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Muacevic A, Adler JR, Matbouli S, Alnahdi YA, Meriky LH, Hagi S. Assessing Radiation Dosage in Pediatric Head and Neck Computed Tomography Examinations During COVID-19 in a Tertiary Hospital in Saudi Arabia, Jeddah. Cureus 2023; 15:e33588. [PMID: 36779139 PMCID: PMC9910031 DOI: 10.7759/cureus.33588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
This study aimed to assess the practice of imaging and optimization of the radiation dose in pediatric head and neck computed tomography (CT) examinations during the coronavirus disease of 2019 (COVID-19) period. This study is based on a retrospective analysis of pediatric head CT records, conducted in the Radiology Department of the King Abdulaziz University Hospital in Jeddah, Saudi Arabia. We examined the data of all pediatric patients between 0 and 14 years of age who underwent head CT scans between March and September in both 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). In total, we analyzed 1005 scans; 531 (52.8%) were performed before and 474 (47.2%) during COVID-19. The dose parameters were similar; however, the exposure time was significantly lower during COVID-19 (5432 ms vs. 5811 before; p < 0.001). In contrast, the mean total CTDIvol and dose-length product (DLP) were slightly higher during COVID-19 than those before (23.34 mGy vs. 22.04 mGy (p-value=0.565) and 577.36 mGy*cm vs. 518.93 mGy*cm (p-value=0.193) respectively). These changes could be attributed to the desire to limit the contact between technicians and patients. The limitation of contact with the patient allows the technicians to be independent during the scan, possibly accounting for this slight decrease.
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Inoue Y, Itoh H, Shiibashi N, Sasa R, Mitsui K. Sample Size and Estimation of Standard Radiation Doses for Pediatric Brain CT. Tomography 2022; 8:2486-2497. [PMID: 36287806 PMCID: PMC9612354 DOI: 10.3390/tomography8050207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
Estimation of the standard radiation dose at each imaging facility is required for radiation dose management, including establishment and utilization of the diagnostic reference levels. We investigated methods to estimate the standard dose for pediatric brain computed tomography (CT) using a small number of data. From 980 pediatric brain CT examinations, 25, 50, and 100 examinations were randomly extracted to create small, medium, and large datasets, respectively. The standard dose was estimated by applying grouping and curve-fitting methods for 20 datasets of each sample size. For the grouping method, data were divided into groups according to age or body weight, and the standard dose was defined as a median value in each group. For the curve-fitting methods, logarithmic, power, and bilinear functions were fitted to plots of radiation dose against age or weight, and the standard dose was calculated at the designated age or weight using the derived equation. When the sample size was smaller, the random variations of the estimated standard dose were larger. Better estimation of the standard dose was achieved with the curve-fitting methods than with the grouping method. Power fitting appeared to be more effective than logarithmic and bilinear fittings for suppressing random variation. Determination of the standard dose for pediatric brain CT by the curve-fitting method is recommended to improve radiation dose optimization at facilities performing the imaging procedure infrequently.
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Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0374, Kanagawa, Japan
| | - Nao Shiibashi
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Ryosuke Sasa
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0374, Kanagawa, Japan
| | - Kohei Mitsui
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
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Inoue Y, Itoh H, Waga A, Sasa R, Mitsui K. Radiation Dose Management in Pediatric Brain CT According to Age and Weight as Continuous Variables. Tomography 2022; 8:985-998. [PMID: 35448713 PMCID: PMC9027691 DOI: 10.3390/tomography8020079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022] Open
Abstract
The diagnostic reference levels (DRLs) for pediatric brain computed tomography (CT) are provided for groups divided according to age. We investigated the relationships of radiation dose indices (volume CT dose index and dose length product) with age and weight, as continuous variables, in pediatric brain CT. In a retrospective analysis, 980 pediatric brain CT examinations were analyzed. Curve fitting was performed for plots of the CT dose indices versus age and weight, and equations to estimate age- and weight-dependent standard dose indices were derived. Standard dose indices were estimated using the equations, and the errors were calculated. The results showed a biphasic increase in dose indices with increasing age and weight, characterized by a rapid initial and subsequent slow increase. Logarithmic, power, and bilinear functions were well fitted to the plots, allowing estimation of standard dose indices at an arbitrary age or weight. Error analysis suggested that weight was mildly better than age and that the best results were obtained with the bilinear function. Curve fitting of the relationship between CT dose indices and age or weight facilitates the determination of standard dose indices in pediatric brain CT at each facility and is expected to aid the establishment and application of the DRLs.
