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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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Tung EL, Baird GL, Ayyala RS, Sams C, Herliczek TW, Swenson DW. Comparison of MRI appendix biometrics in children with and without acute appendicitis. Eur Radiol 2021; 32:1024-1033. [PMID: 34383146 DOI: 10.1007/s00330-021-08120-4] [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: 11/10/2020] [Revised: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The goal of this study is to improve MRI-specific diagnostic criteria for pediatric appendicitis through comparison of normal and abnormal appendix-related imaging features. METHODS A retrospective multireader-multicase design was used, including non-contrast MRI performed for suspected pediatric appendicitis following non-diagnostic US from January 2014 to December 2017. Positive diagnosis was defined by surgical pathology or symptom resolution after antibiotics. Four pediatric radiologists independently graded study biometrics while blinded to clinical data. Balanced complete block design was used to determine performance characteristics. RESULTS Global diagnosis of appendicitis (208 studies) had sensitivity 90.6% and specificity 97.7%. Median appendix diameter was 10.4 mm among positive cases and 5.8 mm among negative cases (p < 0.001) with an optimal diagnostic cutoff of 7.5 mm (sensitivity 89.4%, specificity 86.5%). Median appendix wall thickness was 2.6 mm among positive cases and 1.7 mm among negative cases (p < 0.001) with an optimal diagnostic cutoff of 2.3 mm (sensitivity 63.1%, specificity 82.9%). Performance characteristics for qualitative appendix features included distinguishable appendix luminal signal (sensitivity 89.6%, specificity 83.7%), intraluminal fluid-signal intensity (sensitivity 63.6%; specificity 52.3%), intraluminal signal intermediate between fluid and bowel wall (sensitivity 91.0%; specificity 37.1%), appendicolith (sensitivity 34.9%; specificity 100.0%), intraluminal layering (sensitivity 25.9%; specificity 100.0%), hyperintense appendix wall signal (sensitivity 31.7%; specificity 100.0%), periappendiceal fluid (sensitivity 66.8%; specificity 72.5%), periappendiceal fatty edema (sensitivity 91.3%; specificity 94.5%), and free pelvic fluid (sensitivity 88.5%; specificity 26.0). CONCLUSIONS This study provides MRI-specific performance of pediatric appendicitis quantitative and qualitative biometrics with peri-appendiceal fatty edema, appendix diameter > 7.5 mm, and distinguishable appendix luminal signal demonstrating the highest overall accuracy. KEY POINTS • This retrospective multireader-multicase study characterized magnetic resonance imaging-specific diagnostic accuracy of quantitative and qualitative biometrics for pediatric appendicitis. • The optimal quantitative diagnostic thresholds for an abnormal pediatric appendix at MRI included diameter and wall thickness of 7.5 mm and 2.3 mm, respectively. • Qualitative imaging biometrics with high specificity for pediatric appendicitis on MRI included the presence of distinguishable appendix lumen signal from wall signal, appendicolith, intraluminal fluid-fluid layer, appendix wall hyperintensity, and peri-appendiceal fatty edema.
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Affiliation(s)
- Eric L Tung
- , Cambridge, USA. .,Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, 3320 Eden Ave, Cincinnati, OH, 45267, USA
| | - Cassandra Sams
- Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Thaddeus W Herliczek
- Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - David W Swenson
- Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
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Hefferman GM, Baird GL, Swenson DW, Ward RC, Jayaraman MV, Cutting S, Jindal G. Effects of multiphase versus single-phase CT angiography for the detection of distal cerebral vessel occlusion. Emerg Radiol 2021; 28:891-898. [PMID: 33866443 DOI: 10.1007/s10140-021-01933-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The goal of this study was to determine whether the benefits of multiphase CTA (mCTA) over single-phase CTA (sCTA) for the detection of proximal cerebrovascular occlusions similarly extend to the distal cerebral vasculature. METHODS Four attending radiologists, two neuroradiologists and two emergency radiologists, contributed as readers to this retrospective study. For each reader, two sessions were conducted, one using sCTA and one using mCTA. During each session, the reader interpreted the studies of 104 patients who underwent imaging for suspicion of acute ischemic stroke, resulting in a total of 832 interpretations. Changes in diagnostic accuracy, time to render final decision, and reported levels of reader confidence were quantitatively assessed. Further analysis comparing the effects for neuroradiologists versus emergency radiologists was additionally conducted. RESULTS Using mCTA resulted in a significant 5.0% absolute increase in sensitivity (91.6% vs. 96.6%, p = .004) and an insignificant increase in specificity (99.5% vs. 99.7%, p = .39). A significant reduction in reading time (66.7 s vs. 59.6 s, p = .001) and an increase in diagnostic confidence (2.26 vs. 2.58, p < .001) were observed. Using sCTA, higher sensitivity was achieved by neuroradiologists than emergency radiologists (96.0% vs. 86.9%, p = .002); using mCTA resulted in an absolute increase in sensitivity of 0.9% (97.4%, p = .44) for neuroradiologists and 9.6% (96.5%, p < .001) for emergency radiologists, eliminating significant differences between the groups (p = 0.57). CONCLUSION The use of mCTA results in increased sensitivity and negative predictive value, decreased reading time, increased diagnostic confidence, and the elimination of differences in accuracy between neuroradiologists and emergency radiologists.
