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Reis J, Koo KSH, Shivaram GM, Shaw DW, Iyer RS. Time-Driven Activity-Based Cost Comparison of Osteoid Osteoma Ablation Techniques. J Am Coll Radiol 2024; 21:567-575. [PMID: 37473855 DOI: 10.1016/j.jacr.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Compare the cost of performing an osteoid osteoma ablation using cone beam CT (CBCT) with overlay fluoroscopic guidance to ablation using conventional CT (CCT) guidance and microwave ablation (MWA) to radiofrequency ablation (RFA). METHODS An 11-year retrospective study was performed of all patients undergoing osteoid osteoma ablation. Ablation equipment included a Cool tip RFA probe (Covidien, Minneapolis, Minnesota) or a Neuwave PR MWA probe (Ethicon, Rariton, New Jersey). The room times as well as immediate recovery time were recorded for each case. Cost analysis was then performed using time-driven activity-based costing for rate-dependent variables including salaries, equipment depreciation, room time, and certain supplies. Time-independent costs included the disposable interventional radiology supplies and ablation systems. Costs were reported for each service providing care and using conventional cost accounting methods with variable and fixed expenditures. RESULTS A total of 91 patients underwent 96 ablation procedures in either CBCT (n = 66) or CCT (n = 30) using either MWA (n = 51) or RFA (n = 45). The anesthesia induction (22.7 ± 8.7 min versus 15.9 ± 7.2 min, P < .001), procedure (64.7 ± 27.5 min versus 47.3 ± 15.3 min; P = .001), and room times (137.7 ± 33.7 min versus 103.9 ± 22.6. min; P < .001) were significantly longer for CBCT procedures. The procedure time did not differ significantly between MWA and RFA (62.1 ± 27.4 min versus 56.1 ± 23.3 min; P = .27). Multiple regression analysis demonstrated lower age (P = .046), CBCT use (P = .001), RFA use (P = .02), and nonsupine patient position (P = .01) significantly increased the total procedural cost. After controlling for these variables, the total cost of CBCT ($5,981.32 ± $523.93 versus $5,378.93 ± $453.12; P = .001) remained higher than CCT and the total cost of RFA ($5,981.32 ± $523.93 versus $5,674.43 ± $549.14; P = .05) approached a higher cost than MWA. CONCLUSION The use of CBCT with overlay fluoroscopic guidance for osteoid osteoma ablation resulted in longer in-room times and greater cost when compared with CCT. These cost considerations should be weighed against potential radiation dose advantage of CBCT when choosing an image guidance modality. Younger age, RFA use, and nonsupine patient position additionally contributed to higher costs.
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Affiliation(s)
- Joseph Reis
- Director of Interventional Radiology Enteric Access Service, Department of Radiology, Seattle Children's Hospital, Seattle, Washington; Co-Medical Director of Vascular Access Service, and Medical Director of Clinical Strategy in Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington; Section Chief of Pediatric Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington.
| | - Kevin S H Koo
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington; Vice Chair of Education, Department of Radiology, University of Washington School of Medicine; Panel Chair, ACR Appropriateness Criteria-Pediatrics; Chair, ACR Strategic Planning and Compliance Committee, Commission on Publications and Lifelong Learning
| | - Giri M Shivaram
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington; Vice Chair of Education, Department of Radiology, University of Washington School of Medicine; Panel Chair, ACR Appropriateness Criteria-Pediatrics; Chair, ACR Strategic Planning and Compliance Committee, Commission on Publications and Lifelong Learning
| | - Dennis W Shaw
- Director of Magnetic Resonance Imaging, Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington; Vice Chair of Education, Department of Radiology, University of Washington School of Medicine; Panel Chair, ACR Appropriateness Criteria-Pediatrics; Chair, ACR Strategic Planning and Compliance Committee, Commission on Publications and Lifelong Learning
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2
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Kim HHR, Leschied JR, Noda SM, Sarma A, Pruthi S, Iyer RS. Planetary health: an imperative for pediatric radiology. Pediatr Radiol 2024; 54:20-26. [PMID: 37962606 DOI: 10.1007/s00247-023-05807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.
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Affiliation(s)
- Helen H R Kim
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Jessica R Leschied
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sakura M Noda
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Asha Sarma
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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3
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O'Sullivan J, Kim HHR, Otjen JP, Ngo AV, Maloney E, Menashe SJ, Iyer RS, Thapa M. Frequency of technical success of ultrasound-guided arthrogram injections in children. Pediatr Radiol 2023; 53:2380-2385. [PMID: 37773443 DOI: 10.1007/s00247-023-05777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND MR arthrography is an essential diagnostic tool to assess and guide management of labral, ligamentous, fibrocartilaginous, and capsular abnormalities in children. While fluoroscopy is traditionally used for intra-articular contrast administration, ultrasound offers advantages of portability and lack of ionizing radiation exposure for both the patient and proceduralist. OBJECTIVE The purpose of this retrospective study is to quantify technical success and frequency of complications of ultrasound-guided arthrogram injections at our institution. MATERIALS AND METHODS This retrospective analysis investigates the results of 217 ultrasound-guided arthrograms of the shoulder, elbow, and hip in patients aged 5-18 years. Successful injection of contrast into the target joint, clinical indication for MR arthrography, and complications were reviewed. RESULTS Accurate ultrasound-guided intra-articular administration of contrast into the target joint was successful for 100% of shoulder cases (90/90), 97% of elbow cases (77/79), and 98% of hip cases (47/48). Leak of contrast outside the target joint occurred in 1.4% (3/217) of cases. No major side effects including excessive bleeding, paresthesia, allergic reactions, or infection occurred during or after the procedure. Additionally, no major vessel, nerve, or tendon complications were observed on MR images. CONCLUSION Ultrasound guidance is a reliable, effective, and safe approach to arthrography in children.
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Affiliation(s)
- Joseph O'Sullivan
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Helen H R Kim
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Mahesh Thapa
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Krishnamurthy R, Suman G, Chan SS, Kirsch J, Iyer RS, Bolen MA, Brown RKJ, El-Sherief AH, Galizia MS, Hanneman K, Hsu JY, de Rosen VL, Rajiah PS, Renapurkar RD, Russell RR, Samyn M, Shen J, Villines TC, Wall JJ, Rigsby CK, Abbara S. ACR Appropriateness Criteria® Congenital or Acquired Heart Disease. J Am Coll Radiol 2023; 20:S351-S381. [PMID: 38040460 DOI: 10.1016/j.jacr.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Pediatric heart disease is a large and diverse field with an overall prevalence estimated at 6 to 13 per 1,000 live births. This document discusses appropriateness of advanced imaging for a broad range of variants. Diseases covered include tetralogy of Fallot, transposition of great arteries, congenital or acquired pediatric coronary artery abnormality, single ventricle, aortopathy, anomalous pulmonary venous return, aortopathy and aortic coarctation, with indications for advanced imaging spanning the entire natural history of the disease in children and adults, including initial diagnosis, treatment planning, treatment monitoring, and early detection of complications. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Garima Suman
- Research Author, Mayo Clinic, Rochester, Minnesota
| | | | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington
| | | | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | | | | | | | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island; American Society of Nuclear Cardiology
| | - Margaret Samyn
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Society for Cardiovascular Magnetic Resonance
| | - Jody Shen
- Stanford University, Stanford, California
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Jessica J Wall
- University of Washington, Seattle, Washington; American College of Emergency Physicians
| | - Cynthia K Rigsby
- Specialty Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Suhny Abbara
- Specialty Chair, University of Texas Southwestern Medical Center, Dallas, Texas
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5
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Cajigas-Loyola SC, Chow JS, Hayatghaibi S, Iyer RS, Kwon J, Rubesova E, Sánchez-Jacob R, Wyers M, Otero HJ. Imaging of Vesicoureteral Reflux: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023. [PMID: 37672329 DOI: 10.2214/ajr.23.29741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequela requiring surgery but can also spontaneously resolve without complication. Therefore, it is important to recognize those patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR, while avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrogram (VCUG), radionucleotide cystography (RNC), and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.
