Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse.

OBJECTIVE: Previous studies have found that fractures involving the spine, hands, and feet are rare on skeletal surveys in cases of suspected child abuse, leading some authors to suggest eliminating these regions from the initial skeletal survey protocol. We assessed this recommendation by performing a historical review of these injuries in a pediatric population undergoing film screen-based radiographic skeletal surveys for suspected child abuse. MATERIALS AND METHODS: This cross-sectional retrospective study reviewed reports of initial skeletal surveys of all children younger than 2 years with suspected abuse imaged between April 1988 and December 2001. Radiographic skeletal survey imaging was performed according to American College of Radiology standards. Sixty-two percent (225/365) of all skeletal surveys had positive findings, and 44% (98/225) showed more than one fracture. Surveys with fractures involving the spine, hands, or feet were identified, and the data were tabulated and analyzed. RESULTS: Twenty of 365 studies (5.5%) yielded fractures involving the spine, hands, or feet. Of all positive skeletal surveys, 8.9% (20/225) had fractures involving the spine, hands, or feet. Of all patients with more than one fracture on skeletal survey, 20.4% (20/98) had fractures involving these regions. CONCLUSION: These data, acquired during the film-screen era, suggest that fractures of the spine, hands, and feet may not be rare in infants and toddlers in cases of suspected child abuse. The benefits of eliminating views of these regions from the initial skeletal survey should be carefully weighed against the cost of missing these potentially important injuries in at-risk pediatric populations.

Injuries and conditions of the extensor mechanism of the pediatric knee.

The extensor mechanism of the knee is essential to ambulation and is subject to a number of traumatic, congenital, and inflammatory processes. In the pediatric population, the spectrum of pathologic conditions affecting the extensor mechanism is specific to skeletally immature patients. In addition, certain congenital and developmental disorders may further predispose the knee extensor mechanism to injury. The pathologic processes can be subdivided into categories: conditions of the attachments and insertions of the quadriceps and patellar tendons, conditions of the patella, conditions of the quadriceps muscle group, and avulsions of the superior attachments of the quadriceps. Cases of conditions affecting the extensor mechanism of the pediatric knee were collected at two large trauma centers, and the clinical and radiologic features were reviewed. Initial evaluation of these conditions is performed with radiography, but magnetic resonance imaging has evolved into a useful adjunct for assessing the soft tissues for a more precise evaluation of the true extent of an injury, thereby affecting decisions about surgical intervention and prognosis.

Do Interventions Intended to Increase Female Medical Student Interest in Radiology Work? Preliminary Findings.

PURPOSE: The purpose of this study is to share the preliminary findings after initiation of interventions at the medical school level, which have been suggested by the literature to increase female medical student interest in radiology at one institution. Additionally, the paper provides discussion of how to better future interventions for increasing female medical student interest. METHODS: Interventions to increase medical student exposure to radiology were implemented at the University of Massachusetts Medical School in 2012. Radiology was incorporated into the preclinical curriculum; flexible clinical experiences stressing patient contact were created for early exposure to radiology during third-year clerkships; and a 'Women in Radiology' panel was held to promote visibility of female radiologists. In addition, female radiology faculty became more involved in medical school activities and events. RESULTS: Our results suggest that early exposure in the preclinical curriculum and patient-centered electives increase overall student interest in radiology but only minimally increase female interest. Simply offering the patient-centered electives is not enough as it resulted in more male student enrollment than female (60% vs. 40%, respectively). Just one event promoting visibility of female radiologists changed female medical student perception of patient contact within radiology by a statistically significant amount. Examination of current UMass faculty radiologists by gender demonstrates that full-time, junior female radiologists-the demographic suggested to have the biggest impact on female medical students-only accounted for 4% of faculty. CONCLUSION: This article may be informative for radiology departments looking to increase female medical student interest. Required visibility of female radiologists and active publicity of female radiologists from the first preclinical year are likely to have the biggest impact in increasing female medical student interest.

Glowing in the dark: time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children.

BACKGROUND/PURPOSE: Although ultrasound is often the preferred pediatric imaging study, many institutions lack ultrasound access at night; and computerized tomography (CT) becomes the only radiological method available for evaluation of appendicitis in children. The purpose of this study was to characterize patterns of daytime and nighttime use of ultrasound or CT for evaluation of pediatric appendicitis and to measure consequent differences in radiation exposure and cost. METHODS: A retrospective chart review of patients evaluated for appendicitis from October 2004 to October 2009 (N = 535) was performed to evaluate daytime and nighttime use of ultrasound and CT for pediatric patients. RESULTS: Average age was 10.2 years (range, 3-17 years). During the day, 6 times as many ultrasounds were performed as CTs (230 vs 35). At night, half as many ultrasounds were performed (50 vs 110). Average radiation dose per child during the day was significantly lower than at night (day, 0.52 mSv per patient; night, 2.75 mSv per patient). Average radiology costs were lower for daytime patients ($2491.06 day vs $4045.00 night; P < .05). CONCLUSIONS: Dependence on CT at night results in higher average radiation exposure and cost. Twenty-four-hour ultrasound availability would decrease radiation exposure and cost of evaluation of children presenting with appendicitis.

Percutaneous treatment of a gastrocutaneous fistula after gastrostomy tube removal.

Gastrocutaneous fistula formation is a potential complication resulting from nonsurgical gastrostomy or gastrojejunostomy tube removal. Limited success in conservative treatment has been achieved with either mechanical obstruction of the tract or pharmacologically based increase in gastric pH and improvement of gastric emptying. A case of successful conservative percutaneous treatment of a gastrocutaneous fistula with use of the sequence of initial tract de-epithelialization followed by direct tract sclerosis and mechanical obstruction is presented in this article.