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Affiliation(s)
- Gerald M Hefferman
- Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Grayson L Baird
- Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,The Lifespan Biostatistics Core, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David W Swenson
- Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Robert C Ward
- Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mahesh V Jayaraman
- Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,The Norman Prince Neuroscience Institute, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Shawna Cutting
- Department of Neurology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gaurav Jindal
- Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
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Bassell JL, Swenson DW, Serrano-Gonzalez M, Topor LS. Cerebral oedema and dural sinus thrombosis in an adolescent with diabetic ketoacidosis. BMJ Case Rep 2021; 14:e241690. [PMID: 33837035 PMCID: PMC8043037 DOI: 10.1136/bcr-2021-241690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Julia L Bassell
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David W Swenson
- Center for Pediatric Imaging, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Monica Serrano-Gonzalez
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lisa Swartz Topor
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Abstract
Panoramic radiography, particularly in the pediatric population, is rarely addressed in the radiology literature. The authors provide an in-depth discussion of how these images are acquired, what artifacts can be visualized, and how to mitigate these artifacts. Dental anatomy, as well as relevant osseous and soft-tissue anatomy visible on a panoramic image, are reviewed. The appearance of the normal pediatric panoramic radiograph, with an emphasis on the dental follicle, is discussed, as well as how to differentiate this normal structure from underlying pathologic conditions. The most commonly encountered pathologic conditions of carious disease and trauma are emphasized. A systematic approach to diagnosing mass lesions and their appropriate work-up, including multimodality imaging examples of relevant pathologic conditions, is also provided. Finally, congenital anomalies, including some of the more commonly encountered dysplasias, are reviewed. The authors provide a concise review of the relevant information needed to confidently interpret a pediatric panoramic radiograph. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Cassandra M Sams
- From the Department of Diagnostic Imaging (C.M.S., E.W.D., D.W.S., R.S.A.) and Department of Dentistry, Samuels Sinclair Dental Center (G.J.D.), Warren Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, 593 Eddy St, Providence, RI 02903
| | - Eric W Dietsche
- From the Department of Diagnostic Imaging (C.M.S., E.W.D., D.W.S., R.S.A.) and Department of Dentistry, Samuels Sinclair Dental Center (G.J.D.), Warren Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, 593 Eddy St, Providence, RI 02903
| | - David W Swenson
- From the Department of Diagnostic Imaging (C.M.S., E.W.D., D.W.S., R.S.A.) and Department of Dentistry, Samuels Sinclair Dental Center (G.J.D.), Warren Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, 593 Eddy St, Providence, RI 02903
| | - George J DuPont
- From the Department of Diagnostic Imaging (C.M.S., E.W.D., D.W.S., R.S.A.) and Department of Dentistry, Samuels Sinclair Dental Center (G.J.D.), Warren Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, 593 Eddy St, Providence, RI 02903
| | - Rama S Ayyala
- From the Department of Diagnostic Imaging (C.M.S., E.W.D., D.W.S., R.S.A.) and Department of Dentistry, Samuels Sinclair Dental Center (G.J.D.), Warren Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, 593 Eddy St, Providence, RI 02903
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Sams CM, Dietsche EW, Swenson DW, DuPont GJ, Ayyala RS. Pediatric Panoramic Radiography: Techniques, Artifacts, and Interpretation. Radiographics 2021. [DOI: 10.1148/rg.2021200112.pres] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pan I, Baird GL, Mutasa S, Merck D, Ruzal-Shapiro C, Swenson DW, Ayyala RS. Rethinking Greulich and Pyle: A Deep Learning Approach to Pediatric Bone Age Assessment Using Pediatric Trauma Hand Radiographs. Radiol Artif Intell 2020; 2:e190198. [PMID: 33937834 DOI: 10.1148/ryai.2020190198] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 12/25/2022]
Abstract