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Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (A.W.); (K.M.)
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (R.S.)
| | - Anri Waga
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (A.W.); (K.M.)
| | - Ryosuke Sasa
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (R.S.)
| | - Kohei Mitsui
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (A.W.); (K.M.)
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Model-based iterative reconstruction in paediatric head computed tomography: a pilot study on dose reduction in children. Pol J Radiol 2021; 86:e504-e510. [PMID: 34567298 PMCID: PMC8449558 DOI: 10.5114/pjr.2021.108884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the potential of model-based iterative reconstruction (MBIR) on dose reduction and image quality in children undergoing computed tomography (CT) head examinations. Material and methods This prospective study was approved by the institutional ethics committee. A total of 88 children (age range of 5 to 16 years) with a history of seizures underwent contrast-enhanced CT scan. Forty-one children underwent CT study according to the MBIR technique, while 47 children underwent CT of the head with the non-MBIR protocol. Images were reviewed by 2 blinded paediatric radiologists in a random order. Mean dose-length product, CT dose index (CTDI) volume, and mean effective dose were recorded for both groups. Image quality, image noise, and diagnostic acceptability of 2 image sets were also recorded. Results In the MBIR group, the mean dose-length product was reduced by 79.8%; the mean CTDI volume was reduced by 88.5%, while the mean effective dose was reduced by 81% when compared to the non-MBIR group. No significant difference was seen in diagnostic acceptability, image noise, and image quality between the 2 groups. Conclusions MBIR technique is highly effective in reducing radiation dose in paediatric head CT examinations without any significant difference in image quality, image noise, and diagnostic acceptability.
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LaQuaglia MJ, Anderson M, Goodhue CJ, Bautista-Durand M, Spurrier R, Ourshalimian S, Lai L, Stanley P, Chaudhari PP, Bliss D. Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan. J Trauma Acute Care Surg 2021; 91:566-570. [PMID: 34137741 DOI: 10.1097/ta.0000000000003318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs). We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CT at AGHs for similar injury profiles. METHODS We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDIvol) and dose-length product (DLP; the product of CTDIvol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children's Hospital Los Angeles and AGHs. RESULTS Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDIvol 20.3/DLP 408.7 vs. CTDIvol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDIvol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDIvol 25.6 vs. 36.5, p < 0.0001). CONCLUSIONS Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT. LEVEL OF EVIDENCE Care Management/Therapeutic, level IV.
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Affiliation(s)
- Michael J LaQuaglia
- From the Division of Pediatric Surgery (M.J.L., R.S., S.O., D.B.), Children's Hospital Los Angeles; Department of Surgery (M.J.L., R.S., S.O., D.B.), Keck School of Medicine, University of Southern California; Division of Pediatric Surgery (M.A., C.J.G., M.B.-D.) and Department of Radiology (L.L., P.S.), Children's Hospital Los Angeles; Department of Radiology (L.L., P.S.), Keck School of Medicine, University of Southern California; and Division of Emergency and Transport Medicine (P.P.C.), Children's Hospital Los Angeles, California
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Smith TB, Zhang S, Erkanli A, Frush D, Samei E. Variability in image quality and radiation dose within and across 97 medical facilities. J Med Imaging (Bellingham) 2021; 8:052105. [PMID: 33977114 DOI: 10.1117/1.jmi.8.5.052105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: To characterize variability in image quality and radiation dose across a large cohort of computed tomography (CT) examinations and identify the scan factors with the highest influence on the observed variabilities. Approach: This retrospective institutional-review-board-exempt investigation was performed on 87,629 chest and abdomen-pelvis CT scans acquired for 97 facilities from 2018 to 2019. Images were assessed in terms of noise, resolution, and dose metrics (global noise, frequency in which modulation transfer function is at 0.50, and volumetric CT dose index, respectively). The results were fit to linear mixed-effects models to quantify the variabilities as affected by scan parameters and settings and patient characteristics. A list of factors, ranked by t -value with p < 0.05 , was ascertained for each of the six mixed effects models. A type III p -value test was used to assess the influence of facility. Results: Across different facilities, image quality and dose were significantly different ( p < 0.05 ), with little correlation between their mean magnitudes and consistency (Pearson's correlation coefficient < 0.34 ). Scanner model, slice thickness, recon field-of-view and kernel, mAs, kVp, patient size, and centering were the most influential factors. The two body regions exhibited similar rankings of these factors for noise (Spearman's correlation coefficient = 0.76 ) and dose (Spearman's correlation coefficient = 0.86 ) but not for resolution (Spearman's correlation coefficient = 0.52 ). Conclusions: Clinical CT scans can vary in image quality and dose with broad implications for diagnostic utility and radiation burden. Average scan quality was not correlated with interpatient scan-quality consistency. For a given facility, this variability can be quite large, with magnitude differences across facilities. The knowledge of the most influential factors per body region may be used to better manage these variabilities within and across facilities.
