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Tree K, Chang N, Huynh R, Indrajit B, Fisher D, Baskaranathan S. Radiation exposure in emergency ureteric stenting: A subgroup analysis by operator. BJUI COMPASS 2023; 4:680-687. [PMID: 37818026 PMCID: PMC10560617 DOI: 10.1002/bco2.245] [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: 02/02/2023] [Revised: 03/05/2023] [Accepted: 03/29/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives To review radiation exposure during emergency ureteric stent insertion to identify differences based on operator experience, specialty operator and stone characteristics. Patients and methods A retrospective audit over 10 years was performed for patients who underwent emergency stent insertion for urolithiasis with intraoperative fluoroscopy. Outcomes measured included operator experience, radiation exposure (mGy), dose area product (Gy/cm2), fluoroscopy time, stone characteristics and patient BMI. Analysis was performed in IBM SPSS Version 28. p < 0.05 was considered statistically significant. Results Four hundred ten patients were identified, with a median age of 57 years, 64.6% male and a median BMI of 30. Urolithiasis was left-sided in 50.8%, with a median size of 7 mm and predominantly proximal (49%) followed by mid (34.5%) and distal (12.1%) location. Median radiation exposure was 12.6 mGy, 2.94 Gy/cm2 and fluoroscopy time 44.5 s, with no significant difference between consultants and registrars. No significant association between radiation exposure for subgroups of stone location, gender, size, laterality or specialty registrar (general surgery vs. urology). Conclusion No significant difference in radiation exposure was identified between registrars and consultants or between subspecialty registrars. We suggest formal radiation safety education for all health professionals involved with intra-operative fluoroscopy and personal dosimeters.
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Affiliation(s)
- Kevin Tree
- Department of SurgeryDubbo Base HospitalDubboAustralia
- University of NewcastleNewcastleAustralia
| | | | - Roy Huynh
- Department of SurgeryDubbo Base HospitalDubboAustralia
- University of SydneySydneyAustralia
| | | | - Dean Fisher
- Department of SurgeryDubbo Base HospitalDubboAustralia
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Cheng JW, Fernandez N, Kim HHR, Tang ER, Ferguson M, Nicassio LN, Dick AAS, Smith JM, Cain MP. Contrast-enhanced voiding urosonography (CEVUS) as a safe alternate means of assessing vesicoureteral reflux in pediatric kidney transplant patients. Pediatr Transplant 2023; 27:e14429. [PMID: 36345140 DOI: 10.1111/petr.14429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/16/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although voiding cystourethrogram (VCUG) is currently the gold standard in VUR evaluation, there is ionizing radiation exposure. Contrast-enhanced voiding urosonography (CEVUS) uses ultrasound contrast agents to visualize the urinary tract and has been reported to be safe and effective in VUR evaluation in children. CEVUS application has yet to be specifically described in VUR evaluation in the pediatric kidney transplant population. The purpose of this study was to report the use of CEVUS and VCUG in evaluating and managing VUR in pediatric renal transplant patients. METHODS Retrospective review was conducted for pediatric kidney transplant patients (18 years and younger) who underwent VCUG or CEVUS to assess for transplant VUR from July 2019 through June 2021. Demographic information, reason for VUR evaluation, fluoroscopy time, and postimaging complications were evaluated. Costs of imaging modalities were also considered. RESULTS Eight patients were evaluated for transplant VUR during the study period. Of the 3 patients who underwent VCUG, all 3 had VUR (median grade 3). Median fluoroscopy time was 18 s and dose-area product was 18.7 uGy*m2 . Of the 5 patients who underwent CEVUS, 4 had VUR (median grade 4). There were no complications for either modality. Based on clinical and radiographic findings, patients were recommended no intervention, behavioral modification, or ureteral reimplantation. The total cost of CEVUS was $800 less than that of VCUG. CONCLUSION CEVUS can provide an alternate means of safely evaluating VUR in kidney transplant patients with similar outcomes, potentially lower costs, and no exposure to ionizing radiation.
