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Sayed IS, Mohd Yusof MI. Techniques and Strategies to Minimize Radiation Exposure in Pediatric Computed Tomography (CT) Abdominal Examinations: A Review. Cureus 2024; 16:e67494. [PMID: 39310635 PMCID: PMC11416189 DOI: 10.7759/cureus.67494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
As children are more vulnerable to radiation-induced cancers and have longer life expectancies, it is essential to implement strict radiation protection measures in pediatric imaging. This study aimed to review radiation dose-minimizing measures in pediatric abdominal computed tomography (CT) examinations. A systematic search across various databases, including Web of Science, PubMed, SpringerLink, ScienceDirect, and Google Scholar, yielded a total of 7,314 articles. The search used keywords that aligned with the objectives of the study. This study included 77 publications after applying the criteria for inclusion and exclusion. We carefully reviewed these selected articles for compliance with the inclusion criteria and excluded them if they did not meet the specified criteria. Only 12 articles fulfilled the strict criteria. An in-depth review of 12 selected articles demonstrated the radiation dose reduction techniques and strategies, which include prefiltering and post-processing algorithms, careful adjustment of exposure parameters such as tube voltage (kVp) and current (mAs), and the establishment of diagnostic reference levels (DRL). Reduction of radiation exposure in pediatric CT imaging demands multifaceted approaches. To reduce the ionizing radiation dose while still obtaining high-quality diagnostic images, healthcare practitioners should adhere to DRL, adjust exposure factors, implement prefiltration, employ AI, and use post-processing algorithms.
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Affiliation(s)
- Inayatullah Shah Sayed
- Department of Diagnostic Imaging and Radiotherapy, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, MYS
| | - Muhammad Irfan Mohd Yusof
- Department of Diagnostic Imaging and Radiotherapy, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, MYS
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2
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Chen LG, Kao HW, Wu PA, Sheu MH, Huang LC. Optimal image quality and radiation doses with optimal tube voltages/currents for pediatric anthropomorphic phantom brains. PLoS One 2024; 19:e0306857. [PMID: 39037987 PMCID: PMC11262643 DOI: 10.1371/journal.pone.0306857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE Using pediatric anthropomorphic phantoms (APs), we aimed to determine the scanning tube voltage/current combinations that could achieve optimal image quality and avoid excessive radiation exposure in pediatric patients. MATERIALS AND METHODS A 64-slice scanner was used to scan a standard test phantom to determine the volume CT dose indices (CTDIvol), and three pediatric anthropomorphic phantoms (APs) with highly accurate anatomy and tissue-equivalent materials were studied. These specialized APs represented the average 1-year-old, 5-year-old, and 10-year-old children, respectively. The physical phantoms were constructed with brain tissue-equivalent materials having a density of ρ = 1.07 g/cm3, comprising 22 numbered 2.54-cm-thick sections for the 1-year-old, 26 sections for the 5-year-old, and 32 sections for the 10-year-old. They were scanned to acquire brain CT images and determine the standard deviations (SDs), effective doses (EDs), and contrast-to noise ratios (CNRs). The APs were scanned by 21 combinations of tube voltages/currents (80, 100, or 120 kVp/10, 40, 80, 120, 150, 200, or 250 mA) and rotation time/pitch settings of 1 s/0.984:1. RESULTS The optimal tube voltage/current combinations yielding optimal image quality were 80 kVp/80 mA for the 1-year-old AP; 80 kVp/120 mA for the 5-year-old AP; and 80 kVp/150 mA for the 10-year-old AP. Because these scanning tube voltages/currents yielded SDs, respectively, of 12.81, 13.09, and 12.26 HU, along with small EDs of 0.31, 0.34, and 0.31 mSv, these parameters and the induced values were expediently defined as optimal. CONCLUSIONS The optimal tube voltages/currents that yielded optimal brain image quality, SDs, CNRs, and EDs herein are novel and essentially important. Clinical translation of these optimal values may allow CT diagnosis with low radiation doses to children's heads.
