Lall Neil,  Mcgee Jack,  Sarkar Korak

Final Pr. ID: Poster #: EDU-043

Fluoroscopy of the upper GI tract (UGI) can be difficult to master given the time-sensitive nature of the examination, the necessary hand-eye coordination, the complex button layout and broad featureset of the fluoroscopic equipment, the desire for minimizing radiation dose, and the required understanding of normal anatomy. Additionally, encountering abnormal findings for the first time, particularly before one is familiar with normal findings, can lead to confusion and increased difficulty in performing the examination. The use of 3D printed models of normal anatomy in pediatric fluoroscopic UGI training simulation has previously been demonstrated as a viable alternative to learning on live patients; however, such a technique has not previously been used with known pathological anatomic configurations. Read More

Authors:  Lall Neil , Mcgee Jack , Sarkar Korak

Keywords:  3D printing, fluoroscopy, simulation

Veselis Clinton,  Venkatakrishna Shyam Sunder,  Silvestro Elizabeth,  Bennett Brittany,  Srinivasan Abhay,  Acord Michael,  Sze Raymond,  Reid Janet,  Anupindi Sudha

Final Pr. ID: Poster #: EDU-021

Teaching fluoroscopy skills remains an ongoing challenge in pediatric radiology education. Radiologists must be competent to perform a wide range of fluoroscopy procedures and are often required to teach these clinical skills to their peers, junior staff, and students. Teaching procedural skills through frameworks, observation, and feedback, with opportunities for repeated practice, assists in the learner’s acquisition and retention of skills. Fluoroscopy presents patient safety and ethical challenges as “practicing” this skill on patients requires ionizing radiation exposure and often invasive procedures. Through this educational exhibit, we describe a proposed program to improve skill performance, determine competency, and provide feedback. To improve voiding cystourethrogram (VCUG) training two patient models were created for bladder catheterization with different grades of vesicoureteral reflux using 3D printing and silicon rubber. Additional educational materials, including videos and graphical representations, were created to better help the learner understand the steps of the VCUG protocol. A three-component curriculum included 1) Knowledge (indications, contraindications, complications); 2) Communication (with patient and family, with fluoroscopy team); and 3) Performance of the skill (preparation before commencing, steps and dexterity, immediate aftercare of the patient). We modeled our evaluation of the learner from Peyton’s four-step approach to skills teaching (Demonstration, Deconstruction, Formulation, and Performance) to teach the physical performance of the fluoroscopy procedure. Feedback was provided to the learners using the Pendleton Feedback Model. Finally, competency was assessed using the Framework for clinical assessment developed by Miller. This educational exhibit aims to provide radiologists in training with an alternative learning curriculum to better understand and evaluate the steps of the VCUG and its performance on patients in a simulated setting before being performed on patients. Read More

Authors:  Veselis Clinton , Venkatakrishna Shyam Sunder , Silvestro Elizabeth , Bennett Brittany , Srinivasan Abhay , Acord Michael , Sze Raymond , Reid Janet , Anupindi Sudha

Keywords:  Voiding cystourethrogram, VCUG, Fluoroscopy

Kim Jane,  Son Jennifer,  Poletto Erica,  Phelps Andrew,  Levin Terry

Final Pr. ID: Poster #: SCI-027

To describe the fluoroscopic practice patterns during pregnancy in pediatric radiologists and potential impact on professional relationships and career. Read More

Authors:  Kim Jane , Son Jennifer , Poletto Erica , Phelps Andrew , Levin Terry

Keywords:  Pregnancy, Fluoroscopy

De Leon-benedetti Laura,  Lazarte Claudia,  Miranda Schaeubinger Monica,  Miliard Derbew Hermon,  Jalloul Mohammad,  Otero Hansel

Final Pr. ID: Poster #: EDU-024

Introduction:
Fluoroscopy plays an important role in pediatric diagnostic imaging. However, its use has been replaced by other imaging modalities for some applications. While fluoroscopy offers dynamic evaluations of the airway, gastrointestinal tract, and urinary system, multiple barriers exist. It is an operator-dependent modality that requires expertise and additional training. Furthermore, concerns for radiation exposure and lower reimbursement rates exist, which add safety and financial disincentives. This educational exhibit provides a side-by-side comparison of traditional fluoroscopic studies and their replacement modalities.
Fluoroscopy applications and their alternatives:

