Venkatakrishna Shyam Sunder,  Sultan Laith,  Gabbert Morgan,  Morgan Trudy,  Anupindi Sudha

Final Pr. ID: Poster #: SCI-014

Pediatric chronic liver disease (CLD) poses a significant clinical challenge, necessitating precise diagnostic tools for comprehensive evaluation. Microvascular perfusion abnormalities play a pivotal role in disease progression. Contrast-enhanced ultrasound (CEUS) detects the flow in the micro-vessels, however, objective means are needed for better understanding. In this study we evaluate a novel quantitative method utilizing CEUS for assessing microvascular perfusion in pediatric patients with CLD. Read More

Authors:  Venkatakrishna Shyam Sunder , Sultan Laith , Gabbert Morgan , Morgan Trudy , Anupindi Sudha

Keywords:  Liver microvasculature, Contrast enhanced ultrasound, image analysis

De Medeiros Bruno,  Gatidis Sergios

Final Pr. ID: Poster #: SCI-005

Deep learning models have become instrumental in medical imaging, with a wide array of applications such as automated segmentation and diagnosis. However, the majority of these models are trained on adult imaging datasets, leading to underperformance when applied to the pediatric population. This discrepancy arises from anatomical differences between these populations, posing a significant challenge in fields requiring high precision like spine segmentation in Computed Tomography (CT) scans. Read More

Authors:  De Medeiros Bruno , Gatidis Sergios

Keywords:  Computed Tomography, Segmentation, Image Database

Parikh Ashishkumar,  Pruthi Sumit,  Hernanz-schulman Marta

Final Pr. ID: Poster #: SCI-001

Recently JACHO proposed to address double scanning in pediatric chest CT, yet there are no data to determine whether this takes place; similarly, there is discussion regarding validity of sending pediatric patients to adult-focused practices for routine imaging by third party payors. Our purpose is to review the technical factors that impact upon radiation dose and image quality in CT scans of children referred from adult-focused practices to a children’s hospital, referenced to pre-Image Gently values. To our knowledge this is the first such review that includes body and neuro scans and extensive technique and exposure data Read More

Authors:  Parikh Ashishkumar , Pruthi Sumit , Hernanz-schulman Marta

Keywords:  ALARA, Image Gently, Radiation

Juang Eric,  Collard Michael,  Katz Danielle,  Adams Megan,  Wachs Michael,  Annam Aparna,  Zavaletta Vaz

Final Pr. ID: Poster #: EDU-048

Through a series of cases, this poster demonstrates how to diagnose and treat biliary anastomotic complications with image-guided techniques in infants after liver transplant.

We present several cases to illustrate the variability of biliary anastomoses including location, type, and number of anastomoses. Pediatric interventional radiologists and image-guided procedures are critical in the successful management of post-transplant biliary anastomotic strictures and leaks and minimize the need for invasive reoperation.

The selected cases illustrate complex image-guided percutaneous management of multiple duct anastomotic strictures, anastomotic dehiscence, cut surface leaks, and removal of surgically placed stents that may be malpositioned and/or causing obstruction. The interventional methods used to percutaneously manage these cases include complex biliary access utilizing snares, multiple drain placement, stent placement, and rendezvous procedures with endoscopic retrograde cholangiopancreatography.

The use of image-guided techniques by the pediatric interventional radiologist are invaluable in the management of biliary complications post-liver transplant in infants. Read More

Authors:  Juang Eric , Collard Michael , Katz Danielle , Adams Megan , Wachs Michael , Annam Aparna , Zavaletta Vaz

Keywords:  Transplant Interventions, Biliary, Image-Guided

Abe Shuji,  Shimada Makoto,  Abe Yuki,  Nishikawa Masanori,  Tominaga Masahide,  Yatake Hidetoshi,  Yabunaka Koichi,  Katsuda Toshizo

Final Pr. ID: Poster #: SCI-01 (R)

The 320-row multidetector computed tomography (MDCT) enables the scanning of a maximum length of 160 mm by volume scanning (VS). Dynamic volume scanning (DVS) with MDCT enables the development of a 4D dynamic image.
The 3D findings of tracheobronchial imaging in children who cannot control their breathing fail to reveal the phase of breathing in which the image was taken, which affects the accuracy of the diagnosis of tracheobronchial stenosis. Imaging by 4D-DVS enables the accurate observation of the tracheal dynamics in association with the respiratory kinetics, thus revealing the mechanism of the former. Furthermore, 4D-DVS would enable the imaging of the cardiac blood vessels by a contrast study simultaneously with the imaging of the stenosed area.
We assessed the efficacy of the 4D-DVS imaging technique in the diagnosis of pediatric tracheobronchial stenosis. Read More

