Pediatric radiology
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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.
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Pediatric radiology · Aug 2011
External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center.
Head CT scans are considered the imaging modality of choice to screen patients with head trauma for neurocranial injuries; however, widespread CT imaging is not recommended and much research has been conducted to establish objective clinical predictors of intracranial injury (ICI) in order to optimize the use of neuroimaging in children with minor head trauma. ⋯ The number of cranial CT scans conducted in our pediatric cohort with head trauma would have been reduced had any of the three clinical decision aids been applied. Therefore, we recommend that further validation and adoption of pediatric head CT decision aids in non-trauma centers be considered to ultimately increase patient safety while reducing medical expense.
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Pediatric radiology · Jun 2011
Comparative StudyValue of postmortem thoracic CT over radiography in imaging of pediatric rib fractures.
Studies have reported that thoracic CT may provide greater sensitivity compared with radiography in detection of pediatric rib fractures and fracture healing. The additional sensitivity afforded by thoracic CT may have medicolegal implications where abuse is suspected. ⋯ Postmortem thoracic CT provides greater sensitivity than radiography in detecting pediatric rib fractures, most notably in anterior and posterior fractures. However, the degree of improvement in sensitivity provided by CT might depend on observer experience.
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Interventional radiology techniques to treat oncological disease have already shown value in adults. The adoption and development of interventional oncology (IO) in children have been more limited and challenging. ⋯ This paper will discuss how new procedures are developed and approved, and the new therapies that will become available to better treat pediatric malignancies. Bringing the benefits of IO to children will require initiative on the part of pediatric diagnostic and interventional radiologists as well as the cooperation of our clinical colleagues.