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BACKGROUND: Radiologists generally treat pediatric ileocolic intussusceptions emergently given potential worse outcomes from delayed reduction attempts. However, relevant literature is conflicting. OBJECTIVE: To identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention to the time interval since diagnosis. METHODS: This retrospective study included patients <6 years old who underwent attempted image-guided enema reduction of ileocolic intussusception between May 2009 and July 2023. Patients were separated into two groups: those presenting directly to the institution (nontransferred patients, who all underwent attempted reduction <8 hours after ultrasound diagnosis), and those transferred from outside facilities. EHR data were extracted. Each patient's first image-guided reduction attempt was classified as successful or unsuccessful. Univariable and multivariable analyses were performed. RESULTS: The study included 1065 patients (649 male, 416 female; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). In nontransferred patients, the mean interval between ultrasound diagnosis and reduction attempt was 150.8 minutes; in transferred patients, the mean interval between outside facility advanced imaging and reduction attempt was 460.1 minutes (p<.001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (p=.25). In nontransferred patients, success occurred in 85.6% of attempts <2 hours after diagnosis versus 84.0% of attempts 2-<8 hours after diagnosis (p=.54); the mean interval from diagnosis to attempted reduction was 149.7 minutes and 156.8 minutes for successful and unsuccessful attempts, respectively (p=.53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR=3.63, p<.001) and absence of high-risk ultrasound findings (OR=2.57, p<.001); success was not independently associated with age, sex, bloody stools, reduction method, or time since diagnosis <2 hours (p>.05). In transferred patients, the mean interval from outside advanced imaging to attempted reduction was 463.1 minutes and 440.2 minutes for successful and unsuccessful attempts, respectively (p=.74). CONCLUSION: Intussusception reduction may not require completion emergently (within 2 hours after diagnosis), but potentially may be safely performed on an urgent basis (within 8 hours). CLINICAL IMPACT: The findings have implications for determining the standard of care, including criteria for oncall activation of radiologic resources, in pediatric intussusception management.
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We review the etiologies of bowel obstruction in infants and children that can be identified on ultrasound (US) including perforated appendicitis, intussusception, foreign body ingestion, colonic volvulus, intra-abdominal mass lesions, internal hernia, and stricturing inflammatory bowel disease. US can potentially identify the cause of bowel obstruction in these age groups, without the need for additional cross-sectional imaging, and can aid in patient management including interventional and surgical planning. Hence, it is important to be familiar with the sonographic imaging findings of bowel obstruction in infants and children.
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Obstrucción Intestinal , Ultrasonografía , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Lactante , Ultrasonografía/métodos , Niño , Preescolar , Apendicitis/diagnóstico por imagenRESUMEN
The combination of low dose CT and AI performance in the pediatric population has not been explored. Understanding this relationship is relevant for pediatric patients given the potential radiation risks. Here, the objective was to determine the diagnostic performance of commercially available Computer Aided Detection (CAD) for pulmonary nodules in pediatric patients at simulated lower radiation doses. Retrospective chart review of 30 sequential patients between 12-18 years old who underwent a chest CT on the Siemens SOMATOM Force from December 20, 2021, to April 12, 2022. Simulated lower doses at 75%, 50%, and 25% were reconstructed in lung kernel at 3 mm slice thickness using ReconCT and imported to Syngo CT Lung CAD software for analysis. Two pediatric radiologists reviewed the full dose CTs to determine the reference read. Two other pediatric radiologists compared the Lung CAD results at 100% dose and each simulated lower dose level to the reference on a nodule by nodule basis. The sensitivity (Sn), positive predictive value (PPV), and McNemar test were used for comparison of Lung CAD performance based on dose. As reference standard, 109 nodules were identified by the two radiologists. At 100%, and simulated 75%, 50%, and 25% doses, lung CAD detected 60, 62, 58, and 62 nodules, respectively; 28, 28, 29, and 26 were true positive (Sn = 26%, 26%, 27%, 24%), 30, 32, 27, and 34 were false positive (PPV = 48%, 47%, 52%, 43%). No statistically significance difference of Lung CAD performance at different doses was found, with p-values of 1.0, 1.0, and 0.7 at simulated 75%, 50%, and 25% doses compared to standard dose. CONCLUSION: The Lung CAD shows low sensitivity at all simulated lower doses for the detection of pulmonary nodules in this pediatric population. However, radiation dose may be reduced from standard without further compromise to the Lung CAD performance. WHAT IS KNOWN: ⢠High diagnostic performance of Lung CAD for detection of pulmonary nodules in adults. ⢠Several imaging techniques are applied to reduce pediatric radiation dose. WHAT IS NEW: ⢠Low sensitivity at all simulated lower doses for the detection of pulmonary nodules in our pediatric population. ⢠Radiation dose may be reduced from standard without further compromise to the Lung CAD performance.
