[Pediatric thoracic spine radiographs: Comparison of two scintillators]. / Radiographies thoraciques pédiatriques: comparaison de deux détecteurs à mémoire.

PURPOSE: To compare image quality and radiation exposure from pediatric thoracic spine radiographs from two systems, one using a granular structure scintillator and another using a needle structure scintillator with 40% reduction of exposure. PATIENTS AND METHODS: Randomized prospective study of 296 patients divided into 2 groups of 5 weight categories from 4 to 60 kg. Standard technique parameters are used for granular structure scintillators with dose reduction of 40% applied for needle structure scintillators based on results from a phantom study. Image quality based on detectability of 8 anatomical structures for both types of scintillators was assessed by 6 blinded radiologists. Exposure was expressed by DLP. Results underwent statistical analysis. RESULTS: Overall, image quality was superior with corresponding dose reduction between 33-46% according to weight with needle structure scintillators. For the 4 lower weight categories, image quality was identical. CONCLUSION: With image quality at least equal, new needle structure scintillator units allow a dose reduction of about 40%.

[Radiography of scoliosis: comparative dosimetry between conventional technique and digital fluorography]. / Radiographie des scolioses: dosimétrie comparée entre la technique conventionnelle et la fluorographie numérique.

OBJECTIVE: Compare the irradiation delivered in conventional radiography and digital radiography by image intensifier during a scoliosis workup. PATIENTS AND METHODS: Our prospective randomized study included 105 patients, all of whom were identified according to sociodemographic parameters as well as criteria evaluating the quality of the full front spinal x-ray at PA incidence. The entry dose at the scapula and the exit dose in interorbital, thyroid, mammary, and hypogastric projection was measured by thermoluminescent dosimeters. RESULTS: The results of 71 girls and 28 boys, aged a mean 13.8 years with a mean weight of 47 kg were analyzed. At equal image quality, the entry dose was not significantly different between the two techniques; the mean exit dose reduction was 64% during digital acquisition. This reduction involved the interorbital (162%), mammary (43%), and thyroid (309%) regions. However, this system is more irradiating in the hypogastric region (34%). CONCLUSION: The dosimetric evaluation of the different imaging techniques used to explore the entirety of the spine should be part of radiologists' quality standard used to document their work and their choices.

[Kidney trauma in children: state of the art medical imaging]. / Traumatisme du rein de l'enfant: bonnes pratiques en imagerie médicale.

Traumatic renal lesions have some particularities in the pediatric age group, especially for anatomic reasons. Imaging is very important for diagnosis and staging. Ultrasonography with Doppler is the first line examination performed in children and frequently allows initial diagnosis. From the Doppler-ultrasonographic results and the type of trauma, renal Computed Tomography (CT) is complementary performed. The association of these imaging techniques allows comprehensive work-up of traumatic renal lesions, and also of associated or pre-existing lesions. Conservative management is the rule in most cases. Interventional imaging techniques are sometimes used for therapeutic care of renal pedicular vascular lesions or lesions of the collecting system. Far from the traumatic event, imaging allows to follow up the morphologic and functional evolution of major renal lesions, in particular lesions of excretory renal ducts.

[Systemic learning planification for residents during the 6-month pediatric radiology training]. / Planification systémique de l'apprentissage des internes pendant un semestre de radiopédiatrie.

Diagnostic Radiology and Medical Imaging residents of French University Hospitals benefit from a wide array of learning tools. However, the professors' clinical workload, lack of sufficient proper formal training, lack of practical applicability of existing standards, and absence of rigorous assessment during the specialized training, reduce their very good quality formation to the level of accidental learning. This study originates from the need to apply a systemic planification of learning activities to the French residents' formal training curriculum, such as the one originally designed and applied within the Quebec educational system. This presentation also benefits from the recent introduction of the CanMEDS 2000 objectives by the Royal College of Physicians and Surgeons of Canada, in order to design an adapted version for the professional and academic activities of French radiologists. Needless to say this work will respect the outlined systematic planning of any learning activity: learning requirements, definition of learning objectives, selection of learning methods, assessment of the participants' achievement of these objectives, and evaluation of the learning activity itself.