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Affiliation(s)
- Stephanie C Cajigas-Loyola
- Children's Hospital of Philadelphia, Department of Radiology, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Jeanne S Chow
- Boston's Children's Hospital, Department of Radiology, 300 Longwood Ave, Boston, MA 02115
| | - Shireen Hayatghaibi
- Cincinnati Children's Hospital, Department of Radiology, 3401 Burnet Ave, Cincinnati, OH 45229
| | - Ramesh S Iyer
- Seattle Children's Hospital, Department of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Jeannie Kwon
- University of Texas Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd., Dallas, TX 75390
| | - Erika Rubesova
- Stanford Medicine Children's Health, Department of Radiology, 900 Welch Rd, Palo Alto, CA 94304
| | - Ramón Sánchez-Jacob
- Children's National Hospital, Department of Radiology, 111 Michigan Ave NW, Washington, DC 20010
| | - Mary Wyers
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Radiology, 225 East Chicago Avenue, Box 9, Chicago, Illinois 60611-2605
| | - Hansel J Otero
- Children's Hospital of Philadelphia, Department of Radiology, 3401 Civic Center Blvd, Philadelphia, PA 19104
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Yang C, Rosenwasser N, Wang X, Xu Z, Scheck J, Boos MD, Gupta D, Brandling-Bennet HA, Sidbury R, Iyer RS, Zhao Y. Golimumab in Children with Chronic Recurrent Multifocal Osteomyelitis: A Case Series and Review of the Literature. Paediatr Drugs 2023; 25:603-611. [PMID: 37479948 DOI: 10.1007/s40272-023-00581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disease requiring immunosuppressive treatment in half of patients. Monoclonal tumor necrosis factor inhibitors (TNFi) are often used as effective second-line off-label therapies. However, paradoxical psoriasis can occur in a subset of patients exposed to monoclonal TNFi and can prompt conversion to alternate therapy if severe. OBJECTIVE The aim of this study was to determine the efficacy and safety of golimumab, a fully humanized TNFi, in children with CRMO, including those who develop paradoxical psoriasis after exposure to other monoclonal TNFi. METHODS A retrospective chart review was conducted of patients with CRMO who received golimumab in a single center between 01 June, 2018 and 31 December, 2020. Patients who were diagnosed before 21 years of age and followed up for CRMO at least once after receiving ≥ 3 months of golimumab were included. Extracted data included patient demographics, whole-body MRI lesion counts, clinically relevant data, laboratory results, patient-reported outcomes, and psoriasis burden. Linear mixed models with log-transformed outcomes were used to assess changes in the outcomes over time. The random effect is included in the model to account for the within-subject correlation of repeated measures. p-values and 95% confidence intervals were reported. RESULTS Eighteen patients were included. Patients were observed for a median of 9.95 months [interquartile range 3.84-15.64]. The median age at the initiation of golimumab was 10.95 years [9.86-13.77] and the median duration of disease between the disease onset and the initiation of golimumab was 2.60 years [1.66-3.62]. Ten patients received golimumab via intravenous route and eight patients received golimumab via subcutaneous route. The median dose was 1.64 mg/kg/month [1.46, 2]. Fourteen patients were previously treated with disease-modifying antirheumatic drugs and 17 with other TNFi. Patients treated with golimumab showed significant improvement in median physician global assessment for CRMO from 2.00 [1.00-3.00] to 0.00 [0.00-0.25] by the fourth visit (p < 0.001), with median erythrocyte sedimentation rate (ESR) decreasing significantly from 12.00 [6.75-23.75] to 5.00 [3.00-10.00] by the fourth visit (p < 0.05). The median number of lesions on MRI decreased significantly from 3.50 [2.00-5.50] to 0.50 [0.00-4.25] lesions per patient (p < 0.01). Nine out of 12 patients who had previous paradoxical psoriasis associated with adalimumab or infliximab had persistent active psoriasis at study baseline. For patients with psoriasis at study baseline, the prevalence of psoriasis had decreased from 100% to approximately 50-57% at the following visits. Of the 18 patients initiated on golimumab in this study, there was only one new case of mild psoriasis in a patient with previously resolved infliximab-associated paradoxical psoriasis. No serious infections or adverse events were noted during the study. Two patients in the study showed clinical improvement with concomitant golimumab and ustekinumab with no reported adverse side effects or increased effects in these patients over a 16-month interval, showing that this combination can be safe and effective for children with CRMO. CONCLUSION In our experience, golimumab has been shown to be a safe and effective therapy for CRMO and demonstrated improvement in paradoxical psoriasis in many patients. Longer follow-up periods would be helpful to develop longer term outcomes data for patients with CRMO and overall paradoxical psoriasis risk.
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Affiliation(s)
- Claire Yang
- Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Natalie Rosenwasser
- Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA, USA
| | - Xing Wang
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA, USA
| | - Zheng Xu
- Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Joshua Scheck
- Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Markus D Boos
- Pediatric Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Deepti Gupta
- Pediatric Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Heather A Brandling-Bennet
- Pediatric Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Robert Sidbury
- Pediatric Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Yongdong Zhao
- Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA, USA.
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Cederberg KB, Iyer RS, Chaturvedi A, McCarville MB, McDaniel JD, Sandberg JK, Shammas A, Sharp SE, Nadel HR. Imaging of pediatric bone tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30000. [PMID: 36250990 PMCID: PMC10661611 DOI: 10.1002/pbc.30000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022]
Abstract
Malignant primary bone tumors are uncommon in the pediatric population, accounting for 3%-5% of all pediatric malignancies. Osteosarcoma and Ewing sarcoma comprise 90% of malignant primary bone tumors in children and adolescents. This paper provides consensus-based recommendations for imaging in children with osteosarcoma and Ewing sarcoma at diagnosis, during therapy, and after therapy.
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Affiliation(s)
- Kevin B. Cederberg
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ramesh S. Iyer
- Department of Radiology, Seattle Children’s Hospital, Seattle, WA
| | - Apeksha Chaturvedi
- Division of Pediatric Radiology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - MB McCarville
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, TN
| | - Janice D. McDaniel
- Department of Pediatric Interventional Radiology, Akron Children’s Hospital, Akron, OH and Department of Radiology, Northeast Ohio Medical University, Rootstown, OH
| | - Jesse K. Sandberg
- Department of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA
| | - Amer Shammas
- Division of Nuclear Medicine, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, OH, Canada
| | - Susan E. Sharp
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Helen R. Nadel
- Department of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA
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8
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Thacker PG, Iyer RS, Pace E, States LJ, Guillerman RP. Imaging of pediatric pulmonary tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29964. [PMID: 36121877 PMCID: PMC10641895 DOI: 10.1002/pbc.29964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/25/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022]
Abstract
Pediatric pulmonary malignancy can be primary or metastatic, with the latter being by far the more common. With a few exceptions, there are no well-established evidence-based guidelines for imaging pediatric pulmonary malignancies, although computed tomography (CT) is used in almost all cases. The aim of this article is to provide general imaging guidelines for pediatric pulmonary malignancies, including minimum standards for cross-sectional imaging techniques and specific imaging recommendations for select entities.
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Affiliation(s)
| | - Ramesh S. Iyer
- Department of Radiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lisa J. States
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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9
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Acord MR, Pace E, El-Ali A, Chaturvedi A, Iyer RS, Navarro OM, Pandit-Taskar N, K Parikh A, Schechter A, Shaikh R, McCarville MB. Imaging of pediatric extremity soft tissue tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29944. [PMID: 36070194 PMCID: PMC10641877 DOI: 10.1002/pbc.29944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
Pediatric soft tissue tumors of the extremity include rhabdomyosarcoma and nonrhabdomyosarcoma neoplasms. This manuscript provides consensus-based imaging recommendations for imaging evaluation at diagnosis, during treatment, and following completion of therapy for patients with a soft tissue tumor of the extremity.
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Affiliation(s)
- Michael Richard Acord
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Erika Pace
- Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alexander El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Apeksha Chaturvedi
- Department of Imaging Science, University of Rochester Medical Center, Rochester, New York, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Neeta Pandit-Taskar
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashishkumar K Parikh
- Department of Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ann Schechter
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Raja Shaikh
- Division of Interventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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10
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Menashe SJ, Iyer RS, Ngo AV, Rosenwasser NL, Zhao Y, Maloney E. Whole-body MRI at initial presentation of pediatric chronic recurrent multifocal osteomyelitis and correlation with clinical assessment. Pediatr Radiol 2022; 52:2377-2387. [PMID: 35670843 DOI: 10.1007/s00247-022-05388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion, relying heavily on whole-body magnetic resonance imaging (WB-MRI) for diagnosing and evaluating response to therapy. Information with respect to disease distribution and imaging correlation with clinical disease severity at initial presentation is lacking. OBJECTIVE To retrospectively characterize distribution of disease on WB-MRI and to correlate imaging findings with disease severity at initial rheumatology presentation. MATERIALS AND METHODS Using a modified version of a recently devised imaging-based scoring system, we evaluated disease distribution and correlation between findings on WB-MRI and clinical disease severity in 54 patients presenting for initial evaluation of CRMO. Symptomatic lesion sites were extracted from chart review and physician global assessment was determined by the consensus of two rheumatologists. RESULTS Sites of CRMO involvement evident on imaging at initial presentation had a strong predilection for the pelvis and lower extremities. There was significant correlation between the number of lesions detected on WB-MRI and total clinical severity score at initial rheumatology presentation (P<0.01). However, no other imaging parameter correlated with disease severity. CONCLUSION While the overall number of lesions identified on MRI correlates with clinical severity scores at initial imaging, other MR parameters of CRMO lesions may not be reliable indicators of disease severity at initial presentation. Further research is needed to assess whether these parameters are implicated in longitudinal disease severity or overall response to therapy.
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Affiliation(s)
- Sarah J Menashe
- Pediatric Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Pediatric Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Anh-Vu Ngo
- Pediatric Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Natalie L Rosenwasser
- Pediatric Rheumatology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Yongdong Zhao
- Pediatric Rheumatology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.,Center of Clinical and Translational Research, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ezekiel Maloney
- Pediatric Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
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11
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Otjen JP, Moore MM, Romberg EK, Perez FA, Iyer RS. The current and future roles of artificial intelligence in pediatric radiology. Pediatr Radiol 2022; 52:2065-2073. [PMID: 34046708 DOI: 10.1007/s00247-021-05086-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/27/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
Artificial intelligence (AI) is a broad and complicated concept that has begun to affect many areas of medicine, perhaps none so much as radiology. While pediatric radiology has been less affected than other radiology subspecialties, there are some well-developed and some nascent applications within the field. This review focuses on the use of AI within pediatric radiology for image interpretation, with descriptive summaries of the literature to date. We highlight common features that enable successful application of the technology, along with some of the limitations that can inhibit the development of this field. We present some ideas for further research in this area and challenges that must be overcome, with an understanding that technology often advances in unpredictable ways.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Michael M Moore
- Department of Radiology, Penn State Children's Hospital, Penn State Health System, Hershey, PA, USA
| | - Erin K Romberg
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Francisco A Perez
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA.