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Affiliation(s)
- Taylor B Smith
- Duke University, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Durham, North Carolina, United States.,Duke University, Medical Physics Graduate Program, Durham, North Carolina, United States.,Duke University Medical Center, Durham, North Carolina, United States
| | - Shuaiqi Zhang
- Duke University School of Medicine, BERD Methods Core, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States
| | - Alaattin Erkanli
- Duke University School of Medicine, BERD Methods Core, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States
| | - Donald Frush
- Stanford University, Lucile Salter Packard Children's Hospital, Stanford, California, United States
| | - Ehsan Samei
- Duke University, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Durham, North Carolina, United States.,Duke University, Medical Physics Graduate Program, Durham, North Carolina, United States.,Duke University Medical Center, Durham, North Carolina, United States
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Abdulkadir MK, Izge IY, Yunusa GH, Mohammed A, Osman ND. Evaluation of age-based radiation dose in paediatric patients received from head CT examination at a tertiary hospital, Nigeria. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Muroi A, Enomoto T, Ihara S, Ishikawa E, Inagaki T, Matsumura A. Developmental changes in the occipital cranial sutures of children less than 2 years of age. Childs Nerv Syst 2021; 37:567-572. [PMID: 32767105 DOI: 10.1007/s00381-020-04844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The occipital bone is located on the boundary between the membranous and cartilage bones and contains a wide variety of accessory sutures. In this study, we describe the age distribution of pediatric patients who are less than 2 years of age with occipital cranial sutures using a three-dimensional computed tomography (3D-CT). METHODS A total of 167 consecutive patients who are less than 2 years of age and underwent computed tomography for head trauma were included in this study. RESULTS Based on the results of this study, various types of sutures were observed among the pediatric participants. In particular, superior median fissures, mendosal sutures, other interparietal segment's accessory sutures, and interparietal sutures were noted in 21%, 35%, 9%, and 6% of the participants, respectively. Additionally, Wormian bones within the lambdoid suture were noted in 32% of the patients. The median age of children with superior median fissure and mendosal suture was 0 month. Meanwhile, superior median fissure was not observed among children older than 5 months of age. In this population, 13 patients (8%) were found to have skull fracture. CONCLUSIONS Knowledge of the normal cranial anatomy and developmental patterns of cranial sutures is crucial in the evaluation of questionable fractures in the occipital region. A combination of 3D-CT and axial bone window imaging is useful in differentiating normal structures from pathological changes in the cranium.
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Affiliation(s)
- Ai Muroi
- Division of Pediatric Neurosurgery, Ibaraki Children's Hospital, Mito, Ibaraki, Japan. .,Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Takao Enomoto
- Department of Neurosurgery, Tsukuba Central Hospital, Ushiku, Tsukuba, Japan
| | - Satoshi Ihara
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takayuki Inagaki
- Division of Pediatric Neurosurgery, Ibaraki Children's Hospital, Mito, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Sherif FM, Said AM, Elsayed YN, Elmogy SA. Value of using adaptive statistical iterative reconstruction-V (ASIR-V) technology in pediatric head CT dose reduction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With widespread use of pediatric head CT, it is critically important to protect patients from radiation hazards, using reduced dose CT techniques. In this regard, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm can decrease image noise, generating CT images of reasonable diagnostic quality with less radiation. The objective of this study was radiation dose assessment, quantitative and qualitative evaluation of reduced dose pediatric head CT using ASIR-V 60% and 80% reconstruction.
