Boileau Caroline,  Treanor Lee,  Kapoor Cassandra,  Highmore Kerri,  Miller Elka

Final Pr. ID: Poster #: EDU-001 (T)

Imaging requisitions are the legal documents that health professionals use to communicate to radiologists and Medical Radiation Technologists (MRT(R)s) the relevant clinical information to guide their requested radiographic examination. Inadequate or incomplete information may have a substantial impact on patient care.

Since the implementation of our electronic medical record system, EPIC (Epic Systems Corp.), we have the ability to track the number of errors on requisitions; the most common error is having the incorrect body parts selected or multiple unnecessary exams being ordered. The MRT(R)’s identify these errors and correct the inconsistencies following departmental protocols. Without such vigilance on the MRT(R)’s part, inappropriate radiographs could have been performed and could lead to additional, unnecessary radiation exposure. To help select the most appropriate protocol, educate and guide the health professionals at our hospital, an electronic software tool, “EDI” has been created.

EDI (Examine the patient, Determine the correct radiograph, Input the order with pertinent and relevant clinical information) is an interactive tool that includes the exam protocol with the associated views per body part. Each exam also includes EDI with the field of view that will be exposed to radiation during the exam.

Our goal is that EDI will serve health professionals to better understand what order needs to be selected in the electronic system and which radiographs will be provided. Ultimately, this will reduce any unnecessary exams and reduce pediatric radiation exposure. Read More

Authors:  Boileau Caroline,  Treanor Lee,  Kapoor Cassandra,  Highmore Kerri,  Miller Elka

Keywords:  Appropriateness Criteria ,  Image Gently ,  ALARA

Rendon Kathleen,  Rigsby Cynthia

Final Pr. ID: Poster #: EDU-002 (T)

Purpose: The long-term effects from gadolinium tissue deposition in organs and the brain is unknown especially in children who may need repeated contrast studies for necessary follow-up of cardiovascular abnormalities. We aim to show the utility of a non-contrast MRA sequence in older children and young adults undergoing chest and/or abdominal MRA. Read More

Authors:  Rendon Kathleen,  Rigsby Cynthia

Keywords:  Non-contrast ,  3D imaging ,  Cardiac

Cielma Tara,  Durfee Teela,  Bulas Dorothy,  Loomis Judyta,  Adeyiga Adebunmi,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-003 (T)

Bowel ultrasound is a critical component of gastrointestinal evaluation. Serial examination allows real-time assessment of disease progression or improvement, and assists the clinician in therapeutic decision making and clinical management.

The goals of this exhibit are:
1. Describe the technical approach of performing bowel ultrasound.
2. Review tips, and up to date technology that assist in optimizing studies.
3. Discuss sonographic appearance of various pathologies.
4. Review future potential techniques and applications including utility of Doppler flow and contrast enhanced ultrasound. Read More

Authors:  Cielma Tara,  Durfee Teela,  Bulas Dorothy,  Loomis Judyta,  Adeyiga Adebunmi,  Bandarkar Anjum

Keywords:  gastrointestinal disorder ,  inflammatory bowel disease ,  bowel

Schneeman Libby,  Khwaja Asef,  Bloom Glenn,  Otero Hansel

Final Pr. ID: Poster #: EDU-004 (T)

Ultrasound has become a powerful tool for the evaluation of bowel pathology in the children. In the newborn, ultrasound (US) can be used to diagnose, stage, and follow up necrotizing enterocolitis (NEC) and its complication. US has excellent sensitivity and specificity for the identification of bowel wall thickening, peristalsis, pneumatosis, portal venous gas and free air and has become an integral evaluation tool for the newborn with abdominal distention. Our educational poster will:
1. Summarize proper US equipment, technique and protocol for diagnosing and following up NEC
2. Discuss advantages and benefits of incorporating US in the evaluation of bowel in newborns
3. Illustrate the sonographic findings of mild, moderate and severe NEC through cases Read More