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Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Adulto , Humanos , Niño , Adolescente , Inteligencia Artificial , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodos , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Dosis de RadiaciónRESUMEN
Of over 100 FDA-cleared artificial intelligence (AI) tools for triage, detection, or diagnosis in medical imaging, only one is cleared for use in children. Thus, children may be unable to benefit from the advances that AI provides to adults. Furthermore, dataset demographics are frequently absent from the publicly available FDA documents, and it is not apparent that the software is unsuitable for use in pediatric patients. Herein, recommendations for change are proposed.
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Inteligencia Artificial , Diagnóstico por Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Pediatría/métodos , Niño , Humanos , Triaje/métodosRESUMEN
Midgut volvulus in association with malrotation is a pediatric surgical emergency. Prompt and accurate diagnosis is necessary to avoid bowel ischemia and necrosis, thereby reducing morbidity and mortality. Historically, the fluoroscopic upper gastrointestinal series has been the preferred imaging modality for the evaluation of both midgut malrotation and volvulus, although the use of ultrasound (US) is increasing. In this Narrative Review, we describe the findings of midgut malrotation and volvulus on US, including practical tips for acquisition and interpretation; discuss the advantages and challenges of both imaging modalities; and propose a path and safeguards for possible transition to the use of US as the first-line modality for diagnosis based on our experience in imaging children with midgut malrotation and volvulus.
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Anomalías del Sistema Digestivo , Vólvulo Intestinal , Niño , Diagnóstico por Imagen , Anomalías del Sistema Digestivo/diagnóstico por imagen , Anomalías del Sistema Digestivo/cirugía , Humanos , Vólvulo Intestinal/diagnóstico por imagen , Ultrasonografía/métodosRESUMEN
BACKGROUND: Evidence suggests severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may be associated with appendicitis or clinical symptoms that mimic appendicitis, but it is not clear if the findings or utility of imaging in pediatric patients with suspected appendicitis have changed since the onset of the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To evaluate for potential differences in SARS-CoV-2 positive and SARS-CoV-2 negative pediatric patients imaged for suspected appendicitis to determine the reliability of the existing medical imaging approach for appendicitis in a population that contains both SARS-CoV-2 positive and SARS-CoV-2 negative pediatric patients. MATERIALS AND METHODS: Patients imaged for suspected appendicitis Apr. 1, 2020, to Dec. 31, 2020, were identified via an electronic medical records search. Differences in ultrasound (US) diagnostic performance, use of computed tomography (CT) following US, rates of appendicitis, imaging findings of appendicitis and perforation were compared between SARS-CoV-2 positive and SARS-CoV-2 negative tested patients, using pathology and surgery as reference standards for appendicitis and perforation, respectively. Fisher exact test and Student's t-test were used for statistical analysis. RESULTS: One thousand, six hundred and ninety-three patients < 18 years old met inclusion criteria, with 46% (772/1,693) female, 11 imaged with only CT and 1,682 with US. Comparing SARS-CoV-2 positive and SARS-CoV-2 negative patients, no statistically significant differences in sensitivity or specificity of US (P = 1 and P = 1, respectively), or in the US (P-values ranging from 0.1 to 1.0) or CT imaging findings (P-values ranging from 0.2 to 1.0) in appendicitis were found. Perforation rates were similar between SARS-CoV-2 positive (20/57, 35.1% perforated) and SARS-CoV-2 negative (359/785, 45.7% perforated) patients with appendicitis (P = 0.13). Use of CT following first-line US was similar, with 7/125 (5.6%) of SARS-CoV-2 positive imaged with CT after US and 127/1,557 (8.2%) of SARS-CoV-2 negative imaged with CT after US (P = 0.39). CONCLUSION: In pediatric patients with suspected appendicitis, no significant difference was found in the diagnostic performance of US, CT usage or perforation rates between SARS-CoV-2 positive and SARS-CoV-2 negative patients.