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12
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Menashe SJ, Ngo AV, Osorio MB, Iyer RS. Ultrasound assessment of glenohumeral dysplasia in infants. Pediatr Radiol 2022; 52:1648-1657. [PMID: 34549315 DOI: 10.1007/s00247-021-05180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/10/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Brachial plexus birth injury can lead to irreversible neuromuscular dysfunction and skeletal deformity of the upper extremity and shoulder girdle, ultimately resulting in glenohumeral dysplasia. Diagnosis and treatment of affected infants requires a multi-disciplinary approach in which imaging plays a vital role. While MRI is excellent for assessing both the shoulder and spine of these children, it is costly and requires sedation and is thus typically reserved for preoperative planning. US, however, is inexpensive, dynamic and readily available and provides excellent visualization of the largely cartilaginous glenohumeral joint. As such, it has become a highly useful modality during early diagnosis and follow-up of children with brachial plexus birth injuries. In this review, we describe the relevant anatomy of the glenohumeral joint, outlining the normal sonographic appearance as well as providing tips and tricks for identifying and characterizing pathology.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, 4800 Sandpoint Way NE, MA.7.220, Seattle, WA, 98105, USA.
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, 4800 Sandpoint Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Marisa B Osorio
- Seattle Children's Hospital, Medicine and University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, 4800 Sandpoint Way NE, MA.7.220, Seattle, WA, 98105, USA
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13
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Huang Y, Abad-Santos M, Iyer RS, Monroe EJ, Malone CD. Imaging to intervention: Thoracic outlet syndrome. Clin Imaging 2022; 89:23-36. [PMID: 35689965 DOI: 10.1016/j.clinimag.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
Thoracic outlet syndrome (TOS) is a clinical disorder resulting from compression of the neurovascular bundle of the lower neck and upper chest. TOS can be categorized into neurogenic, venous, and arterial subtypes which result from anatomical compression of the brachial plexus, subclavian vein, and subclavian artery, respectively. This can lead to neurogenic pain as well as vascular injury with thrombosis and thromboembolism. Interventional and diagnostic radiologists play a critical role in the imaging diagnosis and treatment of vascular TOS. Prompt imaging and endovascular management with surgical collaboration has been shown to provide the most successful and long-lasting clinical outcomes, from vessel patency to symptom relief. In this article, we review the anatomy and clinical presentations of TOS as well as the initial imaging modalities used for diagnosis. Furthermore, we detail the role of the diagnostic and interventional radiologist in the management of TOS, including pre-procedure and endovascular interventions, along with medical and surgical treatments. PRECIS: Diagnostic and Interventional Radiologists play a key role in diagnosis and management of vascular thoracic outlet syndromes and are critical for timely and successful outcomes.
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Affiliation(s)
- Yijin Huang
- Emory University, Atlanta, GA, United States of America
| | - Matthew Abad-Santos
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Ramesh S Iyer
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Eric J Monroe
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology at Washington University School of Medicine, St. Louis, MO, United States of America.
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14
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Moore MM, Gee MS, Iyer RS, Chan SS, Ayers TD, Bardo DME, Chandra T, Cooper ML, Dotson JL, Gadepalli SK, Gill AE, Levin TL, Nadel HR, Schooler GR, Shet NS, Squires JH, Trout AT, Wall JJ, Rigsby CK. ACR Appropriateness Criteria® Crohn Disease-Child. J Am Coll Radiol 2022; 19:S19-S36. [PMID: 35550801 DOI: 10.1016/j.jacr.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Crohn disease is an inflammatory condition of the gastrointestinal tract with episodes of exacerbation and remission occurring in children, adolescents, and adults. Crohn disease diagnosis and treatment depend upon a combination of clinical, laboratory, endoscopic, histological, and imaging findings. Appropriate use of imaging provides critical information in the settings of diagnosis, assessment of acute symptoms, disease surveillance, and therapy monitoring. Four variants are discussed. The first variant discusses the initial imaging for suspected Crohn disease before established diagnosis. The second variant pertains to appropriateness of imaging modalities during suspected acute exacerbation. The third variant is a substantial discussion of recommendations related to disease surveillance and monitoring of Crohn disease. Finally, panel recommendations and discussion of perianal fistulizing disease imaging completes the document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Michael M Moore
- Co-Director, Division of Radiology Innovation and Value Enhancement, Penn State Health Children's Hospital, Hershey, Pennsylvania.
| | - Michael S Gee
- Research Author, Deputy Chair of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Travis D Ayers
- Medical Director of Inflammatory Bowel Disease, Arkansas Children's Hospital, Little Rock, Arkansas; North American Society for Pediatric Gastroenterology, Hepatology & Nutrition
| | - Dianna M E Bardo
- Vice Chair of Radiology-Quality & Safety, Phoenix Children's Hospital, Phoenix, Arizona
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-Director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Matthew L Cooper
- Pediatric Radiology Division Chief and Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - Jennifer L Dotson
- Co-Director of the Center for Pediatric and Adolescent IBD, Nationwide Children's Hospital, Columbus, Ohio; American Academy of Pediatrics
| | - Samir K Gadepalli
- Surgical Director for Pediatric IBD, Director of Clinical Research for Pediatric Surgery, and Associate Program Director for Pediatric Surgery Fellowship, University of Michigan, Ann Arbor, Michigan; American Pediatric Surgical Association
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | | | - Narendra S Shet
- Children's National Hospital, Washington, District of Columbia
| | - Judy H Squires
- Chief of Ultrasound and Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew T Trout
- Director of Clinical Research for Radiology and Director of Nuclear Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Vice-Chair-JRCNMT
| | - Jessica J Wall
- Associate Medical Director of Pediatric Transport, UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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15
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Shet NS, Iyer RS, Chan SS, Baldwin K, Chandra T, Chen J, Cooper ML, Creech CB, Gill AE, Levin TL, Moore MM, Nadel HR, Saidinejad M, Schooler GR, Squires JH, Swenson DW, Rigsby CK. ACR Appropriateness Criteria® Osteomyelitis or Septic Arthritis-Child (Excluding Axial Skeleton). J Am Coll Radiol 2022; 19:S121-S136. [PMID: 35550797 DOI: 10.1016/j.jacr.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Imaging plays an integral role in the evaluation of suspected musculoskeletal infections in children, not only in the accurate identification of infection such as osteomyelitis or septic arthritis, but also in guiding management. Various diagnostic modalities serve different purposes in the assessment of suspected pediatric musculoskeletal infections. The purpose of this document is to provide imaging guidance in the most frequently encountered clinical scenarios in which osteomyelitis and/or septic arthritis are suspected, outside of the axial skeleton. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion.
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Affiliation(s)
- Narendra S Shet
- Children's National Hospital, Washington, District of Columbia.
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; and Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Keith Baldwin
- Associate Professor, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Jimmy Chen
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Matthew L Cooper
- Pediatric Radiology Division Chief, Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - C Buddy Creech
- Vanderbilt University Medical Center, Nashville, Tennessee; Infectious Diseases Society of America; and President, Pediatric Infectious Diseases Society
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Michael M Moore
- Co-director, Division of Radiology Innovation and Value Enhancement (DRIVE), Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | - Mohsen Saidinejad
- UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians; and Director, Institute for Health Services and Outcomes Research-The Lundquist Institute for Biomedical Innovation at Harbor UCLA
| | | | - Judy H Squires
- Chief of Ultrasound; Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - David W Swenson
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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16
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Aden S, Wong S, Yang C, Bui T, Higa T, Scheck J, Iyer RS, Egbert M, Lindberg A, Zhao Y. Increasing Cases of Chronic Nonbacterial Osteomyelitis in Children: a series of 215 cases from a single tertiary referral center. J Rheumatol 2022; 49:929-934. [DOI: 10.3899/jrheum.210991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/22/2022]
Abstract
Objective Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disease that is gaining recognition from clinicians and researchers. We aim to publish data from our cohort of CNO patients living in the northwestern United States to increase the awareness of specific demographics, characteristics, and presentation of this rare disease. Methods A retrospective chart review was performed of our electronic medical records. Patients with complete chart records that met criteria for a diagnosis of CNO from 2005-2019 were included. Extracted data including patient demographics, bone biopsy results, and lesion locations on advanced imaging were analyzed. King County census data were used to calculate the annual new case rate within our center. Results A total of 215 CNO cases were diagnosed at our large tertiary pediatric hospital. The majority of cases were of Caucasian descent residing in Washington's most populous county, specifically, in King County. Most cases were diagnosed in 2016-2019, showing a significant increase in the annual case rate from 8 to 23 per million children in King County, though there did not appear to be a seasonal predilection. Biopsy rate decreased from 75% to 52%. 152 (71%) children had family history of autoimmunity. With increasing use of whole-body MRI, results demonstrated that 68% had multiple lesions. Conclusion CNO has been diagnosed at an increased rate in recent years. Whole-body MRI may assist in identifying other lesions that may be asymptomatic on presentation. Bone biopsy is still required in some children at time of diagnosis.
