A 1-Tesla MRI system for dedicated brain imaging in the neonatal intensive care unit.

Objective: To assess the feasibility of a point-of-care 1-Tesla MRI for identification of intracranial pathologies within neonatal intensive care units (NICUs). Methods: Clinical findings and point-of-care 1-Tesla MRI imaging findings of NICU patients (1/2021 to 6/2022) were evaluated and compared with other imaging modalities when available. Results: A total of 60 infants had point-of-care 1-Tesla MRI; one scan was incompletely terminated due to motion. The average gestational age at scan time was 38.5 ± 2.3 weeks. Transcranial ultrasound (n = 46), 3-Tesla MRI (n = 3), or both (n = 4) were available for comparison in 53 (88%) infants. The most common indications for point-of-care 1-Tesla MRI were term corrected age scan for extremely preterm neonates (born at greater than 28 weeks gestation age, 42%), intraventricular hemorrhage (IVH) follow-up (33%), and suspected hypoxic injury (18%). The point-of-care 1-Tesla scan could identify ischemic lesions in two infants with suspected hypoxic injury, confirmed by follow-up 3-Tesla MRI. Using 3-Tesla MRI, two lesions were identified that were not visualized on point-of-care 1-Tesla scan: (1) punctate parenchymal injury versus microhemorrhage; and (2) small layering IVH in an incomplete point-of-care 1-Tesla MRI with only DWI/ADC series, but detectable on the follow-up 3-Tesla ADC series. However, point-of-care 1-Tesla MRI could identify parenchymal microhemorrhages, which were not visualized on ultrasound. Conclusion: Although limited by field strength, pulse sequences, and patient weight (4.5 kg)/head circumference (38 cm) restrictions, the Embrace® point-of-care 1-Tesla MRI can identify clinically relevant intracranial pathologies in infants within a NICU setting.

Using an Annual Diversity, Equity and Inclusion Dashboard to Accelerate Change in Academic Radiology Departments.

Despite widespread interest in creating a more equitable and inclusive culture, a lack of workforce diversity persists in Radiology, in part due to a lack of universal and longitudinal metrics across institutions. In an attempt to establish benchmarks, a subset of the Society of Chairs of Academic Radiology Departments (SCARD) Diversity, Equity and Inclusion (DEI) Committee volunteered to design a DEI dashboard as a potential tool for academic radiology programs to use to document and track their progress. This freely-available, modular dashboard includes suggested (plus optional department-defined) DEI activities/parameters and suggested assessment criteria across three domains: faculty, residents & fellows, and medical students; it can be completed, in whole or in part, by departmental leaders annually. The suggested metrics and their associated rubrics were derived from the collective experiences of the five working group members, all of whom are chairs of academic radiology departments. The resulting dashboard was unanimously approved by the remaining 14 DEI committee members and endorsed by the SCARD board of directors.

Proctoring of New Emergency Radiologists to Promote Clinical Excellence and Ensure Quality of Care.

PURPOSE: The authors' institution provides 24/7 attending radiologist final interpretations for all emergency, urgent, and inpatient studies. As a supplement to the existing emergency radiology faculty, the institution relies on two groups of radiologists to provide final imaging interpretations after hours: radiology fellows (RFs) and newly hired subspecialty radiologists (NRs). For both groups, subspecialty services provide overreads the following day to improve the skills of the staff members and ensure clinical excellence. The purpose of this study was to compare the clinical significance and rate of discrepancies between RFs and NRs. METHODS: A retrospective review of all overreads from July 1, 2012, to June 30, 2015, was performed. Discrepancy rates for RFs and NRs were calculated. Error significance for cases requiring addenda was categorized as follows: acute, likely malignant, indeterminate, unlikely to be of clinical significance, insignificant typographic error, or significant typographic error. RESULTS: In total, 10,796 studies were rechecked, of which 1.9% (n = 205) required addenda, 3.6% (n = 384) were deemed addendum-optional, and 94.5% (n = 10,207) required no comments. There was no significant difference in cases requiring addenda (RFs, 1.7% [119 of 6,847]; NRs, 2.2% [86 of 3,949]; P = .11). Of the 205 cases requiring addenda, 21.0% (n = 43) were deemed to be acute, 4.9% (n = 10) likely malignant, 28.3% (n = 58) indeterminate, 32.7% (n = 67) unlikely to be of clinical significance, and 13.1% (n = 27) secondary to typographic errors (66.7% [n = 18] deemed to be significant). CONCLUSIONS: After-hours coverage with RFs and NRs allows high-quality final, actionable interpretations with low discrepancy rates and no significant difference between both groups for addendum-needed cases. The program strikes a balance between the need for timely interpretations and the need to continually monitor and improve the quality of interpretations through subspecialist feedback.