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Affiliation(s)
- Julie W Cheng
- Division of Urology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Helen H R Kim
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elizabeth R Tang
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Mark Ferguson
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Lauren N Nicassio
- Division of Urology, Seattle Children's Hospital, Seattle, Washington, USA
| | - André A S Dick
- Section of Transplantation, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Jodi M Smith
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark P Cain
- Division of Urology, Seattle Children's Hospital, Seattle, Washington, USA
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Chirurgische Intervention bei der kindlichen Ureterabgangsstenose. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Rohner K, Mazzi S, Buder K, Weitz M. Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis. KLINISCHE PADIATRIE 2020; 234:5-13. [PMID: 33336329 DOI: 10.1055/a-1303-4695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knowledge of the baseline risk of febrile urinary tract infections in patients with primary non-refluxing megaureter can help clinicians to make informed decisions for offering continuous antibiotic prophylaxis. OBJECTIVE The primary objective of this systematic review was to determine the pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter selected for primary non-surgical management independent of associated attributed risk factors at initial presentation in order to assess the value of continuous antibiotic prophylaxis. METHODS MEDLINE, EMBASE, and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language and time restriction. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO registration number CRD42018104752). RESULTS Of 25 871 records, 16 studies (n=749 patients) were eligible for inclusion. The overall pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter was 14.35% (95% confidence interval: 8.8-22.6). The calculated number needed to treat for patients on continuous antibiotic prophylaxis to prevent one single febrile urinary tract infection over the course of 1-2 years would be 4.3. CONCLUSION Based on the current available evidence the use of continuous antibiotic prophylaxis for children with PM selected for primary non-surgical treatment should be taken into consideration, at least in patients with urinary outflow impairment, higher grade of ureteral dilatation, and for children in the first months of life.
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Affiliation(s)
- Katharina Rohner
- Pediatric Nephrology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Sara Mazzi
- Pediatric Nephrology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Kathrin Buder
- Pediatric Nephrology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Marcus Weitz
- Pediatric Nephrology, University Children's Hospital Tübingen, Tuebingen, Germany
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Bilge I. Symptomatology and Clinic of Hydronephrosis Associated With Uretero Pelvic Junction Anomalies. Front Pediatr 2020; 8:520. [PMID: 33102401 PMCID: PMC7554633 DOI: 10.3389/fped.2020.00520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
The most common cause of hydronephrosis in the pediatric age group is ureteropelvic junction-type hydronephrosis (UPJHN). Since the advent of widespread maternal ultrasound screening, clinical presentation of hydronephrosis associated with UPJ anomalies has changed dramatically. Today most cases are diagnosed in the prenatal period, and neonates present without signs or symptoms. For those who are not detected at birth, UPJHN eventually presents throughout childhood and even adulthood with various symptoms. Clinical picture of UPJHN highly depends on the presence and severity of obstruction, and whether it affects single or both kidneys. Abdominal or flank pain, abdominal mass, hematuria, kidney stones, urinary tract infections (UTI), and gastrointestinal discomfort are the main symptoms of UPJHN in childhood. Other less common findings in such patients are growth retardation, anemia, and hypertension. UTI is a relatively rare condition in UPJHN cases, but it may occur as pyelonephritis. Vesicoureteric reflux should be kept in mind as a concomitant pathology in pediatric UPJHN that develop febrile UTI. Although many UPJHN cases are known to improve over time, close clinical observation is critical in order to avoid irreversible kidney damage. The most appropriate approach is to follow-up the patients considering the presence of symptoms, the severity of hydronephrosis and the decrease in kidney function and, if necessary, to decide on early surgical intervention.