[Cystic intrathoracic hemolymphangioma: a rare differential diagnosis of acute bronchiolitis in an infant]. / Hémolymphangiome kystique intrathoracique: un diagnostic différentiel rare de bronchiolite aiguë chez un nourrisson.

Hemolymphangioma is a benign malformation of the lymphatic vessels. Cervical localisation is the most frequent. Mediastinal localisation is rare, but may be life-threatening because of airway compression. We report on a four-month-old boy who presented, in a context of epidemics, with clinical signs of acute bronchiolitis requiring mechanical ventilation for several days. Chest X-rays showed an important mediastinal mass with airways compression. Diagnosis was evoked on CT-scan aspects and confirmed by histology. Surgery allowed complete resolution, but dysphonia and oropharyngeal disorders persisted for several months. This rare congenital malformation is reviewed.

[Immature hemangiomas in infants: MR and Doppler-US imaging features]. / Sémiologie IRM et écho-Doppler des hémangiomes immatures du nourrisson: à propos de 12 cas.

PURPOSE: To determine the MR imaging features of immature hemangiomas. To discuss the value of MR imaging compared to Doppler ultrasonography (US). MATERIALS AND METHODS: We performed a retrospective study of clinical, Doppler US and MRI data of 12 immature hemangiomas in 11 children. The mean age was 2 months and 21 days. The mean clinical follow up was 22 months and 7 days. RESULTS: MRI was performed for non-diagnosed lesions (4 cases) or to further define lesion extension (8 cases). The lesions either involved the head and neck (8 cases) or the extremities (4 cases). At MR imaging, all immature hemangiomas corresponded to well defined homogeneous T2W hyperintense masses. On T1-weighted images, 11 immature hemangiomas were isointense with intense homogeneous enhancement. Eleven tumors contained linear low signal intensity flow voids. Ten lesions had superficial cutaneous and/or subcutaneous extension whereas 2 lesions had intra-muscular extension. At Doppler US, immature hemangiomas were highly vascularized masses, with well defined margins, often compressibles, homogeneous isoechoic or heterogeneous with nodular hypoechoic foci, relative to subcutaneous fat. A diagnosis of immature hemangioma was confirmed either by pathology (2 cases) or clinical follow up (10 cases). CONCLUSION: In our study, the MR imaging features of immature hemangiomas were reproducible and similar to reports from the literature. MRI is a useful tool to better define the extent of immature hemangiomas, which can be difficult to assess at US. The sensitivity and specificity of MR imaging for this pathology remain to be defined.

[Non-traumatic abdominal emergencies in paediatric practice]. / Les urgences abdominales non traumatiques de l'enfant.

Do advances in MR imaging and Computed Tomography have encroached upon the private territory of Ultrasound-Doppler imaging on paediatric practice? Do the enthusiasm promoted by the use of CT on non traumatic acute abdomen in adult has contaminated the indomitable village of paediatric radiologist? Undoubtfully, Ultrasound-Doppler stayed the first imaging modality to perform. However, the habits are less crystallised than a few years ago. The goal of this article is to describe the ultrasound findings and the potential indications for MRI or CT in the major non traumatic abdominal paediatric emergencies.

[Imaging of the pediatric pancreas: state of the art]. / Imagerie du pancréas de l'enfant en 2005.

The use of high frequency (7-12 MHz) transducers on state of the art US units equipped with Doppler imaging provides excellent evaluation of the pediatric pancreas that compares to other cross-sectional imaging techniques. The availability of multidetector CT imaging reduces the need for sedation but requires additional review of the indications and protocols to avoid unnecessary radiation exposure. Evaluation of pancreatitis and tumors remains the main indication. Advances in MR imaging and MRCP has lead to very good results in children. Storage diseases of the pancreas can be diagnosed at MRI. The length of the examinations, the need for sedation and the limited spatial resolution remain the main pitfalls of MR imaging of the pancreas in pediatric patients.