Purpose To develop a deep learning approach to bone age assessment based on a training set of developmentally normal pediatric hand radiographs and to compare this approach with automated and manual bone age assessment methods based on Greulich and Pyle (GP). Methods In this retrospective study, a convolutional neural network (trauma hand radiograph-trained deep learning bone age assessment method [TDL-BAAM]) was trained on 15 129 frontal view pediatric trauma hand radiographs obtained between December 14, 2009, and May 31, 2017, from Children's Hospital of New York, to predict chronological age. A total of 214 trauma hand radiographs from Hasbro Children's Hospital were used as an independent test set. The test set was rated by the TDL-BAAM model as well as a GP-based deep learning model (GPDL-BAAM) and two pediatric radiologists (radiologists 1 and 2) using the GP method. All ratings were compared with chronological age using mean absolute error (MAE), and standard concordance analyses were performed. Results The MAE of the TDL-BAAM model was 11.1 months, compared with 12.9 months for GPDL-BAAM (P = .0005), 14.6 months for radiologist 1 (P < .0001), and 16.0 for radiologist 2 (P < .0001). For TDL-BAAM, 95.3% of predictions were within 24 months of chronological age compared with 91.6% for GPDL-BAAM (P = .096), 86.0% for radiologist 1 (P < .0001), and 84.6% for radiologist 2 (P < .0001). Concordance was high between all methods and chronological age (intraclass coefficient > 0.93). Deep learning models demonstrated a systematic bias with a tendency to overpredict age for younger children versus radiologists who showed a consistent mean bias. Conclusion A deep learning model trained on pediatric trauma hand radiographs is on par with automated and manual GP-based methods for bone age assessment and provides a foundation for developing population-specific deep learning algorithms for bone age assessment in modern pediatric populations.Supplemental material is available for this article.© RSNA, 2020See also the commentary by Halabi in this issue.
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Affiliation(s)
- Ian Pan
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
| | - Grayson L Baird
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
| | - Simukayi Mutasa
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
| | - Derek Merck
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
| | - Carrie Ruzal-Shapiro
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
| | - David W Swenson
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
| | - Rama S Ayyala
- Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903 (I.P., D.W.S., R.S.A.); Department of Diagnostic Imaging and Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI (G.L.B.); Department of Radiology, Columbia University Medical Center, New York, NY (S.M., C.R.); and Department of Emergency Medicine, University of Florida Shands Hospital, Gainesville, Fla (D.M.)
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Tung EL, Dibble EH, Jindal G, Movson JS, Swenson DW. Survey of radiologists and emergency department providers after implementation of a global radiology report categorization system. Emerg Radiol 2020; 28:65-75. [PMID: 32725602 DOI: 10.1007/s10140-020-01824-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] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Breakdown in communication of important imaging results threatens patient safety and risks malpractice claims. To facilitate closed-loop communication, our institution developed a unique radiology report categorization (RADCAT) system employing automated alert notification systems. This study aimed to understand users' initial experiences with the RADCAT system and obtain feedback. METHODS Web-based surveys were distributed to radiologists and emergency department (ED) providers at our hospital system within 1 year of institution-wide RADCAT implementation. Survey designs differed based on clinical setting. Most prompts utilized declarative statements with 5-point agreement Likert scales. Closed-response data was analyzed with descriptive statistics. RESULTS Response rates among radiologists and ED providers were 59.4% (63/106) and 38.4% (69/211), respectively. 78.0% (46/59) of radiologists and 60.9% (42/69) of ED providers agreed that RADCAT improves patient care. Of radiologists, 84.1% (53/63) agreed that RADCAT design is intuitive, and 57.6% (34/59) agreed that RADCAT improves efficiency. Of ED providers, 69.6% (48/69) agreed that RADCAT appropriately differentiates urgent and non-urgent findings, and 65.2% (45/69) agreed that auto-population of discharge documents with imaging results containing follow-up recommendations protects them from liability. Only 35.6% (21/59) of radiologists and 21.7% (15/69) of ED providers agreed that RADCAT implementation decreased reading room visits by ordering providers. Open-response feedback showed that some ED providers find RADCAT too complex while some radiologists desire improved transparency regarding imaging study communication status. CONCLUSION Since its implementation, RADCAT has been well received among radiologists and ED providers with agreement that it improves patient care and effectively distinguishes and communicates important imaging findings.
