Evaluation of pediatric VCUG at an academic children's hospital: is the radiographic scout image necessary?

BACKGROUND: There is heterogeneity in how pediatric voiding cystourethrography (VCUG) is performed. Some institutions, including our own, obtain a radiographic scout image prior to contrast agent instillation. OBJECTIVE: To demonstrate that the radiographic scout image does not augment VCUG interpretation or contribute management-changing information but nonetheless carries a non-negligible effective dose. MATERIALS AND METHODS: We evaluated 181 children who underwent VCUG in 2012, with an age breakdown of less than 1 year (56 children), 1-5 years (66 children), 6-10 years (43 children) and 11-18 years (16 children), with a mean age of 4.0 years. We investigated patient demographics, clinical indication for the examination, scout image findings and estimated effective radiation dose, as well as overall exam findings and impression. RESULTS: No clinically significant or management-changing findings were present on scout images, and no radiopaque urinary tract calculi or concerning incidental finding was identified. Scout image estimated effective radiation dose averaged 0.09 mSv in children younger than 1 y, 0.09 mSv in children age 1-5, 0.13 mSv in children age 6-10 and 0.18 mSv in children age 11-18. Total fluoroscopy time per examination averaged 36.7 s (range 34.8-39.6 s for all age group averages). Evaluation of known or suspected vesicoureteral reflux (VUR) and urinary tract infection (UTI) were the most common clinical indications, stated in 40.9% and 37.0% of exams, respectively. CONCLUSION: Although the estimated effective dose is low for VCUG radiographic scout images, this step did not augment VCUG interpretation or contribute management-changing information. This step should be omitted or substituted to further reduce dose in pediatric VCUG.

Occult injury of the pediatric craniocervical junction.

The objective of this study is to review the occurrence of occult craniocervical junction injury in children. All patients <18 years of age with negative CT of the craniocervical junction and subsequent MRI between July 2003 and June 2008 were included. Age, gender, mechanism of injury, and presence of injuries below C2 were tabulated. Of the forty-five patients with negative CT of the craniocervical junction, 30 had positive MRI findings at the craniocervical junction. Seventeen of the 30 patients fulfilled criteria for significant craniocervical junction injury by MRI. Eleven of 17 patients with significant craniocervical junction injury were less than 8 years old and 13 of 17 were involved in motor vehicle accidents. Six of 12 patients with injury below C2 had significant craniocervical injury. Pediatric craniocervical injuries are often not evident on radiographic or CT imaging but present on MR imaging. Craniocervical injury is most common in younger age groups and is associated with motor vehicle accidents and injuries of the lower cervical spine.