Machine learning that can identify and localize objects in an image using a labeled bounding box is called object detection. The purpose of this study is to demonstrate object detection in identifying rickets on pediatric wrist radiographs. Read More

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

Authors: Meda Karthik, Milla Sarah, Rostad Bradley

Keywords: Machine learning, Artificial intelligence, rickets

Patients with Von Hippel Lindau are predisposed to develop neuroendocrine tumors (NET) such as pheochromocytoma. These tumors are known to be somatostatin receptor positive and therefore can be imaged with specific radiotracers that target these receptors like ¹¹¹In-octreotide and ⁶⁸Ga-Dotatate. In addition to NET’s, 80% of these patients will also develop hemangioblastomas in the brain and spinal cord which have been shown to harbor somatostatin receptor subtypes including SSTR-2a, one of the target receptors for DOTATATE. We present a case of a teenager with suspected NET in the adrenal gland who underwent ⁶⁸Ga-DOTATATE PET/CT. The PET confirmed uptake in the adrenal lesion, but also highlighted a focus of uptake in the spine. Correlative MRI of the spine demonstrates classic imaging features of hemangioblastoma. This finding has not previously been described in the published literature in children. This case report will discuss the mechanism and utility of ⁶⁸Ga-Dotatate PET/CT and emphasize the manifestations of Von Hippel Lindau disease. We will review the normal pattern of Dotatate uptake and the significance of somatostatin receptors in neoplasms in the VHL patient population. Read More

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

Authors: Chen Jennifer, Milla Sarah, Alazraki Adina

Keywords: hemangioblastoma, dotatate, von hippel lindau

Several unique radiologic diagnoses occur with greater frequency in the Mountain West region of the United States. On account of the altitude, hypobaric hypoxic induced pathology can acutely affect those traveling to the region who are otherwise unaccustomed to the effects of elevation. Chronic hypoxia also has effects on those living in the area. The outdoor recreational activities available in the region (particularly skiing and snowboarding) also result in unique patterns of musculoskeletal injury. Lastly, the harsh winter conditions result in potential cold-weather injuries. We will review the radiologic findings and pathophysiology of these unique musculoskeletal, cardiopulmonary, and neurologic conditions not commonly encountered by radiologists practicing elsewhere. Table of Contents/Outline: I. High altitude pulmonary edema II. High altitude cerebral edema III. Frostbite IV. Ski and snowboard injuries V. Tick-borne illnesses (e.g., Rocky Mountain Spotted Fever) VI. Congenital heart disease at elevation VII. Sickle cell anemia/sickle cell trait and associated pathologies VIII. Cosmic, terrestrial, and ultraviolet radiation and associated risks IX. Hypoxia induced red marrow reconversion Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Boehnke Mitchell, Milla Sarah, Tutman Jeffrey

Keywords: Altitude, Mountain, Elevation

Head trauma is a significant cause of morbidity and mortality in pediatrics. Non-contrast Head CT is the accepted gold standard imaging study to evaluate for suspected acute intracranial hemorrhage (ICH), however small acute extra-axial hemorrhage may be easily missed due to size and similar density to the bony calvarium. In Dual Energy CT (DECT), materials within the body such as bone/calcium and hemorrhage can be more easily discriminated based on differential attenuation at high and low peak voltage image acquisitions. This allows for advanced post-processing including automated bone removal which has been shown to improved visualization of acute ICH in the adult radiology literature, but has not yet been described in pediatrics. We report a retrospective review of DECT with automated bone removal for detection of acute ICH in the pediatric population. Read More

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

Authors: Arceo Salvador, Christopher Ross, Milla Sarah, Riedesel Erica

Keywords: Dual Energy, Trauma, Intracranial Hemorrhage

Prior studies have suggested that patients undergoing fetal MRI have a high level of anxiety, while other studies have indicated that patients have a limited understanding of the role of the radiologist in patient care. Further, many patients would prefer to learn their results immediately after the examination rather than wait to meet with their obstetrician. Our objective is to assess patient perception of what fetal MRI is and the role of the radiologist. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Golden Eleza, Alazraki Adina, Milla Sarah, Desai Nilesh

