Diagnostic errors of right lower quadrant pain in children: beyond appendicitis.

Right lower quadrant pain in children can result from various underlying conditions other than acute appendicitis. The common mimics of acute appendicitis are related to acute gastrointestinal and genitourinary diseases. Diagnosis of right lower quadrant pain in the pediatric population can be challenging, especially when the symptoms are often nonspecific. This article reviews the currently available imaging techniques for evaluating a child with right lower quadrant pain and the spectrum of differential diagnoses with a focus on imaging clues to a specific diagnosis.

Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia.

BACKGROUND: Neonates with congenital diaphragmatic hernia (CDH) often require placement of lines and tubes for supportive therapy. The resulting altered anatomy can result in diagnostic errors when interpreting the location of support lines and tubes such as UVCs (umbilical venous catheters). OBJECTIVE: The purpose of this study was to evaluate the effect of CDH on UVC position and to evaluate the accuracy at which radiologists describe the position on chest radiographs. MATERIALS AND METHODS: During a 5-year period, 406 chest radiographs performed within 7 days of birth in infants with congenital diaphragmatic hernia were identified and reviewed for the following data: presence of UVC, location of catheter tip (cavoatrial junction, intracardiac, intrahepatic or umbilical vein), and location of CDH (right or left). The radiologic report of the UVC tip location for each case was then reviewed individually to determine the adequacy of interpretation. Inadequate reports were classified as incorrect (the wrong location of the catheter tip was reported), no mention (the location of the catheter tip was in a suboptimal location but not mentioned), and not specified (the precise location of the catheter tip was not clearly stated in the report when the tip was in a suboptimal location). RESULTS: A total of 60 infants were identified as having CDH (56 on the left, 4 on the right). The most common location for an incorrectly placed UVC was the contralateral chest, accounting for 26.7% (16/60) of the infants, followed by an abdominal intrahepatic location (16.7%) and the umbilical vein (8.3%). Thirty percent (120/406) of the chest radiograph reports were found to be inadequate regarding the interpretation of the location of the catheter tip. The majority of the inadequate reports (48/406, 11.8%) did not specify when the catheter tip was in a suboptimal location. In 37 reports (9.1%), the location of the catheter tip was reported incorrectly, and no mention of the catheter location was made in 35 reports (8.6%). CONCLUSION: The location of an UVC in an infant with Bochdalek hernia can pose a diagnostic challenge because of the altered anatomy and change in the expected course of the catheter. Familiarity with the altered anatomy and vigilance of the various abnormal locations in which UVCs can be placed can help optimize management for the child and reduce morbidity and mortality.

An electronic tool for systematic reporting of fractures on skeletal surveys in suspected child abuse: prototype development and physician feedback.

OBJECTIVE: To describe a skeletal survey data entry and compilation tool and assess physician attitudes toward this reporting approach. BACKGROUND: Narrative skeletal survey reports are highly variable and prone to inconsistencies with potential adverse impact on patients. MATERIALS AND METHODS: The prototype skeletal survey data entry and compilation tool was developed and introduced into clinical practice at a large urban children's hospital. Pediatric radiologists and child protection team (CPT) pediatricians completed a survey of reporting preferences. Skeletal survey reports between March 1, 2013, and March 1, 2014, were reviewed to assess use of the tool. RESULTS: The survey response rate was 70% (14/20) for radiologists and 100% (4/4) for CPT pediatricians. Among responding radiologists, 54.5% (6/11) indicated that a skeletal survey data entry and compilation tool was helpful for skeletal surveys with >3 fractures; 80% (8/10) of responding radiologists indicated that tabulated data from prior skeletal survey was helpful when interpreting a follow-up skeletal survey with >3 fractures; 90.9% (10/11) of radiologists thought the tool improved report organization; 72.7% (8/11) thought it improved accuracy. Most radiologists (11/12, 91.7%) and 100% (4/4) of CPT clinicians preferred reports with both free text and a tabulated fracture list for testifying in court when >3 fractures were present. The tool was used in the reporting of 14/23 (61%) skeletal surveys with >3 fractures during a 1-year period. A case example using the application is presented. CONCLUSION: Most radiologists and CPT physicians at our center prefer skeletal survey reports with tabulated data and narrative description; 91.7% (11/12) of radiologists and all CPT clinicians prefer this approach for testifying in court when >3 fractures are present.