Authors:  Schneeman Libby,  Khwaja Asef,  Bloom Glenn,  Otero Hansel

Keywords:  Necrotizing Enterocolitis ,  Newborn ,  Ultrasound

Bushur Katherine

Final Pr. ID: Poster #: EDU-005 (T)

In 2016, we focused on MRI safety and the inherent cultural barriers to reduce the risk of undetected or misplaced metal objects causing MRI accidents. We successfully addressed this opportunity using a coordinated approach with Patient Safety, Performance Improvement and Radiology Leadership to provide a multi-faceted solution.
Despite implementation of ferromagnetic detection systems (FMDS) technology, numerous gaps in screening effectiveness were identified. Three primary improvement objectives were established involving place, people and process leading to 42 new practice changes that were implemented, and 68 existing process improvements instituted. Alarm fatigue was one among many identified risks. Variables included the physical location of the projectile on the transport person, as well as the horizontal or vertical orientation of potential hazard while being carried were identified during a series of nine standardized PDSA testing sessions that were completed in the clinical setting. Read More

Authors:  Bushur Katherine

Keywords:  MRI Safety ,  Ferromagnetic detection ,  projectile hazards

Garza Michelle

Final Pr. ID: Poster #: EDU-006 (T)

Understand how collaboration and innovation merged to reduce non valued leader time to improve effectiveness.
Recognize the importance of how leveraging existing resources and infrastructure come together to reduce costs
Through collaboration and innovation B.O.S.S. will reduce non value added time, improve effectiveness and reduce costs while creating more successful leaders. Read More

Authors:  Garza Michelle

Keywords:  Leadership ,  BOSS ,  toolbox

Goehner Melissa,  Anderson Mary,  Pinson Monica,  Simoneaux Stephen

Final Pr. ID: Poster #: EDU-007 (T)

To describe and discuss some of the challenges of performing DEXA scans on pediatric patients including positioning, technical obstacles, reference data and post-processing and describing how to overcome some of these challenges.
1. Positioning: Many patients with syndromes, have scoliosis, para or quadriplegia, or contractures that make placing the patient on the table difficult. In these patients, imaging has to be adapted to the patients’ abilities and some components may need to be eliminated. With cerebral palsy and muscular dystrophy for example, the whole body and AP spine might have to be deferred and only a hip and forearm obtained.
2. Technical obstacles: There are many technical obstacles that can present challenges when performing DEXA scans on pediatric patients. Patients who have prostheses or metal rods present technical obstacles. There is no way to remove the metal artifacts in a whole body scan on these patients, so a hip or forearm might be the most accurate way to obtain the patient’s bone density due to this technical factor.
3. Reference Data: The reference data for pediatrics is limited in national data bases. For example, a total Z-score will not be factored for children under the age of 5 because there is not enough information in the national database for comparison. There is also not enough information on children of certain ethnicities. This presents a problem when diagnosing and treating children with abnormal bone density.
4. Post-processing could be different for each user. It can also be different for machines manufactured by different companies. For example, a machine made by Hologic might produce different numbers than a machine made by General Electric. Also, if the user does not place the post-processing tools the exact same way the prior user did, the results can vary.
Overcoming some of these challenges has presented opportunities to grow. Sedation is used for children who may not be able to be perfectly still for a Dexa and positioning tools help on some of the more challenging patients. Learning how to work around prostheses and working with the ordering physicians and radiologists with the limited amount of reference data are a few ways of growing from these challenges. Placement of post-processing tools are the key to providing key information in comparing Dexa scans for patients who have them regularly for evaluations. Staff Education is the largest challenge to overcome. Read More

Authors:  Goehner Melissa,  Anderson Mary,  Pinson Monica,  Simoneaux Stephen

Keywords:  Dexa ,  pediatric

Nevo Elad,  States Lisa,  Magee Ralph

Final Pr. ID: Poster #: EDU-008 (T)