Results
Retrospective analysis was performed on two groups of pediatric head CT examinations, a reduced dose CT examination group with ASIR-V reconstruction (ASIR group) (n = 27) and a standard dose CT examination group without ASIR reconstruction (non-ASIR group) (n = 14). The average effective dose (ED) of ASIR group was significantly lower than that of the non-ASIR group (1.04 ± 0.1 mS vs 3.48 ± 0.45 mS; p = 0.001). Quantitative analysis revealed comparable results of signal to noise ratio (SNR) and contrast to noise ratio (CNR) of ASIR and non-ASIR groups (p > 0.05). Qualitative evaluation of resulting images by two readers revealed comparable results of both ASIR and non-ASIR groups (p > 0.05) with excellent inter-reader agreement (κ = 0.97). Both quantitative and qualitative assessment demonstrated better ASIR-V 80% than ASIR-V 60% reconstructed images.
Conclusion
ASIR-V algorithm is a promising technology for effective dose reduction of pediatric head CT with preservation of diagnostic image quality.
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Kharita MH, Al-Naemi H, Arru C, Omar AJ, Aly A, Tsalafoutas I, Alkhazzam S, Singh R, Kalra MK. Relation between age and CT radiation doses: Dose trends in 705 pediatric head CT. Eur J Radiol 2020; 130:109138. [PMID: 32619755 DOI: 10.1016/j.ejrad.2020.109138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the relationship between patient age and radiation doses associated with routine pediatric head CT performed with automatic tube potential selection and tube current modulation techniques. METHODS We obtained patient demographics, scan parameters, and radiation dose descriptors (CT dose index volume -CTDIvol and dose length product -DLP) associated with consecutive routine head CT in 705 children (mean age 6.9 ± 5 years). Children were scanned on one of the three multidetector-row CTs (64-128 slices, Siemens) over 6 months period in a tertiary hospital. All head CT exams were performed in helical scan mode using automatic tube potential selection (Care kV) and automatic tube current modulation (Care Dose 4D) techniques. The information was obtained from a radiation dose monitoring software. Data were analyzed using linear correlation and analysis of variance. RESULTS Most age-wise median CTDIvol (9-27 mGy; 703/705 pediatric head CT, >99 %) from our institution were lower than the European Diagnostic Reference Levels (EDRL, CTDIvol 24-50 mGy) but median DLP (151-586 mGy cm) from 201/705 children (28 %) was higher than the EDRL (DLP 300-650 mGy cm). Unlike the age-stratified EDRL, a combination of automatic tube potential selection and tube current modulation for pediatric head results in a significant linear correlation between radiation doses and patient age (r2 = 0.66, p < 0.001). CONCLUSIONS Radiation doses for head CT change linearly with children's age. Despite lower CTDIvol and DLP for most children, longer scan length resulted in higher DLP for some pediatric head CT compared to the corresponding EDRL; this result underscores the need to promote clear guidelines for technologists operating CT.
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Affiliation(s)
| | | | - Chiara Arru
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Antar Aly
- Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ramandeep Singh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mannudeep K Kalra
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Louie JP, Alfano J, Nguyen-Tran T, Nguyen-Tran H, Shanley R, Holm T, Furnival RA. Reduction of paediatric head CT utilisation at a rural general hospital emergency department. BMJ Qual Saf 2020; 29:912-920. [PMID: 32111643 DOI: 10.1136/bmjqs-2019-010322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Blunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department. METHODS Children presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts. RESULTS The preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation. CONCLUSION The series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.
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Affiliation(s)
| | - Joseph Alfano
- Emergency Medicine, Fairview Lakes Medical Center, Wyoming, Minnesota, USA
| | | | - Hai Nguyen-Tran
- Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ryan Shanley
- Masonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tara Holm
- Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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Berger RP, Furtado AD, Flom LL, Fromkin JB, Panigrahy A. Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Pediatr Radiol 2020; 50:75-82. [PMID: 31901990 DOI: 10.1007/s00247-019-04506-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/19/2019] [Accepted: 08/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Head computed tomography (CT) is the current standard of care for evaluating infants at high risk of abusive head trauma. OBJECTIVE To both assess the feasibility of using a previously developed magnetic resonance imaging (MRI) brain injury screen (MRBRscreen) in the acute care setting in place of head CT to identify intracranial hemorrhage in high-risk infants and to compare the accuracy of a rapid imaging pulse sequence (single-shot T2 fast spin echo [ssT2FSE]) to a conventional pulse sequence (conventional T2 fast spin echo [conT2FSE]). MATERIALS AND METHODS This was a quality improvement initiative to evaluate infants <12 months of age who were screened for intracranial hemorrhage using an MRBRscreen as part of clinical care. The MRBRscreen included axial conT2FSE, axial gradient recalled echo, coronal T1-weighted inversion recovery, axial diffusion-weighted image and an axial ssT2FSE. A comparison of ssT2FSE to conT2FSE with respect to lesion detection was also performed. RESULTS Of 158 subjects, the MRBRscreen was able to be completed in 155 (98%); 9% (14/155) were abnormal. Ninety-four percent (137/145) of subjects underwent only an MRBRscreen and avoided both radiation from head CT and sedation from MRI. The axial ssT2FSE and conT2FSE results were congruent 99% of the time. CONCLUSION An MRBRscreen in place of a head CT is feasible and potentially could decrease head CT use by more than 90% in this population. Using a rapid ssT2FSE in place of a conT2FSE can reduce total scan time without losing lesion detection. If an MRBRscreen is readily available, physicians' threshold to perform neuroimaging may be lowered and lead to earlier detection of abusive head trauma.