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Affiliation(s)
- Ilmay Bilge
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Koc University, Istanbul, Turkey
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Alkhorayef M, Hamza Y, Sulieman A, Salih I, Babikir E, Bradley D. Effective dose and radiation risk estimation in certain paediatric renal imaging procedures. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kirac M, Ergin G, Kibar Y, Köprü B, Biri H. The Efficacy of Ureteroscopy Without Fluoroscopy for Ureteral and Renal Stones in Pediatric Patients. J Endourol 2018; 32:100-105. [DOI: 10.1089/end.2017.0593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mustafa Kirac
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Giray Ergin
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Burak Köprü
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Hasan Biri
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
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Weitz M, Schmidt M, Laube G. Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol 2017; 32:2203-2213. [PMID: 28012005 DOI: 10.1007/s00467-016-3566-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 12/21/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) is the most common obstructive uropathy and its optimal management remains controversial. However, there is a current trend towards non-surgical management. We aimed to determine the effects of the non-surgical management in children with unilateral UPJO. For a systematic review, we searched MEDLINE, EMBASE, CENTRAL, clinical trials registries, and selected conference proceedings for eligible studies. Any type of study reporting the outcomes renal function, secondary surgical intervention, drainage pattern or hydronephrosis of non-surgical management in children with unilateral UPJO was included. Data from 20 studies were extracted and evaluated by two independent authors. The pooled prevalence was 21% for split renal function deterioration, 27.9% for secondary surgical intervention, 3.2% for progressive hydronephrosis, and 82.2% for improved drainage pattern. Not all patients with surgical intervention regained split renal function from enrolment. Renal imaging methods did not strongly correlate with each other. Many studies had to be excluded because of a lack of detection of an obstruction or mixed populations with bilateral UPJO or other uropathies. The variable definitions of UPJO, different criteria for surgical intervention, incongruity of management protocols, and the imprecise reporting of outcomes were limiting factors in the comparability of the results, leading to heterogeneity in meta-analyses. Although the available evidence cannot recommend or refute the current non-surgical management, the systematic review clarifies aspects of the ongoing controversy by providing realistic estimates for non-surgical management in children with unilateral UPJO. Additionally, it reveals unclear potential risks, particularly for long-term outcomes, which were rarely reported.
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Affiliation(s)
- Marcus Weitz
- Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Maria Schmidt
- Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Guido Laube
- Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Use of medical expulsive therapy in children: An assessment of nationwide practice patterns and outcomes. J Pediatr Urol 2017; 13:509.e1-509.e7. [PMID: 28483465 PMCID: PMC5947996 DOI: 10.1016/j.jpurol.2017.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/14/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Early data support the use of medical expulsive therapy (MET) in children. However, little is known regarding use or outcomes associated with MET outside of pediatric-specific practices. Using a national administrative dataset, we sought to characterize utilization patterns of MET as well as assess outcomes associated with MET exposure. STUDY DESIGN We interrogated the MarketScan Commercial Claims and Encounters database to identify children under the age of 18 presenting to the emergency department (ED) with any diagnosis of upper urinary tract calculi (UUTC, including renal and ureteral calculi). MET exposure was defined as having a prescription filled for a MET agent within 1 week of the ED encounter. Characteristics of children receiving MET were defined and outcomes compared between children with and without MET exposure. RESULTS Of 1325 children included in the study, 13.2% received MET, including 15.4% of children with a diagnosis of "calculus of the ureter." MET use increased significantly throughout the study period (p = 0.004), although only 30.4% of children considered potential MET candidates received MET in the final year of the study (2013). Among all patients, receipt of MET was associated with male gender, presence of comorbidity, provider-type (urologist), and year of diagnosis, although among those with a specific diagnosis of "calculus of the ureter," only year of diagnosis remained a significant factor. Rates of unplanned physician visits and surgical interventions were similar between groups. Children receiving MET were more likely to receive follow-up imaging, although only 46% of children with ureteral calculi had appropriate follow-up imaging within 90 days, regardless of MET exposure. Odds ratios of factors and outcomes associated with MET exposure are shown in the Table. DISCUSSION Although early data support safety and efficacy MET in children, nationwide use in children is low among potential candidates for MET. For children with ureteral calculi, only year of diagnosis was a significant factor associated with MET use. No difference in unplanned physician visits or surgical interventions was noted. Most notable, however, was the low rate of follow-up imaging within 90 days for children presenting acutely with UUTC. CONCLUSIONS Use of MET for children with ureteral calculi is increasing, although still fewer than a third of children considered potential candidates receive this treatment. Follow-up imaging is not obtained for many children with ureteral calculi. Future work is needed to standardize management and follow-up protocols for children with acute renal colic.