Cybersecurity in radiology: Access of public hot spots and public Wi-Fi and prevention of cybercrimes and HIPAA violations.

OBJECTIVE: The purpose of this article is to review the steps that can be taken to ensure secure transfer of information over public and home networks, given the increasing utilization of mobile devices in radiology. CONCLUSION: With the rapid technologic developments in radiology, knowledge of various technical aspects is crucial for any practicing radiologist. Utilization of mobile devices, such as laptops, tablets, and even cellular phones, for reading radiologic studies has become increasingly prevalent. With such usage comes a need to ensure that both the user's and the patient's private information is protected. There are several steps that can be taken to protect sensitive information while using public networks. These steps include being diligent in reviewing the networks to which one connects, ensuring encrypted connections to web-sites, using strong passwords, and using a virtual private network and a firewall. As the role of information technology in modern radiology practice becomes more critical, these safety mechanisms must be addressed when viewing studies on any mobile device.

Extended outlook: description, utilization, and daily applications of cloud technology in radiology.

OBJECTIVE: The purpose of this article is to discuss the concept of cloud technology, its role in medical applications and radiology, the role of the radiologist in using and accessing these vast resources of information, and privacy concerns and HIPAA compliance strategies. CONCLUSION: Cloud computing is the delivery of shared resources, software, and information to computers and other devices as a metered service. This technology has a promising role in the sharing of patient medical information and appears to be particularly suited for application in radiology, given the field's inherent need for storage and access to large amounts of data. The radiology cloud has significant strengths, such as providing centralized storage and access, reducing unnecessary repeat radiologic studies, and potentially allowing radiologic second opinions more easily. There are significant cost advantages to cloud computing because of a decreased need for infrastructure and equipment by the institution. Private clouds may be used to ensure secure storage of data and compliance with HIPAA. In choosing a cloud service, there are important aspects, such as disaster recovery plans, uptime, and security audits, that must be considered. Given that the field of radiology has become almost exclusively digital in recent years, the future of secure storage and easy access to imaging studies lies within cloud computing technology.

Abnormal MIBG uptake in a neuroblastoma patient with right upper lobe atelectasis.

A 3-month-old boy with a history of an abdominopelvic neuroblastoma presented 1 week after tumor resection for a routine follow-up 123-I Meta-iodobenzylguanidine (MIBG) scan to assess for residual mass. The study demonstrated abnormal radiotracer uptake in the right upper lobe, which correlated on the SPECT/CT to an area of airspace consolidation thought to be secondary to atelectasis. To the best of our knowledge, there is one published case of MIBG radiotracer uptake in the lung correlating with pneumonia; however, there are no reported cases to date in the literature of focal pulmonary MIBG uptake corresponding to atelectasis.

Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications.

MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.

Pediatric Abdominal Organ Transplantation: Current Indications, Techniques, and Imaging Findings.

The anatomy, normal postoperative radiological appearance, and imaging features of common postoperative complications of pediatric abdominal transplants are reviewed, including renal, liver, and intestinal transplants. Doppler ultrasound is the mainstay of imaging after transplantation. Computed tomography (CT) and CT angiography, MR imaging and magnetic resonance (MR) angiography, MR cholangiopancreatography, conventional angiography, and nuclear medicine imaging may be used for problem-solving in pediatric transplant patients. Accurate and timely radiological diagnosis of transplant complications facilitates appropriate treatment and minimizes morbidity and mortality.

Pediatric Thoracic Organ Transplantation: Current Indications, Techniques, and Imaging Findings.

In the past decade, with improved surgical technique and knowledge of immunosuppression, pediatric lung and heart transplantation have been established as viable therapeutic interventions for pediatric patients with end-stage cardiopulmonary disease from various underlying congenital and acquired disorders. Although outcomes for pediatric patients are similar to those for adult patients, thoracic organ transplantation in this special age group carries unique challenges for preoperative and postoperative imaging evaluation. The article provides an up-to-date review of the postoperative transplant anatomy, imaging techniques, and complications of pediatric lung and heart transplantation.