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Apendicitis , COVID-19 , Adolescente , Apendicitis/diagnóstico por imagen , Apendicitis/epidemiología , Apendicitis/cirugía , Niño , Femenino , Humanos , Pandemias , Reproducibilidad de los Resultados , Estudios Retrospectivos , SARS-CoV-2 , Centros de Atención Terciaria , UltrasonografíaRESUMEN
BACKGROUND: Due to the COVID-19 pandemic, some pediatric radiologists have shifted to working from home; the long-term ramifications for pediatric radiologists and departments have not yet been defined. OBJECTIVE: To characterize experiences of working from home associated with the COVID-19 pandemic and guide expectations after the pandemic is controlled, via separate surveys of Society for Pediatric Radiology (SPR) and Society of Chiefs of Radiology at Children's Hospitals (SCORCH) members. MATERIALS AND METHODS: Two separate surveys were conducted. In the first, SPR members were surveyed Jan. 11 through Feb. 8, 2021. The response rate was 17.0% (255 of 1,501). Survey questions included demographics, information on the ability to work from home and subjective experiences ranked on a scale of 0 to 10. The survey enabled segregation and comparison of responses between those with and without home PACS. In the second survey, SCORCH members were surveyed Dec. 8, 2020, through Jan. 8, 2021. The response rate was 51.5% (51/99). Survey questions included the logistics of working from home, technical specifications and the expectations on clinical duties performed from home. The Wilcoxon rank test was used to determine statistical significance of compared variables between respondents with and without home PACS in SPR members, and expectations between SPR and SCORCH members. Descriptive statistics summarized demographic questions and free text responses. RESULTS: The majority of member respondents (81.2%, 207/255) had a home PACS and most departments provided home PACS to faculty (94.1%, 48/51). Overall, radiologists who could work from home were satisfied with their ability to work from home (mean rating: 8.3/10) and were significantly more satisfied than predicted by those without home PACS (5.9/10, P<0.0001). Respondents overwhelmingly indicated they were less able to teach trainees (mean rating: 2.7/10) and had decreased emotional engagement (mean rating: 4.4/10), but had improved research productivity and cognitive ability for research when working from home (mean rating for both: 5.3/10). Regarding the expectations of the ability to work from home after no longer needing to address the pandemic, department chairs generally favored fewer rotations from home, with 97.9% (47/48) indicating working from home should be 60% or fewer assignments, compared with 84.1% (164/195) of individual radiologists (P=0.071). CONCLUSIONS: Due to the COVID-19 pandemic, there has been a shift to working from home using PACS. Results of these SPR and SCORCH member surveys can help inform future decisions regarding pediatric radiologists working from home once the pandemic has been controlled.
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COVID-19 , Radiología , Niño , Hospitales Pediátricos , Humanos , Pandemias , Encuestas y CuestionariosRESUMEN
PURPOSE: COVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound. METHODS: Children under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients' demographic, clinical, radiological and surgical characteristics were reviewed. RESULTS: Twenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months-18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel-small bowel intussusception which was surgically repaired. CONCLUSION: Given the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.
