Recently JACHO proposed to address double scanning in pediatric chest CT, yet there are no data to determine whether this takes place; similarly, there is discussion regarding validity of sending pediatric patients to adult-focused practices for routine imaging by third party payors. Our purpose is to review the technical factors that impact upon radiation dose and image quality in CT scans of children referred from adult-focused practices to a children’s hospital, referenced to pre-Image Gently values. To our knowledge this is the first such review that includes body and neuro scans and extensive technique and exposure data Read More

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

Authors: Parikh Ashishkumar, Pruthi Sumit, Hernanz-schulman Marta

Keywords: ALARA, Image Gently, Radiation

First described by Rathbun in 1948, hypophosphatasia is an inherited metabolic disorder arising from the deficient activity of the tissue-nonspecific isoenzyme of alkaline phosphatase. There are several different types and varying clinical presentations of hypophosphatasia, characterized according to their age of onset by Fraser in 1957. In addition, the severity of the radiographic findings is inversely correlated with the age of presentation, with older patients presenting with less severe forms of the disease. Classically, the radiographic findings resemble rickets/osteomalacia, but in the presence of normal Vitamin D metabolism. Additional findings associated with hypophosphatasia are Bowdler spurs, which are transverse bony spurs in the radius, fibula and ulna and central lucencies or “punched out” lesions in the metaphysis, particularly of the knee (Case 1). In this case series of 3 patients, these characteristic radiographic features as depicted on skeletal surveys, along with their clinical manifestations, diagnostic criteria, management, treatment, and prognosis will be discussed. In particular, the evolution of radiographic changes with treatment in one patient will be assessed (Case 2). Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Parikh Ashishkumar, Luo Yu, Spottswood Stephanie

Keywords: hypophosphatasia, skeletal dysplasia, phosphate, hypophosphatemia, Bowdler

Head CT is often performed in the emergency setting to evaluate for new neurologic symptoms. CT is limited in evaluation of acute stroke, brainstem and posterior fossa lesions, demyelinating disease, and diffuse axonal injury. Unremarkable head CT may be falsely reassuring and can delay treatment. Limited sequence MR (LSMR) is a new approach for evaluating a patient with neurologic symptoms. In order for LSMR to be feasible, it must be accurate, efficient, and cost-effective. Read More

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

Authors: Albers Brittany, Yang Yiting, Parikh Ashishkumar, Shah Chetan

Keywords: Emergency, CT, MR

Foreign body (FB) aspiration is a common medical emergency in children, which can be fatal. Prompt diagnosis is crucial to avoid complication. Bronchoscopy represents the gold standard for diagnosis; however, false negatives can lead to unnecessary invasive testing and exposes children to procedural risks. While lateral decubitus radiographs can assess for air trapping, this exam has low sensitivity for detecting airway foreign bodies. Thus, there is a need for a sensitive and specific diagnostic imaging test in the detection of airway FB. We developed and implemented a FB chest CT protocol that is characterized by low-dose relative to a standard chest CT and no intravenous contrast. We hypothesize that low-dose chest CT is a sensitive and specific modality for detection of airway FB in the pediatric population that may ultimately decrease the negative bronchoscopy rate. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Dennison Chelsea B, Onnis Carlotta, Ali Sumera, Huang Hui, Jergel Andrew, Alazraki Adina, Parikh Ashishkumar

Keywords: Chest Computed Tomography (CT), Foreign Body Ingestion, Low Dose Protocol