Respiratory system:
Foreign body aspiration: Radiography or CT
Tracheomalacia: CT
Diaphragmatic motion: Ultrasound or MRI

Gastrointestinal Tract:
Esophageal foreign body: Radiography
Gastrostomy tube dislodgement: Radiography
Upper GI (Malrotation and volvulus): Ultrasound
Enema for intussusception reduction: Ultrasound guided reduction
Enema for Hirschsprung diagnosis: Contrast radiograph

Urinary Tract:
Voiding cystourethrograms (VCUG): Contrast-enhanced vesicourethrosonography (CeVUS) Read More

Authors:  De Leon-benedetti Laura , Lazarte Claudia , Miranda Schaeubinger Monica , Miliard Derbew Hermon , Jalloul Mohammad , Otero Hansel

Keywords:  Radiology, Fluoroscopy

Yang Ronald,  Hayes Kari,  Milla Sarah,  Zhou Wei

Final Pr. ID: Poster #: SCI-005

Fluoroscopy is a valuable diagnostic tool, but it also exposes patients to radiation. Our study assesses variation in pediatric fluoroscopy radiation dose performance by hospital site and radiologist experience. Read More

Authors:  Yang Ronald , Hayes Kari , Milla Sarah , Zhou Wei

Keywords:  Fluoroscopy, Radiation Dose, Alara

Lee Gregory,  Noel-macdonnell Janelle,  Robinson Amie,  Crockett Jay,  Chan Sherwin

Final Pr. ID: Poster #: SCI-010

Gastrostomy tube (GT) or gastrojejunostomy tube (GJT) checks are a frequently ordered radiographic procedure to confirm placement. The goal of this study was to evaluate the accuracy of after-hours examinations for GJ or GJT placement using abdominal radiographs after injection of contrast, as compared to traditional fluoroscopy exams, which utilize a radiologist to perform the procedure.
Read More

Authors:  Lee Gregory , Noel-macdonnell Janelle , Robinson Amie , Crockett Jay , Chan Sherwin

Keywords:  G Tube, Fluoroscopy

Acord Michael,  Shellikeri Sphoorti,  Vatsky Seth,  Nazario Maricarmen,  Srinivasan Abhay,  Krishnamurthy Ganesh,  Keller Marc,  Cahill Anne Marie

Final Pr. ID: Poster #: EDU-074

Low dose C-arm Computed Tomography (CT), is a technology that uses flat panel detectors to acquire real-time 3D images during an interventional radiology (IR) procedure to assist with anatomic localization and procedural mapping. This study describes our low dose protocol and applications of its use at a pediatric institution. Read More

Authors:  Acord Michael , Shellikeri Sphoorti , Vatsky Seth , Nazario Maricarmen , Srinivasan Abhay , Krishnamurthy Ganesh , Keller Marc , Cahill Anne Marie

Keywords:  dose reduction, 3D fluoroscopy, guidance

Dillard Austin,  Kraus Steve

Final Pr. ID: Poster #: EDU-026

Bowel obstruction in the neonate is common. When neonatal intestinal obstruction is suspected, initial workup may include abdominal radiographs or ultrasound; however, in most busy pediatric radiology practices fluoroscopy is indicated to diagnose the cause, which helps the surgeon make management decisions. Accurate diagnosis is key to the successful management of these neonates. The fluoroscopist should be mindful of the methods and techniques which make evaluation of distal bowel obstruction straightforward and efficient. This exhibit will detail the rationale and protocol to perform the optimal contrast enema, which is essential to have a chance to reliably distinguish the several causes of distal bowel obstruction in neonates. Will include examples with imaging findings and differential diagnoses. Read More

Authors:  Dillard Austin , Kraus Steve

Keywords:  Fluoroscopy, Protocol

Linam Leann,  Loewen Jonathan

Final Pr. ID: Poster #: EDU-012

Learning Objectives: The learner should be able to
Know basic fluoroscopy technique for multiple studies
Identify the abnormalities of the GI and GU system on fluoroscopy.