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COVID-19 , Enfermedades del Íleon , Intususcepción , Adolescente , Niño , Enema , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Masculino , Estudios Retrospectivos , SARS-CoV-2 , Resultado del TratamientoRESUMEN
OBJECTIVES: To assess the association between body composition measures in children with COVID-19 and severity of the disease course and clinical outcome. METHODS: A retrospective study of children (< 19 years) with COVID-19 admitted to the hospital who underwent CT of the chest and/or abdomen was conducted. Data compiled from electronic medical records included demographics, body mass index (BMI), length of stay, ICU admission, invasive mechanical ventilation and death. Waist circumference and perimeters for skeletal muscle mass (abdominal, psoas and paraspinal muscles) were measured on an axial CT image at the level of the twelfth thoracic vertebra or first lumbar vertebra using FIJI software. RESULTS: Fifty-seven subjects were identified (54% male, median age 15.6 years, 61% Hispanic, 23% African-American). 25% (14/57) were admitted to the ICU and 21% (12/57) needed intubation. 9% (5/57) died. Waist circumference ranged between 53.2 and 138.4 cm (mean 86.58 ± 18.74 cm) and skeletal muscle mass ranged between 0.6 and 6.8 cm2 (mean 3.5 ± 1.19 cm2). Lower skeletal muscle mass had a univariate association with ICU admission (odds ratio (OR) 0.4; 95%CI 0.17-0.76; p = 0.01) and mortality (OR 0.22; 95%CI 0.04-0.69; p = 0.01). Multivariate analysis showed similar association after controlling for comorbidities (adjusted OR 0.46; 95%CI 0.19-0.95; p = 0.04 and adjusted OR 0.31; 95%CI 0.06-0.95; p = 0.04, respectively). There was no association between BMI or waist circumference with ICU stay, mechanical ventilation or mortality. CONCLUSION: Lower skeletal muscle mass is associated with an adverse clinical course and outcome in children with COVID-19.
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COVID-19 , Adolescente , Composición Corporal , Índice de Masa Corporal , Niño , Femenino , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
The value of obtaining second-opinion interpretations by specialty radiologists has been established. In pediatric radiology, this has primarily been explored in general terms, comparing tertiary pediatric radiologists' interpretations to referral reads. In adults, second reads by subspecialty radiologists have been shown to yield changes in patient management, including in neuroradiology, musculoskeletal radiology and oncological radiology. Here, we examine second-opinion reads by pediatric radiologists by reviewing the pediatric and adult subspecialty literature. We also present our experience in providing subspecialty outside reads, summarizing lessons learned in implementing a system for outside interpretations into a pediatric radiology practice.
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Radiología , Derivación y Consulta , Adulto , Niño , Humanos , Variaciones Dependientes del Observador , Radiólogos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Unnecessary imaging is a potential cost driver in the United States health care system. OBJECTIVE: Using a clinical decision support tool, we determined the percentage of low-utility non-contrast head computed tomography (CT) examinations on emergency patients and calculated the prospective cost implications of providing low-value imaging using time-driven activity-based costing at an academic quaternary pediatric hospital. MATERIALS AND METHODS: A clinical decision support tool for imaging, CareSelect (National Decision Support Co., Madison, WI), was integrated in silent mode into the electronic health record from September 2018 through August 2019. Each non-contrast head CT order received a score from the clinical decision support tool based on the American College of Radiology Appropriateness Criteria. Descriptive statistics for all levels of appropriateness scores were compiled with an emphasis on low-utility exams. A micro-costing assessment was conducted using time-driven activity-based costing on head CT without contrast examinations. RESULTS: Within the 11-month time period, 3,186 head CT examinations without contrast were ordered for emergency center patients. Among these orders, 28% (896/3,186) were classified as low-utility studies. The base case CT pathway time was 43 min and base case total cost was $193.35. The base case opportunity cost of these low-utility exams extrapolated annually amounts to $188,902 for our institution. CONCLUSION: Silent mode implementation of a clinical decision support tool resulted in 28% of head CT non-contrast exams on emergency patients being graded as low-utility studies. Prospective cost implications resulted in an annual base case cost of $188,902 to Texas Children's Hospital.
