Pub Date : 2025-03-29DOI: 10.1007/s00247-025-06224-3
Marcy L Hutchinson, Mohammad Jalloul, Brandon Stormes, Addison A McInnes, Hannah Stinson, Kumar Ashwarya, Valerie A Rigby, Summer L Kaplan
Background: Timely and accurate portable radiographs are essential in the pediatric intensive care unit (PICU) for managing critically ill patients. However, an overuse of STAT orders for non-urgent exams leads to inefficiencies, delays, and strains on resources. This project aimed to increase the percentage of STAT radiographs performed within 30 min and improve the appropriateness of STAT orders in a high-volume PICU.
Methods: A quality improvement initiative was conducted in a quaternary care pediatric hospitals using the ACR ImPower methodology. A multidisciplinary team restructured the technologist staffing model, introduced standardized criteria for STAT/ASAP orders, and developed a communication tip sheet for nursing staff ordering portable radiographs. Data were tracked using statistical process control charts, and results were compared pre- and post-intervention.
Results: From January to September 2024, STAT radiographs completed within 30 min increased from 55 to 71%, and mean turnaround time decreased from 71 to 38 min. Compliance with communication standards improved, while the appropriateness of STAT orders increased modestly from 42 to 44%.
Conclusion: This QI project significantly improved the timeliness and workflow efficiency for STAT radiographs in the PICU, though further efforts are needed to fully standardize STAT order usage and communication practices.
{"title":"Improving timeliness of STAT portable radiographs in pediatric critical care.","authors":"Marcy L Hutchinson, Mohammad Jalloul, Brandon Stormes, Addison A McInnes, Hannah Stinson, Kumar Ashwarya, Valerie A Rigby, Summer L Kaplan","doi":"10.1007/s00247-025-06224-3","DOIUrl":"https://doi.org/10.1007/s00247-025-06224-3","url":null,"abstract":"<p><strong>Background: </strong>Timely and accurate portable radiographs are essential in the pediatric intensive care unit (PICU) for managing critically ill patients. However, an overuse of STAT orders for non-urgent exams leads to inefficiencies, delays, and strains on resources. This project aimed to increase the percentage of STAT radiographs performed within 30 min and improve the appropriateness of STAT orders in a high-volume PICU.</p><p><strong>Methods: </strong>A quality improvement initiative was conducted in a quaternary care pediatric hospitals using the ACR ImPower methodology. A multidisciplinary team restructured the technologist staffing model, introduced standardized criteria for STAT/ASAP orders, and developed a communication tip sheet for nursing staff ordering portable radiographs. Data were tracked using statistical process control charts, and results were compared pre- and post-intervention.</p><p><strong>Results: </strong>From January to September 2024, STAT radiographs completed within 30 min increased from 55 to 71%, and mean turnaround time decreased from 71 to 38 min. Compliance with communication standards improved, while the appropriateness of STAT orders increased modestly from 42 to 44%.</p><p><strong>Conclusion: </strong>This QI project significantly improved the timeliness and workflow efficiency for STAT radiographs in the PICU, though further efforts are needed to fully standardize STAT order usage and communication practices.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1007/s00247-025-06229-y
Sergio Valencia, Fedel Machado-Rivas, Arman Avesta, Emil J Barkovich, Samuel C D Cartmell, Simon K Warfield, Camilo Jaimes, Onur Afacan
{"title":"Correction: Optimizing T2* imaging for adolescent and young adult patients at 7 T.","authors":"Sergio Valencia, Fedel Machado-Rivas, Arman Avesta, Emil J Barkovich, Samuel C D Cartmell, Simon K Warfield, Camilo Jaimes, Onur Afacan","doi":"10.1007/s00247-025-06229-y","DOIUrl":"https://doi.org/10.1007/s00247-025-06229-y","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-22DOI: 10.1007/s00247-025-06217-2
Dan Dyar, Elizabeth LaSalle, Heidi Ostler, Seth Degner, Robyn Augustyn, Parham Gholami, Amanda Potersnak, Jeff Koning, Eleanor Lehnert Schuchardt, Hari K Narayan, Beth F Printz, Frederic Dallaire, Justin Ryan, Sanjeet Hegde
Heart size and vessel diameters naturally increase with a child's growth, development, and needs. Measuring the size of blood vessels and tracking their growth have become a common practice among pediatric imaging specialists. Practitioners use tools like z-scores to standardize measurements against reference values that account for age, sex, and/or body size and habitus and help determine if vascular measurements deviate from what is expected in a healthy population. In this article, we review measurement techniques of significant vascular regions of interest in children covering "how to measure," "where to measure," and "sources of measurement errors." We also go over the concept of reporting z-scores in children with a review of the available literature and commonly used pediatric z-score calculators.
心脏大小和血管直径会随着儿童的生长、发育和需求而自然增大。测量血管大小并跟踪其生长情况已成为儿科影像专家的常见做法。医生使用 Z 值等工具将测量值与参考值进行标准化，参考值包括年龄、性别和/或体型和习惯，并帮助确定血管测量值是否偏离健康人群的预期值。在本文中，我们将回顾儿童重要血管区域的测量技术，包括 "如何测量"、"在哪里测量 "和 "测量误差的来源"。此外，我们还通过对现有文献和常用儿科 Z 值计算器的回顾，介绍了报告儿童 Z 值的概念。
{"title":"Practical approach to measuring vessels and reporting z-scores in children.","authors":"Dan Dyar, Elizabeth LaSalle, Heidi Ostler, Seth Degner, Robyn Augustyn, Parham Gholami, Amanda Potersnak, Jeff Koning, Eleanor Lehnert Schuchardt, Hari K Narayan, Beth F Printz, Frederic Dallaire, Justin Ryan, Sanjeet Hegde","doi":"10.1007/s00247-025-06217-2","DOIUrl":"https://doi.org/10.1007/s00247-025-06217-2","url":null,"abstract":"<p><p>Heart size and vessel diameters naturally increase with a child's growth, development, and needs. Measuring the size of blood vessels and tracking their growth have become a common practice among pediatric imaging specialists. Practitioners use tools like z-scores to standardize measurements against reference values that account for age, sex, and/or body size and habitus and help determine if vascular measurements deviate from what is expected in a healthy population. In this article, we review measurement techniques of significant vascular regions of interest in children covering \"how to measure,\" \"where to measure,\" and \"sources of measurement errors.\" We also go over the concept of reporting z-scores in children with a review of the available literature and commonly used pediatric z-score calculators.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1007/s00247-025-06221-6
Bianca Schmiliver Cukierman, Niccolò Stomeo, Arosh S Perera Molligoda Arachchige
{"title":"Simple preparation for pediatric magnetic resonance imaging: reply to Sawada et al.","authors":"Bianca Schmiliver Cukierman, Niccolò Stomeo, Arosh S Perera Molligoda Arachchige","doi":"10.1007/s00247-025-06221-6","DOIUrl":"https://doi.org/10.1007/s00247-025-06221-6","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1007/s00247-025-06209-2
Fides Regina Schwartz, Steve Bache, Rachel Lee, Charles M Maxfield, Michael F Fadell, Ana M Gaca, Ehsan Samei, Donald P Frush, Joseph Y Cao
<p><strong>Background: </strong>Photon-counting detector (PCD) computed tomography (CT) has been shown to provide better image quality at lower radiation and intravenous contrast doses than energy-integrating detector (EID) CT in adult patients. There is limited data on these benefits for the pediatric population especially for abdominopelvic CT examinations.</p><p><strong>Objective: </strong>This study examines a reduced weight-based iodinated contrast dosing strategy in pediatric abdominopelvic CT on a PCD-CT system compared to standard dosing protocols on EID-CT using 1 mL/kg and 2 mL/kg, respectively. Image quality is assessed using both quantitative and qualitative measures. We also compare the radiation dose profile between the two PCD-CT and EID-CT cohorts.</p><p><strong>Materials and methods: </strong>This HIPAA-compliant, IRB-approved, retrospective study included pediatric patients (≤18 years of age) who underwent contrast-enhanced CT examinations of the abdomen and pelvis for routine clinical care (01/2022 - 01/2023) in the portal-venous phase on a PCD-CT (NAEOTOM Alpha; Siemens Healthineers). Inclusion criteria included a similar prior examination within 12-months on a dual-source EID-CT scanner from the same vendor. All PCD-CT and EID-CT scans were acquired using weight-based dosing for intravenous contrast media, 1 mL/kg and 2 mL/kg, respectively, based on institutional protocols. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured in the aorta, portal vein, liver parenchyma, and skeletal muscle. Three pediatric radiologists qualitatively evaluated each scan for overall image quality, noise, and contrast on a scale of 0-100. Confidence in small structure detection (common bile duct) was also rated on a scale of 0-3. Radiation doses (size-specific dose estimate (SSDE)) were calculated. Statistical analysis included paired t-tests and a mixed linear effects model to account for patient age, sex, and X-ray tube voltage. A P<0.05 indicated statistical significance.</p><p><strong>Results: </strong>A total of 49 patients were included (24 female; mean [SD] age 9.9 [6.3] years, range 0.6-18 years). Compared to EID-CT, PCD-CT had a higher mean SNR in the portal vein (23.4 [SD=9.3] vs 17.2 [SD=7.4], P<0.001), aorta (23.4 [SD=11.6] vs 17.7 [10.1], P=0.017), hepatic parenchyma (15.2 [SD=5.6] vs 13.2 [5.1], P=0.016), and skeletal muscle (5.7 [SD=3.1] vs 4.5 [SD=3.1], P=0.01). Compared to EID-CT, PCD-CT also had a higher mean CNR in the portal vein (27.5 [SD=9.6] vs 22.1 [SD=21.1], P=0.003), aorta (27.3 [SD=9.6] vs 22.3 [SD=11.8], P=0.004), hepatic parenchyma (20 [SD=6.9] vs 16.9 [SD=8.5], P=0.013), and skeletal muscle (14.6 [4.9] vs 12.1 [5.6], P=0.008). Overall image quality, image noise, and small structure detection confidence scores were higher on PCD-CT than EID-CT (P=0.037, P<0.001, and P=0.006, respectively). Mean SSDE for PCD-CT was lower than EID-CT (9.1 mGy [SD=4.3] vs 11 mGy [5.9], P=0.012).</p><p><strong>Conc
{"title":"Photon-counting CT yields superior abdominopelvic image quality at lower radiation and iodinated contrast doses.","authors":"Fides Regina Schwartz, Steve Bache, Rachel Lee, Charles M Maxfield, Michael F Fadell, Ana M Gaca, Ehsan Samei, Donald P Frush, Joseph Y Cao","doi":"10.1007/s00247-025-06209-2","DOIUrl":"https://doi.org/10.1007/s00247-025-06209-2","url":null,"abstract":"<p><strong>Background: </strong>Photon-counting detector (PCD) computed tomography (CT) has been shown to provide better image quality at lower radiation and intravenous contrast doses than energy-integrating detector (EID) CT in adult patients. There is limited data on these benefits for the pediatric population especially for abdominopelvic CT examinations.</p><p><strong>Objective: </strong>This study examines a reduced weight-based iodinated contrast dosing strategy in pediatric abdominopelvic CT on a PCD-CT system compared to standard dosing protocols on EID-CT using 1 mL/kg and 2 mL/kg, respectively. Image quality is assessed using both quantitative and qualitative measures. We also compare the radiation dose profile between the two PCD-CT and EID-CT cohorts.</p><p><strong>Materials and methods: </strong>This HIPAA-compliant, IRB-approved, retrospective study included pediatric patients (≤18 years of age) who underwent contrast-enhanced CT examinations of the abdomen and pelvis for routine clinical care (01/2022 - 01/2023) in the portal-venous phase on a PCD-CT (NAEOTOM Alpha; Siemens Healthineers). Inclusion criteria included a similar prior examination within 12-months on a dual-source EID-CT scanner from the same vendor. All PCD-CT and EID-CT scans were acquired using weight-based dosing for intravenous contrast media, 1 mL/kg and 2 mL/kg, respectively, based on institutional protocols. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured in the aorta, portal vein, liver parenchyma, and skeletal muscle. Three pediatric radiologists qualitatively evaluated each scan for overall image quality, noise, and contrast on a scale of 0-100. Confidence in small structure detection (common bile duct) was also rated on a scale of 0-3. Radiation doses (size-specific dose estimate (SSDE)) were calculated. Statistical analysis included paired t-tests and a mixed linear effects model to account for patient age, sex, and X-ray tube voltage. A P<0.05 indicated statistical significance.</p><p><strong>Results: </strong>A total of 49 patients were included (24 female; mean [SD] age 9.9 [6.3] years, range 0.6-18 years). Compared to EID-CT, PCD-CT had a higher mean SNR in the portal vein (23.4 [SD=9.3] vs 17.2 [SD=7.4], P<0.001), aorta (23.4 [SD=11.6] vs 17.7 [10.1], P=0.017), hepatic parenchyma (15.2 [SD=5.6] vs 13.2 [5.1], P=0.016), and skeletal muscle (5.7 [SD=3.1] vs 4.5 [SD=3.1], P=0.01). Compared to EID-CT, PCD-CT also had a higher mean CNR in the portal vein (27.5 [SD=9.6] vs 22.1 [SD=21.1], P=0.003), aorta (27.3 [SD=9.6] vs 22.3 [SD=11.8], P=0.004), hepatic parenchyma (20 [SD=6.9] vs 16.9 [SD=8.5], P=0.013), and skeletal muscle (14.6 [4.9] vs 12.1 [5.6], P=0.008). Overall image quality, image noise, and small structure detection confidence scores were higher on PCD-CT than EID-CT (P=0.037, P<0.001, and P=0.006, respectively). Mean SSDE for PCD-CT was lower than EID-CT (9.1 mGy [SD=4.3] vs 11 mGy [5.9], P=0.012).</p><p><strong>Conc","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1007/s00247-025-06208-3
Gary R Schooler
{"title":"Comment: Radiomics in pediatric oncology.","authors":"Gary R Schooler","doi":"10.1007/s00247-025-06208-3","DOIUrl":"https://doi.org/10.1007/s00247-025-06208-3","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-19DOI: 10.1007/s00247-025-06218-1
Kessy Djonis Martins de Mattos, Paolo Marra, Francesco Saverio Carbone, Riccardo Muglia, Ludovico Dulcetta, Stefano Fagiuoli, Lorenzo D'Antiga, Sandro Sironi
Portal hypertension resulting from non-cirrhotic extrahepatic portal vein obstruction is a cause of severe morbidity related to variceal bleeding in children. In patients not eligible for Meso-Rex bypass, rescue interventions for refractory variceal bleeding have traditionally included surgical porto-systemic shunts or transjugular intrahepatic porto-systemic shunt (TIPS), which alter the normal physiology of liver perfusion and expose children to long-term complications. Portal vein recanalization is a recently described technique which aims to restore the hepatopetal flow through the native portal system but its feasibility is often limited. We aim to present two innovative techniques of percutaneous non-anatomical portal vein recanalization for treating non-cirrhotic extrahepatic portal vein obstruction in children who failed anatomical revascularization.
{"title":"Non-anatomical revascularization of the portal vein in children with non-cirrhotic extrahepatic portal vein obstruction.","authors":"Kessy Djonis Martins de Mattos, Paolo Marra, Francesco Saverio Carbone, Riccardo Muglia, Ludovico Dulcetta, Stefano Fagiuoli, Lorenzo D'Antiga, Sandro Sironi","doi":"10.1007/s00247-025-06218-1","DOIUrl":"https://doi.org/10.1007/s00247-025-06218-1","url":null,"abstract":"<p><p>Portal hypertension resulting from non-cirrhotic extrahepatic portal vein obstruction is a cause of severe morbidity related to variceal bleeding in children. In patients not eligible for Meso-Rex bypass, rescue interventions for refractory variceal bleeding have traditionally included surgical porto-systemic shunts or transjugular intrahepatic porto-systemic shunt (TIPS), which alter the normal physiology of liver perfusion and expose children to long-term complications. Portal vein recanalization is a recently described technique which aims to restore the hepatopetal flow through the native portal system but its feasibility is often limited. We aim to present two innovative techniques of percutaneous non-anatomical portal vein recanalization for treating non-cirrhotic extrahepatic portal vein obstruction in children who failed anatomical revascularization.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1007/s00247-025-06215-4
Merter Keceli, Özge Öztürk, E Yagiz Ertuna
{"title":"Orbital mass in newborn: neuroblastoma.","authors":"Merter Keceli, Özge Öztürk, E Yagiz Ertuna","doi":"10.1007/s00247-025-06215-4","DOIUrl":"https://doi.org/10.1007/s00247-025-06215-4","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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