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11
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Weitz M, Schmidt M. To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review. Eur J Pediatr 2017; 176:1-9. [PMID: 27888411 DOI: 10.1007/s00431-016-2818-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are the most common uropathies. The co-occurrence of both anomalies has led to the practice of screening for VUR in children with UPJO to prevent deterioration of kidney function due to renal scarring following urinary tract infections (UTIs). We determined the prevalence of VUR in children with UPJO for a critical assessment of VUR screening by voiding cystourethrography (VCUG). A systematic search strategy in MEDLINE, EMBASE, and CENTRAL was carried out for all articles that included VCUG, and renal scintigraphy or any other appropriate imaging technique for the diagnosis of UPJO. Twenty studies were eligible for inclusion. We found a pooled prevalence for VUR of 8.2 % (95 % CI = 3.6-12.7), about a threefold increase compared to the general pediatric population. VUR occurred bilateral or contralateral to the kidney with UPJO in 5.7 % (95 % CI = 3.0-8.5), equivalent to 75 % of all children with VUR. Considering the effect size of VUR treatment with antibiotics, about 207 and 278 children would need to undergo VCUG to prevent one febrile UTI and one case of renal scarring by 1-2 years, respectively. CONCLUSION Against this background, screening for VUR needs to be scrutinized and restricted to selected risk groups. What is known: • Screening of patients with ureteropelvic junction obstruction (UPJO) for vesicoureteral reflux (VUR) is recommended based on a small number of repeatedly cited studies. • The lack of conclusive evidence results in different treatment strategies and leads to difficulties when communicating diagnoses and treatment options to parents. What is new: • A robust prevalence for VUR in children with UPJO based on all published evidence and the resulting number needed to screen are given for decision-making in daily clinical practice. • The results may be a precursor for implementation into guidelines.
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Affiliation(s)
- Marcus Weitz
- Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Maria Schmidt
- Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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12
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Prospective Assessment of Radiation in Pediatric Urology: The Pediatric Urology Radiation Safety Evaluation Study. J Urol 2016; 196:202-6. [DOI: 10.1016/j.juro.2016.01.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/22/2022]
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Hsi RS, Holt SK, Gore JL, Lendvay TS, Harper JD. National Trends in Followup Imaging after Pyeloplasty in Children in the United States. J Urol 2015; 194:777-82. [PMID: 25868576 DOI: 10.1016/j.juro.2015.03.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Radiographic followup after pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric pyeloplasty. MATERIALS AND METHODS Using the MarketScan® database, we identified patients 0 to 18 years old undergoing pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns. RESULTS We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6 months postoperatively 853 patients (91%) underwent at least 1 imaging study and 192 (24%) underwent renography. Within the first 12 months postoperatively 91% of patients underwent at least 1 imaging study, most commonly ultrasound. After 12 months almost a third of the patients were not followed with imaging. Of the 71% undergoing imaging most underwent ultrasound. Younger age and female gender were independently associated with frequent imaging (at least yearly) on multivariate logistic regression. CONCLUSIONS Following pediatric pyeloplasty there is variation in modality and frequency of imaging followup. The majority of patients are followed with renal ultrasound, with less frequent use of functional imaging. Almost a third of patients do not undergo followup imaging after 1 year.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Thomas S Lendvay
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
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Abstract
The epidemiology of kidney stones is evolving – not only is the prevalence increasing, but also the gender gap has narrowed. What drives these changes? Diet, obesity or environmental factors? This article will review the possible explanations for a shift in the epidemiology, with the hope of gaining a better understanding of the extent to which modifiable risk factors play a role on stone formation and what measures may be undertaken for disease prevention in view of these changing trends.
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Affiliation(s)
| | - Manoj Monga
- Stevan Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
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Weitz M, Licht C, Müller M, Haber P. Renal ultrasound volume in children with primary vesicoureteral reflux allows functional assessment. J Pediatr Urol 2013; 9:1077-83. [PMID: 23639632 DOI: 10.1016/j.jpurol.2013.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Renal scintigraphy represents the current diagnostic standard to assess split kidney function. We tested the hypothesis that the relative renal volume assessed by ultrasound provides an equally reliable but less invasive tool for assessment of kidney function as compared to renal scintigraphy in patients with primary vesicoureteral reflux. METHODS Renal ultrasound and renal scintigraphy were performed in 85 patients (median age 4.5 years, range 0.25-7.7) and repeated in 74 patients after 2-13 months (mean 7) of the primary investigation. Renal size was measured by ultrasound, and relative renal volume was calculated for each kidney by using the formula of a prolate ellipsoid. Renal function was estimated for each side (split renal function) by scintigraphy with (99m)Tc MAG3. RESULTS The mean difference between relative renal volume measured by ultrasound and split renal function determined by renal scintigraphy was 2.8% (standard deviation ± 4.1%; 95% confidence interval 10.8/-5.2%). There was a statistically significant correlation between relative renal volume estimated by ultrasound and split renal function estimated by renal scintigraphy at first examination (r = 0.98; p < 0.001) and at follow-up (r = 0.91; p < 0.001). CONCLUSION We conclude that ultrasound measurement of relative renal volume is capable of assessing split renal function in children with primary vesicoureteral reflux and, thus, should be considered instead of the more invasive MAG3 scintigraphy.