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Affiliation(s)
- Rachel P Berger
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 4117 Penn Ave., Pittsburgh, PA, 15224, USA.
| | - Andre D Furtado
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lynda L Flom
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Janet B Fromkin
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 4117 Penn Ave., Pittsburgh, PA, 15224, USA
| | - Ashok Panigrahy
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Strauss KJ, Somasundaram E, Sengupta D, Marin JR, Brady SL. Radiation Dose for Pediatric CT: Comparison of Pediatric versus Adult Imaging Facilities. Radiology 2019; 291:158-167. [PMID: 30720404 DOI: 10.1148/radiol.2019181753] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The American College of Radiology Dose Index Registry for CT enables evaluation of radiation dose as a function of patient characteristics and examination type. The hypothesis of this study was that academic pediatric CT facilities have optimized CT protocols that may result in a lower and less variable radiation dose in children. Materials and Methods A retrospective study of doses (mean patient age, 12 years; age range, 0-21 years) was performed by using data from the National Radiology Data Registry (year range, 2016-2017) (n = 239 622). Three examination types were evaluated: brain without contrast enhancement, chest without contrast enhancement, and abdomen-pelvis with intravenous contrast enhancement. Three dose indexes-volume CT dose index (CTDIvol), size-specific dose estimate (SSDE), and dose-length product (DLP)-were analyzed by using six different size groups. The unequal variance t test and the F test were used to compare mean dose and variances, respectively, at academic pediatric facilities with those at other facility types for each size category. The Bonferroni-Holm correction factor was applied to account for the multiple comparisons. Results Pediatric radiation dose in academic pediatric facilities was significantly lower, with smaller variance for all brain, 42 of 54 (78%) chest, and 48 of 54 (89%) abdomen-pelvis examinations across all six size groups, three dose descriptors, and when compared with that at the other three facilities. For example, abdomen-pelvis SSDE for the 14.5-18-cm size group was 3.6, 5.4, 5.5, and 8.3 mGy, respectively, for academic pediatric, nonacademic pediatric, academic adult, and nonacademic adult facilities (SSDE mean and variance P < .001). Mean SSDE for the smallest patients in nonacademic adult facilities was 51% (6.1 vs 11.9 mGy) of the facility's adult dose. Conclusion Academic pediatric facilities use lower CT radiation dose with less variation than do nonacademic pediatric or adult facilities for all brain examinations and for the majority of chest and abdomen-pelvis examinations. © RSNA, 2019 See also the editorial by Strouse in this issue.
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Affiliation(s)
- Keith J Strauss
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., E.S., S.L.B.); University of Cincinnati School of Medicine, Cincinnati, Ohio (K.J.S., E.S., S.L.B.); National Radiology Data Registries, American College of Radiology, Reston, Va (D.S.); and Department of Pediatrics and Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa (J.R.M.)
| | - Elanchezhian Somasundaram
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., E.S., S.L.B.); University of Cincinnati School of Medicine, Cincinnati, Ohio (K.J.S., E.S., S.L.B.); National Radiology Data Registries, American College of Radiology, Reston, Va (D.S.); and Department of Pediatrics and Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa (J.R.M.)
| | - Debapriya Sengupta
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., E.S., S.L.B.); University of Cincinnati School of Medicine, Cincinnati, Ohio (K.J.S., E.S., S.L.B.); National Radiology Data Registries, American College of Radiology, Reston, Va (D.S.); and Department of Pediatrics and Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa (J.R.M.)