3D printing from diagnostic images: a radiologist's primer with an emphasis on musculoskeletal imaging-putting the 3D printing of pathology into the hands of every physician.

Three-dimensional (3D) printing has recently erupted into the medical arena due to decreased costs and increased availability of printers and software tools. Due to lack of detailed information in the medical literature on the methods for 3D printing, we have reviewed the medical and engineering literature on the various methods for 3D printing and compiled them into a practical "how to" format, thereby enabling the novice to start 3D printing with very limited funds. We describe (1) background knowledge, (2) imaging parameters, (3) software, (4) hardware, (5) post-processing, and (6) financial aspects required to cost-effectively reproduce a patient's disease ex vivo so that the patient, engineer and surgeon may hold the anatomy and associated pathology in their hands.

Incidence and acute complications of asymptomatic central venous catheter-related deep venous thrombosis in critically ill children.

OBJECTIVE: To determined the current incidence and acute complications of asymptomatic central venous catheter (CVC)-related deep venous thrombosis (DVT) in critically ill children. STUDY DESIGN: We performed a prospective cohort study in 3 pediatric intensive care units. A total of 101 children with newly inserted untunneled CVC were included. CVC-related DVT was diagnosed using compression ultrasonography with color Doppler. RESULTS: Asymptomatic CVC-related DVT was diagnosed in 16 (15.8%) children, which equated to 24.7 cases per 1000 CVC-days. Age was independently associated with DVT. Compared with children aged <1 year, children aged >13 years had significantly higher odds of DVT (aOR, 14.1, 95% CI, 1.9-105.8; P = .01). Other patient demographics, interventions (including anticoagulant use), and CVC characteristics did not differ between children with and without DVT. Mortality-adjusted duration of mechanical ventilation, a surrogate for pulmonary embolism, was statistically similar in the 2 groups (22 ± 9 days in children with DVT vs 23 ± 7 days in children without DVT; P = .34). Mortality-adjusted intensive care unit and hospital lengths of stay also were similar in the 2 groups. CONCLUSION: Asymptomatic CVC-related DVT is common in critically ill children. However, the acute complications do not seem to differ between children with and without DVT. Larger studies are needed to confirm these results. Future studies should also investigate the chronic complications of asymptomatic CVC-related DVT.

Underutilized ultrasound applications in the neonatal intensive care unit.

Bedside duplex/color Doppler sonography is used for a wide gamut of abnormalities encountered in the neonatal intensive care unit. This article emphasizes the use of bedside sonography for evaluation of infants with necrotizing enterocolitis, infants requiring line placement, and those in whom a diaphragmatic abnormality is suspected. Although the assessment of those infants requires excellent operator skills, learning to do so is a definite benefit to these babies who would otherwise be exposed to ionizing radiation.

Medical imaging radiation safety for the female patient: rationale and implementation.