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Affiliation(s)
- Marcus Weitz
- University of Tuebingen, Department of Pediatrics, Hoppe-Seyler-Strasse 1, 72076 Tübingen, Germany.
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Jeon M, Jenkins S, Oh J, Kim J, Peterson T, Chen J, Kim C. Nonionizing photoacoustic cystography with near-infrared absorbing gold nanostructures as optical-opaque tracers. Nanomedicine (Lond) 2013; 9:1377-88. [PMID: 24151863 DOI: 10.2217/nnm.13.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM The objectives of this study were to demonstrate nonionizing photoacoustic tomography (PAT) of bladders with near-infrared absorbing gold nanocages (GNCs) as an optical-turbid tracer and to investigate the fate of GNCs after photoacoustic imaging. MATERIALS & METHODS The rats' bladders were visualized using PAT after transurethral injection of 2-nM GNCs. The fate of GNCs in the bladders was investigated. Spectroscopic PAT was applied to identify GNC-filled bladders in vivo and study biodistribution ex vivo. RESULTS Rats' bladders filled with GNCs were successfully imaged using a PAT system. The photoacoustic amplitude was enhanced by approximately 2240%. Both in vivo and ex vivo PAT results reveal that no accumulation of GNCs in the bladder and kidney was observed, and were validated with inductively coupled plasma mass spectrometry. CONCLUSION The PAT with transurethral injection of GNCs provides two crucial safety features for clinical translation: no radiation exposure and no long-term heavy metal accumulation.
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Affiliation(s)
- Mansik Jeon
- Department of Creative IT Engineering, Pohang University of Science & Technology, Pohang, 790-784, Republic of Korea
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Hsi RS, Dearn J, Dean M, Zamora DA, Kanal KM, Harper JD, Merguerian PA. Effective and organ specific radiation doses from videourodynamics in children. J Urol 2013; 190:1364-9. [PMID: 23707437 PMCID: PMC4843507 DOI: 10.1016/j.juro.2013.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Effective and organ specific doses of ionizing radiation during videourodynamics are unknown. We estimated radiation exposure in children undergoing videourodynamics, and identified patient and examination factors that contribute to higher dosing. MATERIALS AND METHODS Fluoroscopy data were collected from consecutive patients undergoing videourodynamics. Documented dose metrics were used to calculate entrance skin dose after applying a series of correction factors. Effective doses and organ specific doses (ovaries/testes) were estimated from entrance skin dose using Monte Carlo methods on a mathematical anthropomorphic phantom (ages 0, 1, 5, 10 and 15 years). Regression analysis was performed to determine patient and procedural factors associated with higher dosing. RESULTS A total of 100 children (45% male, mean ± SD age 9.3 ± 5.7 years) were studied. Diagnoses included neurogenic bladder (73%), anatomical abnormality (14%) and functional/nonneurogenic disorder (13%). Mean fluoroscopy time was 0.17 ± 0.12 minutes. Mean age adjusted entrance skin dose, effective dose, and testis and ovary doses were 2.18 ± 2.00 mGy, 0.07 ± 0.05 mSv, 0.09 ± 0.10 mGy and 0.20 ± 0.13 mGy, respectively. On univariate analysis age, height, weight, body mass index, bladder capacity and fluoroscopy time were associated with effective dose. On multivariate adjusted analysis, body mass index, bladder capacity and fluoroscopy time were independently associated with effective dose. CONCLUSIONS The average effective dose of ionizing radiation from videourodynamics was less compared to voiding cystourethrogram dose reported in the literature. Greater fluoroscopy time, body mass index and bladder capacity are independently associated with higher dosing.