| | - Jennifer R Marin
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., E.S., S.L.B.); University of Cincinnati School of Medicine, Cincinnati, Ohio (K.J.S., E.S., S.L.B.); National Radiology Data Registries, American College of Radiology, Reston, Va (D.S.); and Department of Pediatrics and Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa (J.R.M.)
| | - Samuel L Brady
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., E.S., S.L.B.); University of Cincinnati School of Medicine, Cincinnati, Ohio (K.J.S., E.S., S.L.B.); National Radiology Data Registries, American College of Radiology, Reston, Va (D.S.); and Department of Pediatrics and Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa (J.R.M.)
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14
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Matenine D, Schmittbuhl M, Bedwani S, Després P, de Guise JA. Iterative reconstruction for image enhancement and dose reduction in diagnostic cone beam CT imaging. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:805-819. [PMID: 31450539 DOI: 10.3233/xst-190523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Iterative reconstruction is well-established in diagnostic multidetector computed tomography (MDCT) for dose reduction and image quality enhancement. Its application to diagnostic cone beam computed tomography (CBCT) is only emerging and warrants a quantitative evaluation. METHODS Several phantoms and a canine head specimen were imaged using a commercially available small-field CBCT scanner. Raw projection data were reconstructed using the Feldkamp-Davis-Kress (FDK) method with different filters, including denoising via total variation (TV) minimization (FDK-TV). Iterative reconstruction was carried out using the TV-regularized ordered subsets convex technique (OSC-TV). Signal-to-noise ratio (SNR), noise power spectrum (NPS) and spatial resolution of images were estimated. Dose levels were measured via the weighted computed tomography dose index, while low-dose image quality degradation was estimated via structural similarity (SSIM). RESULTS OSC-TV and FDK-TV were shown to significantly improve image signal-to-noise ratio (SNR) compared to FDK with a standard filter, 5.8 and 4.0 times, respectively. Spatial resolution attained with different algorithms varied moderately across different experiments. For low-dose acquisitions, image quality decreased dramatically for FDK but not for FDK-TV nor OSC-TV. For low-dose canine head images acquired using about 1/5 of the dose compared to a reference image, SSIM dropped to about 0.3 for FDK, while remaining at 0.92 for FDK-TV and 0.96 for OSC-TV. CONCLUSION OSC-TV was shown to improve image quality compared to FDK and FDK-TV. Moreover, this iterative approach allowed for significant dose reduction while maintaining image quality.
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Affiliation(s)
- Dmitri Matenine
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de génie des systèmes, École de technologie supérieure, Montréal, QC, Canada
| | - Matthieu Schmittbuhl
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - Stéphane Bedwani
- Département de physique, Université de Montréal, Montréal, QC, Canada
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Philippe Després
- Département de physique, de génie physique et d'optique and Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
- Département de radio-oncologie and Centre de recherche du CHU de Québec, Québec (QC) G1R 2J6, Canada
| | - Jacques A de Guise
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de génie des systèmes, École de technologie supérieure, Montréal, QC, Canada
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15
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Spampinato MV, Stalcup S, Matheus MG, Byington K, Tyler M, Bickley S, Tipnis S. RADIATION DOSE AND IMAGE QUALITY IN PEDIATRIC HEAD CT. RADIATION PROTECTION DOSIMETRY 2018; 182:310-316. [PMID: 30590841 DOI: 10.1093/rpd/ncy066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/10/2018] [Indexed: 06/09/2023]
Abstract
Our goal was to define a pediatric head CT protocol able to provide images of diagnostic quality, using the least amount of radiation, in children <10 years of age, while using a filtered back projection reconstruction algorithm. Image quality of 119 pediatric head CTs was assessed using a 5-point scoring system. Exams with scores ≥2.5 were considered of sufficient diagnostic quality. The contrast-to-noise ratio (CNR) was also measured. For children <1 year and 1-9 years, all studies performed with CTDIvol ≥ 20.1 mGy (range: 9-46 mGy) and CTDIvol ≥ 27.5 mGy (range: 15-60 mGy) yielded images of diagnostic quality. All diagnostic studies had a minimum CNR of 1.4. These CTDIvol values represent a good balance between image quality and radiation burden. This information can be helpful in designing pediatric head CT protocols with further dose-reduction, namely, iterative reconstruction algorithms and automated exposure control.