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Sistemas de Apoyo a Decisiones Clínicas , Niño , Medios de Contraste , Servicio de Urgencia en Hospital , Humanos , Neuroimagen , Estudios Prospectivos , Tomografía Computarizada por Rayos XRESUMEN
Abdominal US is emerging as an alternative to the upper gastrointestinal (GI) series as the preferred diagnostic imaging test for midgut malrotation complicated by volvulus. Unlike the upper GI series, US is free from ionizing radiation, does not require oral contrast agent, and can be performed portably and at times remotely from the interpreting radiologist, expediting diagnosis. Although some institutions do not have a standardized US protocol for midgut volvulus, many routinely use US in the setting of an infant or child with acute abdominal signs or symptoms to evaluate for common conditions such as hypertrophic pyloric stenosis, intussusception, necrotizing enterocolitis and appendicitis. Because these common conditions can overlap in age and clinical presentation with midgut volvulus, the aim of this pictorial essay is to provide instruction on the technique and diagnostic findings of midgut volvulus on US to ensure confident, accurate interpretation, and prompt treatment.
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Anomalías del Sistema Digestivo , Vólvulo Intestinal , Intususcepción , Niño , Medios de Contraste , Anomalías del Sistema Digestivo/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Vólvulo Intestinal/diagnóstico por imagen , UltrasonografíaRESUMEN
In our pediatric radiology department, radiographs (XR) are the shared responsibility of the body section and interpreted in addition to modality or site-specific assignments. Given an unequal contribution amongst radiologists to the XR workload, a software solution was developed to distribute radiographs and improve workload balance. Metrics to evaluate the intervention's effectiveness were compared before and after the intervention. Data was retrieved from the radiology analytics platform, scheduling software, and the peer learning database. Metrics were compared 12 months pre (March 2018-February 2019) and 6 months post (March 2019-August 2019) intervention on non-holiday weekdays, 7 am-5 pm. To evaluate the intervention's effectiveness, variance between radiologists' contributions to XR volume was assessed using Levene's and Fisher's tests. Changes in turnaround times (TATs) and error rates pre- and post-intervention were evaluated as secondary metrics. Following the intervention, the average number of XR interpreted on target rotations increased by 8.9% (p = 0.011) while the departmental volume of radiographs increased only 4.5%. The variance between radiologists' daily XR contribution was 21.3% (p < 0.0001) higher prior to the intervention. Days where target rotations read fewer than 5 XR decreased from 17.8 to 1.1% (p < 0.0001) after the intervention. Days in which more than 75% of all XR had a TAT less than 60 min improved from 26.8 to 39.7% (p = 0.017) after the intervention. There was no statistically significant difference in error frequency (error rate 2.49% pre and 2.72% post, p = 0.636). In conclusion, the software intervention improved XR workload contribution with decreased variability. Despite increased volumes, there was an improvement in turnaround times with no effect on error rates.
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Sistemas de Información Radiológica , Radiología , Niño , Humanos , Radiólogos , Programas Informáticos , Carga de TrabajoRESUMEN
OBJECTIVE. The purpose of this article is to share an experience in the rapid deployment of home workstations that illustrates a creative solution that transcended typical administrative barriers. CONCLUSION. In response to the global coronavirus disease (COVID-19) pandemic, radiology departments need to rapidly deploy home PACS workstations to facilitate physical distancing and to guarantee radiologic expertise despite possible home quarantining or stay home, work safe orders.
