Abstract
A major goal of imaging is to obtain the correct examination to answer the clinical questions with the lowest possible radiation exposure. While CT examination provides essential information in many cases, other modalities that do not entail ionizing radiation exposure may be appropriate substitutes either as an initial screening study or as an alternative to CT. US has become a valuable imaging tool in children encompassing many different clinical scenarios. This manuscript highlights some of the less well-accepted applications of US as the first imaging study in pediatric patients, especially in the emergency room environment. These include evaluation of suspected appendicitis, abdominal mass, pleural effusion/empyema, thymic abnormality vs. mediastinal mass and extremity soft-tissue mass or vessel patency. Adoption of US imaging as a problem-solving tool for issues such as these requires appropriate allocation of resources to ensure high-quality performance and interpretation of pediatric US studies around the clock.
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References
Amis ES Jr, Butler PF, Applegate KE et al (2007) American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272–284
Brenner DJ, Hall EJ (2007) Computed tomography–an increasing source of radiation exposure. N Engl J Med 357:2277–2284
Brenner DJ, Hricak H (2010) Radiation exposure from medical imaging: time to regulate? JAMA 304:208–209
FDA (2010) Initiative to reduce unnecessary radiation exposure from medical imaging. In: Administration FaD (ed), pp 1–12
Bogdanich W, Akam S (2009) Radiation overdoses point up dangers of CT scans. New York Times. The New York Times Company, New York, p A13
Goske MJ, Applegate KE, Boylan J et al (2008) The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 38:265–269
Nievelstein RA, van Dam IM, van der Molen AJ (2010) Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol 40:1324–1344
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94
Vissers RJ, Lennarz WB (2010) Pitfalls in appendicitis. Emerg Med Clin North Am 28:103–118, viii
Garcia Pena BM, Mandl KD, Kraus SJ et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046
Krishnamoorthi R, Ramarajan N, Wang NE et al (2011) Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology 259:231–239
Pedrosa I, Levine D, Eyvazzadeh AD et al (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238:891–899
Donnelly LF (2001) Neuroblastoma. Fundamentals of Pediatric Radiology. W. B. Saunders Company, Philadelphia, pp 163–165
Daneman A, Baunin C, Lobo E et al (1997) Disappearing suprarenal masses in fetuses and infants. Pediatr Radiol 27:675–681
Petrus LV, Hall TR, Boechat MI et al (1992) The pediatric patient with suspected adrenal neoplasm: which radiological test to use? Med Pediatr Oncol 20:53–57
Hryhorczuk AL, Strouse PJ (2009) Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol 39:1075–1079
Pfluger T, Czekalla R, Hundt C et al (1999) MR angiography versus color Doppler sonography in the evaluation of renal vessels and the inferior vena cava in abdominal masses of pediatric patients. AJR 173:103–108
Quillin SP, Siegel MJ (1993) Color Doppler US of children with acute lower abdominal pain. Radiographics 13:1281–1293, discussion 1294
Ben-Ami TE, O’Donovan JC, Yousefzadeh DK (1993) Sonography of the chest in children. Radiol Clin North Am 31:517–531
Kim OH, Kim WS, Kim MJ et al (2000) US in the diagnosis of pediatric chest diseases. Radiographics 20:653–671
Kurian J, Levin TL, Han BK et al (2009) Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR 193:1648–1654
Riccabona M (2008) Ultrasound of the chest in children (mediastinum excluded). Eur Radiol 18:390–399
Gupta H, Araki Y, Davidoff AM et al (2007) Evaluation of pediatric oncology patients with previous multiple central catheters for vascular access: is Doppler ultrasound needed? Pediatr Blood Cancer 48:527–531
Disclaimer
The supplement this article is part of is not sponsored by the industry. Dr. Newman has no financial interests, investigational or off-label uses to disclose.