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Affiliation(s)
- Ryan S. Hsi
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
| | - Jean Dearn
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
| | - Melanie Dean
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
| | - David A. Zamora
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
| | - Kalpana M. Kanal
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
| | - Jonathan D. Harper
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
| | - Paul A. Merguerian
- Division of Pediatric Urology, Seattle Children’s Hospital (JD, MD, PAM), Departments of Urology (RSH, JDH) and Radiology (DAZ, KMK), University of Washington School of Medicine, Seattle, Washington
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Silay MS, Tepeler A, Atis G, Sancaktutar AA, Piskin M, Gurbuz C, Penbegul N, Ozturk A, Caskurlu T, Armagan A. Initial report of microperc in the treatment of pediatric nephrolithiasis. J Pediatr Surg 2013; 48:1578-83. [PMID: 23895975 DOI: 10.1016/j.jpedsurg.2013.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE To report the first technical feasibility and safety of microperc in the treatment of pediatric nephrolithiasis. METHODS A multicenter prospective trial was initiated and microperc was performed in 19 children from four different centers. In all cases, 4.85-Fr all-seeing needle was used to access the collecting system under direct vision. Stone fragmentation was performed using a 200-μm holmium: YAG laser fiber either through the same needle sheath or an 8-Fr microsheath. Patient- and procedure-related factors and perioperative and postoperative parameters were analyzed. RESULTS The mean age of the children was 7.5 ± 4.4 years. Mean stone size was 14.8 ± 6.8mm. Conversion to Mini-PNL was required in two patients because of optical default in one and the high stone burden in the other. The mean hospital stay was 1.8 ± 0.8 days and the mean hemoglobin decrease was 0.1 mg/dl. The overall stone-free rate at 1 month was 89.5%. In one patient with obstructed ureteropelvic junction, intravasation of the irrigation fluid has led to abdominal distention and managed with percutaneous drainage intraoperatively. No other postoperative complication was recorded and no ancillary procedure was required. CONCLUSIONS Microperc is a safe and effective procedure in the treatment of pediatric kidney stones.
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Affiliation(s)
- Mesrur Selcuk Silay
- Faculty of Medicine, Department of Urology, Bezmialem Vakif University, Istanbul, Turkey.
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20
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Abstract
Conventional pediatric cystography, which is based on diagnostic X-ray using a radio-opaque dye, suffers from the use of harmful ionizing radiation. The risk of bladder cancers in children due to radiation exposure is more significant than many other cancers. Here we demonstrate the feasibility of nonionizing and noninvasive photoacoustic (PA) imaging of urinary bladders, referred to as photoacoustic cystography (PAC), using near-infrared (NIR) optical absorbents (i.e. methylene blue, plasmonic gold nanostructures, or single walled carbon nanotubes) as an optical-turbid tracer. We have successfully imaged a rat bladder filled with the optical absorbing agents using a dark-field confocal PAC system. After transurethral injection of the contrast agents, the rat's bladders were photoacoustically visualized by achieving significant PA signal enhancement. The accumulation was validated by spectroscopic PA imaging. Further, by using only a laser pulse energy of less than 1 mJ/cm(2) (1/20 of the safety limit), our current imaging system could map the methylene-blue-filled-rat-bladder at the depth of beyond 1 cm in biological tissues in vivo. Both in vivo and ex vivo PA imaging results validate that the contrast agents were naturally excreted via urination. Thus, there is no concern regarding long-term toxic agent accumulation, which will facilitate clinical translation.
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Affiliation(s)
- Mansik Jeon
- Department of Biomedical Engineering, University at Buffalo, The State University of New York
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21
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Koo J, Jeon M, Oh Y, Kang HW, Kim J, Kim C, Oh J. In vivo non-ionizing photoacoustic mapping of sentinel lymph nodes and bladders with ICG-enhanced carbon nanotubes. Phys Med Biol 2012; 57:7853-62. [PMID: 23151772 DOI: 10.1088/0031-9155/57/23/7853] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We demonstrate the feasibility of mapping a sentinel lymph node (SLN) and urinary bladder by using modified single-walled carbon nanotubes (SWNTs) as a nonionizing photoacoustic (PA) contrast agent. To improve the PA sensitivity, indocyanine green (ICG) was conjugated with SWNTs and the optical absorption of SWNTs-ICG was enhanced by approximately four times compared to that of plain SWNTs at a concentration of 0.3 µM. In vivo PA imaging results showed that the SLN and bladder were clearly visualized due to accumulation of SWNTs-ICG. This implies that the SWNTs-ICG could be potentially utilized to identify SLNs in breast cancer patients and tracking vesicoureteral reflux in combination with PA imaging.
