Congenital anomalies of bone are many and can be difficult to approach. In addition, it is important to recognize that while some of these anomalies occur sporadically or in isolation, others are inherited or associated with systemic conditions/syndromes that require further assessment, diagnostic testing, and proper referral. In this two-part exhibit, congenital bone anomalies of the upper and lower extremities will be reviewed. The first part of the exhibit will cover upper extremity anomalies while the second part will focus on the lower extremity. The purpose is multifold: 1. To illustrate the wide spectrum of congenital bone anomalies based on classic clinical presentation and demographics. 2. Highlight key imaging characteristics across multiple modalities to allow for accurate differentiation between the various congenital bone anomalies of the extremities. 3. Guide the viewer to proper workup and referral for these entities. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Al-saraf Ali, Ong Seng

Keywords: Radial Deficiency, Ulnar Deficiency, Kirner Deformity, Delta Phalanx, Radioulnar Synostosis

In the second part of this exhibit, congenital bone anomalies of the lower extremity will be identified and reviewed. Through this exhibit, the reader will be able to: 1. Define the most common entities encompassing congenital lower extremity bone anomalies based on classic clinical presentation and demographics. 2. Highlight key multi-modality imaging characteristics to accurately differentiate between the various congenital bone anomalies of the lower extremity. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Al-saraf Ali, Ong Seng

Keywords: Tibial Hemimelia, Proximal Focal Femoral Deficiency, Amniotic Band Syndrome, Fibular Hemimelia, Tarsal Coalition

Neuroblastoma is recognized as having a broad spectrum of clinical behavior in children diagnosed with the disease. Some tumors exhibit aggressive characteristics and portend a poor prognosis, while others that appear aggressive spontaneously regress. Accurately identifying high risk neuroblastoma is important in determining which patients will benefit most from intense chemotherapy, which unfortunately carries a risk of significant adverse effects later in life. Historically this has been difficult, as the classification schemes vary in different parts of the world, limiting the ability to pool data and improve prognostication. In recent years, efforts among experts around the globe have led to a consensus on the most evidenced based approach to staging. The aim of this educational exhibit is to describe the new standardized language for radiology reports, which will contribute to accurate staging and improve treatment for patients with neuroblastoma. Additionally, key imaging features highlighting image defined risk factors will be presented. Read More

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

Authors: Lionberg Alex, Ong Seng

Keywords: Neuroblastoma, Oncology, Tumor Staging

We intended to develop and test a PACS based radiology simulation program as an objective tool to evaluate residents. We utilized the simulator as the pediatric “end of rotation” (EOR) exam and compared it to our institution’s traditional EOR review. We hypothesized that a simulator evaluation tool would better identify areas for residents to improve, create a clear gradient of resident performance, or identify a struggling resident. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: O'brien Kevin, Ong Seng

Keywords: Simulation, Pediatrics, Resident, Education

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

<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

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