2 Peds Radiology
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| Dose dependent | deterministic event. Severity depends on dose. there is a threshold; burns, hair loss.
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| Non dose dependent | stochastic effects. severity is independent of dose. Risk of event occuring is dependent on dose. There is no "threshold", cancer, genetic mutations
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| ALARA | as low as reasonably achievable
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| bone scan | 310 CXRs
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| Chest CT | 150 CXRs
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| Abdomen CT | 250 CXRs
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| One PET CT in a 5 year old | 1165 CXRs or 7.5 years of background
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| Plain films | excellent screening exams, uses ionizing radiation (generally low dose), low cost. Shouldn't worry about ordering when child has a fever and a cough
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| Fluoroscopy | Gives functional information (like a movie, can watch change with time), Uses ionizing radiation, may be unpleasant for patient and parents
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| Ultrasound | No ionizing radiation, portable if needed, not motion dependent, operator dependent, limited in some locations and body types. Can't penetrate through bone (so hard to look through ribs and spine, but in kids, it's still mostly cartilaginous).
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| CT | Excellent spatial resolution, fast, expensive, ionizing radiation, Motion sensitive
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| MRI | excellent tissue contrast, good spatial resolution, no ionizing radiaiton, motion sensitive, may require sedation due to time, expensive
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| Nuclear medicine | gives functional information, ionizing radiation, expensive, may require sedation. Can label masses with specific receptors (able to identify specific cancers). can localize radiation for cancer tx with radiotracers
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| Pediatric Airway | more prone to airway problems b/c the airway is smaller and more flexible
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| Foreign bodies may cause | Acute: air trapping or atelectasis. Consider fluoroscopy to evaluate unilateral air trapping. Chronic: Recurrent infections or atelectasis. Diagnosis requires broncoscopy. CXR for localization
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| Definitive diagnosis and tx of foreign body | Broncoscopy
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| FB CXR | May not be immediately obvious which side is abnl (or if there is hyperinflation or pneumonia). Use decubitus films.
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| Childhood structure in the superior part of the chest but may be on the right side of the heart | thymus. Around age 10 on CXR, you don't expect to see it. But on CT can see it much older.
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| Causes of Vomiting in kids | obstruction, gastric irritation (infectious, ingestion), neurologic/metabolic causes, motility/reflux
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| Causes of Vomiting infant | Reflux (most common), hypertrophic pyloric stenosis, Malrotation with midgut volvulus (MUST FIND IN THE FIRST 24 HOURS!!), Other causes of obstruction
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| reflux | extremely common, usually requires no imaging. pH probe or nuclear medicine study used to diagnosis refluex
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| Hypertrophic pyloric stensosis most common in | first born males at 3-6 weeks. Projectile non-bilious vomiting. Hungry after vomiting
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| Diagnosis of Hypertrophic Pyloric stenosis | PE: palpable olive. Characteristic caterpillar sign on KUB. US or Upper GI for diagnosis. US has high positive predictive value. UpperGI barium can screen for other causes of vomiting
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| Diagnosis of HPS | US muscle thickness>3mm, Length<15mm, pylorus does not open. Upper GI: beak sign, mushroom sign, shoulder sign. Delayed gastric emptying, narrow pyloric channel
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| Bilious Emesis | Any obstruction distal to ampulla. Tx as emergency. Upper GI to r/o malrotation. Many other causes. 62% of infants with BE will have no obstruction
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| most common time presentation of Malrotation and volvulus | 80% in the first month of life. Bowel twists and cuts off blood supply. Life-threatening
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| Volvulus | twist around Superior Mesenteric artery obstructing blood flow. Resulting bowel ischemia is life-threatening. Can be intermittent.
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| Work up of bilious emesis | KUB/plain film of the abdomen (to r/o free air or another reason, or need to go to the OR stat, or determine whether to do enema or upper GI). Then Upper GI to evaluate for malrotation or if suggestive of lower, contrast enema
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| Upper GI | fluoroscoppy study, patient immobilized, no sedation, NPO preferred, no IV needed
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| Causes of Vomiting in children | Gastroenteritis, Ingestions, Obstructions (KUB used to evaluate for obstruction)
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| Diagnosis of obstruction | dilated small bowel, air fluid levels (need two views)
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| Fever, vomiting and RLQ pain suggests | Appendicitis. Can be nonspecific in younger children. Can be seen in toddler/preschool age children. In most kids <3, appendix has already ruputred/diffuse abdominal pain, lethargy. US or CT for imaging. Look for appendocolith
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| US for appendicitis | high positive predictive value. Low negative predictive value
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| CT for appendicitis | high diagnostic accuracy, high radiation dose. Can diagnosis other pathology. IV needed, oral contrast needed. If sx are not specific for appendicitis, you could use this first.
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| Common age presentation for Intussusception | 6-36 months. Most common is at ileocecal junction (terminal ileus sucked into the cecum/colon). Crampy, intermittent pain. Vomiting, blood in stool (current jelly stool=classic late finding)
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| complications of intussusception | ischemia of bowel dragged within cecum, obstruction
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| Imaging Intussusception | KUB may show a paucity of gas in the right abdomen. If so, then US next (direct visualization of intussuscepted bowel, pseudokidney sign)
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| two tx for intussussception | air enema or in the OR. CIs to air enema: peritonitis and pneumoperitoneum.
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| Air enema | rectal tube with air pumped into the colon to try and push the bowel back
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| Pseudokidney sign is associated with | intussussception
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| Injuries that have high specificity for non-accidental injury | posterior rib fx, sternal fx, depressed skull fx, fx of varying ages, metaphyseal corner fx
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| Injuries that have low specificity for non-accidental injury | spiral fx, linear skull fx, fx consistent with mechanism
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| Salter IV fx | high rate of growth arrest
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| Toddler's fx | common in children beginning to walk, refusa to bear weight, can be very subtle. If you get two nl views, but sx continue, bring back in 10 days to re-image
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| buckle fx | torus fx; FOOSH
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| UTI | voiding cystourethrogram (VCUG; this is fluoroscopy) and a renal US. Nuclear medicine imaging as indicated.
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| VCUG | assesses reflux, evaluates anatomy, assesses urethra
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| Use of Renal US | assess hydronephrosis, anatomic variants, Sequela of infxn (scar, abscess)
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| Which study assesses the cortex of the kidneys? (most accurate way to check for scarring) | DMSA scan. Need IV, requires radiation
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| _____ assesses kidney obstruction and quantifies function. | Lasix renal scan. Need IV and requires radiation. PO radiotracer
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