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Affiliation(s)
- Eric L Tung
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 3rd floor Main Building, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 3rd floor Main Building, 593 Eddy Street, Providence, RI, 02903, USA
| | - Gaurav Jindal
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 3rd floor Main Building, 593 Eddy Street, Providence, RI, 02903, USA
| | - Jonathan S Movson
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 3rd floor Main Building, 593 Eddy Street, Providence, RI, 02903, USA
| | - David W Swenson
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 3rd floor Main Building, 593 Eddy Street, Providence, RI, 02903, USA
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Dibble EH, Ryan VM, Baird GL, Swenson DW, Healey TT. Psychometric Validation of a Nonproprietary Survey of Patient Satisfaction for Use in Outpatient Radiology Centers. J Am Coll Radiol 2020; 17:423-432. [DOI: 10.1016/j.jacr.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
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10
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Sams C, Ayyala RS, Swenson DW. Falling through the worm hole: an exploration of the imaging workup of the vermiform appendix in the pediatric population. BJR Open 2019; 1:20190016. [PMID: 33178945 PMCID: PMC7592479 DOI: 10.1259/bjro.20190016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022] Open
Abstract
Despite the thousands of articles discussing appendicitis in the literature, the dilemma of how to best diagnosis and manage pediatric appendicitis remains unsettled. Over the past decade, evidence has been mounting about the use of antibiotics as the sole therapy in uncomplicated appendicitis in the adult population. This debate has even recently bled over into the lay press. While this change in practice pattern is still in its infancy for the pediatric population, radiologists should be aware of this change in therapy and how it can impact the imaging work-up and relevant findings. This article concisely summarizes the imaging findings and various imaging pathways to arrive at the diagnose of appendicitis with an emphasis of how to best be of use to our surgical colleagues in this evolving paradigm. It also highlights venues for further research, namely increasing accuracy of differentiating complicated from uncomplicated appendicitis.
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Affiliation(s)
- Cassandra Sams
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence
| | - Rama S Ayyala
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence
| | - David W. Swenson
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence
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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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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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Hefferman GM, Swenson DW, Ayyala RS, Murphy B, Johnson M, Jindal G. Information availability on emergency radiology fellowship websites: current state and paths to improvement. Emerg Radiol 2019; 26:295-299. [DOI: 10.1007/s10140-019-01674-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/11/2019] [Indexed: 11/28/2022]
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Guenther LM, Rowe RG, Acharya PT, Swenson DW, Meyer SC, Clinton CM, Guo D, Sridharan M, London WB, Grier HE, Ecklund K, Janeway KA. Response Evaluation Criteria in Solid Tumors (RECIST) following neoadjuvant chemotherapy in osteosarcoma. Pediatr Blood Cancer 2018; 65. [PMID: 29251406 DOI: 10.1002/pbc.26896] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 08/11/2017] [Revised: 09/28/2017] [Accepted: 10/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND In osteosarcoma, patient survival has not changed in over 30 years. Multiple phase II trials have been conducted in osteosarcoma using the Response Evaluation Criteria in Solid Tumors (RECIST) as a primary endpoint; however, none of these have revealed new treatment strategies. We investigated RECIST in newly diagnosed patients who received neoadjuvant chemotherapy proven to be beneficial. METHODS Patients treated from 1986 to 2011 for newly diagnosed osteosarcoma with paired tumor imaging before and after adequate neoadjuvant chemotherapy were included in this retrospective study. Two radiologists performed independent, blinded (to image timing) RECIST measurements of primary tumor and lung metastases at diagnosis and post-neoadjuvant chemotherapy. Association between RECIST and histological necrosis and outcome were assessed. RESULTS Seventy-four patients met inclusion criteria. Five-year overall survival and progression-free survival (PFS) were 77 ± 7% and 61 ± 8%, respectively. No patients had RECIST partial or complete response in the primary tumor. Sixty-four patients (86%) had stable disease, and 10 (14%) had progressive disease (PD). PD in the primary tumor was associated with significantly worse PFS in localized disease patients (P = 0.02). There was no association between RECIST in the primary tumor and necrosis. There were an insufficient number of patients with lung nodules ≥1 cm at diagnosis to evaluate RECIST in pulmonary metastases. CONCLUSIONS PD by RECIST predicts poor outcome in localized disease patients. In bone lesions, chemotherapy proven to improve overall survival does not result in radiographic responses as measured by RECIST. Further investigation of RECIST in pulmonary metastatic disease in osteosarcoma is needed.