For the modern practitioner of women's imaging, achieving a balance between the positive diagnostic benefits available from current medical imaging on the one hand, and the potentially deleterious effects of ionizing radiation exposure on the other, has become a central issue. Increased public and professional awareness of the side effects of radiation now require a comprehensive understanding of the facts involved, the various risks to which patients are exposed, and the measures that can be implemented to minimize these risks. The major challenges posed by pregnancy, radiosensitive breast tissue, lactation, and an inability to easily exclude ovaries from the imaging field make female patients particularly vulnerable to medical imaging radiation exposure. The nature of this vulnerability changes frequently and depends on the imaging being performed, the age of the patient, and the clinical situation. For this reason, attention to gynecologic imaging radiation exposure across the whole life span is vitally important.

Diagnosis of intussusception by physician novice sonographers in the emergency department.

STUDY OBJECTIVE: We investigate the performance characteristics of bedside emergency department (ED) ultrasonography by nonradiologist physician sonographers in the diagnosis of ileocolic intussusception in children. METHODS: This was a prospective, observational study conducted in a pediatric ED of an urban tertiary care children's hospital. Pediatric emergency physicians with no experience in bowel ultrasonography underwent a focused 1-hour training session conducted by a pediatric radiologist. The session included a didactic component on sonographic appearances of ileocolic intussusception, review of images with positive and negative results for intussusceptions, and a hands-on component with a live child model. On completion of the training, a prospective convenience sample study was performed. Children were enrolled if they were to undergo diagnostic radiology ultrasonography for suspected intussusception. Bedside ultrasonography by trained pediatric emergency physicians was performed and interpreted as either positive or negative for ileocolic intussusception. Ultrasonographic studies were then performed by diagnostic radiologists, and their results were used as the reference standard. Test characteristics (sensitivity, specificity, positive and negative predictive values) and likelihood ratios were calculated. RESULTS: Six pediatric emergency physicians completed the training and performed the bedside studies. Eighty-two patients were enrolled. The median age was 25 months (range 3 to 127 months). Thirteen patients (16%) received a diagnosis of ileocolic intussusception by diagnostic radiology. Bedside ultrasonography had a sensitivity of 85% (95% confidence interval [CI] 54% to 97%), specificity of 97% (95% CI 89% to 99%), positive predictive value of 85% (95% CI 54% to 97%), and negative predictive value of 97% (95% CI 89% to 99%). A positive bedside ultrasonographic result had a likelihood ratio of 29 (95% CI 7.3 to 117), and a negative bedside ultrasonographic result had a likelihood ratio of 0.16 (95% CI 0.04 to 0.57). CONCLUSION: With limited and focused training, pediatric emergency physicians can accurately diagnose ileocolic intussusception in children by using bedside ultrasonography.

A survey of policies and procedures on the communication and documentation of radiologic interpretations.

Research into emergency medicine (EM) diagnostic errors identified imaging as a contributing factor in 94% of cases. Discrepancies between the preliminary (trainee) and the final (attending) diagnostic imaging interpretation represent a system issue that is particularly prone to creating diagnostic errors. Understanding the types of systematic communication and documentation strategies developed by academic radiology departments to address differences between preliminary and final radiology interpretations to clinicians are threshold steps toward minimizing this risk. This study investigates policies and practices associated with the communication and documentation of preliminary and final radiologic interpretations among U.S. academic radiology departments through a questionnaire directed at radiology department chairs.

Dysphagia testing and aspiration status in medically stable infants requiring mechanical ventilation via tracheotomy.