Authors:  Abe Shuji , Shimada Makoto , Abe Yuki , Nishikawa Masanori , Tominaga Masahide , Yatake Hidetoshi , Yabunaka Koichi , Katsuda Toshizo

Keywords:  Dynamic volume scanning, 4D dynamic image, tracheobronchial stenosis

Boileau Caroline,  Treanor Lee,  Kapoor Cassandra,  Highmore Kerri,  Miller Elka

Final Pr. ID: Poster #: EDU-001 (T)

Imaging requisitions are the legal documents that health professionals use to communicate to radiologists and Medical Radiation Technologists (MRT(R)s) the relevant clinical information to guide their requested radiographic examination. Inadequate or incomplete information may have a substantial impact on patient care.

Since the implementation of our electronic medical record system, EPIC (Epic Systems Corp.), we have the ability to track the number of errors on requisitions; the most common error is having the incorrect body parts selected or multiple unnecessary exams being ordered. The MRT(R)’s identify these errors and correct the inconsistencies following departmental protocols. Without such vigilance on the MRT(R)’s part, inappropriate radiographs could have been performed and could lead to additional, unnecessary radiation exposure. To help select the most appropriate protocol, educate and guide the health professionals at our hospital, an electronic software tool, “EDI” has been created.

EDI (Examine the patient, Determine the correct radiograph, Input the order with pertinent and relevant clinical information) is an interactive tool that includes the exam protocol with the associated views per body part. Each exam also includes EDI with the field of view that will be exposed to radiation during the exam.

Our goal is that EDI will serve health professionals to better understand what order needs to be selected in the electronic system and which radiographs will be provided. Ultimately, this will reduce any unnecessary exams and reduce pediatric radiation exposure. Read More

Authors:  Boileau Caroline , Treanor Lee , Kapoor Cassandra , Highmore Kerri , Miller Elka

Keywords:  Appropriateness Criteria, Image Gently, ALARA

Goncalves Luis,  Lindblade Christopher,  Cornejo Patricia,  Patel Mittun,  Wishah Fidaa,  Bardo Dianna

Final Pr. ID: Paper #: 107

The purpose of this study is to report visualization rates for standard cardiac axial views by FCMR using a prospective ECG pseudogating method and compare visualization rates for acquisitions performed in 1.5 and 3T. Secondary aims include a comparison of image quality between 2 observers and between 1.5 and 3T. Specific absorption rates (SAR) are also compared. Read More

Authors:  Goncalves Luis , Lindblade Christopher , Cornejo Patricia , Patel Mittun , Wishah Fidaa , Bardo Dianna

Keywords:  fetal cardiac MRI, 3T, image quality

Alam Aisha,  Maier Pia,  Smitthimedhin Anilawan,  Acord Michael,  Cahill Anne Marie,  Vatsky Seth

Final Pr. ID: Paper #: 072

Lymphoma is the most common mediastinal mass in children. Obtaining tissue for diagnosis can be challenging due to reported low diagnostic yield and risk of cardiorespiratory collapse, especially in the setting of anesthesia. We report our experience with biopsy of mediastinal masses, report the diagnostic rate for lymphoma and biopsy/anesthetic complications related to the procedure. Read More

Authors:  Alam Aisha , Maier Pia , Smitthimedhin Anilawan , Acord Michael , Cahill Anne Marie , Vatsky Seth

Keywords:  Image guided biopsy, Mediastinal Mass, Lymphoma

Schaiberger Gregory,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-022 (S)

The use of computed tomography (CT) in radiology has risen dramatically over the past 2 decades. Over 7 million pediatric CT studies per year are performed in the United States. Children are particularly at risk for the cumulative adverse lifetime effects of ionizing radiation. It is associated with a small but significant increase in lifetime risk of fatal cancer. For this reason, the campaign of “Imaging Gently” was created, whose purpose is to raise awareness of the opportunities to lower radiation dose in the imaging of children. Minimizing the dose in children is a high priority in pediatric radiology, and as a result the use of modalities utilizing non-ionizing radiation is encouraged.