PET/MRI is a relatively new imaging modality whose efficacy is still being determined. One of the major draws to PET/MR over PET/CT is the reduction in radiation exposure to patients. This is especially desirable in the pediatric population due to the likelihood of multiple exposures during their lifetime, and the increased sensitivity they have to radiation. A typical whole body PET/CT exam can take about 30 minutes, whereas a typical whole body PET/MR exam takes about 90 minutes at our institution. The introduction of a new 3D T2 Dixon technique sequence for PET/MR has the potential of decreasing total scan time significantly, however maintaining current image quality and diagnostic value is critical. Our objective is to test out this new sequence to see whether scan times are reduced and if it is a viable diagnostic replacement for our current T2 sequence. Read More

Authors:  Nevo Elad,  States Lisa,  Magee Ralph

Keywords:  PET/MR ,  Optimization

Baida Amal,  Simoneaux Stephen

Final Pr. ID: Poster #: EDU-009 (T)

The purpose of this study is to outline the benefit of speed stitching and recognize it as one of the best stitching tools available for the pediatric population. Looking at the history of stitching, we started by using the CR for scoliosis and long bones stitching. The time of exposure, the radiation dose, and image quality were not optimal. Moving to automatic DR stitching was a good step in the right direction. However, there was still a frustration from having to repeat so many exams because of the high possibility of motion captured between exporsures. That’s when speed stich came to play with fast acquisation and less operator interference while doing the exam. Read More

Authors:  Baida Amal,  Simoneaux Stephen

Keywords:  Scoliosis

Stanley Parker,  Stanley Charles

Final Pr. ID: Poster #: EDU-010 (T)

In 2017, roughly 2 trillion (2,000,000,000,000) medical images were produced, reviewed, reported, archived, and used in the detection and management of disease. Based on historical trends, this number has doubled every 5 years and is accelerating. This explosive growth in imaging data has created major opportunities for the use of Artificial Intelligence (AI). The question is less whether radiologists, and technologists, will be replaced by AI (they will not) and more about whether we could survive without AI. Although intelligent algorithms have been used for some time in segments of the imaging field, new methods of machine learning, based particularly on “deep learning”, are much more powerful. Many of the deep learning publications today point to the promise of significant advances in efficiency, precision, reproducibility, and prognostic abilities.
If AI will not replace radiologists/technologists but rather augment them with tools to meet the rising demands for diagnostic imaging, then it is imperative that we have a basic understanding of the concepts and language that defines this area of knowledge. In the not so distant past the average technologist understood the basics of film processing but wouldn’t even recognize the words DICOM or EMR; we are now at that point of change with AI. Deep learning, machine learning, neural networks, ground truth, the list goes on. The goal of this presentation is to provide a basic framework of the concepts, terminology, and references to how AI has, and likely, will be employed in medical imaging, thus making us better practitioners and partners with this technology.
Read More

Authors:  Stanley Parker,  Stanley Charles

Keywords:  Artificial Intelligence ,  Medical Imaging ,  Technologist

Patel Falguni

Final Pr. ID: Poster #: EDU-011 (T)

My purpose is to teach my audience about a congenital condition called Pediatric Trigger Thumb. My educational poster will include anatomy, causes, and symptoms associated with Trigger thumb and a pediatric ultrasound case that relate with a finding of Trigger thumb. Read More

Authors:  Patel Falguni

Keywords:  Trigger Thumb ,  Trigger Finger ,  Tenosynovitis

Ulikowska Ewelina

Final Pr. ID: Poster #: EDU-012 (T)

