing enterocolitis.

The cumulative radiation dose paradigm in pediatric imaging

Medical imaging professionals have an accountability for both quality and safety in the care of patients that have unexpected or anticipated repeated imaging examinations that use ionizing radiation. One measure in the safety realm for repeated imaging is cumulative effective dose (CED). CED has been increasingly scrutinized in patient populations, including adults and children. Recognizing the challenges with effective dose, including the cumulative nature, effective dose is still the most prevalent exposure currency for recurrent imaging examinations. While the responsibility for dose monitoring incorporates an element of tracking an individual patient cumulative radiation record, a more complex aspect is what should be done with this information. This challenge also differs between the pediatric and adult population, including the fact that high cumulative doses (e.g.,>100 mSv) are reported to occur much less frequently in children than in the adult population. It is worthwhile, then, to review the general construct of CED, including the comparison between the relative percentage occurrence in adult and pediatric populations, the relevant pediatric medical settings in which high CED occurs, the advances in medical care that may affect CED determinations in the future, and offer proposals for the application of the CED paradigm, considering the unique aspects of pediatric care.

Radiobiological risks following dentomaxillofacial imaging: should we be concerned?

OBJECTIVES

This review aimed to present studies that prospectively investigated biological effects in patients following diagnostic dentomaxillofacial radiology (DMFR).

METHODS

Literature was systematically searched to retrieve all studies assessing radiobiological effects of using X-ray imaging in the dentomaxillofacial area, with reference to radiobiological outcomes for other imaging modalities and fields.

RESULTS

There is a lot of variability in the reported radiobiological assessment methods and radiation dose measures, making comparisons of radiobiological studies challenging. Most radiological DMFR studies are focusing on genotoxicity and cytotoxicity, data for 2D dentomaxillofacial radiographs, albeit with some methodological weakness biasing the results. For CBCT, available evidence is limited and few studies include comparative data on both adults and children.

CONCLUSIONS

In the future, one will have to strive towards patient-specific measures by considering age, gender and other individual radiation sensitivity-related factors. Ultimately, future radioprotection strategies should build further on the concept of personalized medicine, with patient-specific optimization of the imaging protocol, based on radiobiological variables.