[Pneumoblastoma in children. A clinical case and review of the literature]. / Pneumoblastome chez l'enfant. Cas clinique et revue de la littérature.

Pulmonary blastoma is a rare malignant tumor. A new case is reported in a 3 years 6 month-old girl. An apparent clinical remission was first obtained after a surgical treatment followed by a conventional chemotherapy during six months. Afterwards the persistence of a microscopic residual pulmonary disease lead us to deliver successfully an intensive chemotherapy followed by autologous peripheral blood stem cells reinjection. The child remains disease free 12 months after graft. Problems set by the histogenesis of this tumor, its unspecific clinical and paraclinical features and the role of conventional and intensive chemotherapy followed by autologous bone marrow transplantation are discussed on the basis of a review of 50 cases in the literature.

Ultrasonographic diagnosis and laparoscopic surgical treatment of Meckel's diverticulum.

A two-year-old boy was admitted for melena. Ultrasonography depicted an abnormal intestinal structure in the right iliac fossa and the diagnosis of Meckel's diverticulum was suggested. Laparoscopic approach confirmed the diagnosis and allowed resection.

[Choledocal cyst associated with congenital cystic duct dilatation: report of two cases]. / Kyste du cholédoque avec dilatation congénitale du canal cystique : à propos de deux cas.

We report two cases of a choledochal cyst associated with dilatation of the cystic duct. This unusual variant of choledochal cyst was explored by ultrasonography and MR cholangiopancreatography.

[Activities of radiologists in teaching hospitals]. / Activité des radiologistes des services de radiologie des Centres Hospitalo-Universitaires.

AIM: To determine if teaching hospital imaging units are adequately staffed: how are the medical activities of radiologists distributed in such units? MATERIALS AND METHODS: A questionnaire was sent to all teaching hospital radiologists in June 2001. The questionnaire covered 7 areas RESULTS: Urgent cases represent, on average, 22% of patients. Imaging procedures are becoming more frequent (increase of 2 to 8% per year). The mean working week (excluding periods on duty and on call) is 48 hours per FTE radiologist. The mean time spent on teaching, expertise and organization is 10 hours per week. The mean working time per FTE radiologist is thus 58 h/week. The medical activity per FTE radiologist represents 530.240e. CONCLUSION: The workload of radiologists in teaching hospitals is extremely high, whatever the indicator used (time or activity), indicating major under-staffing.

[Presence of parents in pediatric imaging]. / Présence parentale en imagerie pédiatrique.

The purpose of this study was to evaluate the attitude of French pediatric radiologists regarding the presence or absence of parents during pediatric imaging of their child. A mail survey was sent to the French members of the "Société Francophone de Radiologie Pédiatrique". We asked about the inclusion of parents during pediatric imaging procedures. They gave the reasons for their choice and stated if parental presence was helpful or not for the achievement of imaging procedures. Responses were received from 76% of those surveyed. Excluding vascular and interventional procedures, few respondents (13%) permit parents to be present for all types of examinations. One respondent excluded parents from every procedure. Others excluded parents from selected studies: plain films (18%), upper gastrointestinal series (33%), contrast enema (44%), retrograde (47%) and suprapubic (67%) voiding cystourethrography, intra-venous pyelography (45%), US (5%), CT (27%), MRI (25%). Regarding angiography, only 2% of the respondents allow parental presence. Every respondent performing interventional procedures did not accept parents in the interventional suite. When parents were present, they were close to their child (76%) and could help in his immobilization (47%). Most of the respondents (49%) thought parental presence to affect examination in a favorable way. The opposite opinion was supported by 25% of them. An equivocal response was given in 26% of the answers. Numerous reasons supported these responses, they could be classified according to the child and his illness, the parents, the radiologist and his team, the examination performed. Most pediatric radiologists in France allow parents to accompany their children during selected examinations. Radiologists vary in their perception of how parental presence affects the outcome of the pediatric imaging procedures.