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Menashe SJ, Maloney E, Perez FA, Ngo AV, Otjen JP, Iyer RS, Friedman S, Thapa M. Normative Values for the Sonographic Measurement of the Pediatric Median and Ulnar Nerves. Acad Radiol 2022; 29 Suppl 3:S147-S156. [PMID: 34518058 DOI: 10.1016/j.acra.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
RATIONAL AND OBJECTIVES Ultrasound investigation of peripheral nerves, long used in the adult population, has been shown to be of value in diagnosing a variety of peripheral nerve abnormalities. More recently, nerve sonography has also been shown to be of use in pediatrics. However, normative values for nerve size in children have been lacking. As such, the goal of this research was to establish normative data for cross sectional area (CSA) measurements of the median and ulnar nerves in children. MATERIALS AND METHODS The median and ulnar nerves of 48 children ranging in age from 2 years to 17 years were imaged by ultrasound. CSA measurements were made at 2 separate sites for each nerve and measured independently by 6 pediatric radiologists. Reliability of ultrasound measurements between the radiologists was assessed by calculating intraclass correlation coefficients. Linear mixed-effects modeling was performed to develop prediction models for nerve cross sectional area for each nerve segment; 95% prediction values were generated from these models to approximate normal ranges. RESULTS Agreement in nerve cross-sectional area measurements among the 6 radiologists for all nerve segments was good (ICC 0.82, 95% CI 0.78 to 0.85). CSA for both the median and ulnar nerves is larger in older children. However, statistical models to predict CSA using height perform better rather than those using a child's age. The range of normal nerve segment CSA using these prediction models based on child height are reported. CONCLUSION Median and ulnar nerve CSA can be reliably measured with ultrasound. Normal reference values for ulnar and median nerve CSA correlate with patient age but may be more optimally determined based on a child's height.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington.
| | - Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Francisco A Perez
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Jeff P Otjen
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Seth Friedman
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Mahesh Thapa
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
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18
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Otjen JP, Menashe SJ, Romberg EK, Brown ECB, Iyer RS. Pearls and Pitfalls of Thoracic Manifestations of Abuse in Children. Semin Ultrasound CT MR 2022; 43:51-60. [PMID: 35164910 DOI: 10.1053/j.sult.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Child abuse is a broad term that includes, but is not limited to, physical or emotional harm, neglect, sexual abuse, and exploitation. In 2018 in the United States, there were nearly 700,000 victims of such maltreatment, of which 1700 children died. The majority of deaths occur in infants and toddlers under 3 years of age. While clinical signs and symptoms may raise suspicion for inflicted injury, such as bruising in young infants, imaging often plays a central role in identifying and characterizing nonaccidental trauma. The purpose of this article is to discuss the array of inflicted traumatic injuries to the thorax in children. Rib fractures are among the most common and telling features of physical abuse, especially in infants. The locations of such fractures and differences in appearance while healing will be presented, along with potential mimics and pitfalls. Less typical fractures seen in abuse will also be reviewed, including those of the sternum, clavicle, spine, and scapula. Finally, uncommon injuries to the lungs, heart and esophagus will also be considered.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Erin K Romberg
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Emily C B Brown
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
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19
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Noda SM, Oztek MA, Stanescu AL, Maloney E, Shaw DWW, Iyer RS. Gadolinium retention: should pediatric radiologists be concerned, and how to frame conversations with families. Pediatr Radiol 2022; 52:345-353. [PMID: 33978802 DOI: 10.1007/s00247-021-04973-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/01/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Gadolinium retention in the brain and other organs has recently been identified by imaging and confirmed histologically. No direct clinical effects of gadolinium retention, which occurs after gadolinium-based contrast agent (GBCA) administration for MRI, have been scientifically accepted at this time. However, there is understandable concern among medical professionals and the public about the potential effects of gadolinium retention, particularly in the brain. Part of this concern might stem from the identification of nephrogenic systemic fibrosis caused by GBCAs in people with severe renal failure in 2006. This article briefly describes the characteristics of GBCAs; reviews and differentiates gadolinium retention, nephrogenic systemic fibrosis, and "gadolinium deposition disease" or "gadolinium toxicity"; and discusses societal guidelines and current usage in children. With the belief that GBCAs should not be withheld for appropriate indications in the absence of evidence of its potential risks, we offer a framework for determining when GBCA use is appropriate and suggestions for discussing its risks and benefits with children and their families.
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Affiliation(s)
- Sakura M Noda
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA. .,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Murat Alp Oztek
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Dennis W W Shaw
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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20
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Moore MM, Iyer RS, Sarwani NI, Sze RW. Artificial intelligence development in pediatric body magnetic resonance imaging: best ideas to adapt from adults. Pediatr Radiol 2022; 52:367-373. [PMID: 33851261 PMCID: PMC8043435 DOI: 10.1007/s00247-021-05072-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/09/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
Emerging manifestations of artificial intelligence (AI) have featured prominently in virtually all industries and facets of our lives. Within the radiology literature, AI has shown great promise in improving and augmenting radiologist workflow. In pediatric imaging, while greatest AI inroads have been made in musculoskeletal radiographs, there are certainly opportunities within thoracoabdominal MRI for AI to add significant value. In this paper, we briefly review non-interpretive and interpretive data science, with emphasis on potential avenues for advancement in pediatric body MRI based on similar work in adults. The discussion focuses on MRI image optimization, abdominal organ segmentation, and osseous lesion detection encountered during body MRI in children.
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Affiliation(s)
- Michael M Moore
- Department of Radiology, Penn State Children's Hospital, Penn State Health, 500 University Drive, H066, Hershey, PA, 17033, USA.
| | - Ramesh S Iyer
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Raymond W Sze
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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21
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Kim HHR, Menashe SJ, Ngo AV, Otjen JP, Maloney E, Iyer RS, Thapa M. Uniquely pediatric upper extremity injuries. Clin Imaging 2021; 80:249-261. [PMID: 34375796 DOI: 10.1016/j.clinimag.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
The pediatric population is prone to unique upper extremity injuries that are not typically seen in adults. The normal dynamic maturation pattern of ossification centers and open physis can potentially confuse radiologists who are not familiar with the pediatric patients. In this review article, we discuss the normal anatomy and commonly encountered acute and chronic upper extremity injuries such as supracondylar distal humeral fracture and osteochondritis dissecans, in pediatric patients. Diagnosing the correct type of fracture (e.g., buckle vs Salter-Harris) is important for proper management of the injury. With an increasing number of adolescents participating in competitive sports, specific sports related injuries such as little league shoulder, gymnast wrist, and medial epicondyle apophysitis, are also discussed in this review. We examine late complications of injuries, such as physeal bar formation and fishtail deformity of the distal humerus.
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Affiliation(s)
- Helen H R Kim
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
| | - Sarah J Menashe
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Anh-Vu Ngo
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeffrey P Otjen
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ezekiel Maloney
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh S Iyer
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. https://twitter.com/Iyer_MD
| | - Mahesh Thapa
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. https://twitter.com/ThapaMD
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22
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Sammer MBK, Hollingsworth CL, Stanescu AL, Iyer RS. Employing caution when applying the American College of Radiology Thyroid Imaging Reporting and Data System for pediatric thyroid nodule management. Pediatr Radiol 2021; 51:1290-1293. [PMID: 33959792 DOI: 10.1007/s00247-021-05083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Marla B K Sammer
- Edward B Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA. .,Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | | | - A Luana Stanescu
- Department of Pediatric Radiology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh S Iyer
- Department of Pediatric Radiology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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23
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Zhao Y, Iyer RS, Thapa M, Biswas D, Bhide N, Scheck J, Cain K, Partridge SC, Wallace CA. A Novel Algorithm using Within-leg Calibration for Enhanced Accuracy of Detection of Arthritis by Infrared Thermal Imaging in Children. J Rheumatol 2021; 49:81-88. [PMID: 34210832 DOI: 10.3899/jrheum.210077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To standardize and improve the accuracy of detection of arthritis by thermal imaging. METHODS Children with clinically active arthritis in the knee or ankle, as well as healthy controls, were enrolled to the development cohort and another group of children with knee symptoms were enrolled to the validation cohort. Ultrasound was performed for the arthritis subgroup for the development cohort. Joint exam by certified rheumatologists was used as a reference for the validation cohort. Infrared thermal data were analyzed using a custom software. Temperature after within-limb calibration (TAWiC) was defined as the temperature differences between joint and ipsilateral midtibia. TAWiC of knees and ankles was evaluated using ANOVA across subgroups. Optimal thresholds were determined by receiver operating characteristic (ROC) analysis using Youden index. RESULTS There were significant differences in mean and 95th TAWiC of knee in anterior, medial, lateral views, and of ankles in anterior view, between inflamed and uninflamed counterparts (p<0.05). The area under the curve (AUC) was higher by 36% when using TAWiCKnee than those when using absolute temperature. Within validation cohort, the sensitivity of accurate detection of arthritis in knee using both mean and 95th TAWiC from individual views or combined all 3 views ranged from 0.60 to 0.70 and the specificity was greater than 0.90 in all views. CONCLUSION Children with active arthritis or tenosynovitis in knees or ankles exhibited higher TAWiC than healthy joints. Our validation cohort study showed promise of the clinical utility of infrared thermal imaging for arthritis detection.
