CT-guided localization of pulmonary nodules in children prior to video-assisted thoracoscopic surgical resection utilizing a combination of two previously described techniques.

Background: Pulmonary nodules in pediatric oncology patients can present a diagnostic and treatment dilemma. Imaging findings are often nonspecific and tissue diagnosis may be required for appropriate treatment. The smaller subpleural nodules may not be visualized and cannot be palpated during video-assisted thoracoscopic surgical (VATS) resection.

Venous thrombosis and stenosis after peripherally inserted central catheter placement in children.

Background: Peripherally inserted central catheters (PICCs) can lead to development of venous thrombosis and/or stenosis. The presence of venous thrombosis and/or stenosis may preclude children with chronic medical conditions from receiving lifesaving therapies, from hemodialysis in end-stage renal disease to total parenteral nutrition in short bowel syndrome. Several adult studies have found an association between PICCs and venous thrombosis and/or stenosis, but none has evaluated for this association in children.

Comparison of complications between pediatric peripherally inserted central catheter placement techniques.

Background: Peripherally inserted central catheter (PICC) is among the most common procedures performed in children in the hospital setting. PICC insertion can be simplified with the use of a sheathed needle as an alternative to the modified Seldinger technique.

Objective: To retrospectively evaluate PICC placement for the technique used and the incidence of complications at a large pediatric tertiary care center.

Comparison of pediatric radiation dose and vessel visibility on angiographic systems using piglets as a surrogate: antiscatter grid removal vs. lower detector air kerma settings with a grid - a preclinical investigation.

The purpose of this study was to reduce pediatric doses while maintaining or improv-ing image quality scores without removing the grid from X-ray beam. This study was approved by the Institutional Animal Care and Use Committee. Three piglets (5, 14, and 20 kg) were imaged using six different selectable detector air kerma (Kair) per frame values (100%, 70%, 50%, 35%, 25%, 17.

Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents.

Background: Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques.

Objective: To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents.

Materials And Methods: A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015.

Communication in diagnostic radiology: meeting the challenges of complexity.

Objective: As patients and information flow through the imaging process, value is added step-by-step when information is acquired, interpreted, and communicated back to the referring clinician. However, radiology information systems are often plagued with communication errors and delays. This article presents theories and recommends strategies to continuously improve communication in the complex environment of modern radiology.

Ultrasound-guided interventions in children.

There are a variety of available imaging modalities used for minimally invasive procedures in children, however, among the most frequently used is ultrasound (US). The advantages of US are vast and include real-time visualization, lack of ionizing radiation, and all-around versatility. US is also inexpensive, portable and widely available.

Endovascular venous thrombolysis in children younger than 24 months.

Purpose: To evaluate the technical feasibility and safety of percutaneous endovascular thrombolysis for extremity deep venous thrombosis (DVT) in children < 24 months old.

Materials And Methods: A retrospective chart review of a clinical and imaging database was performed for pediatric patients who underwent endovascular therapy for DVT between January 2010 and July 2013. Indications, techniques, technical and clinical success, and complications were reviewed.

Clinically useful dilution factors for iodine and gadolinium contrast material: an animal model of pediatric digital subtraction angiography using state-of-the-art flat-panel detectors.

Background: Iodinated and gadolinium contrast agents pose some risk for certain pediatric patients, including allergic-like reactions, contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF). Digital flat-panel detectors enhance image quality during angiography and might allow use of more dilute contrast material to decrease risk of complications that might be dose-dependent, such as CIN and NSF.

Objective: To assess the maximum dilution factors for iodine- and gadolinium-based contrast agents suitable for vascular imaging with fluoroscopy and digital subtraction angiography (DSA) on digital flat-panel detectors in an animal model.

Inferior vena cava filters in children: our experience and suggested guidelines.

Although use of inferior vena cava (IVC) filters for prophylaxis against pulmonary embolism (PE) is well reported in adults, long-term studies in children are lacking. We performed retrospective review of imaging and clinical database of IVC filters for the last 12 years. Thirty-five patients (mean age: 15.

Use of an Amplatz dilator to facilitate transrectal abscess drainage in children.