OBJECTIVE: To perform objective testing to determine aspiration status with the goal of initiating safe and timely oral alimentation in medically stable infants who require mechanical ventilation via tracheotomy. Medically compromised infants who require mechanical ventilation via tracheotomy and are nil by mouth are conventionally deemed as being at risk for aspiration and feeding difficulties. There is little information available in the literature regarding diagnostic testing and habilitation intervention to promote safe and timely initiation of oral alimentation when these infants are medically stable. DESIGN: Prospective, consecutive, referral-based sample. SETTING: Newborn, pediatric, and respiratory intensive care units in an urban, tertiary care, teaching hospital. PATIENTS: Fourteen consecutive medically stable but mechanically ventilated infants (mean chronological age, 8.1 mos, range, 3-14 mos; mean gestational age, 28.4 wks, range, 24-39 wks) referred for swallow evaluation between April 2003 and May 2008. INTERVENTIONS: Videofluoroscopic and fiberoptic endoscopic evluations of swallowing. MEASUREMENTS AND MAIN RESULTS: Aspiration status was determined by objective testing with videofluoroscopic and fiberoptic endoscopic evaluations of swallowing. Aspiration was defined as evidence of food material in the airway below the level of the true vocal folds. Eight infants exhibited a coordinated suck-swallow reflex, and six infants exhibited an oral dysphagia characterized by a weak, inconsistent, or absent suck. Nonetheless, 13 of 14 (93%) infants demonstrated a successful pharyngeal swallow with no evidence of aspiration and were started successfully on an oral diet. CONCLUSIONS: Objective dysphagia testing is recommended for medically stable infants who are ventilator dependent via a tracheotomy. The prevalence of aspiration in this group is low and a negative examination can promote safe and timely oral alimentation.

Simple multicystic dysplastic kidney disease: end points for subspecialty follow-up.

Simple multicystic dysplastic kidney (MCDK) disease, defined as unilateral MCDK without other genitourinary tract involvement, portends an excellent prognosis. Nevertheless, its long-term management remains undefined. This study aims to provide subspecialty discharge recommendations for these patients. We identified eighty patients with simple MCDK disease by renal ultrasound between 1996 and 2006. Their charts were reviewed for growth of the contralateral kidney, involution of the MCDK, and incidence of complications, specifically hypertension, chronic renal insufficiency (CRI), urinary tract infection (UTI), and malignancy. Mean follow-up was 5 years. At approximately 1 year, 59% of unaffected kidneys were hypertrophied (>or=95th percentile for age/height) and 100% were >50th percentile. With continued follow-up, 80.3% of unaffected kidneys were hypertrophied. Likewise, at 1 year, 71.2% of MCDKs assessed were either involuting or had disappeared; on further follow-up, this increased to 89.6%. No patient had hypertension, CRI, or malignancy. Four patients (5%) developed nonrecurrent UTIs, none leading to renal scarring or growth impairment. These data suggest that subspecialty follow-up may be discontinued once contralateral hypertrophy and ipsilateral involution occur, assuming that the patient has not experienced hypertension, CRI, or UTI. These criteria are often met by 1 year of age, which would preclude repeated visits, uncomfortable investigations, and unnecessary costs.

The appendix sign: a radiographic marker for irreducible intussusception.

PURPOSE: Radiographic reduction (hydrostatic or pneumatic) of intussusception has become the standard of care in the pediatric population with success rates of more than 80%. Identification of those patients who are likely to fail nonoperative management could lead to earlier operation, a reduction in radiation exposure, and a decreased risk for complications after repeated attempts at enema reduction. During successful radiographic reduction, the small bowel is almost always visualized before the appendix. Visualization of the appendix before visualization of the small bowel during a successful reduction of an intussusception is a rare event. We report a new radiographic sign that we have termed the appendix sign (radiographic visualization of the appendix without reflux of air or contrast into the small intestine), which we hypothesize may have association with failure of nonoperative management. METHOD: We performed a retrospective review of the last 12 years of irreducible intussusception. The associated studies were then reviewed to examine the incidence, sensitivity, and specificity of this radiographic finding. RESULTS: Ninety-one cases of intussusception were identified and had films available for review. Seventy-seven (76%) of the studies included the appropriate image. The appendix sign was visualized in 14 studies for an incidence of 18%. Of 14 patients, 10 failed enema reduction (positive predictive value, 71%). The sensitivity of the appendix sign is 43%. The specificity of the sign is 93%. CONCLUSIONS: Our experience suggests that the presence of an appendix sign is associated with failing enema reduction of an intussusception and may be useful as a marker for determining the end point for further attempts at radiographic reduction.