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Affiliation(s)
- Maria Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, USA
| | - Seth Stalcup
- Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, USA
| | - Maria Gisele Matheus
- Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, USA
| | | | - Michael Tyler
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, USA
| | - Stetson Bickley
- Department of Radiology, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, USA
| | - Sameer Tipnis
- Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, USA
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16
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Sadigh G, Kadom N, Karthik P, Sengupta D, Strauss KJ, Frush D, Applegate KE. Noncontrast Head CT in Children: National Variation in Radiation Dose Indices in the United States. AJNR Am J Neuroradiol 2018; 39:1400-1405. [PMID: 29976832 DOI: 10.3174/ajnr.a5719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiologists should manage the radiation dose for pediatric patients to maintain reasonable diagnostic confidence. We assessed the variation in estimated radiation dose indices for pediatric noncontrast head CT in the United States. MATERIALS AND METHODS Radiation dose indices for single-phase noncontrast head CT examinations in patients 18 years of age and younger were retrospectively reviewed between July 2011 and June 2016 using the American College of Radiology CT Dose Index Registry. We used the reported volume CT dose index stratified by patient demographics and imaging facility characteristics. RESULTS The registry included 295,296 single-phase pediatric noncontrast head CT studies from 1571 facilities (56% in male patients and 53% in children older than 10 years of age). The median volume CT dose index was 33 mGy (interquartile range = 22-47 mGy). The volume CT dose index increased as age increased. The volume CT dose index was lower in children's hospitals (median, 26 mGy) versus academic hospitals (median, 32 mGy) and community hospitals (median, 40 mGy). There was a lower volume CT dose index in level I and II trauma centers (median, 27 and 32 mGy, respectively) versus nontrauma centers (median, 40 mGy) and facilities in metropolitan locations (median, 30 mGy) versus those in suburban and rural locations (median, 41 mGy). CONCLUSIONS Considerable variation in the radiation dose index for pediatric head CT exists. Median dose indices and practice variations at pediatric facilities were both lower compared with other practice settings. Decreasing dose variability through proper management of CT parameters in pediatric populations using benchmarks generated by data from registries can potentially decrease population exposure to ionizing radiation.
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Affiliation(s)
- G Sadigh
- From the Department of Radiology and Imaging Sciences (G.S., N.K.,), Emory University School of Medicine, Atlanta, Georgia
| | - N Kadom
- From the Department of Radiology and Imaging Sciences (G.S., N.K.,), Emory University School of Medicine, Atlanta, Georgia
| | - P Karthik
- American College of Radiology (P.K., D.S.), Reston, Virginia
| | - D Sengupta
- American College of Radiology (P.K., D.S.), Reston, Virginia
| | - K J Strauss
- Department of Radiology (K.J.S.), University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - D Frush
- Department of Radiology (D.F.), Duke University Medical Center, Durham, North Carolina
| | - K E Applegate
- Department of Radiology (K.E.A.), University of Kentucky, Lexington, Kentucky
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17
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Journy NMY, Dreuil S, Boddaert N, Chateil JF, Defez D, Ducou-le-Pointe H, Garcier JM, Guersen J, Habib Geryes B, Jahnen A, Lee C, Payen-de-la-Garanderie J, Pracros JP, Sirinelli D, Thierry-Chef I, Bernier MO. Individual radiation exposure from computed tomography: a survey of paediatric practice in French university hospitals, 2010-2013. Eur Radiol 2018; 28:630-641. [PMID: 28836026 DOI: 10.1007/s00330-017-5001-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs). METHODS The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms. RESULTS CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years). CONCLUSION The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children. KEY POINTS • CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).
