Pediatric radiology
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Pediatric radiology · Sep 2011
ReviewAdvances in CT technology and application to pediatric imaging.
The use of imaging in both hospital and non-hospital settings has expanded to more than 70 million CT procedures in the United States per year, with nearly 10% of procedures performed on children. The availability of multiple-row detector CT (MDCT) systems has played a large part in the wider usage of CT. This rapid increase in CT utilization combined with an increasing concern with regard to radiation exposure and associated risk demands the need for optimization of MDCT protocols. This manuscript will briefly discuss how technology has changed in regard to MDCT protocols, helping to reduce radiation dose in CT, especially in pediatric imaging.
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Greater than 10% of diagnostic imaging studies performed in developed countries are CT examinations. In the United States, as many as 60 million CT studies are performed each year, up to 7 million of which are performed in pediatric patients. ⋯ This can be achieved by utilizing imaging studies that do not require the use of ionizing radiation, thus decreasing the number of CT studies performed. If a CT study is indicated, the delivered dose should be optimized to use the lowest possible dose level while still answering the clinical question.
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Pediatric radiology · Sep 2011
ReviewThe appropriate use of CT: quality improvement and clinical decision-making in pediatric emergency medicine.
An increasing number of patients presenting to a shrinking number of hospital emergency departments has contributed to challenges to providing high-quality care, specifically care that is safe, efficient and effective. These challenges are magnified by trends in CT utilization with uncertain implications for care delivery. ⋯ Strategies for minimizing CT utilization in managing appendicitis, traumatic brain injury and cervical spine injuries are described. Clinical scores, clinical decision rules and evidence-based guidelines can assist the clinician in providing high-quality care through effective utilization of CT.
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Sedation and anesthesia for pediatric imaging departments has changed dramatically for the following reasons: (1) radiologists have stopped sedating patients; (2) the majority of sedations are not for CT (because of the speed of the procedure) but for MR, which lasts 45 min or greater; (3) a cadre of services--pediatricians, emergency medicine physicians, hospitalists and intensivists, as well as anesthesiologists--can provide the services. These changes have significantly influenced the type of agents utilized for sedation and anesthesia and, most important, have created operational issues for MR departments. Nevertheless, it is important for each imaging department to create a uniform approach to sedation, taking into account patient expectations, efficiency of through-put, facilities and personnel available, and institutional costs.
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Pediatric radiology · Sep 2011
ReviewSedation and anesthesia for CT: emerging issues for providing high-quality care.
During the past decades, the use of CT to diagnose conditions and monitor treatment in the pediatric setting has increased. Infants and children often require procedural sedation to maintain a motionless state to ensure high-quality imaging. ⋯ While the incidence of adverse events remains low, procedural sedation carries the risk of serious morbidity and mortality. The use of evidence-based, structured approaches to procedural sedation should be used to reduce variation in clinical practice and improve outcomes.