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Affiliation(s)
- Yongdong Zhao
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Ramesh S Iyer
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Mahesh Thapa
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Debosmita Biswas
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Nivrutti Bhide
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Joshua Scheck
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Kevin Cain
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Savannah C Partridge
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Carol A Wallace
- Pediatric Rheumatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Statistics, School of Nursing, University of Washington, Seattle, WA. Corresponding author: Yongdong Zhao, MD, PhD MA 7.110, 4800 Sand Point Way NE, Seattle, WA 98105
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24
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Aboughalia H, Tang ER, Iyer RS. Boggy pseudomass sonographic sign for testicular torsion. Abdom Radiol (NY) 2021; 46:1286-1287. [PMID: 32989554 DOI: 10.1007/s00261-020-02784-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
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25
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Kim HHR, Ngo AV, Maloney E, Otjen JP, Iyer RS, Menashe SJ, Thapa M. Contemporary imaging of the pediatric shoulder: pearls and pitfalls. Pediatr Radiol 2021; 51:338-352. [PMID: 33544190 DOI: 10.1007/s00247-021-04963-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/13/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023]
Abstract
In skeletally immature patients, the presence of growth plates and articular cartilage of the shoulder can create a predisposition for unique injuries not observed in adults. Furthermore, increasing participation in sports by children and adolescents appears to be leading to a corresponding increase in the number of sports-related injuries. The importance of radiologists being familiar with pediatric shoulder imaging and its associated injuries is therefore growing. In this article, we review the normal development and maturation pattern of ossification centers of the shoulder from the early gestational period through adolescence. Brachial plexus birth palsy, physeal injuries, shoulder dislocation, and internal impingement are discussed within the context of the child's age and the mechanism of injury to guide radiologists to a correct diagnosis.
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Affiliation(s)
- Helen H R Kim
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA.
| | - Anh-Vu Ngo
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Ezekiel Maloney
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Ramesh S Iyer
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Sarah J Menashe
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
| | - Mahesh Thapa
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way N.E, Seattle, WA, 98105, USA
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26
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Aboughalia H, Kim HH, Dick AAS, Pacheco MC, Cilley RE, Iyer RS. Pediatric biliary disorders: Multimodality imaging evaluation with clinicopathologic correlation. Clin Imaging 2021; 75:34-45. [PMID: 33493735 DOI: 10.1016/j.clinimag.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/04/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
The spectrum of pathologies affecting the biliary tree in the pediatric population varies depending on the age of presentation. While in utero insults can result in an array of anatomic variants and congenital anomalies in newborns, diverse acquired biliary pathologies are observed in older children. These acquired pathologies display different presentations and consequences than adults. Multimodality imaging assessment of the pediatric biliary system is requisite to establishing an appropriate management plan. Awareness of the imaging features of the various biliary pathologies and conveying clinically actionable information is essential to facilitate appropriate patient management. In this paper, we will illustrate the anatomy and embryology of the pediatric biliary system. Then, we will provide an overview of the imaging modalities used to assess the biliary system. Finally, we will review the unique features of the pediatric biliary pathologies, complemented by histopathologic correlation and discussions of clinical management.
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Affiliation(s)
- Hassan Aboughalia
- Radiology Department, University of Washington Medical Center, Seattle, WA 98195, United States of America.
| | - Helen Hr Kim
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, 98105, United States of America.
| | - Andre A S Dick
- Department of Surgery, Section of Pediatric Transplant, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, 98105, United States of America.
| | - M Cristina Pacheco
- Department of Pathology, University of Washington, Department of Laboratories, Seattle Children's Hospital, United States of America.
| | - Robert E Cilley
- Children's Surgery Center, Penn State Children's Hospital, Milton S. Hershey Medical Center, United States of America.
| | - Ramesh S Iyer
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, 98105, United States of America.
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27
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Alazraki AL, Rigsby CK, Iyer RS, Bardo DME, Brown BP, Chan SS, Chandra T, Dietrich A, Falcone RA, Garber MD, Gill AE, Levin TL, Moore MM, Nguyen JC, Shet NS, Squires JH, Trout AT, Karmazyn B. ACR Appropriateness Criteria® Vomiting in Infants. J Am Coll Radiol 2020; 17:S505-S515. [PMID: 33153561 DOI: 10.1016/j.jacr.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Vomiting in infants under the age of 3 months is one of the most common reasons for parents to seek care from their doctor or present to an emergency room. The imaging workup that ensues is dependent on several factors: age at onset, days versus weeks after birth, quality of emesis, bilious or nonbilious vomiting, and the initial findings on plain radiograph, suspected proximal versus distal bowel obstruction. The purpose of these guidelines is to inform the clinician, based on current evidence, what is the next highest yield and most appropriate imaging study to pursue a diagnosis. The goal is rapid and accurate arrival at a plan for treatment, whether surgical or nonsurgical. The following modalities are discussed for each variant of the symptom: plain radiography, fluoroscopic upper gastrointestinal series, fluoroscopic contrast enema, ultrasound of the abdomen, nuclear medicine gastroesophageal reflux scan. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Adina L Alazraki
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia.
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | - Ann Dietrich
- Nationwide Children's Hospital, Columbus, Ohio; American College of Emergency Physicians
| | - Richard A Falcone
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association
| | - Matthew D Garber
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Michael M Moore
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Narendra S Shet
- Children's National Health System, Washington, District of Columbia
| | - Judy H Squires
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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28
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Brown BP, Simoneaux SF, Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Bardo DME, Chan SS, Chandra T, Dorfman SR, Garber MD, Moore MM, Nguyen JC, Peters CA, Shet NS, Siegel A, Waseem M, Karmazyn B. ACR Appropriateness Criteria® Antenatal Hydronephrosis-Infant. J Am Coll Radiol 2020; 17:S367-S379. [PMID: 33153550 DOI: 10.1016/j.jacr.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
Antenatal hydronephrosis is the most frequent urinary tract anomaly detected on prenatal ultrasonography. It occurs approximately twice as often in males as in females. Most antenatal hydronephrosis is transient with little long-term significance, and few children with antenatal hydronephrosis will have significant obstruction, develop symptoms or complications, and require surgery. Some children will be diagnosed with more serious conditions, such as posterior urethral valves. Early detection of obstructive uropathy is necessary to mitigate the potential morbidity from loss of renal function. Imaging is an integral part of screening, diagnosis, and monitoring of children with antenatal hydronephrosis. Optimal timing and appropriate use of imaging can reduce the incidence of late diagnoses and prevent renal scarring and other complications. In general, follow-up neonatal ultrasound is recommended for all cases of antenatal hydronephrosis, while further imaging, including voiding cystourethrography and nuclear scintigraphy, is recommended for moderate or severe cases, or when renal parenchymal or bladder wall abnormalities are suspected. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Brandon P Brown
- Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana.
| | | | | | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | - Adina L Alazraki
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | | | | | | | | | - Matthew D Garber
- Wolfson Children's Hospital, Jacksonville, Florida; American Academy of Pediatrics
| | - Michael M Moore
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig A Peters
- UT Southwestern Medical Center, Dallas, Texas; Society for Pediatric Urology
| | - Narendra S Shet
- Children's National Hospital, Washington, District of Columbia
| | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Muhammad Waseem
- Lincoln Medical Center, Bronx, New York; American College of Emergency Physicians
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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29
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Koberlein GC, Trout AT, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DME, Brown BP, Chan SS, Chandra T, Dillman JR, Dorfman SR, Falcone RA, Garber MD, Joseph MM, Nguyen JC, Safdar NM, Karmazyn B. ACR Appropriateness Criteria ® Suspected Appendicitis-Child. J Am Coll Radiol 2020; 16:S252-S263. [PMID: 31054752 DOI: 10.1016/j.jacr.2019.02.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 12/29/2022]
Abstract
Acute appendicitis represents the most common abdominal surgical urgency/emergency in children. Imaging remains a central tool in the diagnosis of acute appendicitis and has been shown to facilitate management and decrease the rate of negative appendectomies. The initial consideration for imaging in a child with suspected acute appendicitis is based on clinical assessment, which can be facilitated with published scoring systems. The level of clinical risk (low, intermediate, high) and the clinical scenario (suspicion for complication) define the need for imaging and the optimal imaging modality. In some situations, no imaging is required, while in others ultrasound, CT, or MRI may be appropriate. This review frames the presentation of suspected acute appendicitis in terms of the clinical risk and also discusses the unique situations of the equivocal or nondiagnostic initial ultrasound examination and suspected appendicitis with suspicion for complication (eg, bowel obstruction). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - George C Koberlein
- Research Author, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | | | | | - Richard A Falcone
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association
| | - Matthew D Garber
- Wolfson Children's Hospital, Jacksonville, Florida; American Academy of Pediatrics
| | - Madeline M Joseph
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American College of Emergency Physicians
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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30
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Khalatbari H, Menashe SJ, Otto RK, Hoke AC, Stanescu AL, Maloney EJ, Iyer RS. Clarifying radiology's role in safety events: a 5-year retrospective common cause analysis of safety events at a pediatric hospital. Pediatr Radiol 2020; 50:1409-1420. [PMID: 32681235 DOI: 10.1007/s00247-020-04711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/08/2020] [Accepted: 05/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Common cause analysis of hospital safety events that involve radiology can identify opportunities to improve quality of care and patient safety. OBJECTIVE To study the most frequent system failures as well as key activities and processes identified in safety events in an academic children's hospital that underwent root cause analysis and in which radiology was determined to play a contributing role. MATERIALS AND METHODS All safety events involving diagnostic or interventional radiology from April 2013 to November 2018, for which the hospital patient safety department conducted root cause analysis, were retrospectively analyzed. Pareto charts were constructed to identify the most frequent modalities, system failure modes, key processes and key activities. RESULTS In 19 safety events, 64 sequential interactions were attributed to the radiology department by the patient safety department. Five of these safety events were secondary to diagnostic errors. Interventional radiology, radiography and diagnostic fluoroscopy accounted for 89.5% of the modalities in these safety events. Culture and process accounted for 55% of the system failure modes. The three most common key processes involved in these sequential interactions were diagnostic (39.1%) and procedural services (25%), followed by coordinating care and services (18.8%). The two most common key activities were interpreting/analyzing (21.9%) and coordinating activities (15.6%). CONCLUSION Proposing and implementing solutions based on the analysis of a single safety event may not be a robust strategy for process improvement. Common cause analyses of safety events allow for a more robust understanding of system failures and have the potential to generate more specific process improvement strategies to prevent the reoccurrence of similar errors. Our analysis demonstrated that the most common system failure modes in safety events attributed to radiology were culture and process. However, the generalizability of these findings is limited given our small sample size. Aligning with other children's hospitals to use standard safety event terminology and shared databases will likely lead to greater clarity on radiology's direct and indirect contributions to patient harm.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA.