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Affiliation(s)
- Li-Guo Chen
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hung-Wen Kao
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Radiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ping-An Wu
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Huei Sheu
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Li-Chuan Huang
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan
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3
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Foust AM, Rameh V, Lee EY, Winant AJ, Sarma A. Pediatric Neuroradiologic Emergencies: From Techniques to Imaging Findings. Semin Roentgenol 2024; 59:220-237. [PMID: 38997178 DOI: 10.1053/j.ro.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Alexandra M Foust
- Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN.
| | - Vanessa Rameh
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Asha Sarma
- Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
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4
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Gužvinec P, Muscogiuri G, Hrabak-Paar M. CT Assessment of Aortopulmonary Septal Defect: How to Approach It? J Clin Med 2024; 13:3513. [PMID: 38930042 PMCID: PMC11204932 DOI: 10.3390/jcm13123513] [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: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
An aortopulmonary septal defect or aortopulmonary window (APW) is a rare cardiovascular anomaly with direct communication between the ascending aorta and the main pulmonary artery leading to a left-to-right shunt. It is accompanied by other cardiovascular anomalies in approximately half of patients. In order to avoid irreversible sequelae, interventional or surgical treatment should be performed as soon as possible. Cardiovascular CT, as a fast, non-invasive technique with excellent spatial resolution, has an increasing role in the evaluation of patients with APW, enabling precise and detailed planning of surgical treatment of APW and associated anomalies if present. This article aims to review the anatomical and clinical features of aortopulmonary septal defect with special emphasis on its detection and characterization by a CT examination.
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Affiliation(s)
| | | | - Maja Hrabak-Paar
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- University Hospital Center Zagreb, 10000 Zagreb, Croatia
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Tan Z, Zhang L, Sun X, Yang M, Makamure J, Wu H, Wang J. Dual-Layer Detector Head CT to Maintain Image Quality While Reducing the Radiation Dose in Pediatric Patients. AJNR Am J Neuroradiol 2023; 44:1212-1218. [PMID: 37735089 PMCID: PMC10549953 DOI: 10.3174/ajnr.a7999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AND PURPOSE Radiation exposure in the CT diagnostic imaging process is a conspicuous concern in pediatric patients. This study aimed to evaluate whether 60-keV virtual monoenergetic images of the pediatric cranium in dual-layer CT can reduce the radiation dose while maintaining image quality compared with conventional images. MATERIALS AND METHODS One hundred six unenhanced pediatric head scans acquired by dual-layer CT were retrospectively assessed. The patients were assigned to 2 groups of 53 and scanned with 250 and 180 mAs, respectively. Dose-length product values were retrieved, and noise, SNR, and contrast-to-noise ratio were calculated for each case. Two radiologists blinded to the reconstruction technique used evaluated image quality on a 5-point Likert scale. Statistical assessment was performed with ANOVA and the Wilcoxon test, adjusted for multiple comparisons. RESULTS Mean dose-length product values were 717.47 (SD, 41.52) mGy×cm and 520.74 (SD, 42) mGy×cm for the 250- and 180-mAs groups, respectively. Irrespective of the radiation dose, noise was significantly lower, SNR and contrast-to-noise ratio were significantly higher, and subjective analysis revealed significant superiority of 60-keV virtual monoenergetic images compared with conventional images (all P < .001). SNR, contrast-to-noise ratio, and subjective evaluation in 60-keV virtual monoenergetic images were not significantly different between the 2 scan groups (P > .05). Radiation dose parameters were significantly lower in the 180-mAs group compared with the 250-mAs group (P < .001). CONCLUSIONS Dual-layer CT 60-keV virtual monoenergetic images allowed a radiation dose reduction of 28% without image-quality loss in pediatric cranial CT.
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Affiliation(s)
- Zhengwu Tan
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Lan Zhang
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Xiaojie Sun
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Ming Yang
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Joyman Makamure
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Hongying Wu
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Jing Wang
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
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Regmi PR, Amatya I, Paudel S, Kayastha P. Modern Paediatric Radiology: Meeting the Challenges in CT and MRI. JNMA J Nepal Med Assoc 2022; 60:661-663. [PMID: 36705198 PMCID: PMC9297347 DOI: 10.31729/jnma.7539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/25/2022] [Indexed: 01/31/2023] Open
Abstract
Radiology plays a very important part in the diagnosis, treatment, and follow-up of children. Computed tomography and magnetic resonance imaging are the two most crucial developments in the modern era. However, the two modalities have their challenges to overcome. Radiation dose is the most unwanted side effect of computed tomography scans while longer scan time along with sedation is a major disadvantage in children during magnetic resonance imaging. Paediatric-specific protocol selection and limiting the exposure to the area of interest aid in reducing the dose during computed tomography scans. Faster scan protocols and sequences can result in imaging without sedation in magnetic resonance imaging. Considering the radiation exposure, "as low as reasonably achievable" principle should be followed strictly in the paediatric population. In this article, possible ways for minimising the radiation dose in computed tomography, as well as effective, short, and sedation-free magnetic resonance imaging, are discussed. Keywords computed X-ray tomography; magnetic resonance imaging; pediatrics; radiation exposure; X-ray.
