Colleran Gabrielle,  Barnewolt Carol,  Chow Jeanne,  Paltiel Harriet

Final Pr. ID: Poster #: EDU-122

Fluoroscopic voiding cystourethrography (VCUG) and radionuclide cystography (RNC) are conventional techniques used for the diagnosis of vesicoureteral reflux (VUR) in children. Contrast-enhanced voiding urosonography (ceVUS) is a radiation-free alternative to the traditional VCUG. ceVUS has gained acceptance in Europe, but has not yet been widely adopted in the USA.

The purpose of this educational review is to describe our initial experience with ceVUS using the second generation US contrast agent Optison™, with a focus on optimization of examination technique, utility in the depiction of a variety of pathological entities, and a discussion of potential pitfalls. Read More

Authors:  Colleran Gabrielle , Barnewolt Carol , Chow Jeanne , Paltiel Harriet

Keywords:  contrast enhanced voiding urosonography, VCUG, ALARA, ultrasound contrast, Optison

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

Sellers Emily,  Stahoviak Katherine,  Ong Seng,  Feinstein Kate

Final Pr. ID: Poster #: EDU-037

In this exhibit, we will describe the synergistic effect of urodynamics and imaging. Bladder dysfunction, a common problem in children, accounts for up to 40 percent of pediatric urology clinic visits. Urodynamics is a key study to determine the etiology of bladder dysfunction yet, many radiologists are unfamiliar with this exam. Urodynamics is a fluoroscopic evaluation of the bladder with contrast during which abdominal and bladder pressures are measured while the bladder fills and empties. It uses a combination of electromyogram to evaluate pelvic floor contractions, cystometrogram to evaluate bladder pressures and capacity, and voiding cystourethrography to evaluate lower urinary tract anatomy. This exhibit will explain the indications for urodynamics, the basics of its interpretation including detrusor function and pressure flow studies, and the types of pathologies which may be diagnosed. Neurogenic bladder, congenital abnormalities, and how to differentiate between subsets of overactive bladder and underactive bladder will be explained. We will show imaging findings which correlate with these urodynamic diagnoses and describe ways to enhance voiding cystourethrograms and sonograms to better evaluate children with lower urinary tract dysfunction. Read More

Authors:  Sellers Emily , Stahoviak Katherine , Ong Seng , Feinstein Kate

Keywords:  VCUG, GU

Noorbakhsh Abraham,  Koning Jeffrey,  Kruk Peter

Final Pr. ID: Poster #: CR-008

We report a case of a 7 year old female who presented to urology clinic due to recurrent urinary tract infections that had started 4 years ago. The patient also reported symptoms of urge incontinence and nocturnal enuresis beginning at the same time. She previously consulted an adult gynecologist, which showed no physical exam evidence of genitourinary abnormalities. An MRI of the abdomen and pelvis was also ordered at that time which reported a normal exam except for a small left renal cyst. At our institution she underwent DMSA renal scan, which was normal. She underwent a voiding cystourethrogram (VCUG), which showed no vesicoureteral reflux. However, during the VCUG, an incidental note was made of large amounts of vaginal reflux extending into the cervix, uterus, and with spillage into the peritoneal cavity presumably via the salpinges. Read More

Authors:  Noorbakhsh Abraham , Koning Jeffrey , Kruk Peter

Keywords:  VCUG, Vaginal Reflux, Peritoneum