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Affiliation(s)
- Jasung Koo
- Department of Mechatronics Engineering, Pukyong National University, Busan 608-737, Korea
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22
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Rowe CK, Franco FB, Barbosa JABA, Minnillo BJ, Chow JS, Treves T, Retik AB, Nguyen HT. A novel method of evaluating ureteropelvic junction obstruction: dynamic near infrared fluorescence imaging compared to standard modalities to assess urinary obstruction in a swine model. J Urol 2012; 188:1978-85. [PMID: 22999537 DOI: 10.1016/j.juro.2012.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Dynamic near infrared fluorescence imaging of the urinary tract provides a promising way to diagnose ureteropelvic junction obstruction. Initial studies demonstrated the ability to visualize urine flow and peristalsis in great detail. We analyzed the efficacy of near infrared imaging in evaluating ureteropelvic junction obstruction, renal involvement and the anatomical detail provided compared to conventional imaging modalities. MATERIALS AND METHODS Ten swine underwent partial or complete unilateral ureteral obstruction. Groups were survived for the short or the long term. Imaging was performed with mercaptoacetyltriglycine diuretic renogram, magnetic resonance urogram, excretory urogram, ultrasound and near infrared imaging. Scoring systems for ureteropelvic junction obstruction were developed for magnetic resonance urogram and near infrared imaging. Physicians and medical students graded ureteropelvic junction obstruction based on magnetic resonance urogram and near infrared imaging results. RESULTS Markers of vascular and urinary dynamics were quantitatively consistent among control renal units. The same markers were abnormal in obstructed renal units with significantly different times of renal phase peak, start of pelvic phase and start of renal uptake. Such parameters were consistent with those obtained with mercaptoacetyltriglycine diuretic renography. Near infrared imaging provided live imaging of urinary flow, which was helpful in identifying the area of obstruction for surgical planning. Physicians and medical students categorized the degree of obstruction appropriately for fluorescence imaging and magnetic resonance urogram. CONCLUSIONS Near infrared imaging offers a feasible way to obtain live, dynamic images of urine flow and ureteral peristalsis. Qualitative and quantitative parameters were comparable to those of conventional imaging. Findings support fluorescence imaging as an accurate, easy to use method of diagnosing ureteropelvic junction obstruction.
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Affiliation(s)
- Courtney K Rowe
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts 02115, USA
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23
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Tepeler A, Armagan A, Akman T, Sılay MS, Akçay M, Başıbüyük I, Erdem MR, Önol ŞY. Is fluoroscopic imaging mandatory for endoscopic treatment of ureteral stones? Urology 2012; 80:1002-6. [PMID: 22854137 DOI: 10.1016/j.urology.2012.02.082] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/18/2012] [Accepted: 02/28/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To present the feasibility and safety of fluoro-less endoscopic treatment of ureteral stones to diminish radiation exposure of the patient and operating team, and to determine circumstances where a fluoroscopic imaging is mandatory. METHODS Between 2010 and 2011, 93 patients with ureteral calculi who underwent ureteroscopic treatment by experienced urologists were retrospectively evaluated. Manipulations, such as guidewire, ureteral stent insertion, and balloon dilatation were performed with visual and tactile cues. Patient demographics, need for fluoroscopic imaging, operation and fluoroscopy time, and complication and success rates were investigated. RESULTS The mean age of patients was 34.03 ± 12.09 years (range, 9-63 years). The mean stone size was 10.64 ± 3.16 mm (range, 6-17 mm). The stones were localized in the proximal, middle, and distal segments in 11, 30, and 52 patients, respectively. The mean duration of the operation was 34.51 ± 7.94 minutes (range, 24-55 minutes). Stone-free status was achieved for 90 patients (96.77%). Fluoroscopic imaging was required for 7 patients with a mean fluoroscopy time of 9 ± 4.72 seconds (range, 4-16 seconds) for the following reasons: stone migration to the kidney (3 patients), double collecting system with 2 ureters (1 patient), and ureteral orifice stricture extending to the upper segment (1 patient). No major complications were observed, but minor complications were observed in 11 patients (11.8%). CONCLUSION The ureteroscopic treatment of ureteral stones can be safely and effectively performed in experienced hands, with limited or no usage of fluoroscopy except in special circumstances, such as anatomic abnormalities, upper ureteral strictures, and impacted ureteral stones leading to ureteral tortuosity, kinking, and obstruction.
