Kids put all sorts of things in their mouths. Foreign body ingestion is a common occurrence in children, and diagnostic imaging plays an important role in determining the nature of the foreign body and the need for emergent removal. This presentation uses a question and answer format to provide high-yield clinically relevant information on the most commonly encountered foreign bodies including management guidelines for things like coins, batteries, and magnets. Both GI and airway foreign bodies are discussed. The presentation is catered mostly to trainees, but even experienced radiologists will enjoy challenging themselves to identify uncommon foreign bodies on imaging. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Finkle Joshua, Feinstein Kate

Keywords: Foreign Body

Robotic-assisted laparoscopic surgery (RALS) has gained an upsurge in attention within the past two decades and now rivals many of the gold standard, open surgical procedures in pediatric urology. Since the first published cases of pediatric robotic surgery in 2001, case volumes of genitourinary RALS in children have increased exponentially. Given similar complication rates to their open surgical counterparts, and with the benefits of decreased pain medication usage and length of hospitalization, urologic procedures in children such as pyeloplasty, ureteral reimplantation, nephrectomy, and Mitrofanoff appendicovesicostomy will likely continue to see growth in the upcoming years. However, like many innovative technologies, RALS require years of experience to understand the operating control systems, to develop manual dexterity, and to master the technical aspects of specific procedures. As more hospitals and trainees are exposed to systems such as the Da Vinci Surgical System and new upcoming robotic platforms, such as the Senhance Surgical Robotic System, surgeons and radiologists alike will need to recognize common RALS-associated complications on imaging. This educational exhibit will educate non-surgical physicians on the basic steps of common RALS and provide both pediatric radiologists and pediatric urology surgeons with specific radiographic findings of their complications. Images will include expected post-operative findings, general complications such as hematomas, anastomotic leak, and infection/abscess, as well as more procedure specific complications such as anastomotic stenosis and recurrent ureteropelvic junction obstruction in pyeloplasties. Finally, we will explain and provide images on cases in which interventional radiology can play a pivotal role in the management of pediatric genitourinary RALS complications. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Whittington Angela, Adamic Brittany, Ong Seng, Feinstein Kate

Keywords: Robotic-Assisted, Laparoscopic, Pyeloplasty

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

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

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

Keywords: VCUG, GU

<b>Purpose: </b> <b>A new minimally invasive procedure, the use of magnets (Flourish™) for the treatment of esophageal atresia will be described. The invention’s background, patient selection criteria, procedure details and complications are the subject of this exhibit.</b> <b>Background:</b> <b>Esophageal atresia is a rare congenital defect where the proximal esophagus does not connect to the distal esophagus. Classically, this defect has been treated by surgery to reconnect the ends and reestablish esophageal continuity, however a small subset may be treated with a magnetic catheter-based system. The primary goal of this procedure is to form an anastomosis while avoiding a major thoracic surgery and its complications.</b> <b>The Flourish™ device uses bullet-shaped rare earth magnets which are inserted into the upper esophagus and lower esophagus. Included in these magnets is the rare earth element neodymium, which along with iron and boron create an alloy with a strength of up to 1.2 Tesla. </b> <b>When the magnets are placed in close proximity at the ends of the esophageal pouches, they will attract over several days, eventually connecting the ends of the esophagus and causing an anastomosis via pressure necrosis.</b> <b> </b> <b>Criteria:</b> <b>Selection is based on absence of tracheoesophageal fistula, esophageal gap shorter than 4 cm and a mature gastrostomy tract.</b> <b>Procedure:</b> <b>Under fluoroscopy, the gastric catheter is advanced superiorly through the gastrostomy to the most superior end of the distal esophageal pouch. The oral catheter is then advanced in order to bring the magnets to closest proximity. Daily radiographs are obtained to evaluate magnet positions. </b> <b>Complications/outcomes:</b> <b>Thirteen patients that have undergone placement of the magnetic catheter-based system at six institutions. Twelve patients had an average time to achieve anastomosis of six days and progressed to full oral feeds. The most common complication was magnetic anastomosis stenosis requiring dilatation. Currently, Flourish is approved as a Humanitarian Device Exemption (HDE). </b> Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Groene John, Ong Seng, Feinstein Kate, Slater Bethany, Zaritzky Mario