Table of Contents:
Upper GI
Technique
Abnormalities
Achalasia
Tracheoesophageal fistula
Hiatal hernia
Gastroesophageal reflux
Hypertrophic pyloric stenosis
Gastric volvulus
Malrotation/midgut volvulus
Duodenal web
Small Bowel Follow through
Technique
Abnormalities
Terminal ileitis
Enema
Technique
Abnormalities
Hirschprung’s Disease
Microcolon
Small left colon syndrome
Voiding cystourethrogram
Technique
Abnormalities
Vesicoureteral reflux
Ureterocele
Posterior urethral valves
Neurogenic pladder
Duplicated collecting system Read More

Authors:  Linam Leann , Loewen Jonathan

Keywords:  fluoroscopy

Hayes Kari,  Kraus Steve

Final Pr. ID: Poster #: EDU-017

The purpose of our presentation is to discuss the UGI protocols, tips and tricks, standardized reports we obtained by consensus of the 17 member, multi-institutional, multi-continenetal SPR fluoroscopy committee. We present our standarized UGI protocols along with acceptable variations in practice. We also present tips and tricks to tailor the study to specific indications. Discussion includes case examples of recommended protocols and special modifications based on specific clinical presentation. Read More

Authors:  Hayes Kari , Kraus Steve

Keywords:  Fluoroscopy, Consensus, Protocol

Contreras Jesus,  Seekins Jayne

Final Pr. ID: Poster #: EDU-001

The aim of this strategy is to standardize the performance of our modified barium swallow studies (MBSS) with a focus on communication between team members and the reduction of fluoroscopic radiation dose exposure to the radiosensitive head and neck region.
The radiation dose reduction strategy is composed of the following steps:
The radiology technologist will initiate the patient encounter, begin room setup, and notify the radiologist of patient arrival.
The radiologist will review prior examinations, if available, and discuss the current indication and goal of the examination with the Speech/Occupational Therapist and Radiology Technologist.
The pulsed acquisition rate is standardized at 15 frames/second, and the optimal field of view will be discussed and adjusted dynamically, if necessary.
The team will utilize standardized consistencies based on the International Dysphagia Diet Standardization Initiative (IDDSI).
Once the in-room team has a clear objective the performing radiologist will proceed with the fluoroscopic examination. The radiologist will announce to the in-room team when fluoroscopic time points are met at 1 minute, 2 minutes, and a "hard-stop" at 3 minutes of fluoroscopic exposure.
In order for an examination to continue beyond the 3 minute time point a mandatory discussion regarding clinical necessity will occur between the supervising radiologist and the in-room team members.
The average fluoroscopic time required for the acquisition of a MBSS at our institution was calculated and reviewed before (2.07 minutes) and after (1.35 minutes) the implementation of this fluoroscopic radiation dose reduction strategy. The result is a 36 percent reduction in time of fluoroscopic exposure.
The implementation of a radiation dose reduction strategy to our MBSS protocol has resulted in decreased fluoroscopic times, and therefore, a decrease in fluoroscopic radiation dose. An emphasis on verbal communication between team members ensures an understanding of the goal of the examination and awareness of proper management of radiation dose to patients and workers. This modified approach to the MBSS better aligns with the principle of “as low as reasonably achievable” (ALARA). Read More

Authors:  Contreras Jesus , Seekins Jayne

Keywords:  ALARA, FLUOROSCOPY

Zhou Wei,  Baldwin Heather,  Allen Jeron,  Butler Renee,  White Christina,  Milla Sarah,  Hayes Kari

Final Pr. ID: Poster #: SCI-013

To diagnose intestinal disease or guide an injection treatment, radiation from a fluoroscopy exam is often nontrivial. In addition to regulatory and accreditation requirements, it is clinically important to establish a mechanism to review and improve the use of fluoroscopy, particularly for pediatric patients who are more sensitive to radiation than adults. In this study, we aimed to implement a fluoroscopy dose monitor program, assess overall fluoroscopy performance, and evaluate radiologist performance, in a pediatric hospital system. Read More

Authors:  Zhou Wei , Baldwin Heather , Allen Jeron , Butler Renee , White Christina , Milla Sarah , Hayes Kari

Keywords:  Fluoroscopy, Radiation Dose, ALARA