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Amy C Hoke
- Patient Safety Department, Seattle Children's Hospital, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Ezekiel J Maloney
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
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31
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Aboughalia H, Chisholm KM, Iyer RS. Focal nodular hyperplasia masquerading as malignancy in an infant with elevated alpha-fetoprotein: A case report with literature review. Clin Imaging 2020; 69:228-232. [PMID: 32971452 DOI: 10.1016/j.clinimag.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 01/30/2023]
Abstract
We describe a unique case of focal nodular hyperplasia (FNH) in a 6-month-old-girl with elevated alpha-fetoprotein (AFP). Given the patient's age and elevated AFP, a diagnosis of hepatoblastoma was presumed. However, the histopathologic assessment of the lesion was typical for focal nodular hyperplasia. This was further corroborated using hepatobiliary contrast agent to exclude the possibility of a collision or a composite liver tumor.
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Affiliation(s)
- Hassan Aboughalia
- Radiology Department, University of Washington Medical Center, Seattle, WA, United States of America.
| | - Karen M Chisholm
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States of America.
| | - Ramesh S Iyer
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, United States of America.
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Menashe SJ, Aboughalia H, Zhao Y, Ngo AV, Otjen JP, Thapa MM, Iyer RS. The Many Faces of Pediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Practical Location- and Case-Based Approach to Differentiate CRMO From Its Mimics. J Magn Reson Imaging 2020; 54:391-400. [PMID: 32841445 DOI: 10.1002/jmri.27299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of childhood and adolescence characterized by episodic bone pain. Diagnosis relies heavily on whole-body MRI and is made by excluding a wide variety of other disorders with overlapping imaging features, depending on location, marrow distribution, and the presence or absence of multifocality. We present an overview of the clinical and imaging features of CRMO and, through various clinical scenarios, provide tips for tailoring the differential diagnosis based on location and distribution of encountered abnormalities. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hassan Aboughalia
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yongdong Zhao
- Department of Rheumatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mahesh M Thapa
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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Davenport MS, Bruno MA, Iyer RS, Johnson AM, Herrera R, Nicola GN, Ortiz D, Pedrosa I, Policeni B, Recht MP, Willis M, Zuley ML, Weinstein S. ACR Statement on Safe Resumption of Routine Radiology Care During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Radiol 2020; 17:839-844. [PMID: 32442427 PMCID: PMC7201228 DOI: 10.1016/j.jacr.2020.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The ACR recognizes that radiology practices are grappling with when and how to safely resume routine radiology care during the coronavirus disease 2019 (COVID-19) pandemic. Although it is unclear how long the pandemic will last, it may persist for many months. Throughout this time, it will be important to perform safe, comprehensive, and effective care for patients with and patients without COVID-19, recognizing that asymptomatic transmission is common with this disease. Local idiosyncrasies prevent a single prescriptive strategy. However, general considerations can be applied to most practice environments. A comprehensive strategy will include consideration of local COVID-19 statistics; availability of personal protective equipment; local, state, and federal government mandates; institutional regulatory guidance; local safety measures; health care worker availability; patient and health care worker risk factors; factors specific to the indication(s) for radiology care; and examination or procedure acuity. An accurate risk-benefit analysis of postponing versus performing a given routine radiology examination or procedure often is not possible because of many unknown and complex factors. However, this is the overriding principle: If the risk of illness or death to a health care worker or patient from health care–acquired COVID-19 is greater than the risk of illness or death from delaying radiology care, the care should be delayed; however, if the opposite is true, the radiology care should proceed in a timely fashion.
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Affiliation(s)
| | - Michael A Bruno
- Vice-Chair for Quality and Safety, Chief, Division of Emergency Radiology, Penn State Milton S. Hershey Medical Center Penn State, Hershey, Pennsylvania
| | - Ramesh S Iyer
- Director of Radiology Quality Improvement, Seattle Children's Hospital, Seattle, Washington
| | - Amirh M Johnson
- Department of Radiology, Kaiser Permanente, Pasadena, California
| | - Ramses Herrera
- Department of Radiology, University of Miami, Miami, Florida
| | - Gregory N Nicola
- Executive Leader, Hackensack Radiology Group; Board Member and Finance Chair, Hackensack Meridian Health Partners Clinically Integrated Network, Hackensack, New Jersey
| | - Daniel Ortiz
- Partnership track employee, Summit Radiology Services, P.C., Georgia
| | - Ivan Pedrosa
- Chief of Magnetic Resonance Imaging at UT Southwestern Medical Center; Jack Reynolds, M.D., Chair in Radiology; Co-Leader of the Kidney Cancer Program at the Harold C. Simmons Comprehensive Cancer Center; Chief of Magnetic Resonance Imaging at University of Texas Southwestern, Dallas, Texas
| | - Bruno Policeni
- Vice-Chair of Clinical Operations and Education, University of Iowa, Iowa City, Iowa
| | - Michael P Recht
- Chairman, Department of Radiology, NYU Langone Medical Center, New York University, New York, New York
| | - Marc Willis
- Associate Chair of Quality Improvement, Stanford School of Medicine, Stanford University, Palo Alto, California
| | - Margarita L Zuley
- Chief of Breast Imaging at Magee-Womens Hospital of UPMC; Director of Quality in Breast Imaging; Vice-Chair of Quality Assurance and Strategic Development, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stefanie Weinstein
- Associate Chief of Radiology, San Francisco VA Health Systems, University of California-San Francisco, San Francisco, California
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Chan SS, Kotecha MK, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DME, Brown BP, Chandra T, Dorfman SR, Garber MD, Moore MM, Nguyen JC, Shet NS, Siegel A, Valente JH, Karmazyn B. ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child. J Am Coll Radiol 2020; 17:S215-S225. [PMID: 32370966 DOI: 10.1016/j.jacr.2020.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/27/2022]
Abstract
Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula. Radiographs are recommended for screening for these complications and ultrasound and CT are recommended for confirmation. The second role of imaging is to identify underlying anatomic conditions that may predispose patients to recurrent pneumonia. CT with intravenously administered contrast is recommended for this evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Manish K Kotecha
- Research Author, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | - Matthew D Garber
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Michael M Moore
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Narendra S Shet
- Children's National Health System, Washington, District of Columbia
| | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan H Valente
- Alpert Medical School of Brown University, Providence, Rhode Island; American College of Emergency Physicians
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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Zhao Y, Iyer RS, Reichley L, Oron AP, Gove NE, Kitsch AE, Biswas D, Friedman S, Partridge SC, Wallace CA. A Pilot Study of Infrared Thermal Imaging to Detect Active Bone Lesions in Children With Chronic Nonbacterial Osteomyelitis. Arthritis Care Res (Hoboken) 2020; 71:1430-1435. [PMID: 30387916 DOI: 10.1002/acr.23804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 10/30/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease. An inexpensive and rapid imaging tool, infrared thermal imaging, was evaluated for its utility to detect active bone lesions in extremities of children with CNO. METHODS Children with suspected active CNO and healthy controls were enrolled. All subjects underwent infrared thermal imaging of the lower extremities. Patients in the CNO group also received a magnetic resonance imaging (MRI) examination. Hyperintensity within bone marrow on a fluid-sensitive T2-weighted MRI sequence was considered confirmatory for inflammation. Infrared thermal data were analyzed using custom software by dividing the leg below the knee into 3 equal segments longitudinally and adding the distal femur segment as an equal length above the knee. Median and 95th percentile temperatures were recorded for each leg segment. Temperature differences between inflamed and uninflamed segments in all subjects (both intersubject and intrasubject) were evaluated using a linear mixed-effects model. RESULTS Thirty children in the suspected/known CNO group and 31 healthy children were enrolled. In the healthy control group, males had significantly higher temperature in their lower extremities than females (P < 0.05). There was no difference in temperature detected between inflamed leg segments of patients with CNO versus uninflamed leg segments of the healthy control group. However, within the CNO group, significantly higher temperatures were detected for inflamed versus uninflamed distal tibia/fibula segments (P < 0.01). CONCLUSION Children with active CNO lesions in the distal tibia/fibula exhibited higher regional temperatures on average than healthy extremities. Larger studies are warranted to further evaluate the clinical utility of infrared thermal imaging for CNO detection.