Langerhans Cell Histiocytosis (LCH), is a disorder that primarily affects children, but can affect individuals of all ages. Langerhans cells are cells that are responsible for regulating immune system in our bodies. They are mostly found in the skin, spleen, lymph nodes, liver and bone marrow. In patients who have LCH, these cells grow and multiply excessively. The abnormal growth of the Langerhans cells causes a formation of tumors called granulomas. LCH can affect different areas of the body: skin, nails, lymph nodes, gastrointestinal tract, central nervous system, pituitary and thyroid gland, liver, lungs and bones. The severity and symptoms of the disease vary in individual patients and are dependent on the organs and systems affected. Oftentimes, LCH can be found in multiple areas of the body and when that happens, the disease becomes a multisystem disease. The most common system affected by LCH, seen in about 80 % of individuals affected, is the skeletal system. Granulomas, which develop most commonly in the flat bones such as skull and long bones of arms and legs, cause sclerotic and lytic lesions that can in turn become the cause of pathologic fractures. Therefore it is crucial, to recognize the radiographic signs of skeletal manifestations of LCH. Radiography is the preliminary imaging of choice and skeletal surveys are oftentimes the best assessment of the status of LCH prior and post treatment. The purpose of this abstract is to describe radiographic appearances associated with Langerhans Cell Histiocytosis. In order to confirm the importance of follow up skeletal surveys, I will present cases and associated radiographs that show signs of LCH prior to treatment and post treatment. Read More

Authors:  Ulikowska Ewelina

Keywords:  Langerhans Cell Histiocytosis ,  Radiographic findings ,  Skeletal manifestations

Stanley Parker,  Rubesova Erika

Final Pr. ID: Poster #: EDU-013 (T)

Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic entity in children and the second most common cause of musculoskeletal symptoms in pediatric patients. Treatment of JIA largely depends on frequently managing inflammation within the joints, and as such, ultrasound is a prime imaging modality that can be used for detection and monitoring of inflammation. Ultrasound is more sensitive than plain films in the early detection of JIA, and ultrasound is more sensitive than clinical examinations alone. As a low-cost, high-resolution imaging modality, ultrasound allows visualization of the joint spaces, can be used to detect joint effusions, and can monitor synovial proliferation and joint hyperemia, all while not exposing the patient to radiation. We will present ultrasound images of various joints in children such as knees, ankles, wrists, hands and feet. Ultrasound technique, imaging planes, choice of probes frequencies and ultrasound settings are analyzed for optimization of the images. This presentation will highlight the diagnostic imaging findings of JIA on ultrasound, such the presence of joint effusions, synovial proliferation, capsular thickening, tendinitis as well as provide information on common pitfalls associated with age-specific appearances of pediatric musculoskeletal structures on ultrasound. Familiarity with JIA and musculoskeletal ultrasound findings will allow timely diagnosis and implementation of appropriate treatment strategies. Read More

Authors:  Stanley Parker,  Rubesova Erika

Keywords:  Juvenile Arthritis ,  Ultrasound ,  Musculoskeletal

Lombardi Allison

Final Pr. ID: Poster #: EDU-014 (T)

The MAGEC System is a surgical treatment for children with severe spinal deformities. The system utilizes surgically implanted rods, which are periodically extended by an External Remote Control (ERC). The traditional method to measure lengthening progression involved radiation exposure. Ultrasound provides an immediate evaluation with no bio-effects. Additionally, soft tissue changes incurred by rod implantation can be seen, which is difficult to assess with a radiograph. The sonographer acquires both pre- and post-lengthening measurements before and after the ERC is applied to the child’s skin at the level of the rods. The entire process can be completed in minutes within a single outpatient room, for the ease of both patient and parent. Read More

Authors:  Lombardi Allison

Keywords:  Ultrasound ,  MAGEC Rod

Hutchinson Marcy,  Kozak Brandi,  Ho-fung Victor,  Chauvin Nancy

Final Pr. ID: Poster #: EDU-015 (T)

Background:
Sonographic techniques are simple and safe. The utility and clinical value of dynamic sonographic evaluation of the glenohumeral joint in infants with brachial plexus injury (BPBI) has been described since the late 1990's. However, this technique remains an underutilized tool in most imaging practices. Brachial plexus injury during the birthing process can lead to glenoid dysplasia, posterior shoulder subluxation and significant morbidity if left untreated. Imaging evaluation of the degree of deformity is paramount to guide clinical treatment and the follow-up of complicated cases. Imaging techniques include MRI, CT and US. Shoulder ultrasound provides a dynamic, noninvasive method of evaluation. It has also been our experience that this imaging technique can be mastered by the Sonographer and supported with accurate interpretation by the Radiologist.