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Affiliation(s)
- Pradeep Raj Regmi
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Isha Amatya
- Health Research Section, Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Sharma Paudel
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal,Correspondence: Dr Sharma Paudel, Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. , Phone: +977-9841393486
| | - Prakash Kayastha
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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7
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Lee YJ, Hwang JY, Ryu H, Kim TU, Kim YW, Park JH, Choo KS, Nam KJ, Roh J. Image quality and diagnostic accuracy of reduced-dose computed tomography enterography with model-based iterative reconstruction in pediatric Crohn's disease patients. Sci Rep 2022; 12:2147. [PMID: 35140296 PMCID: PMC8828853 DOI: 10.1038/s41598-022-06246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
This study assessed the image quality and diagnostic accuracy in determining disease activity of the terminal ileum of the reduced-dose computed tomography enterography using model-based iterative reconstruction in pediatric patients with Crohn's disease (CD). Eighteen patients were prospectively enrolled and allocated to the standard-dose (SD) and reduced-dose (RD) computed tomography enterography (CTE) groups (n = 9 per group). Image quality, reader confidence in interpreting bowel findings, accuracy in determining active CD in the terminal ileum, and radiation dose were evaluated. Objective image quality did not show intergroup differences, except for image sharpness. Although reader confidence in detecting mural stratification, ulcer, and perienteric fat stranding of the RD-CTE were inferior to SD-CTE, RD-CTE correctly diagnosed active disease in all patients. The mean values of radiation dose metrics (SD-CTE vs. RD-CTE) were 4.3 versus 0.74 mGy, 6.1 versus 1.1 mGy, 211.9 versus 34.5 mGy∙cm, and 4.4 versus 0.7 mSv mGy∙cm for CTDIvol, size-specific dose estimation, dose-length product, and effective dose, respectively. RD-CTE showed comparable diagnostic accuracy to SD-CTE in determining active disease of the terminal ileum in pediatric CD patients. However, image quality and reader confidence in detecting ulcer and perienteric fat stranding was compromised.
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Affiliation(s)
- Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
| | - Hwaseong Ryu
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Tae Un Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Yong-Woo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Jae Hong Park
- Department of Pediatrics, Pusan National University Children's Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Ki Seok Choo
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Kyung Jin Nam
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Jieun Roh
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
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8
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Svahn TM, Ast JC. EFFECTIVE DOSE AND EFFECT OF DOSE MODULATION FOR LOCALIZER RADIOGRAPHS USING APPLIED AND ALTERNATIVE SETTINGS ON TOSHIBA/CANON CT SYSTEMS. RADIATION PROTECTION DOSIMETRY 2021; 195:198-204. [PMID: 33851201 DOI: 10.1093/rpd/ncab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
The purpose was to estimate the effective dose of Toshiba/Canon thorax localizer radiographs for available parameter settings, and to test their dose modulation ability. Localizer radiographs were acquired of anthropomorphic chest phantoms (body mass indices 29 and 23) using various settings (120-80 kV, 100-10 mA). The milliamperes values were compared from resulting helical scan data. Effective dose was computed for two computed tomography (CT) scanners (Aquilion Prime and One Genesis) using a Monte Carlo-based software. For the smaller phantom, all curves were superimposed. For the larger phantom, most curves were also superimposed, except for the one generated from the lowest parameters. The Aquilion Prime system yielded an effective dose of 0.40/0.56 mSv (male/female) using the default parameters. The localizer radiograph dose could be reduced by >90% without affecting the dose modulation. The dose was further reduced by 30-50% in the One Genesis CT system due to improved beam filtration.