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Affiliation(s)
- Yongdong Zhao
- Seattle Children's Hospital and University of Washington, Seattle
| | - Ramesh S Iyer
- Seattle Children's Hospital and University of Washington, Seattle
| | - Lucas Reichley
- Seattle Children's Hospital and University of Washington, Seattle
| | | | - Nancy E Gove
- Seattle Children's Research Institute, Seattle, Washington
| | - Averi E Kitsch
- University of Washington and Seattle Cancer Care Alliance, Seattle
| | - Debosmita Biswas
- University of Washington and Seattle Cancer Care Alliance, Seattle
| | - Seth Friedman
- Seattle Children's Hospital and University of Washington, Seattle
| | | | - Carol A Wallace
- Seattle Children's Hospital and University of Washington, Seattle
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Zheng H, Iyer RS, Pacheco MC, Soares JJ, Johnson K, Len M, Ambartsumyan L. Respiratory infections and chronic cough due to triple A (Allgrove) syndrome. Clin Case Rep 2020; 8:437-440. [PMID: 32185032 PMCID: PMC7069866 DOI: 10.1002/ccr3.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022] Open
Abstract
Cough and respiratory infections are common in pediatrics. Our case report illustrates the need for pediatricians to consider rare diagnoses such as genetic syndromes and primary gastrointestinal motility disorders in patients with unremitting respiratory and gastrointestinal symptoms. Early identification provides early intervention and reduces long-term morbidity for pediatric patients.
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Affiliation(s)
- Hengqi Zheng
- Division of GastroenterologySeattle Children's HospitalSeattleWashington
| | - Ramesh S. Iyer
- Department of RadiologySeattle Children's HospitalSeattleWashington
| | | | | | - Kaalan Johnson
- Department of OtolaryngologySeattle Children's HospitalSeattleWashington
| | - Mary Len
- Division of GastroenterologySeattle Children's HospitalSeattleWashington
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Miranda-Schaeubinger M, Blumfield E, Chavhan GB, Farkas AB, Joshi A, Kamps SE, Kaplan SL, Sammer MBK, Silvestro E, Stanescu AL, Sze RW, Zerr DM, Chandra T, Edwards EA, Khan N, Rubio EI, Vera CD, Iyer RS. A primer for pediatric radiologists on infection control in an era of COVID-19. Pediatr Radiol 2020; 50:1191-1204. [PMID: 32638055 PMCID: PMC7340753 DOI: 10.1007/s00247-020-04713-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
Pediatric radiology departments across the globe face unique challenges in the midst of the current COVID-19 pandemic that have not been addressed in professional guidelines. Providing a safe environment for personnel while continuing to deliver optimal care to patients is feasible when abiding by fundamental recommendations. In this article, we review current infection control practices across the multiple pediatric institutions represented on the Society for Pediatric Radiology (SPR) Quality and Safety committee. We discuss the routes of infectious transmission and appropriate transmission-based precautions, in addition to exploring strategies to optimize personal protective equipment (PPE) supplies. This work serves as a summary of current evidence-based recommendations for infection control, and current best practices specific to pediatric radiologists.
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Affiliation(s)
| | - Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, New York, NY, USA
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Amy B Farkas
- Department of Radiology, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Aparna Joshi
- Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
| | - Shawn E Kamps
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marla B K Sammer
- Department of Radiology, Texas Children's Hospital,, Houston, TX, USA
| | - Elizabeth Silvestro
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Danielle M Zerr
- Department of Infectious Disease, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Tushar Chandra
- Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA
| | - Emily A Edwards
- Department of Radiology, Doernbecher Children's Hospital, Oregon Health Sciences University, Portland, OR, USA
| | - Naeem Khan
- Department of Diagnostic Imaging, IWK Health Center,, Halifax, NS, Canada
| | - Eva I Rubio
- Department of Diagnostic Imaging and Radiology,, Children's National Hospital, Washington, DC, USA
| | - Chido D Vera
- Department of Radiology, The University of Pittsburgh, Pittsburgh, PA, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, MA.7.220, Seattle, WA, 98105, USA.
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Motz P, Von Saint Andre Von Arnim A, Iyer RS, Chabra S, Likes M, Dighe M. Point-of-care ultrasound for peripherally inserted central catheter monitoring: a pilot study. J Perinat Med 2019; 47:991-996. [PMID: 31605580 DOI: 10.1515/jpm-2019-0198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
Objective To assess the feasibility and accuracy of point-of-care ultrasound (POCUS) in monitoring peripherally inserted central catheter (PICC) location in neonates by non-radiologist physicians. Methods A prospective cohort study compared PICC localization by ultrasound in neonates with a recent radiograph. The ultrasound exam was performed using a standardized protocol with 13-6 MHz linear and 8-4 MHz phased array transducers by a neonatal-perinatal fellow who was blinded to PICC location on the radiograph. Results Of the 30 neonates included, 96.6% (n = 29) were preterm, with 63.3% (n = 19) weighing <1500 g. Nighty-four percent (n = 94) of ultrasound scans matched the radiograph report. The protocol had a sensitivity of 0.97, specificity of 0.66 and positive predictive value of 0.98. Conclusion Limited ultrasound exams to monitor PICC position in neonates using a standardized protocol by non-radiologist physicians are feasible and accurate in a single ultrasound user. Further study in multiple providers is needed before widespread use.
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Affiliation(s)
- Patrick Motz
- Neonatal-Perinatal Fellow, Department of Neonatology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | | | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Shilpi Chabra
- Department of Neonatology, University of Washington, Seattle, USA
| | - Maggie Likes
- Department of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA, USA
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Ambartsumyan L, Zheng HB, Iyer RS, Soares J, Henstorf G, Stevens AM. Relationship Between Esophageal Abnormalities on Fluoroscopic Esophagram and Pulmonary Function Testing in Juvenile Systemic Sclerosis. Arthritis Care Res (Hoboken) 2019; 71:1444-1449. [DOI: 10.1002/acr.23778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/25/2018] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Ramesh S. Iyer
- Seattle Children's HospitalUniversity of Washington Seattle
| | | | | | - Anne M. Stevens
- Seattle Children's HospitalUniversity of Washington, and Seattle Children's Research Institute Seattle Washington
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40
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Zhao Y, Sato TS, Nielsen SM, Beer M, Huang M, Iyer RS, McGuire M, Ngo AV, Otjen JP, Panwar J, Stimec J, Thapa M, Toma P, Taneja A, Gove NE, Ferguson PJ. Development of a Scoring Tool for Chronic Nonbacterial Osteomyelitis Magnetic Resonance Imaging and Evaluation of its Interrater Reliability. J Rheumatol 2019; 47:739-747. [PMID: 31575701 DOI: 10.3899/jrheum.190186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Serial magnetic resonance imaging (MRI) examinations are often needed in chronic nonbacterial osteomyelitis (CNO) to determine the objective response to treatment. Our objectives in this study were (1) to develop a consensus-based MRI scoring tool for clinical and research use in CNO; and (2) to evaluate interrater reliability and agreement using whole-body (WB)-MRI from children with CNO. METHODS Eleven pediatric radiologists discussed definitions and grading of signal intensity, size of signal abnormality within bone marrow, and associated features on MRI through monthly conference calls and a consensus meeting, using a nominal group technique in July 2017. WB-MRI scans from children with CNO were deidentified for training reading and an interrater reliability study. The reading by each radiologist was conducted in a randomized order. Interrater reliability for abnormal signal and severity were assessed using free-marginal κ statistics. RESULTS Radiologists reached a consensus on grading CNO-specific MRI findings and on describing bone units based on anatomy. A total of 45 sets of WB-MRI scans, including 4 sets of non-CNO MRI examinations, were selected for the final reading. The mean κ of each category of bones was > 0.7 with majority > 0.9 demonstrating substantial/almost perfect interrater reliability of readings among radiologists. The agreement on signal intensity and the size of signal abnormality within the most commonly affected bones (femur and tibia) were lower than those of other bones. CONCLUSION The chronic nonbacterial osteomyelitis magnetic resonance imaging scoring (CROMRIS) tool is a comprehensive standardized scoring tool for MRI in children with CNO. Our interrater study demonstrated good interrater reliability and agreement of readings.
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Affiliation(s)
- Yongdong Zhao
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. .,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine.
| | - T Shawn Sato
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Sabrina M Nielsen
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Meinrad Beer
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Mingqian Huang
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Ramesh S Iyer
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Michael McGuire
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Anh-Vu Ngo
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jeffrey P Otjen
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jyoti Panwar
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jennifer Stimec
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Mahesh Thapa
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Paolo Toma
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Angela Taneja
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Nancy E Gove
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Polly J Ferguson
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
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Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium retention and clearance after administration of macrocyclic MR contrast agents to rats: reply to Bussi et al. Pediatr Radiol 2019; 49:1112. [PMID: 31254023 DOI: 10.1007/s00247-019-04440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 1400 Pelham Pkwy. S., Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Motz P, Arnim AVSAV, Likes M, Chabra S, Traudt C, Iyer RS, Dighe M. Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit. J Ultrasound Med 2019; 38:1341-1347. [PMID: 30244492 DOI: 10.1002/jum.14816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess whether a limited ultrasound (US) scanning protocol to monitor the upper extremity peripherally inserted central catheter (PICC) location in neonates is feasible for experienced US operators. METHODS A radiologist, who was blinded to the PICC location on chest radiography, performed 14 US scans on 11 neonates with upper extremity PICCs. A US machine with 13-6-MHz linear and 8-4-MHz phased array transducers was used for the examinations. RESULTS The study population included 54% (n = 6) preterm infants, with 72% (n = 8) weighing less than 1500 g. The US location of the PICC was the same as the chest radiographic report in all 14 scans. A subclavicular long-axis view of the anterior chest visualized all PICCs in the subclavian or brachiocephalic veins. A parasternal long-axis right ventricular inflow view was able to visualize PICCs in the superior vena cava (SVC), and a subcostal long-axis view evaluated PICCs in the lower SVC and heart. The scanning time was location dependent: less than 5 minutes for PICCs in the brachiocephalic or subclavian vein and 5 to 10 minutes for PICCs in the SVC or heart. There were no desaturations below 90%, increases in the fraction of inspired oxygen need, or hypotension episodes during scanning. CONCLUSIONS A limited US scanning protocol to determine the upper extremity PICC location is feasible. Our protocol needs to be tested in neonatal providers before further dissemination.