Purpose:
Describe the imaging features of glenohumeral joint dysplasia due to BPBI with emphasis on ultrasound technique.
Review step-by-step dynamic sonographic evaluation of the glenohumeral joint in BPBI with emphasis on correct positioning of the patient to ensure consistency and reproducible quality imaging.
Improve both confidence and independent evaluation of patients through this presentation by the sonographer. Read More

Authors:  Hutchinson Marcy,  Kozak Brandi,  Ho-fung Victor,  Chauvin Nancy

Keywords:  glenohumeral ,  brachial plexus birth injury (BPBI)

Ksiazek Kathleen

Final Pr. ID: Poster #: EDU-016 (T)

Medical imaging of the soft tissue of the neck or airway is one of the most common, and sometimes challenging, exams performed at a pediatric hospital. Imaging of the airway can help identify enlarged adenoids, the presence of a foreign body, an abscess, pathology or anatomical abnormality. It is crucial to understand the proper technique, breathing instructions and positioning in order to obtain optimal imaging for correct diagnosis. Different radiographic findings will be presented with examples of incorrect positioning, grid usage, exposure factors, artifacts and ways to improve the image quality. This poster will also provide technologists with tips and recommendations to help them to feel prepared and confident to work with all pediatric patients. Read More

Authors:  Ksiazek Kathleen

Keywords:  Airway ,  Soft tissue of neck

Turner Sara

Final Pr. ID: Poster #: EDU-017 (T)

The goal of this presentation is to provide a review of the important role Dual Energy X-ray Absorptiometry (DXA) plays in treating pediatric patients with low bone density. It also aims to educate on the different DXA machines used today, give a review of the official positions for pediatric DXA scans determined by the International Society for Clinical Densitometry (ISCD), give a brief history of the lateral distal femur (LDF) scan and why it was developed, and touch on the other modalities that can be used to asses bone density..

Osteoporosis is commonly thought of as an adult bone health issue; however recently it has gained more attention as being an issue for pediatric patients. Different factors affect bone health, such as genetics and family history, diet and exercise, certain medications, and whether a patient is ambulatory or non-ambulatory. It is important to conduct the proper testing to determine a patient’s fracture risk and trying to prevent further bone deterioration. A DXA Scan is the gold standard across all age groups in providing vital bone health information as it provides a look into the body with minimal radiation exposure to evaluate the bones to determine how much at risk a patient may be. Read More

Authors:  Turner Sara

Keywords:  DXA ,  Bone Density ,  Bone Health

Kozak Brandi

Final Pr. ID: Poster #: EDU-018 (T)

Transcranial Doppler examinations are crucial in the care and treatment of patients in the Sickle cell population. The earlier we are able to obtain diagnostic studies on these patients the more effective treatment is and can reduce the risk of the patient suffering from a life altering stroke. Read More

Authors:  Kozak Brandi

Keywords:  Transcranial Doppler ,  TCD ,  Sickle Cell

Maclean Joseph

Final Pr. ID: Poster #: EDU-019 (T)

To communicate important information to technologists about the challenges associated with performing Y-90 transarterial radio embolization (TARE) therapy on pediatric patients. This “how to” poster will include discussion of: coordination of services, pre-treatment Tc-99m MAA mapping, preparing the dose calibrator for accurate measurement of Y-90 activity, ideal hot lab set-up for dose preparation, and imaging options for post Y-90 therapy scanning.
Read More

Authors:  Maclean Joseph

Keywords:  Yttrium ,  TARE ,  SIRT