The Choosing Wisely initiative, led by the American Board of Internal Medicine (ABIM) Foundation in collaboration with over 80 medical societies and organizations, was launched in 2012 in the United States and Canada. Choosing Wisely is a response to the estimation that roughly 20% of current medical tests and therapies lack justification, provide no value, and may pose risks. The American Academy of Pediatrics (AAP) became a participant in Choosing Wisely from the start, resulting in 16 pediatric specialty-specific lists designed to assist AAP members in responsible healthcare resource management. While pediatric radiology did not develop its own list, imaging recommendations were included on fully half of the published AAP/Choosing Wisely lists. Read More

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

Authors: Ramirez Suarez Karen, Miranda Schaeubinger Monica, Barton Katherine, Riedesel Erica, Otero Hansel

Keywords: Pediatric, Imaging, Radiology

Demonstrate the breadth and value of integrating a human factors engineer into a pediatric radiology department. Read More

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

Authors: Larsen Ethan, Miranda Schaeubinger Monica, Won James, Sze Raymond, Anupindi Sudha

Keywords: Quality, Safety, Human Factors

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

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 However, its use has been replaced by other imaging modalities for some applications.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

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

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

Keywords: Radiology, Fluoroscopy

Advocacy is the act of supporting or defending a specific cause or issue, with the aim of raising public awareness, garnering support, or influencing policy. Traditionally, it has not been included in the pediatric radiology training curriculum or regarded as a conventional academic pursuit. However, we believe it to be a vital aspect of a pediatric radiologist, regardless of their rank or clinical setting. Research efforts can provide support and validate for advocacy processes by generating evidence and measuring their impact and outcomes. We consider that encouraging these efforts is essential for “demystifying’ and better integrating it into academic life. Read More

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

Authors: Yaya Carlos, Miranda Schaeubinger Monica, Morales-tisnés Tatiana, Otero Hansel, Annam Aparna, Acharya Patricia, Joshi Aparna

Keywords: Pediatric radiology, Advocacy, Public Health

To describe imaging requisition patterns for prospective pediatric research studies at a large academic children’s hospital as insight into the role of radiology services in the current research environment. Read More

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

Authors: De Leon-benedetti Laura, Andronikou Savvas, Serai Suraj, Hailu Tigist, Miranda Schaeubinger Monica, Jalloul Mohammad, Otero Hansel

Keywords: Ethics Committees, Research, Radiology, Medical Imaging

Tuberculous meningitis (TBM) causes significant morbidity and mortality in young children. Early treatment can be initiated with MR imaging diagnosis. We present MR detectable miliary meningeal TB in two patients presenting in a developed world setting. Case 1: A 9 y/o girl of Haitian descent, developed fevers, cough, lethargy and seizures. Brain MRI demonstrated multiple, small, T2-dark, rim-enhancing lesions, associated with cranial nerve and leptomeningeal enhancement. Chest CT showed mediastinal lymphadenopathy, multiple small interstitial lung nodules and a splenic hypo enhancing lesion. CSF showed pleocytosis, low glucose, and high protein. She was started on 4-drug treatment for TBM and dexamethasone. Serial bronchoalveolar lavage was Xpert MTB/RIF and acid-fast negative. Contact tracing revealed a remote positive contact with pulmonary tuberculosis from Haiti. Endobronchial US-guided biopsy of a subcarinal lymph node was positive for Xpert MTB PCR. Case 2: A 17 y/o female with Crohn’s disease on adalimumab developed refractory ear infections despite multiple courses of antibiotics and underwent myringotomy, with negative aerobic ear fluid culture. She had two chronic skin lesions. Brain MRI, obtained due to persistent otorrhea, showed multiple, small, round, T2-dark lesions. CSF studies were unremarkable. CT chest, abdomen and pelvis showed left upper lobe tree-in-bud nodules, hypoattenuating splenic lesions and a left obturator internus abscess with adjacent osteomyelitis. She underwent CT guided aspiration of the obturator muscle collection, bronchoscopy with Bronchoalveolar Lavage (BAL), biopsy of her skin lesions and ear fluid aspiration. QuantiFERON Gold was positive. Ear fluid was Xpert MTB/RIF assay and acid-fast stain positive. She was started on 4-drug therapy and prednisone. Cultures from the ear fluid, skin tissue, muscle tissue and BAL showed growth of acid-fast bacilli. TB meningitis is most often due to blood borne spread of the disease from the lungs which may result in miliary nodules in the leptomeninges and brain. The two cases presented illustrate that although TBM is unusual in a developed world, we should suspect it in children of migrants as well as in patients with immunosuppression, where atypical imaging patterns including lack of typical basal enhancement and presence of miliary meningeal nodules may be seen. Read More

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

Authors: Venkatakrishna Shyam Sunder, Vasileiadi Eleana, Siu Navarro Youck Jen, Villavicencio Karen L Hanze, Miranda Schaeubinger Monica, Schoeman Sean, Otero Hansel, Andronikou Savvas

Keywords: Miliary Meningeal Tuberculosis

International clinical observerships in pediatric radiology offer benefits such as academic collaboration and brand recognition. However, they also introduce additional administrative burden, scheduling difficulties, increased faculty workload for the host institution, and regulatory and financial challenges for observers. In January 2021, the observer program at a US-based teaching hospital's radiology department was relaunched following a COVID-19 pandemic hiatus, providing a limited number of scholarships to medical students, residents, fellows, and other colleagues worldwide for 1-6 weeks. During their stay, observers rotated through different divisions, accessed our learning management system (LMS), and were encouraged to attend conferences and to give a lecture or case-based presentation to the department. We aim to evaluate the effectiveness of the program and the impact on the observer’s career. Read More

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

Authors: Derbew Hermon Miliard, Yaya Carlos, Noor Abass, Miranda Schaeubinger Monica, Dennis Rebecca, Jalloul Mohammad, Mekete Yadel, Wang Xinmeng, Otero Hansel

Keywords: International Observership, Pediatric Radiology, Education