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Affiliation(s)
- Lillian M Guenther
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - R Grant Rowe
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Patricia T Acharya
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Stephanie C Meyer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Catherine M Clinton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Dongjing Guo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Madhumitha Sridharan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Holcombe E Grier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Kirsten Ecklund
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Katherine A Janeway
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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Dibble EH, Swenson DW, Cartagena C, Baird GL, Herliczek TW. Effectiveness of a Staged US and Unenhanced MR Imaging Algorithm in the Diagnosis of Pediatric Appendicitis. Radiology 2017; 286:1022-1029. [PMID: 29156146 DOI: 10.1148/radiol.2017162755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To establish, in a large cohort, the diagnostic performance of a staged algorithm involving ultrasonography (US) followed by conditional unenhanced magnetic resonance (MR) imaging for the imaging work-up of pediatric appendicitis. Materials and Methods A staged imaging algorithm in which US and unenhanced MR imaging were performed in pediatric patients suspected of having appendicitis was implemented at the authors' institution on January 1, 2011, with US as the initial modality followed by unenhanced MR imaging when US findings were equivocal. A search of the radiology database revealed 2180 pediatric patients who had undergone imaging for suspected appendicitis from January 1, 2011, through December 31, 2012. Of the 2180 patients, 1982 (90.9%) were evaluated according to the algorithm. The authors reviewed the electronic medical records and imaging reports for all patients. Imaging reports were reviewed and classified as positive, negative, or equivocal for appendicitis and correlated with surgical and pathology reports. Results The frequency of appendicitis was 20.5% (407 of 1982 patients). US alone was performed in 1905 of the 1982 patients (96.1%), yielding a sensitivity of 98.7% (386 of 391 patients) and specificity of 97.1% (1470 of 1514 patients) for appendicitis. Seventy-seven patients underwent unenhanced MR imaging after equivocal US findings, yielding an overall algorithm sensitivity of 98.2% (400 of 407 patients) and specificity of 97.1% (1530 of 1575 patients). Seven of the 1982 patients (0.4%) had false-negative results with the staged algorithm. The negative predictive value of the staged algorithm was 99.5% (1530 of 1537 patients). Conclusion A staged algorithm of US and unenhanced MR imaging for pediatric appendicitis appears to be effective. The results of this study demonstrate that this staged algorithm is 98.2% sensitive and 97.1% specific for the diagnosis of appendicitis in pediatric patients. © RSNA, 2017.
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Affiliation(s)
- Elizabeth H Dibble
- From the Department of Diagnostic Imaging (E.H.D., D.W.S., C.C., G.L.B., T.W.H.) and Lifespan Biostatistics Core (G.L.B.), The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - David W Swenson
- From the Department of Diagnostic Imaging (E.H.D., D.W.S., C.C., G.L.B., T.W.H.) and Lifespan Biostatistics Core (G.L.B.), The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - Claudia Cartagena
- From the Department of Diagnostic Imaging (E.H.D., D.W.S., C.C., G.L.B., T.W.H.) and Lifespan Biostatistics Core (G.L.B.), The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - Grayson L Baird
- From the Department of Diagnostic Imaging (E.H.D., D.W.S., C.C., G.L.B., T.W.H.) and Lifespan Biostatistics Core (G.L.B.), The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - Thaddeus W Herliczek
- From the Department of Diagnostic Imaging (E.H.D., D.W.S., C.C., G.L.B., T.W.H.) and Lifespan Biostatistics Core (G.L.B.), The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
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Dibble EH, Baird GL, Swenson DW, Healey TT. Psychometric Analysis and Qualitative Review of an Outpatient Radiology-Specific Patient Satisfaction Survey: A Call for Collaboration in Validating a Survey Instrument. J Am Coll Radiol 2017; 14:1291-1297. [DOI: 10.1016/j.jacr.2017.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/11/2017] [Indexed: 10/18/2022]
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18