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Affiliation(s)
- Tony M Svahn
- Centre for Research and Development, Uppsala University/Region Gävleborg, Lasarettsvägen 1, 801 88 Gävle, Sweden
- Department of Imaging and functional medicine, Division diagnostics, Lasarettsvägen 1, Gävle hospital, Region Gävleborg, 801 88 Gävle, Sweden
| | - Jennifer C Ast
- Department of Organismal Biology, Uppsala University, Norbyvägen 18 A, 752 36 Uppsala, Sweden
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9
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Lee EY, Vargas SO, Jenkins KJ, Callahan R, Park HJ, Gauthier Z, Winant AJ. Secondary Pulmonary Vein Stenosis Due to Total Anomalous Pulmonary Venous Connection Repair in Children: Extravascular MDCT Findings. CHILDREN-BASEL 2021; 8:children8090726. [PMID: 34572158 PMCID: PMC8468419 DOI: 10.3390/children8090726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022]
Abstract
Purpose: To evaluate extravascular findings on thoracic MDCT angiography in secondary pulmonary vein stenosis (PVS) due to total anomalous pulmonary venous connection (TAPVC) repair in children. Materials and Methods: All patients aged ≤18 years with a known diagnosis of secondary PVS after TAPVC repair, confirmed by echocardiography, conventional angiography, and/or surgery, who underwent thoracic MDCT angiography studies between July 2008 and April 2021 were included. Two pediatric radiologists independently examined MDCT angiography studies for the presence of extravascular thoracic abnormalities in the lung, pleura, and mediastinum. The location and distribution of each abnormality (in relation to the location of PVS) were also evaluated. Interobserver agreement between the two independent pediatric radiology reviewers was studied using kappa statistics. Results: The study group consisted of 20 consecutive pediatric patients (17 males, 3 females) with secondary PVS due to TAPVC repair. Age ranged from 2 months to 8 years (mean, 16.1 months). In children with secondary PVS due to TAPVC repair, the characteristic extravascular thoracic MDCT angiography findings were ground-glass opacity (19/20; 95%), septal thickening (7/20; 35%), pleural thickening (17/20; 85%), and a poorly defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (17/20; 85%) which followed the contours of affected pulmonary veins outside the lung. There was excellent interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: Our study characterizes the extravascular thoracic MDCT angiography findings in secondary pediatric PVS due to TAPVC repair. In the lungs and pleura, ground-glass opacity, interlobular septal thickening, and pleural thickening are common findings. Importantly, the presence of a mildly heterogeneously enhancing, non-calcified mediastinal soft tissue mass in the distribution of the PVS is a novel characteristic thoracic MDCT angiography finding seen in pediatric secondary PVS due to TAPVC repair.
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Affiliation(s)
- Edward Y. Lee
- Department of Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (H.J.P.); (A.J.W.)
- Correspondence: ; Tel.: +1-617-935-9997
| | - Sara O. Vargas
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Kathy J. Jenkins
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (K.J.J.); (R.C.); (Z.G.)
| | - Ryan Callahan
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (K.J.J.); (R.C.); (Z.G.)
| | - Halley J. Park
- Department of Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (H.J.P.); (A.J.W.)
| | - Zachary Gauthier
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (K.J.J.); (R.C.); (Z.G.)
| | - Abbey J. Winant
- Department of Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (H.J.P.); (A.J.W.)
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10
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Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect. CHILDREN-BASEL 2021; 8:children8080667. [PMID: 34438558 PMCID: PMC8394993 DOI: 10.3390/children8080667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 01/01/2023]
Abstract
Purpose: To retrospectively investigate the extravascular thoracic MDCT angiography findings of pulmonary vein stenosis (PVS) in children with a cardiac septal defect. Materials and Methods: Pediatric patients (age ≤ 18 years) with cardiac septal defect and PVS, confirmed by echocardiogram and/or conventional angiography, who underwent thoracic MDCT angiography studies from April 2009 to April 2021 were included. Two pediatric radiologists independently evaluated thoracic MDCT angiography studies for the presence of extravascular thoracic abnormalities in: (1) lung and airway (ground-glass opacity (GGO), consolidation, pulmonary nodule, mass, cyst, septal thickening, fibrosis, and bronchiectasis); (2) pleura (pleural thickening, pleural effusion, and pneumothorax); and (3) mediastinum (mass and lymphadenopathy). Interobserver agreement between the two independent pediatric radiology reviewers was evaluated with kappa statistics. Results: The final study group consisted of 20 thoracic MDCT angiography studies from 20 consecutive individual pediatric patients (13 males (65%) and 7 females (35%); mean age: 7.5 months; SD: 12.7; range: 2 days to 7 months) with cardiac septal defect and PVS. The characteristic extravascular thoracic MDCT angiography findings were GGO (18/20; 90%), septal thickening (9/20; 45%), pleural thickening (16/20; 80%), and ill-defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (9/20; 45%) following the contours of PVS in the mediastinum. There was a high interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: PVS in children with a cardiac septal defect has a characteristic extravascular thoracic MDCT angiography finding. In the lungs and pleura, GGO, septal thickening, and pleural thickening are frequently seen in children with cardiac septal defect and PVS. In the mediastinum, a mildly heterogeneously enhancing, non-calcified soft tissue mass in the distribution of PVS in the mediastinum is seen in close to half of the pediatric patients with cardiac septal defect and PVS.