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COVID-19/epidemiología , Sistemas de Información Radiológica , Telerradiología/métodos , Eficiencia Organizacional , Humanos , Pandemias , Distanciamiento Físico , Cuarentena , SARS-CoV-2 , Estados Unidos/epidemiología , Flujo de TrabajoRESUMEN
BACKGROUND: Pediatric nuclear medicine is evolving, and its practice patterns are uncertain. Knowledge of the current trends in pediatric nuclear medicine might be helpful to direct local decisions, including expectations for patient care, needs for capital acquisitions, and staffing recruitment strategies. OBJECTIVE: To provide data regarding the current practice of pediatric nuclear medicine via a Society for Pediatric Radiology (SPR) membership survey. MATERIALS AND METHODS: The SPR emailed our 25-question survey to all 1,847 SPR members in August 2018 and we accepted responses until April 2019. Questions focused on nuclear medicine staffing, positron emission tomography (PET) utilization, and radiotherapy availability. Respondents could indicate their affiliated hospital, which we used for data cataloguing only. Analysis of survey responses was blinded to reported institution. We analyzed response data using contingency tables. Independence testing between categorical variables based on proportions of physicians with additional nuclear medicine board certification was performed on a subset of questions regarding PET and therapy practices. RESULTS: Sixty-seven people from at least 29 hospitals responded to the survey, including all 10 of the 2018-2019 U.S. News & World Report best children's hospitals. The majority (48/67, 71.6%) of respondents indicated that pediatric nuclear medicine examinations were interpreted in the pediatric radiology department by pediatric radiologists and that most physicians interpreting the exams (43/67, 64.2%) did not have subspecialty certification in nuclear medicine or nuclear radiology. Most facilities offered PET/CT (57/67, 85.1%); few offered PET/MRI (12/67, 17.9%). Most facilities offered radiotherapies (57/67, 85.1%) but at most of these facilities (30/57, 52.6%), fewer than half the physicians who cover nuclear medicine were approved to administer therapies. In the subset analyses based on proportion of physicians with additional nuclear medicine board certification, there were statistically significant differences between the groups in availability of PET/MRI, lutetium-177 dotatate therapy programs, and percentages of physicians approved to administer therapies. CONCLUSION: Pediatric nuclear medicine is largely practiced by pediatric radiologists without subspecialty certification. Staffing, PET practices and therapies vary among practices, in part associated with the number of radiologists with nuclear medicine board certification.
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Medicina Nuclear/tendencias , Pediatría/tendencias , Pautas de la Práctica en Medicina/tendencias , Humanos , Sociedades Médicas , Encuestas y CuestionariosRESUMEN
Pediatric radiology departments across the globe face unique challenges in the midst of the current COVID-19 pandemic that have not been addressed in professional guidelines. Providing a safe environment for personnel while continuing to deliver optimal care to patients is feasible when abiding by fundamental recommendations. In this article, we review current infection control practices across the multiple pediatric institutions represented on the Society for Pediatric Radiology (SPR) Quality and Safety committee. We discuss the routes of infectious transmission and appropriate transmission-based precautions, in addition to exploring strategies to optimize personal protective equipment (PPE) supplies. This work serves as a summary of current evidence-based recommendations for infection control, and current best practices specific to pediatric radiologists.
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Betacoronavirus , Infecciones por Coronavirus/prevención & control , Control de Infecciones/métodos , Pandemias/prevención & control , Pediatría/métodos , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Radiólogos , COVID-19 , Niño , Humanos , Equipo de Protección Personal , Servicio de Radiología en Hospital , SARS-CoV-2RESUMEN
BACKGROUND: Common cause analysis of learning opportunities identified in a peer collaborative improvement process can gauge the potential risk to patients and opportunities to improve. OBJECTIVE: To study rates of learning opportunities based on radiologist assignment, patient type and exam priority at an academic children's hospital with 24/7 in-house attending coverage. MATERIALS AND METHODS: Actively submitted peer collaborative improvement learning opportunities from July 2, 2016, to July 31, 2018, were identified. Learning opportunity rates (number of learning opportunities divided by number of exams in each category) were calculated based on the following variables: radiologist assignment at the time of dictation (daytime weekday, daytime weekend and holiday, evening, and night) patient type (inpatient, outpatient or emergency center) and exam priority (stat, urgent or routine). A statistical analysis of rate differences was performed using a chi-square test. Pairwise comparisons were made with Bonferroni method adjusted P-values. RESULTS: There were 1,370 learning opportunities submitted on 559,584 studies (overall rate: 0.25%). The differences in rates by assignment were statistically significant (P<0.0001), with the highest rates on exams dictated in the evenings (0.31%) and lowest on those on nights (0.19%). Weekend and holiday daytime (0.26%) and weekday daytime (0.24%) rates fell in between. There were significantly higher rates on inpatients (0.33%) than on outpatients (0.22%, P<0.0001) or emergency center patients (0.16%, P<0.0001). There were no significant differences based on exam priority (stat 0.24%, urgent 0.26% and routine 0.24%, P=0.55). CONCLUSION: In this study, the highest learning opportunity rates occurred on the evening rotation and inpatient studies, which could indicate an increased risk for patient harm and potential opportunities for improvement.