Cranial ultrasound performance assessment tool: development and validation.

AIM: A standard assessment tool for direct evaluation of procedural skills to ensure proficiency of trainees is necessary for cranial ultrasound (US) in clinical practice. This study created and validated an assessment tool for cranial US performance by radiologists. MATERIAL AND METHODS: An initial evaluation tool for cranial US using criteria was developed based on existing literature. The assessment form was modified using a three-round Delphi process by an expert panel, conducted between January 2021 and April 2021. Rubric scales for grading were added once consensus regarding generated items was reached. Experts confirmed the final assessment tool using a rubric scale. Two raters evaluated cranial US performance of 27 residents in video clips using the tool. Reliability and percent agreement were assessed. RESULTS: Seventeen pediatric radiologists working in different settings participated in the expert panel. The content validation of the proposed evaluation tool was enabled by expert pediatric radiologists. Following three rounds of the Delphi process, the initial 14-item assessment form became a final 15-item form. A three-part rubric scale was used in the final form (preparation, US machine operation, and cranial US performance). Interrater reliability was evaluated with Cohen's Kappa. The Kappa value and percent interrater agreement for most items was moderate to almost perfect (0.42-0.93 and 77.8-100%, respectively). The Cronbach's alpha values for both raters were 0.856 and 0.891. CONCLUSIONS: This study produced the first validated cranial US assessment tool using a modified Delphi method. The final assessment form is a simple and reliable tool.

Reference Values of Different Height of Diaphragms in Chest Radiographs of Newborns.

Background: There are many causes affecting diaphragmatic height including normal variation and pathology. Both elevation and depression of the diaphragm imply various pathologies. In our knowledge, no previous study of newborn evaluated the different height of diaphragms. Using adult's reference value in interpretation of newborns' chest remains doubtful because of different imaging technique. Objective: To assess diaphragmatic height and measure different height of diaphragms in the chest radiographs of newborns. Material and Method: A retrospective review of chest radiographs was performed on 100 newborns (age less than 1 month) who were diagnosed of transient tachypnea of the newborn (TTNB) that had respiratory distress and abnormalities in chest radiographs disappeared. The diaphragmatic positions and different diaphragmatic height were evaluated in relation to thoracic vertebra and posterior rib. Results: Right diaphragmatic dome was positioned at 8.17+0.72 thoracic vertebral levels below the top of first thoracic vertebra and 8.28+0.78 crossing rib levels. Left diaphragmatic dome was positioned at 8.87+0.71 thoracic vertebral levels and 8.91+0.29 crossing rib levels. The different height of diaphragms was 0.70+0.34 thoracic vertebral body and 0.63+0.29 intercostal spaces. No newborn had the left diaphragmatic dome higher than the right side. Conclusion: The different diaphragmatic height in newborns is less than 1 intercostal space or 1 thoracic vertebral level. This knowledge is useful for assessment of chest radiographs.

Evaluation of pulmonary metastases in children by non-contrast chest computed tomography.

BACKGROUND: Most of the metastatic lung lesions are relatively high contrast in comparison to the lung background and easily detected in non-contrast enhancement chest computed tomography alone (NECCT). Pediatric patients may get benefit from its minimal radiation dose and lack of adverse reaction from iodinated contrast agent. OBJECTIVE: To compare effectiveness of non-contrast enhancement chest computed tomography (NECCT) in detecting thoracic metastasis with full protocol chest computed tomography (FPCCT) (chest computed tomography with and without contrast) in non-hematologic extrathoracic malignancy in children. MATERIAL AND METHOD: Both NECCT and FPCCT were evaluated in 50 pediatric patients with non-hematologic extrathoracic malignancy retrospectively. Lung nodules, ground glass opacities, interlobular septal thickening, pleural effusion, pleural thickening, pericardial effusion, endobronchial lesion, and intravascular metastasis were evaluated separately on each CT protocol by two radiologists. RESULTS: Thirty boys and 20 girls were included in the present study (mean age = 10 years and 3 months). The lesions include nodule (333 detected by NECCT (median = 3), 336 detected by CECCT (median = 3)), ground glass opacity (12 detected by NECCT (median = 0), 15 detected by CECCT (median = 0)), interlobular septal thickening (12 detected by NECCT (median = 0), 11 detected by CECCT (median = 0)). There was 100 percent match of calcified nodules (n = 36), pleural effusion (n = 1), pleural thickening (n = 3), intravascular thrombus (n = 2), and mediastinal lymph node (n = 1) between NECCT and FPCCT studies. There was no statistically significant different in capability of demonstrating all lesions between NECCT and FPCCT. Most of the discrepancies between NECCT and FPCCT were from motion artifact, inadequate inspiration, and radiologist's opinion rather than effect of contrast agent administration itself CONCLUSION: NECCT is as effective as FPCCT in evaluation of pulmonary metastasis in non-hematologic extrathoracic malignancies. For evaluation of lung metastases in this population, NECCT alone is sufficient.

Seeding of osteosarcoma in the biopsy tract of a patient with multifocal osteosarcoma.

We report a case of multifocal osteosarcoma in a 7-year-old boy who developed iatrogenic seeding of tumor along the biopsy tract. The results of the plain radiograph, CT, and histopathological correlation are presented.

Multiple thoracic vertebral compression fractures caused by non-accidental injury: case report with radiological-pathological correlation.

We report a 21-month-old boy with multiple contiguous thoracic vertebral compression fractures involving eight vertebral bodies, attributable to non-accidental injury. No subluxation was associated, however, there was extensive injury to the upper cervical and lower lumbar regions of the spinal cord. Anterosuperior beaking, thought to represent a previous injury, was evident in a mid-lumbar vertebra. Clinical examination revealed bilateral retinal hemorrhages and retinoschisis. Death occurred as a result of severe brain edema with bilateral subdural and subarachnoid hemorrhages. Radiological-pathological correlation is presented.