Keywords: fetal MRI, radiologist, consultation

There is significant variation in the approach to diagnosing PCOS (polycystic ovarian syndrome), particularly in adolescents. PCOS, more recently referred to as hyperandrogenic anovulation, is a classic tried of oligomenorrhea and/or anovulation, hirsutism, and obesity. The Rotterdam criteria are widely used in the adult population, with diagnostic criteria including 2 of the following 3: ovulatory dysfunction, clinical and/or biochemical signs of hyperandrogenism, polycystic ovarian morphology on ultrasound. Although it is acknowledged that ultrasound is not necessary for diagnosing PCOS in adults if the first 2 criteria are met, there is sufficient controversy in adolescent literature that classic morphologic appearance in addition to one other criterion may not be diagnostic. Polycystic ovarian morphology (PCOM), the imaging correlate typically associated with the clinical diagnosis of PCOS, can be a normal finding in adolescents. Given that the criteria for the polycystic ovarian morphology (PCOM) remains controversial, it is important for a pediatric radiologist to understand the significance of PCOM in adolescents, and how radiology can best and most significantly add to the clinical picture. This presentation will provide a review of consensus guidelines for PCOS and PCOM, and best practices of describing findings of PCOM in adolescents. Novel approaches will also be discussed, including ongoing research in follicle counts and stromal volume with 3D ultrasound. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Pradhan Nisha, Trenbeath Zachary, Tutman Jeffrey, Milla Sarah

Keywords: PCOS, PCOM, adolescent

Access to healthcare, and in particular to pediatric subspecialties, including pediatric radiology, is limited. Increasingly limited access creates or accentuates preexisting disparities and injustices. However, because of the complexity of the issue, it is difficult to objectively study and quantify it. This exhibit will describe current barriers to pediatric radiology access, available research tools and methodologies that can help us measure the impact of such barriers. Then, we propose a research agenda to systematically approach the problem. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Morales-tisnés Tatiana, Miranda Schaeubinger Monica, Yaya Carlos, Milla Sarah, Heller Richard, Otero Hansel

Keywords: Pediatric radiology, Access to healthcare, Research agenda

A trend of increased utilization of pediatric breast ultrasound has been suggested in our pediatric healthcare system. Despite this perceived increase in cases, the number of concerning breast findings in our population remains extremely low. Our hypothesis is that there has been significant increase in the number of pediatric breast ultrasounds, yet examinations remain overwhelmingly benign. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Thompson Allison, Alazraki Adina, Tade Funmilayo, Loewen Jonathan, Dickson Paula, Milla Sarah

Keywords: Ultrasound, Breast, Pediatric

Brain death, also known as death by neurologic criteria, (BD/DNC) is the permanent loss of total brain function in individuals who have sustained catastrophic brain injuries. Accounting for approximately 5% of pediatric deaths, BD/DNC remains a clinical diagnosis, which is often emotionally laden and not always straightforward. When results are equivocal or there exist limitations to the safe completion of the clinical assessment, clinicians rely on ancillary testing to make informed decisions. In October 2023, updated adult and pediatric BD/DNC consensus guidelines were published which reinforce differences in the recommendations for testing between the adult and pediatric populations. It is, therefore, crucial for Pediatric Radiologists to understand these guidelines and the critical role radiology plays in supporting this important diagnosis. In this educational exhibit, we will review the recent consensus guidelines and clinical indications for the use of imaging in BD/DNC evaluation. We will provide a step-by-step guide which will include patient preparation, radionuclide or contrast administration, image acquisition, and image interpretation for the two validated methods of pediatric BD/DNC ancillary testing: Radionuclide Perfusion Scintigraphy and 4-Vessel Catheter Angiography. Although 4 vessel catheter angiography is considered the gold standard in ancillary BD/DNC testing, as it is believed to be both 100% sensitive and 100% specific, radionuclide scintigraphy is the more widely used modality in the pediatric population, owing to the less invasive nature of the exam. Neither exam is without challenges related to limited availability and technical skill required yet are currently the only validated radiologic tools recommended for use in brain death diagnosis. Our exhibit will review multiple cases of evaluation for BD/DNC, accentuating imaging findings and pearls/pitfalls of acquisition and interpretation. Opportunities for investigation of other available imaging techniques will also be highlighted. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Hampton Erica, Fuentealba Cargill Andrea, Trenbeath Zachary, Alazraki Adina, Stence Nicholas, Milla Sarah

Keywords: Nuclear Medicine, Interventional Radiology

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

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

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

Keywords: Fluoroscopy, Radiation Dose, ALARA

Idiopathic thickening of the pyloric muscle can occur in young infants, causing projectile vomiting, electrolyte abnormalities, and necessity for surgical intervention to relieve the gastric outlet obstruction. Case reports have been published describing infants with HPS who also have portal venous gas (PVG) visualized within the liver. The presence of PVG in other clinical scenarios often indicates a severe and potentially life threatening bowel condition. The purpose of this study was to determine the incidence of infants with hypertrophic pyloric stenosis (HPS) and concurrent portal venous gas (PVG), as well as whether there are unique clinical features or different outcomes in the HPS patients with PVG versus without PVG. Read More

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

Authors: Milla Sarah, Cantu Cera, Richer Edward, Braithwaite Kiery, Linam Leann, Riedesel Erica, Loewen Jonathan, Simoneaux Stephen

Keywords: pyloric stenosis, portal venous gas, pneumatosis