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Affiliation(s)
- Neige M Y Journy
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
| | - Serge Dreuil
- Unité d'expertise en radioprotection médicale, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Nathalie Boddaert
- Service de radiologie pédiatrique, INSERM U1000, UMR 1163, Institut Imagine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
- PRES Sorbonne Paris, Cité Université René Descartes, 190 avenue de France, 75013, Paris, France
| | - Jean-François Chateil
- Service de radiologie et d'imagerie anténatale, de l'enfant et de la femme, Groupe Hospitalier Pellegrin, Centre Hospitalier Universitaire de Bordeaux, place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Didier Defez
- Service de Physique Médicale, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Hubert Ducou-le-Pointe
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau, 26 avenue du Dr A. Netter, 75012, Paris, France
| | - Jean-Marc Garcier
- Service de radiologie, Centre Hospitalier Universitaire Estaing, 1 place Lucie-Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Joël Guersen
- Pôle Imagerie et Radiologie Interventionnelle, Centre Hospitalier Universitaire Gabriel Montpied, 58 rue Montalembert, 63003, Clermont Ferrand cedex 1, France
| | - Bouchra Habib Geryes
- Direction des affaires médicales, de la qualité et la relation avec les usagers, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), 5 avenue des Hauts-Fourneaux, L-4362, Esch/Alzette, Luxembourg, Luxembourg
| | - Choonsik Lee
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | | | - Jean-Pierre Pracros
- Service d'imagerie pédiatrique, Hôpital Femme Mère Enfants, Groupe Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
| | - Dominique Sirinelli
- Service de radiologie pediatrique, Hôpital Clocheville, Centre Hospitalier Régional Universitaire de Tours, 49 boulevard Béranger, 37000, Tours, France
| | - Isabelle Thierry-Chef
- Section of Environment and Cancer, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon cedex 08, France
| | - Marie-Odile Bernier
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
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18
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Abstract
Pediatric neurocritical care is a growing subspecialty of pediatric intensive care that focuses on the management of acute neurological diseases in children. A brief history of the field of pediatric neurocritical care is provided. Neuromonitoring strategies for children are reviewed. Management of major categories of acute childhood central neurologic diseases are reviewed, including treatment of diseases associated with intracranial hypertension, seizures and status epilepticus, stroke, central nervous system infection and inflammation, and hypoxic-ischemic injury.
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Affiliation(s)
- Christopher M. Horvat
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA
| | - Haifa Mtaweh
- Department of Pediatrics, Toronto Sick Children’s Hospital, Toronto, CA
| | - Michael J. Bell
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA
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19
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Benchmarking pediatric cranial CT protocols using a dose tracking software system: a multicenter study. Eur Radiol 2016; 27:841-850. [DOI: 10.1007/s00330-016-4385-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Heilmaier C, Kara L, Zuber N, Berthold C, Weishaupt D. Combined Use of a Patient Dose Monitoring System and a Real-Time Occupational Dose Monitoring System for Fluoroscopically Guided Interventions. J Vasc Interv Radiol 2015; 27:584-92. [PMID: 26724965 DOI: 10.1016/j.jvir.2015.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/12/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the effect on patient radiation exposure of the combined use of a patient dose monitoring system and real-time occupational dose monitoring during fluoroscopically guided interventions (FGIs). MATERIALS AND METHODS Patient radiation exposure, in terms of the kerma area product (KAP; Gy ∙ cm(2)), was measured in period 1 with a patient dose monitoring system, and a real-time occupational dose monitoring system was additionally applied in period 2. Mean/median KAP in 19 different types of FGIs was analyzed in both periods for two experienced interventional radiologists combined as well as individually. Patient dose and occupational dose were correlated, applying Pearson and Spearman correlation coefficients. RESULTS Although FGIs were similar in numbers and types over both periods, a substantial decrease was found for period 2 in total mean ± SD/median KAP for both operators together (period 1, 47 Gy ∙ cm(2) ± 67/41 Gy ∙ cm(2); period 2, 37 Gy ∙ cm(2) ± 69/34 Gy ∙ cm(2)) as well as for each individual operator (for all, P < .05). Overall, KAP declined considerably in 15 of 19 types of FGIs in period 2. Mean accumulated dose per intervention was 4.6 µSv, and mean dose rate was 0.24 mSv/h. There was a strong positive correlation between patient and occupational dose (r = 0.88). CONCLUSIONS Combined use of a patient dose monitoring system and a real-time occupational dose monitoring system in FGIs significantly lessens patient and operator doses.
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Affiliation(s)
- Christina Heilmaier
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland.
| | - Levent Kara
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
| | - Niklaus Zuber
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
| | - Christian Berthold
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
| | - Dominik Weishaupt
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
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21
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Slovis TL, Strouse PJ, Strauss KJ. Radiation Exposure in Imaging of Suspected Child Abuse: Benefits versus Risks. J Pediatr 2015; 167:963-8. [PMID: 26354874 DOI: 10.1016/j.jpeds.2015.07.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/29/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas L Slovis
- Department of Radiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
| | - Peter J Strouse
- Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, University of Michigan Health System, Ann Arbor, MI.
| | - Keith J Strauss
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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