Purpose or Case Report: Foreign body (FB) ingestion can be a life threatening event for pediatric patients. The imaging for suspected FB is an esophagram. This procedure requires radiologist involvement, patient cooperation and has a higher dose of radiation than chest digital tomosynthesis (DTS). We want to describe usage of DTS in the pediatric population to aid in detection of radiolucent esophageal FB.
Methods & Materials: We conducted a retrospective chart review on patients between 0 and 18 years of age with impacted food bolus or suspected esophageal FB who received an esophagram with a chest DTS scout at our institution between January 2014 and June 2016. In January 2014, we changed our scout protocol for esophagram studies for suspected esophageal FB to use chest DTS instead of conventional chest radiograph. A conventional scout was used if the patient was judged to be unable to breath-hold during the 11 second DTS acquisition. DTS images were obtained using a GE Discovery XR 650 unit with the “Chest VolumeRAD” protocol. DTS images were analyzed by a board certified pediatric radiologist, radiology technologist with DTS experience and radiology resident for identification of FB impaction, compared to esophagram and discharge diagnosis. This study was approved by our local institutional review board.
Results: A total of 17 patients underwent a DTS scout (see Figure 1) and esophagram study for suspected esophageal FB. Seven (41%) were female and the overall mean age was 12 years (range 3-17 years). The chest DTS dose was 0.4 mGy and the average esophagram dose was 1.9 mGy. By discharge diagnosis, 11 (65%) patients were diagnosed with esophageal FB. The conventional esophagram was able to detect a FB in nine (53%) with a sensitivity and specificity of 85% and 100%. DTS scout sensitivity and specificity for trained readers (radiologist and technologist) were 55% and 100% and for an untrained reader was 27% and 100%.
Conclusions: Chest DTS is not only able to detect a subset of esophageal FB in a pediatric population, but also results in a lower radiation dose compared to conventional esophagram. Experienced DTS readers perform better than inexperienced readers.