For the reasons discussed above, ultrasound is often the first line tool in the diagnosis of pediatric emergencies. The purpose of this educational article is to further discuss “imaging gently” and the importance of utilizing non-ionizing radiation such as ultrasound to diagnose various pediatric emergencies. These emergencies include but are not limited to acute appendicitis, hypertrophic pyloric stenosis, intussusception, testicular torsion, and ovarian torsion. The imaging technique, pertinent findings, differential diagnosis, imaging pitfalls and treatment will be discussed. Image-rich examples of each diagnosis will be provided. Read More

Authors:  Schaiberger Gregory , Sharma Priya , Rajderkar Dhanashree

Keywords:  Ultrasound, Image, Gently

Jordan Kathryn,  Killerby Marie,  Patel Arjun,  Cassella Katharyn,  Greene Elton,  Johnstone Lindsey,  Leschied Jessica

Final Pr. ID: Poster #: EDU-014

The majority of children’s hospitals reside in urban settings, and the most common animal related injuries seen in these areas are induced by cats or dogs. However, urban medical centers serve patients from large surrounding rural areas where a more diverse array of animal or agriculture related injuries can occur. Although an altercation with an angry horse, pig, or cow could result in severe trauma in adults, animal related injuries pose an even greater danger to children given their smaller stature and growing bodies. The natural curiosity of children also increases the risk of severe injury when living or playing around industrial agricultural equipment. Even partaking in outdoor sports or leisure activities confers risk for exposure to a variety of injury mechanisms. Depending on the specifics of the surrounding ecosystem, radiologists may also care for patients exposed to envenomation from snakes, scorpions, spiders, and various other insects, resulting in local or systemic complications. When incorporating a mechanism of injury, radiologists may anticipate complications of exposure to these animals or insects and can recommend further imaging evaluation. For example, in addition to characterizing imaging findings, such as local necrosis, from a brown recluse bite injury in a patient transferred from an outlying hospital, the radiologist would anticipate the urgency with which to assess for more systemic complications such as angioedema, rhabdomyolysis, or internal hemorrhage due to disseminated intravascular coagulopathy. To best serve our patients, pediatric radiologists should exhibit familiarity with possible mechanisms of injury related to wildlife, their various imaging manifestations, and potential complications in order to help guide clinicians in managing these potentially devastating injuries. This educational exhibit aims to demonstrate key findings of such pediatric injuries through a series of cases. Read More

Authors:  Jordan Kathryn , Killerby Marie , Patel Arjun , Cassella Katharyn , Greene Elton , Johnstone Lindsey , Leschied Jessica

Keywords:  Pediatric Trauma, Image Findings, Emergency/Acute

Sharma Karun,  Yadav Bhupender,  Vellody Ranjith,  Plishker William,  Shekhar Raj

Final Pr. ID: Poster #: SCI-039

Percutaneous CT-guided biopsy and ablation are established techniques to diagnose and treat solid tumors. However, some tumors are not adequately visualized with CT, even after IV contrast administration, because of transient enhancement. Many of these “CT-occult” tumors are optimally seen on preprocedural MRI or PET scans. To enable targeting of such tumors, we developed software that fuses MRI/PET images to intraprocedural CT in real time. The software corrects for soft-tissue deformations which occur due to differences in patient positioning or motion. The fusion imaging is generated after each intraprocedural CT scan and takes advantage of all available imaging data. We report retrospective evaluation of this fusion method for pediatric interventional radiology procedures. Read More

Authors:  Sharma Karun , Yadav Bhupender , Vellody Ranjith , Plishker William , Shekhar Raj

Keywords:  multimodality guidance, image fusion, CT-occult tumor

Gazzi Lynn

Final Pr. ID: Poster #: EDU-006 (T)