Keywords: Esophageal Atresia, Atresia, Flourish

In this exhibit we will describe a fairly new surgical procedure - total pancreatectomy and islet autotransplant (TPIAT). TPIAT is an uncommon procedure performed in children who suffer from chronic or recurrent acute pancreatitis. The purpose of the exhibit is to learn about the selection criteria, the surgery itself, and the imaging features of surgical complications. Candidates are selected for surgery based on a multitude of factors including severity and chronicity of pain, laboratory evaluation of pancreatic exocrine and endocrine function, and imaging features of chronic pancreatitis on MRCP and/or endoscopic ultrasound. In the surgical procedure, the pancreas and duodenum are resected, islet cells are isolated and then infused through the portal vein into the liver. A splenectomy is performed and continuity of the GI tract restored. Patients may spend three weeks in the hospital after surgery. Months after the infusion, the islet cells will be embedded within the liver and begin to produce insulin. The primary goal of this procedure is to relieve debilitating pain and improve quality of life, for which this procedure is around 90% successful. The secondary goal of the procedure is to retain islet cell function. In this regard, approximately 40% of the pediatric patients will regain complete islet cell function, 30% will regain partial function while 30% will have no islet cell function. Follow up imaging may also be performed on these patients for evaluation of complications such as delayed gastric emptying, small bowel obstruction, surgical site infections, bile leak, and intra-abdominal hemorrhage. Complications seen in our hospital, including small bowel obstruction, delayed gastric emptying, and prolonged ileus will be highlighted. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Groene John, Wieck Minna, Ong Seng, Zaritzky Mario, Feinstein Kate

Keywords: total pancreatectomy and islet autotransplant, TPIAT, islet cell transplantation

In this exhibit, we will outline the revised International Neuroblastoma Response Criteria (INRC) used to assess treatment response in children with neuroblastoma, particularly high risk patients, in the context of clinical relevance to their treatment plan. Neuroblastoma is the most common extracranial solid malignancy in children, accounting for approximately 12% of deaths in children younger than 15 years of age affected with cancer. Up to 50% of children with neuroblastoma are found to have a high-risk phenotype with poor long-term survival and risk of therapy-related toxicity. Due to a lack of consensus regarding the definition of disease response, the development of more effective therapy treatment of high-risk disease has been hindered. The revised INRC consensus integrates modern, functional imaging techniques and quantitative assessment of bone marrow disease. It is anticipated that the revised INRC will enable a more precise assessment of treatment response that can be used to inform treatment decisions. This exhibit will delve into these modalities which are more sensitive and specific for Neuroblastoma detection. This exhibit will also demonstrate how the revised response criteria are used in the clinical setting in the Children’s Oncology Group clinical trials. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Telleria Jessica, Pudela Caileigh, Zaritzky Mario, Cohn Susan, Feinstein Kate

Keywords: Neuroblastoma, INRC, Oncology

Gonadal shielding is currently the standard of care in most radiology practices with gonadal shielding occurring many times throughout the day in practices worldwide. Currently, the utility of gonadal shielding is being widely debated. The American Association of Physicists in Medicine (AAPM) recently published a policy recommending the discontinuation of shielding which was then endorsed by the American College of Radiology (ACR). However, other professional societies as well as many state regulations still recommend the use of gonadal shielding. This educational exhibit will outline the benefits as well as the risks involved in gonadal shielding that are currently being debated. It will also include how to identify the various imaging artifacts which can result from gonadal shielding. We will then discuss the best practices we use at our institution for gonadal shielding, including how to work closely with our radiology technologist colleagues to reduce artifact and radiation dose in order to help mitigate the negative consequences of gonadal shielding while maximizing the benefits. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Sellers Emily, Marshall Emily, Lu Zheng Feng, Reiser Ingrid, Ong Seng, Feinstein Kate

Keywords: Shielding, Radiation

1. Discuss benefits and limitations of different sonographic techniques 2. Provide phantom studies and clinical examples to demonstrate the effect of altering imaging parameters and sonographic techniques on both desired and undesired artifacts 3. Increase awareness of common errors in technique and provide recommendations to tailor the exam to the specific imaging question Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Baad Michael, Sanchez Adrian, Little Kevin, Reiser Ingrid, Lu Zheng Feng, Feinstein Kate

Keywords: Ultrasound, Imaging Artifacts, Spatial Compounding

Global mAs reduction is accepted as being superior to bismuth breast shields in reducing breast organ dose for children undergoing CT of the chest. However, in imaging of chest, abdomen, and pelvis (CAP), globally reducing mAs degrades image quality in the abdomen and pelvis. This study compares bismuth shields to global mAs reduction including a region-specific boost feature to maintain abdominal image quality. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Finkle Joshua, Marshall Emily, Reiser Ingrid, Zhang Yue, Lu Zheng Feng, Jones Anji, Feinstein Kate

Keywords: Bismuth breast shields, CT dose