Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results.

BACKGROUND: Perinatal and childhood postmortem imaging has been accepted as a noninvasive alternative or adjunct to autopsy. However, the variation in funding models from institution to institution is a major factor prohibiting uniform provision of this service. OBJECTIVE: To describe current funding models employed in European and non-European institutions offering paediatric postmortem imaging services and to discuss the perceived barriers to future postmortem imaging service provision. MATERIALS AND METHODS: A web-based 16-question survey was distributed to members of the European Society of Paediatric Radiology (ESPR) and ESPR postmortem imaging task force over a 6-month period (March-August 2021). Survey questions related to the radiologic and autopsy services being offered and how each was funded within the respondent's institute. RESULTS: Eighteen individual responses were received (13/18, 72.2% from Europe). Only one-third of the institutions (6/18, 33.3%) have fully funded postmortem imaging services, with the remainder receiving partial (6/18, 33.3%) or no funding (5/18, 27.8%). Funding (full or partial) was more commonly available for forensic work (13/18, 72%), particularly where this was nationally provided. Where funding was not provided, the imaging and reporting costs were absorbed by the institute. CONCLUSION: Increased access is required for the expansion of postmortem imaging into routine clinical use. This can only be achieved with formal funding on a national level, potentially through health care commissioning and acknowledgement by health care policy makers and pathology services of the value the service provides following the death of a fetus or child. Funding should include the costs involved in training, equipment, reporting and image acquisition.

[Elbow Luxation at Birth? - Differential Diagnosis of Elbow Disorders presenting at Birth]. / Ellbogenluxation bei Geburt? ­ Differenzialdiagnose von Ellbogenpathologien bei Geburt.

This is a case report of an isolated congenital radial head dislocation (CRHD) presenting after a breech delivery. The implications of this delivery mode led to the misdiagnosis of an elbow luxation. We found that elbow luxation is a common misdiagnosis of CRHD, although it has not been reported in children younger than one year. For the experienced clinician, repeated examinations and appropriate imaging usually lead to the exclusion of such misdiagnoses. CRHD itself usually remains asymptomatic until adolescence. Without pain or functional impairment of the joint, no specific therapy is needed. This case prompted us to provide an overview of elbow pathologies presenting at birth.

Agenesis of the Corpus Callosum and Skeletal Deformities in Two Unrelated Patients: Analysis via MRI and Radiography.

Purpose. Mental retardation, mild to severe epilepsy and cerebral palsy often of hemiplegic type are common accompaniments in patients with agenesis/hypoplasia of the corpus callosum. Skeletal deformities of bilateral radiohumeral synostosis, brachydactyly, bilateral elbow dislocation, talipes equinovarus, and juxtacalcaneal accessory bones have been encountered in two unrelated children with agenesis of the corpus callosum. Methods. We report on two unrelated children who presented with the full clinical criteria of agenesis of the corpus callosum. Strikingly, both presented with variable upper and lower limb deformities. The clinical features, radiographic and MRI findings in our current patients, have been compared with previously reported cases identified through a PubMed literature review. Results. Bilateral radiohumeral synostosis associated with pyruvate dehydrogenase deficiency has been encountered in one patient. The other patient manifested bilateral elbow dislocation, coxa valga, talipes equinovarus, and bilateral juxtacalcaneal accessory bones. Conclusion. The constellation of malformation complexes in our current patients have the hitherto not been reported and expanding the spectrum of skeletal deformities in connection with agenesis of the corpus callosum.

Diagnostic performance of liquid crystal and cathode-ray-tube monitors in brain computed tomography.

The aim of this study was to evaluate feasibility of reporting brain CT examinations on liquid crystal display (LCD) flat-screen monitors vs state-of-the-art cathode-ray-tube (CRT) monitors. Ninety-five brain CT examinations of 95 patients were displayed on Picture archiving and communications system (PACS) workstations equipped either with a dedicated medical imaging LCD colour monitor or on a high-resolution CRT which is used for routine reporting of CT, MRI and digital radiography images in our institution. Fifty cases were negative and 45 cases were positive for early brain infarction (EBI), the latter being defined by a combination of one or more signs: dense artery; hypodensity of brain parenchyma; and local brain swelling verified by control scans. Ten radiologists had to rate presence or absence of EBI on a five-point scale. Ratings were evaluated by CORROC2 ROC software and areas under the ROC curve (A(z)) were computed. Significance of differences between the two viewing conditions were evaluated with Wilcoxon test. Mean A(z) of the ten observers was 0.7901 with LCD vs 0.7695 with CRT which did not show statistical significance (p=0.2030). In the setting investigated, reporting of CT studies from high-performance LCD monitors seems feasible without significant detriment to diagnostic performance.

Common tasks and problems in paediatric trauma radiology.

Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology.

Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters.

Preoperative knowledge of full-thickness rotator cuff tear size is important in counseling patients because tear size affects the choice of surgical techniques and the functional outcome of surgery. Twenty-six shoulders of twenty-five consecutive patients were included in a prospective study that compared the preoperative accuracy of magnetic resonance arthrography and ultrasonography for tear size in millimeters with intraoperative findings. No significant differences were found between intraoperative, ultrasonographic, and magnetic resonance arthrographic data for the width of tears. Adoption of a "curved line measurement" for ultrasonographic evaluation of large tears eliminated the tendency of ultrasonography to underestimate tears greater than or equal to 35 mm in width. No significant differences were found between intraoperative, ultrasonographic, and magnetic resonancearthrographic data for retraction of tears. However, a limitation of ultrasonography to evaluate retractions of more than 30 mm was found. Therefore, ultrasound is of equal value for tears less than 30 mm, but magnetic resonance arthrography is more accurate for tears greater than 30 mm.