Image-guided transrectal drainage is an effective treatment option for many deep pelvic abscesses in children. Currently, a variety of imaging and catheter techniques are used to access and drain these abscesses. The present report describes an approach for introducing the transrectal catheter by using transabdominal ultrasound guidance to direct transrectal advancement of an Amplatz dilator with coaxial placement of the metal cannula and inner trocar from a pigtail catheter set, followed by placement of the pigtail catheter via Seldinger technique.

Creating a comprehensive customer service program to help convey critical and acute results of radiology studies.

Objective: Communication of acute or critical results between the radiology department and referring clinicians has been a deficiency of many radiology departments. The failure to perform or document these communications can lead to poor patient care, patient safety issues, medical-legal issues, and complaints from referring clinicians. To mitigate these factors, a communication and documentation tool was created and incorporated into our departmental customer service program.

Teleradiology 2010: technical and organizational issues.

In the United States, teleradiology using an external service to provide preliminary or final medical image interpretation is an increasingly necessary component of radiology services, especially for smaller institutions or practices. This review aims to provide a background history to the current teleradiology services provided and also addresses the limitations and issues involved in organising such a service.

IR challenges in the MSK system.

As the capability of medical imaging equipment improves, and relatively new modalities such as cone beam CT with guidance becomes more widely available, the range and complexity of image guided orthopedic procedures continues to expand. Challenges include the predictable technical and anatomic issues, as well as the complex operational and political issues associated with moving and integrating an interventional radiology service into the traditional operating room environment.

Image Gently: providing practical educational tools and advocacy to accelerate radiation protection for children worldwide.

The Alliance for Radiation Safety in Pediatric Imaging is an organization of over 45 international professional societies and agencies with the goal of promoting radiation safety for children. The Alliance, through the Image Gently campaign, uses social marketing techniques and critical partnerships with vendors, government agencies, and not-for-profit organizations, to advocate best practices in radiation use and safety. Advocacies include improving education regarding radiation risk to patients from medical imaging for radiologists, technologists, and referring physicians; promoting standardization of dose measurements and display across vendor equipment; and improving medical literacy for parents.

Exchange of an occluded nasojejunal tube facilitated by angioplasty balloon-induced rupture.

We describe a method of exchanging a blocked nasojejunal (NJ) tube involving the use of a percutaneous transluminal angioplasty balloon to rupture the tube, followed by insertion of a guidewire through this rupture to create a guide for subsequent placement of a modified NJ tube. We used this technique in a child with a critical need for an NJ tube, in whom routine guidewire exchange was not feasible because of tube obstruction as well as the patient's anatomic abnormalities. This technique might also be useful for other patients in whom standard techniques are ineffective.

Image Gently(SM): a national education and communication campaign in radiology using the science of social marketing.

Communication campaigns are an accepted method for altering societal attitudes, increasing knowledge, and achieving social and behavioral change particularly within public health and the social sciences. The Image Gently(SM) campaign is a national education and awareness campaign in radiology designed to promote the need for and opportunities to decrease radiation to children when CT scans are indicated. In this article, the relatively new science of social marketing is reviewed and the theoretical basis for an effective communication campaign in radiology is discussed.

Efficacy of a radiation safety education initiative in reducing radiation exposure in the pediatric IR suite.

Background: The use of ionizing radiation is essential for diagnostic and therapeutic imaging in the interventional radiology (IR) suite. As the complexity of procedures increases, radiation exposure risk increases. We believed that reinforcing staff education and awareness would help optimize radiation safety.

Non-endoscopic percutaneous gastrostomy placement in children with recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa (RDEB) is associated with high nutritional demands, esophageal strictures and dysphagia. About one quarter of the patients require gastrostomy tube placement to maintain adequate nutritional status. To minimize trauma to the skin and pharyngoesophageal mucosa caused by commonly used gastrostomy tube insertion techniques, we used a non-endoscopic, percutaneous, image-guided approach.

Live 3D guidance in the interventional radiology suite.

Objective: The development of a C-arm cone-beam CT unit coupled with flat detectors has markedly increased anatomic visualization capabilities for interventional radiology procedures. We present technology in which fluoroscopy and 3D imaging from a cone-beam CT-flat-detector C-arm unit are combined with an integrated tracking and navigation system. A description of the technology and representative clinical cases are presented.