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11
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Aremu OO, Samuels P, Jermy S, Lumngwena EN, Mutithu D, Cupido BJ, Skatulla S, Ntusi NAB. Cardiovascular imaging modalities in the diagnosis and management of rheumatic heart disease. Int J Cardiol 2020; 325:176-185. [PMID: 32980432 DOI: 10.1016/j.ijcard.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Rheumatic heart disease (RHD) is prevalent in sub-Saharan Africa, where the capacity for diagnosis and evaluation of disease severity and complications is not always optimal. While the medical history and physical examination are important in the assessment of patients suspected to have RHD, cardiovascular imaging techniques are useful for confirmation of the diagnosis. Echocardiography is the workhorse modality for initial evaluation and diagnosis of RHD. Cardiovascular magnetic resonance is complementary and may provide additive information, including tissue characteristics, where echocardiography is inadequate or non-diagnostic. There is emerging evidence on the role of computed tomography, particularly following valve replacement surgery, in the monitoring and management of RHD. This article summarises the techniques used in imaging RHD patients, considers the evidence base for their utility, discusses their limitations and recognises the clinical contexts in which indications and imaging with various modalities are expanding.
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Affiliation(s)
- Olukayode O Aremu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Evelyn N Lumngwena
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Centre for the Study of Emerging and Ee-emerging Infections (CREMER), Institute for Medical Research and Medicinal Plant studies (IMPM), Ministry of Scientific Research and Innovation, Cameroon
| | - Daniel Mutithu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Blanche J Cupido
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sebastian Skatulla
- Division of Structural Engineering and Mechanics, Department of Civil Engineering, University of Cape Town, South Africa; Department of Civil Engineering, Centre for Research in Computational and Applied Mechanics (CERECAM), University of Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa.
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Deep learning assisted differentiation of hepatocellular carcinoma from focal liver lesions: choice of four-phase and three-phase CT imaging protocol. Abdom Radiol (NY) 2020; 45:2688-2697. [PMID: 32232524 DOI: 10.1007/s00261-020-02485-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate whether a three-phase dynamic contrast-enhanced CT protocol, when combined with a deep learning model, has similar accuracy in differentiating hepatocellular carcinoma (HCC) from other focal liver lesions (FLLs) compared with a four-phase protocol. METHODS Three hundred and forty-two patients (mean age 49.1 ± 10.5 years, range 19-86 years, 65.8% male) scanned with a four-phase CT protocol (precontrast, arterial, portal-venous and delayed phases) were retrospectively enrolled. A total of 449 FLLs were categorized into HCC and non-HCC groups based on the best available reference standard. Three convolutional dense networks (CDNs) with the input of four-phase CT images (model A), three-phase images without portal-venous phase (model B) and three-phase images without precontrast phase (model C) were trained on 80% of lesions and evaluated in the other 20% by receiver operating characteristics (ROC) and confusion matrix analysis. The DeLong test was performed to compare the areas under the ROC curves (AUCs) of A with B, B with C, and A with C. RESULTS The diagnostic accuracy in differentiating HCC from other FLLs on test sets was 83.3% for model A, 81.1% for model B and 85.6% for model C, and the AUCs were 0.925, 0.862 and 0.920, respectively. The AUCs of models A and C did not differ significantly (p = 0.765), but the AUCs of models A and B (p = 0.038) and of models B and C (p = 0.028) did. CONCLUSIONS When combined with a CDN, a three-phase CT protocol without precontrast showed similar diagnostic accuracy as a four-phase protocol in differentiating HCC from other FLLs, suggesting that the multiphase CT protocol for HCC diagnosis might be optimized by removing the precontrast phase to reduce radiation dose.
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Dual-Energy CT of Pediatric Abdominal Oncology Imaging: Private Tour of New Applications of CT Technology. AJR Am J Roentgenol 2020; 214:967-975. [DOI: 10.2214/ajr.19.22242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Dymbe B, Mæland EV, Styve JR, Rusandu A. Individualization of computed tomography protocols for suspected pulmonary embolism: a national investigation of routines. J Int Med Res 2020; 48:300060520918427. [PMID: 32290743 PMCID: PMC7157970 DOI: 10.1177/0300060520918427] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Given the extensive use of computed tomography (CT) in radiation-sensitive patients such as pregnant and pediatric patients, and considering the importance of tailoring CT protocols to patient characteristics for both the radiation dose and image quality, this study was performed to investigate the extent to which individualization of CT protocols is practiced across Norway. Methods This cross-sectional study involved collection of CT protocols and administration of a mini-questionnaire to obtain additional information about how CT examinations are individualized. All public hospitals performing CT to detect pulmonary embolism were invited, and 41% participated. Results Tailoring a standard protocol to different patient groups was more common than using dedicated protocols. Most of the available radiation dose-reduction approaches were used. However, implementation of these strategies was not systematic. Children and pregnant patients were examined without using dedicated CT protocols or by using protocol adjustments focusing on radiation dose reduction in 30% and 39% of the hospitals, respectively. Conclusion Practice optimization is needed, especially the development of dedicated CT protocols or guidelines that tailor the existing protocol to pediatric and pregnant patients. Practice might benefit from a more systematic approach to individualization of CT examinations, such as inserting tailoring instructions into CT protocols.
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Affiliation(s)
- Berit Dymbe
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Elisabeth Vespestad Mæland
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jorunn Rønhovde Styve
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Albertina Rusandu
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Foust AM, Phillips GS, Chu WC, Daltro P, Das KM, Garcia-Peña P, Kilborn T, Winant AJ, Lee EY. International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting, and Imaging Study Recommendations. Radiol Cardiothorac Imaging 2020; 2:e200214. [PMID: 33778577 PMCID: PMC7233446 DOI: 10.1148/ryct.2020200214] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has quickly spread since it was first detected in December 2019 and has evolved into a global pandemic with over 1.7 million confirmed cases in over 200 countries around the world at the time this document is being prepared. Owing to the novel nature of the virus and the rapidly evolving understanding of the disease, there is a great deal of uncertainty surrounding the diagnosis and management of COVID-19 pneumonia in pediatric patients. Chest imaging plays an important role in the evaluation of pediatric patients with COVID-19; however, there is currently little information available describing imaging manifestations of COVID-19 in pediatric patients and even less information discussing the utilization of imaging studies in pediatric patients. To specifically address these concerns, a group of international experts in pediatric thoracic imaging from five continents convened to create a consensus statement describing the imaging manifestations of COVID-19 in the pediatric population, discussing the potential utility of structured reporting during the COVID-19 pandemic, and generating consensus recommendations for utilization of chest radiographs and CT in the evaluation of pediatric patients with COVID-19. The results were compiled into two structured reporting algorithms (one for chest radiographs and one for chest CT) and eight consensus recommendations for the utilization of chest imaging in pediatric COVID-19 infection. © RSNA, 2020.
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Affiliation(s)
- Alexandra M. Foust
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Grace S. Phillips
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Winnie C. Chu
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Pedro Daltro
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Karuna M. Das
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Pilar Garcia-Peña
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Tracy Kilborn
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Abbey J. Winant
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
| | - Edward Y. Lee
- From the Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.M.F., A.J.W., E.Y.L.); Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Wash (G.S.P.); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (W.C.C.); Department of Radiology, ALTA-Excelência Diagnóstica/Dasa, Rio de Janeiro, Brazil (P.D.); Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates (K.M.D.); Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d’Hebron, Barcelona, Spain (P.G.P.); and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa (T.K.)
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