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Affiliation(s)
- Patrick Motz
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | | | | | - Shilpi Chabra
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | - Christopher Traudt
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | - Ramesh S Iyer
- Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Manjiri Dighe
- Radiology, University of Washington, Seattle, Washington, USA
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Nguyen JC, Dorfman SR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DM, Brown BP, Chan SS, Chandra T, Garber MD, Moore MM, Pandya NK, Shet NS, Siegel A, Karmazyn B. ACR Appropriateness Criteria® Developmental Dysplasia of the Hip-Child. J Am Coll Radiol 2019; 16:S94-S103. [DOI: 10.1016/j.jacr.2019.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/09/2023]
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Jones JY, Saigal G, Palasis S, Booth TN, Hayes LL, Iyer RS, Kadom N, Kulkarni AV, Milla SS, Myseros JS, Reitman C, Robertson RL, Ryan ME, Schulz J, Soares BP, Tekes A, Trout AT, Karmazyn B. ACR Appropriateness Criteria® Scoliosis-Child. J Am Coll Radiol 2019; 16:S244-S251. [DOI: 10.1016/j.jacr.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 11/25/2022]
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Shet NS, Flynn JF, Maloney E, Iyer RS. Use of Eovist in Pediatric Patients: Pearls and Pitfalls. Curr Probl Diagn Radiol 2019; 49:266-274. [PMID: 31047739 DOI: 10.1067/j.cpradiol.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts. In this review, we will discuss gadoxetate disodium usage, including a sample-imaging protocol, and demonstrate applications and limitations in the pediatric population.
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Affiliation(s)
- Narendra S Shet
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC.
| | - John F Flynn
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC
| | - Ezekiel Maloney
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
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Iyer RS, Swenson DW, Anand N, Blumfield E, Chandra T, Chavhan GB, Goodman TR, Khan N, Moore MM, Ngo TD, Sammet CL, Sze RW, Vera CD, Stanescu AL. Survey of peer review programs among pediatric radiologists: report from the SPR Quality and Safety Committee. Pediatr Radiol 2019; 49:517-525. [PMID: 30923884 DOI: 10.1007/s00247-018-4289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/20/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
During the last 15 years, peer review has been widely incorporated into radiology quality improvement programs. However, current implementations are variable and carry concerns, including subjectivity of numerical scores and a sense of merely satisfying regulatory requirements. The Society for Pediatric Radiology (SPR) Quality and Safety Committee sought to evaluate the state of peer review programs in pediatric radiology practices, including implementation methods, perceived functions, strengths and weaknesses, and opportunities for improvement. We distributed an online 16-question survey to SPR members. Questions pertained to the type of peer review system, the use of numerical scores and comments, how feedback on discordances is given and received, and the use of peer learning conferences. We collected 219 responses (15% of survey invitations), 80% of which were from children's hospitals. Fifty percent of respondents said they use a picture archiving and communication system (PACS)-integrated peer review system. Comment-enhanced feedback for interpretive discordances was either very important or somewhat important to performance improvement in 86% of responses, compared to 48% with a similar perception of numerical scores. Sixty-eight percent of respondents said they either rarely or never check their numerical scores, and 82% either strongly or somewhat agreed that comments are more effective feedback than numerical scores. Ninety-three percent either strongly or somewhat agreed that peer learning conferences would be beneficial to their practice. Forty-eight percent thought that their current peer review system should be modified. Survey results demonstrate that peer review systems in pediatric radiology practices are implemented variably, and nearly half of respondents believe their systems should be modified. Most respondents prefer feedback in the form of comments and peer learning conferences, which are thought to be more beneficial for performance improvement than numerical scores.
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Affiliation(s)
- Ramesh S Iyer
- Department of Radiology, MA.7.220, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - David W Swenson
- Department of Radiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Neil Anand
- Department of Diagnostic Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tushar Chandra
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL, USA
| | - Govind B Chavhan
- Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Naeem Khan
- Department of Diagnostic Imaging, IWK Health Center, Halifax, NS, Canada
| | - Michael M Moore
- Department of Radiology, Pennsylvania State University, Hershey, PA, USA
| | - Thang D Ngo
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL, USA
| | - Christina L Sammet
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chido D Vera
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - A Luana Stanescu
- Department of Radiology, MA.7.220, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium-based contrast agents - review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients. Pediatr Radiol 2019; 49:448-457. [PMID: 30923876 DOI: 10.1007/s00247-018-4304-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Gadolinium has been used as a base for contrast agents in MRI for the last three decades. Numerous studies over the last 4 years have reported increased signal intensity in deep brain nuclei in non-contrast MRI images following gadolinium-based contrast agent (GBCA) administration. Pathology studies performed on adults and children, and rodent necropsy studies have also shown gadolinium deposition in brain and other tissues after GBCA administration. The purpose of this review was to summarize and discuss the knowledge gained from these reports and the relevance for imaging pediatric patients.
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Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 111E 210th St, Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Sze RW, Vera CD, Hogan L, Iyer RS. If Disney ran your pediatric radiology department: a different approach to improving the patient and family experience. Pediatr Radiol 2019; 49:493-499. [PMID: 30923881 DOI: 10.1007/s00247-018-4308-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/22/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022]
Abstract
The concepts behind the patient experience and patient- and family-centered care have their roots in the 1980s. Prioritization and implementation of programs to improve the patient experience have received increased attention since the passage of legislation tying health insurance reimbursement to patient satisfaction surveys. Radiology has joined these efforts with the Radiology 3.0 initiative, and departments are applying established patient- and family-centered care models and quality-improvement methods to improve patient experience and satisfaction. While these approaches are valuable, they should be supplemented with more qualitative, humanistic and empathetic approaches. We present a "Disney model" for improving the patient and family experience in pediatric radiology and examples of practical implementation.
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Affiliation(s)
- Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Chido D Vera
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Laurie Hogan
- Department of Radiology, Children's National Health System, Washington, DC, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
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49
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Chandra T, Chavhan GB, Sze RW, Swenson D, Holowka S, Fricke S, Davidson S, Iyer RS. Practical considerations for establishing and maintaining a magnetic resonance imaging safety program in a pediatric practice. Pediatr Radiol 2019; 49:458-468. [PMID: 30923877 DOI: 10.1007/s00247-019-04359-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/26/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Magnetic resonance imaging is a multipurpose imaging modality that is largely safe, given the lack of ionizing radiation. However there are electromagnetic and biological effects on human tissue when exposed to magnetic environments, and hence there is a risk of adverse events occurring with these exams. It is imperative to understand these risks and develop methods to minimize them and prevent consequent adverse events. Implementing these safety practices in pediatric MR imaging has been somewhat limited because of gaps in information and knowledge among the personnel who are closely involved in the MR environment. The American College of Radiology has provided guidelines on MR safety practices that are helpful in minimizing such adverse events. This article provides an overview of the issues related to MR safety and practical ways to implement them across different health care facilities.
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Affiliation(s)
- Tushar Chandra
- Department of Radiology, Nemours Children's Hospital, 13535 Nemours Pkwy., Orlando, FL, 32827, USA.
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Swenson
- Department of Radiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Stephanie Holowka
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Stanley Fricke
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA
| | | | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Chan SS, Francavilla ML, Iyer RS, Rigsby CK, Hernanz-Schulman M. Clinical decision support: practical implementation at two pediatric hospitals. Pediatr Radiol 2019; 49:486-492. [PMID: 30923880 DOI: 10.1007/s00247-018-4322-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/13/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
Abstract
Clinical decision support has been identified by the United States government as a method to decrease inappropriate imaging exams and promote judicious use of imaging resources. The adoption of this method will be incentivized by requiring appropriate use criteria to qualify for Medicare reimbursement starting in January 2020. While Medicare reimbursement is unlikely to directly impact pediatric imaging because of largely disparate patient populations, insurance providers typically use Medicare to benchmark their reimbursement guidelines. Therefore soon after their adoption these guidelines could become relevant to pediatric imaging. In this article we discuss how pediatric imaging was initially underrepresented in the clinical decision support realm, and how this was addressed by a subcommittee involving both American College of Radiology and Society for Pediatric Radiology members. We also present the experience of implementing clinical decision support software at two standalone pediatric hospitals and summarize the lessons learned from these deployments.
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Affiliation(s)
- Sherwin S Chan
- Department of Radiology, Children's Mercy Hospital, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Michael L Francavilla
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ramesh S Iyer
- Department of Radiology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marta Hernanz-Schulman
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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