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Blumfield E, Moore MM, Drake MK, Goodman TR, Lewis KN, Meyer LT, Ngo TD, Sammet C, Stanescu AL, Swenson DW, Slovis TL, Iyer RS. Survey of gadolinium-based contrast agent utilization among the members of the Society for Pediatric Radiology: a Quality and Safety Committee report. Pediatr Radiol 2017; 47:665-673. [PMID: 28283728 DOI: 10.1007/s00247-017-3807-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 10/11/2016] [Revised: 12/06/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gadolinium-based contrast agents (GBCAs) have been used for magnetic resonance (MR) imaging over the last three decades. Recent reports demonstrated gadolinium retention in patients' brains following intravenous administration. Since gadolinium is a highly toxic heavy metal, there is a potential for adverse effects from prolonged retention or deposition, particularly in children. For this reason, the Society (SPR) for Pediatric Radiology Quality and Safety committee conducted a survey to evaluate the current status of GBCAs usage among pediatric radiologists. OBJECTIVE To assess the usage of GBCAs among SPR members. MATERIALS AND METHODS An online 15-question survey was distributed to SPR members. Survey questions pertained to the type of GBCAs used, protocoling workflow, requirement of renal function or pregnancy tests, and various clinical indications for contrast-enhanced MRI examinations. RESULTS A total of 163 survey responses were compiled (11.1% of survey invitations), the majority of these from academic institutions in the United States. Ninety-four percent reported that MR studies are always or usually protocoled by pediatric radiologists. The most common GBCA utilized by survey respondents were Eovist (60.7%), Ablavar (45.4%), Gadovist (38.7%), Magnevist (34.4%) and Dotarem (32.5%). For several clinical indications, survey responses regarding GBCA administration were concordant with American College of Radiology (ACR) Appropriateness Criteria, including seizures, headache and osteomyelitis. For other indications, including growth hormone deficiency and suspected vascular ring, survey responses revealed potential overutilization of GBCAs when compared to ACR recommendations. CONCLUSION Survey results demonstrate that GBCAs are administered judiciously in children, yet there is an opportunity to improve their utilization with the goal of reducing potential future adverse effects.
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Affiliation(s)
- Einat Blumfield
- Department of Radiology, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway, South Bronx, NY, 10461, USA.
| | - Michael M Moore
- Department of Radiology, Penn State Hershey Children's Hospital, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Mary K Drake
- Department of Radiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Thomas R Goodman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Kristopher N Lewis
- Department of Radiology, Children's Hospital of Georgia, Augusta University, Augusta, GA, USA
| | | | - Thang D Ngo
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL, USA
| | - Christina Sammet
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Arta Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - David W Swenson
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas L Slovis
- Department of Radiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Dibble EH, Swenson DW, Cobb C, Paul TJ, Karn AE, Portelli DC, Movson JS. The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach. Emerg Radiol 2016; 24:119-125. [DOI: 10.1007/s10140-016-1452-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
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20
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Swenson DW, Schooler GR, Stamoulis C, Lee EY. MRI of the normal appendix in children: data toward a new reference standard. Pediatr Radiol 2016; 46:1003-10. [PMID: 26886909 DOI: 10.1007/s00247-016-3559-1] [Citation(s) in RCA: 11] [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: 10/02/2015] [Revised: 12/29/2015] [Accepted: 01/21/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) might prove useful in the diagnostic evaluation of pediatric appendicitis in the effort to avoid exposing children to the ionizing radiation of CT, yet there is a paucity of literature describing the normal range of appearances of the pediatric appendix on MRI. OBJECTIVE To investigate MRI characteristics of the normal appendix to aid in establishing a reference standard in the pediatric population. MATERIALS AND METHODS We conducted a retrospective study of children and young adults (≤18 years of age) who underwent lumbar spine or pelvis MRI between Jan. 1, 2013, and Dec. 31, 2013, for indications unrelated to appendicitis. Two board-certified radiologists independently reviewed all patients' MRI examinations for appendix visualization, diameter, intraluminal content signal, and presence of periappendiceal inflammation or free fluid. We used the Cohen kappa statistic and Spearman correlation coefficient to assess reader agreement on qualitative and quantitative data, respectively. RESULTS Three hundred forty-six patients met inclusion criteria. Both readers visualized the appendix in 192/346 (55.5%) patients (kappa = 0.88, P < 0.0001). Estimated median appendix diameter was 5 mm for reader 1 and 6 mm for reader 2 ([25th, 75th] quartiles = [5, 6] mm; range, 2-11 mm; r = 0.81, P < 0.0001). Appendix intraluminal signal characteristics were variable. Periappendiceal inflammation was present in 0/192 (0%) and free fluid in 6/192 (3.1%) MRI examinations (kappa = 1.0). CONCLUSION The normal appendix was seen on MRI in approximately half of pediatric patients, with a mean diameter of ~5-6 mm, variable intraluminal signal characteristics, no adjacent inflammatory changes, and rare surrounding free fluid.
