Showing posts with label MRI. Show all posts
Showing posts with label MRI. Show all posts

Wednesday, August 26, 2015

Are We “Choosing Wisely” to Reduce the Frequency of CT Scans in Children? New Study Tells All!

By: Lewis First, MD, MS; Editor-in-Chief 

          Our journal along with many other peer-reviewed pediatric journals have certainly published our share of studies suggesting the potential radiation risks of computed tomography (CT)  scans—especially multiple CT scan exposures in the same child.  This has led to lower dosages of radiation when children need to use this imaging modality as well as a national campaign to “Image Gently” or to avoid overuse of this readily accessible technology unless it’s medically or surgically indicated relative to other radiologic options.  
       So are trends in CT scanning improving?  Parker et al. (doi: 10.1542/peds.2015-0995) opted to assess these trends in a study being released this week in Pediatrics.  The authors performed a cross-sectional study of 33 tertiary care children’s hospitals using data from the Pediatric Health Information System between 2004 and 2012 looking at trends in not just CT but also ultrasound (US) and magnetic resonance imaging (MRI) for ten leading pediatric diagnoses recorded in this extensive dataset.   
      The results show that CT utilization is decreasing for most of the leading diagnoses and US and MRI trends and that alternative radiologic modalities are increasing.  Just what do the trends show more specifically for what disease?  The answers can be found by carefully scanning through the extensive data shared in this interesting study and then reassuring families that just because a CT scanner is available, doesn’t mean that the benefit of using it outweighs some radiation risks when less risky modalities may exist.

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Tuesday, March 17, 2015

Isolated Linear Skull Fractures in Minor Blunt Head Trauma: A Fine Line Regarding the Need for Minimal Further Workup

By: Lewis First, MD, MS; Editor-in-Chief  

Bethesda Medical Center
      Skull fractures are scary and usually when detected on a plain film, lead to further imaging and possible hospitalization for observation. But how concerned should we really be with an isolated linear skull fracture in the setting of a minor head injury?  Powell et al. (doi: 10.1542/peds.2014-2858) elected to study 350 children who had isolated linear skull fractures after experiencing a minor head injury such as from a fall.     
      The good news is that despite CT and MRI imaging, reimaging, and hospitalization in a good number of these patients, none require neurosurgical intervention. 
     This was a prospective cohort (which can be more valid and reliable than a retrospective cohort) and the fact that complications were nonexistent, certainly prompts one to not do more than some initial imaging to diagnose the simple fracture.       
     Is that what you do, or do you hospitalize patients with skull fractures and/or reimage them in the days that follow the minor head injury? Share your approach to this problem by responding to this blog or sending in an e-letter or posting on our Facebook or Twitter sites.

Tuesday, June 3, 2014

CT or Rapid MRI for Diagnosing a Ventricular Shunt Malfunction: Which Would You Choose?

By: Lewis First, MD, MS

Given the concerns of radiation exposure from CT scans that have been written about in our journal and others, it is great to see other modalities like rapid MRI come on the scene to offer imaging alternatives. One situation where this is occurring is in the diagnosing of a ventricular shunt malfunction.

Photo by Aimun AB Jamjoom 
via Wikimedia Commons
Cerebrospinal fluid ventricular shunts, implanted surgically, are the preferred method for treating pediatric hydrocephalus. But, whether due to mechanical obstruction, over-drainage or equipment failure, malfunctions are commonplace and frequently require imaging to evaluate the potential malfunction. This frequent need to image and use of cranial CT can expose children with ventricular shunts to a large cumulative dose of ionizing radiation. But is rapid MRI accurate enough, compared to CT, to help avoid excess CT scans?

Boyle et al. (doi: 10.1542/peds. 2013-3739) performed a retrospective cohort study of almost 300 children and teens under 21 years of age seen in the emergency department with a possible shunt malfunction to determine the non-inferiority of the accuracy of rapid cranial MRI when compared to CT. The results are worth reading about and may change your approach or your discussion with your local pediatric emergency specialists as to what imaging to recommend.

This study will likely get some nice exposure once it is officially published next month (just not radiation exposure). Check it out and learn more.

Related Reading:

Thursday, March 6, 2014

Imaging for Appendicitis: US/MRI vs CT—Which Is Better?

Although the CT scan had previously been thought to be the gold standard for imaging someone with suspected appendicitis, the role of ultrasound (US) followed by magnetic resonance imaging (MRI) has been gaining in popularity. So which does a better job?

Photo by Liz West via Flickr
Aspelund et al. (doi: 10.1542/peds.2013-2128) explored this issue by retrospectively reviewing pediatric patients over a 4 year period during which CT was preferred for the first two years (2008-2010) and
ultrasound/MRI for the latter two years. Positive imaging for suspected appendicitis, negative appendectomy rates, perforation rates, and time to antibiotics were studied among other outcome parameters. As to the results, well, you’ll need to read the study to find out, but we think you’ll be on the (cutting) edge of your seats as you learn how each of these imaging modalities performed.

How are you diagnosing appendicitis? We still feel the history and physical can be very sensitive diagnostic tools when performed well—but what do you think? Do you find yourself needing to image your suspected appendicitis patients, or do you send them right to the pediatric surgeon for an operation? If you do image your patients, what do you find as your preferred imaging technique of choice? Would that change as a result of this study?

Let us know by sharing your thoughts via our blog, Facebook or Twitter, or by submitting an eLetter on the Pediatrics website.

Related Reading: