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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: SCI-024
Is the Scout Out? The utility of scout radiographs in the outpatient pediatric Upper GI exam
Purpose or Case Report: Many institutions include a scout radiograph in the protocol for pediatric upper gastrointestinal (UGI) fluoroscopic studies. Recently, it has been shown that the scout radiograph does not add to the interpretation of VCUG examinations. Given that the scout radiograph is a significant portion of the total radiation exposure of the study, we sought to determine if the scout radiograph contributes to the interpretation of the outpatient pediatric UGI study.
Methods & Materials: We conducted a retrospective review of pediatric outpatient UGI studies performed at two imaging facilities over a two year period. Patient demographics, study indication, scout findings, study impression, and fluoroscopy time were recorded. If there were potentially clinically significant findings on the scout radiograph, a chart review was performed.
Results: 199 studies were analyzed including 79 females (40%) and 120 males (60%) with a mean age of 3.5 years. The average fluoroscopic time was 43 seconds. Common study indications included vomiting (58%), reflux (25%), dysphagia (13%), and feeding issues (12%). In 64 cases (32%), the scout radiograph was normal. In the remaining 135 cases, 196 findings were reported, including stool burden (48%), bowel gas pattern (9%), lines/hardware (13%), bony findings (14%), and chest findings (10%). There were 6 cases with potentially clinically significant, but unrelated findings including 3 cases of atelectasis, 1 questionable pneumothorax, 1 small pleural effusion, and 1 hip dislocation. The pneumothorax and pleural effusion cases received follow-up, and were deemed not clinically significant. The remaining 4 cases did not receive further work-up. Regarding the fluoroscopic exam, 53% of cases were normal. The most common finding was reflux (27%). Of note, there were 5 cases of suspected aberrant subclavian artery, 4 cases of diaphragmatic hernia, 5 cases of mildly low lying duodenojejunal junction and 1 case of confirmed malrotation without volvulus. There were no cases in which the UGI scout imaging findings contributed to the interpretation of the UGI study.
Conclusions: In our review of 199 outpatient pediatric UGI studies, many incidental findings were reported on the scout radiograph. However, there were no cases in which a scout radiograph finding influenced the interpretation of the UGI study. We conclude that the scout image does not contribute to the outpatient pediatric UGI study, and may be eliminated in order to reduce radiation exposure.
Methods & Materials: We conducted a retrospective review of pediatric outpatient UGI studies performed at two imaging facilities over a two year period. Patient demographics, study indication, scout findings, study impression, and fluoroscopy time were recorded. If there were potentially clinically significant findings on the scout radiograph, a chart review was performed.
Results: 199 studies were analyzed including 79 females (40%) and 120 males (60%) with a mean age of 3.5 years. The average fluoroscopic time was 43 seconds. Common study indications included vomiting (58%), reflux (25%), dysphagia (13%), and feeding issues (12%). In 64 cases (32%), the scout radiograph was normal. In the remaining 135 cases, 196 findings were reported, including stool burden (48%), bowel gas pattern (9%), lines/hardware (13%), bony findings (14%), and chest findings (10%). There were 6 cases with potentially clinically significant, but unrelated findings including 3 cases of atelectasis, 1 questionable pneumothorax, 1 small pleural effusion, and 1 hip dislocation. The pneumothorax and pleural effusion cases received follow-up, and were deemed not clinically significant. The remaining 4 cases did not receive further work-up. Regarding the fluoroscopic exam, 53% of cases were normal. The most common finding was reflux (27%). Of note, there were 5 cases of suspected aberrant subclavian artery, 4 cases of diaphragmatic hernia, 5 cases of mildly low lying duodenojejunal junction and 1 case of confirmed malrotation without volvulus. There were no cases in which the UGI scout imaging findings contributed to the interpretation of the UGI study.
Conclusions: In our review of 199 outpatient pediatric UGI studies, many incidental findings were reported on the scout radiograph. However, there were no cases in which a scout radiograph finding influenced the interpretation of the UGI study. We conclude that the scout image does not contribute to the outpatient pediatric UGI study, and may be eliminated in order to reduce radiation exposure.
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Poster____SCI-024.pdf
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