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Affiliation(s)
- Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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24
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Penbegül N, Tepeler A, Sancaktutar AA, Bozkurt Y, Atar M, Yıldırım K, Söylemez H. Safety and Efficacy of Ultrasound-guided Percutaneous Nephrolithotomy for Treatment of Urinary Stone Disease in Children. Urology 2012; 79:1015-9. [DOI: 10.1016/j.urology.2011.10.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
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26
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Tepeler A, Akman T, Binbay M, Muslumanoglu AY. Letter to the Editor regarding the article "Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation". Pediatr Surg Int 2012; 28:215; author reply 217-8. [PMID: 22193635 DOI: 10.1007/s00383-011-3043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2011] [Indexed: 11/24/2022]
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Ngo TC, Clark CJ, Wynne C, Kennedy WA. Radiation Exposure During Pediatric Videourodynamics. J Urol 2011; 186:1672-6. [DOI: 10.1016/j.juro.2011.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Indexed: 11/24/2022]
Affiliation(s)
- Tin C. Ngo
- Stanford University School of Medicine, Stanford, California
| | | | - Colleen Wynne
- Lucile Packard Children's Hospital, Stanford, California
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28
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Abstract
We demonstrate the feasibility of a novel and nonionizing process for bladder imaging in vivo, called photoacoustic cystography (PAC). Using a photoacoustic imaging system, we have successfully imaged a rat bladder filled with clinically used Methylene Blue (MB) dye. An image contrast of ~8 was achieved. Further, spectroscopic PAC confirmed the accumulation of MB in the bladder. Using a laser pulse energy of less than 1 mJ/cm² (1/20 of the ANSI safety limit), a deeply (1.2 cm) positioned bladder in biological tissues was clearly visible in the PA image. Our results suggest that PAC can potentially provide a nonionizing, relatively cheap, and portable tool for bladder mapping. Among our clinical interests, nonionizing PAC with an injection of MB can potentially monitor vesicoureteral reflux in children.
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Affiliation(s)
- Chulhong Kim
- BioOptics and Acoustics Laboratory, Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, New York 14260, USA.
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Goske MJ, Applegate KE, Bulas D, Butler PF, Callahan MJ, Coley BD, Don S, Frush DP, Hernanz-Schulman M, Kaste SC, Morrison G, Sidhu M, Strauss KJ, Treves ST. Image Gently: progress and challenges in CT education and advocacy. Pediatr Radiol 2011; 41 Suppl 2:461-6. [PMID: 21847723 DOI: 10.1007/s00247-011-2133-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/02/2011] [Accepted: 03/17/2011] [Indexed: 10/24/2022]
Abstract
Significant progress has been made in radiation protection for children during the last 10 years. This includes increased awareness of the need for radiation protection for pediatric patients with international partnerships through the Alliance for Radiation Safety in Pediatric Imaging. This paper identifies five areas of significant progress in radiation safety for children: the growth of the Alliance; the development of an adult radiation protection campaign Image Wisely™; increased collaboration with government agencies, societies and the vendor community; the development of national guidelines in pediatric nuclear medicine, and the development of a size-based patient dose correction factor by the American Association of Physicists in Medicine, Task Group 204. However, many challenges remain. These include the need for continued education and change of practice at adult-focused hospitals where many pediatric CT exams are performed; the need for increased emphasis on appropriateness of pediatric imaging and outcomes research to validate the performance of CT studies, and the advancement of the work of the first pediatric national dose registry to determine the "state of the practice" with the final goal of establishing ranges of optimal CT technique for specific scan indications when imaging children with CT.
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Affiliation(s)
- Marilyn J Goske
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH 45229-3039, USA.
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30
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Abstract
While once thought to be relatively rare in developed nations, the prevalence of pediatric urolithiasis appears to be increasing, and a number of factors may be contributing to this increase. Many theories are plausible and such theories include the increasing childhood obesity epidemic, a changing sex predilection, climate change, alterations in dietary habits and improving diagnostic modalities. Yet, unlike adult patients, rigorous epidemiologic studies do not exist in pediatric populations. Thus, in the setting of an increasing prevalence of childhood stone disease, improved research is critical to the development of uniform strategies for pediatric urolithiasis management.
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Affiliation(s)
- Douglass B Clayton
- Vanderbilt University Medical Center, Department of Urologic Surgery, Division of Pediatric Urology, Nashville, TN, USA
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