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Affiliation(s)
- David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.
| | - Gary R Schooler
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Catherine Stamoulis
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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21
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Chang PT, Yang E, Swenson DW, Lee EY. Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. Magn Reson Imaging Clin N Am 2016; 24:449-80. [PMID: 27150329 DOI: 10.1016/j.mric.2015.11.009] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.
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Affiliation(s)
- Patricia T Chang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Swenson DW, Ellermeier A, Dibble EH, Movson JS, Egglin TK, Mainiero MB. Review of outside studies by radiology residents: national survey of chief residents. Emerg Radiol 2014; 21:479-84. [PMID: 24777574 DOI: 10.1007/s10140-014-1228-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to establish practice patterns of radiology residents in regards to interpretation and reporting of outside studies for transferred patients. We performed a national survey of radiology residency chief residents, administered by email through the Association of Program Directors in Radiology (APDR). There were 81 chief resident respondents, representing 42.8 % of 187 total Accreditation Council for Graduate Medical Education (ACGME)-approved radiology residency training programs in the USA. In 97.5 % of programs, residents perform interpretations of outside studies. Up to 76.7 % of respondents state that when outside studies are reviewed by residents, an original report is available in less than one quarter of cases. While 55.1 % of respondents state that there is a mechanism for recording their findings and impressions for outside studies, only 32.1 % are aware of a policy requiring documentation. Of the respondents, 42.3 % report they have no means for documenting their findings and impressions on outside studies. Further, 65.4 % state that there is no policy requiring an attending to review and document agreement with their interpretation of outside studies. There is wide institutional variation in both policy and practice regarding reinterpretation of outside studies for patients transferred to academic hospitals. While the majority of radiology residents are providing the service of reinterpreting outside studies, only a minority of residency programs have a policy requiring (1) documentation of their impressions or (2) attending oversight and documentation of discrepant opinions.
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Affiliation(s)
- David W Swenson
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA,
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Swenson DW, Nickel BJ, Boxerman JL, Klinge PM, Rogg JM. Prenatal MRI characterization of brainstem glioma. Pediatr Radiol 2013; 43:1404-7. [PMID: 23677423 DOI: 10.1007/s00247-013-2706-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 11/28/2022]
Abstract
We describe a unique case of prenatally diagnosed diffuse brainstem glioma, detected during routine obstetric ultrasound and characterized with fetal magnetic resonance imaging. The diagnosis was supported by early postpartum imaging and confirmed at autopsy. Few examples of these rare lesions have been described in neonates by imaging and fewer cases have been confirmed by histopathological examination. Our case contributes to the limited literature concerning the clinical, MRI, and pathological correlates of brainstem gliomas in the perinatal period.
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Affiliation(s)
- David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA,
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24
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Swenson DW, Herliczek TW. 14 year-old female with splenic torsion. Med Health R I 2012; 95:161-162. [PMID: 22808638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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25
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Harris RW, Swenson DW. Effects of reverberation and noise on speech recognition by adults with various amounts of sensorineural hearing impairment. Audiology 1990; 29:314-21. [PMID: 2275646 DOI: 10.3109/00206099009072862] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Speech recognition was assessed under three levels of room reverberation, each in quiet and noise, for subjects with varying amounts of sensorineural hearing impairment. The three acoustic environments were: sound suite, reverberant room with a reverberation time (T) = 0.54 s and reverberant room with T = 1.55 s. Three groups of subjects were utilized: normal hearing, mild sensorineural hearing impairment and moderate-to-severe sensorineural hearing impairment. Speech recognition ability for each of the three groups of subjects significantly differed from the other two groups for each of the three reverberant conditions. The detrimental influences of noise and reverberation increased with the magnitude of hearing impairment. In addition, there was an interaction between noise and room reverberation, where the detrimental effects of room reverberation were compounded by the addition of noise.
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Affiliation(s)
- R W Harris
- Communication Sciences and Disorders, Brigham Young University, Provo, Utah
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