Intestinal malrotation is a defect that occurs in the 10th week of gestation. During this stage the intestines normally migrate back into the abdominal wall following a brief period where they are temporarily located in the base of the umbilical cord. As the intestines returns to the abdomen it makes two rotations and becomes fixed into its normal position. The small bowel is located in the center of the abdomen and the large intestine drapes around the top and sides of the small intestine. When rotation is incomplete and intestinal fixation does not occur, this creates a defect known as malrotation. Malrotation occurs in one of every 500 births in the United States. Up to 40 percent of patients with this show signs of the disease within the first week of life. By one month of age 50-60 percent are diagnosed. 75 to 90 percent are diagnosed by age 1. The remaining cases are diagnosed into adulthood. Some symptoms of malrotation include vomiting and bilious emesis, fussiness, crying in pain, a swollen abdomen that’s tender to the touch, fever, diarrhea and bloody stool or none at all. If malrotation is not treated, it can lead or turn into a midgut vovulus. This is when the gut twists counterclockwise around the superior mesenteric artery and vein causing a narrowing. This may cause abdominal distention and pain or acute bowel necrosis. It can also be life threatening or lead to a lifelong dependence on total parenteral nutrition, so surgical correction is the dependent treatment. When medical history and physical examination indicate a suspicion of malrotation and vovulus, patients must undergo blood tests and diagnostic imaging studies to evaluate the position of the intestine to determine if there is blockage or twisting. The imaging modality of choice remains the upper GI study. This is a fluoroscopic study using barium contrast to look at the upper and middle sections of the gastrointestinal tract. A radiologist’s knowledge of normal anatomy is important in performing and interpreting the upper GI series. From a technical standpoint common pitfalls during this test that can lead to a misdiagnosis would be imaging quality. Improper patient positioning, nonsufficient images taken and the wrong amount of contrast administered during the most crucial part of the study can lead to false findings. The purpose of this abstract is to present case studies and imaging which mimic intestinal rotation but are a normal variant vs. actual cases of malrotation Read More

Authors:  Gazzi Lynn

Keywords:  malrotation, midgut vovulus, image findings

Brown Timothy,  Fordham Lynn,  Mclean Sean,  Guimaraes Carolina,  Pryor William

Final Pr. ID: Poster #: EDU-093

Pediatric chest wall deformities, such as pectus excavatum, carinatum, and arcuatum, are often congenital and can lead to cardiorespiratory deficiencies and varying psychosocial impact on affected individuals. Patients frequently request or need surgical correction, which has unique risks and often positive outcomes. Pediatric radiologists play a key role in the early recognition of congenital chest wall deformities. Cross-sectional imaging is essential for clinical management in the perioperative interval. The Haller index and Correction index are calculated on cross-sectional imaging and are used to help guide patient management and determine surgical necessity in both excavatum and carinatum. This educational exhibit will review diagnostic imaging characteristics of pediatric chest wall malformations, highlight the salient clinical and imaging features for surgical planning, and provide a pictorial review of surgical correction and patient outcomes from an academic tertiary care center. Read More

Authors:  Brown Timothy , Fordham Lynn , Mclean Sean , Guimaraes Carolina , Pryor William

Keywords:  Chest Wall, 3D Images

Le Judy

Final Pr. ID: Poster #: EDU-05 (R)

The goal of this study is to educate Radiographers on varies specialty surfaces that are often under critical care patients and how they affect image quality on portable x-rays. By understanding which items cause image artifacts, radiographers can reduce the amount of repeated images and thus, decrease dose to patients. Read More

Authors:  Le Judy

Keywords:  portable imaging, infant, image quality

Tan Fei,  Zapala Matthew,  Durand Rachelle,  Chan Marilynn,  Larson Peder

Final Pr. ID: Poster #: SCI-035

MRI is not routinely used in clinical practice for lung imaging because of the low proton density and respiratory motion artifact. However, the ultrashort echo time (UTE) MRI technique can increase the signal in the lung. Image reconstruction techniques, such as iterative motion compensated (iMoCo) reconstruction, have improved respiratory motion management for free-breathing lung MRI scans. With the advantage of no ionizing radiation, MRI can benefit patients with immunodeficiency who often require repeat imaging, patients with heightened radiation sensitivity, and/or pediatric patients. In this abstract, we aim to evaluate the imaging quality of UTE lung MRI in the pediatric population. Read More

Authors:  Tan Fei , Zapala Matthew , Durand Rachelle , Chan Marilynn , Larson Peder

Keywords:  MRI, Image Quality, Lung

Sun Yan

Final Pr. ID: Poster #: EDU-065

To investigate the radiological findings of central nervous system complications of leukemia (CNSCL）in children. Read More

Authors:  Sun Yan

Keywords:  leukemia, central nervous system, image

Patel Dhruv,  Loewen Jonathan,  Richer Edward

Final Pr. ID: Paper #: 098

Ileocolic intussusception is a common cause of intestinal obstruction in young children. Most patients undergo image-guided enema reduction followed by a surgical reduction in enema fails. Many factors associated with decreased enema success have been described in the literature, although a concise scoring system to identify patients who are at risk for surgical intervention and complications does not exist. The goal of this project was to develop a scoring system to identify patients who are at increased risk for enema failure and surgical complications. Read More

Authors:  Patel Dhruv , Loewen Jonathan , Richer Edward

Keywords:  Ileocolic Intussusception, Image guided therapeutic enema