The CT scout view: does it need to be routinely reviewed as part of the CT interpretation?

OBJECTIVE: The objective of our study was to determine whether the CT scout view should be routinely reviewed by comparing diagnostic information on the scout view with that provided by the correlative CT study. MATERIALS AND METHODS: Two radiologists blinded to history and CT findings reviewed retrospectively 2032 scout views. All cases with major findings (defined as any abnormality that would prompt additional diagnostic tests or require management) were correlated with the CT study, other imaging study, or medical record when necessary by a third radiologist to determine the validity of the scout view finding and whether the finding was identifiable on the current CT study. RESULTS: Major findings were identified in 257 (13%, reader 1) and 436 (23%, reader 2) of cases. Most major findings were confirmed (69-78%) or refuted (13-16%) by the CT study. However, 15 (6%, reader 1) and 48 (11%, reader 2) of the major findings were not included in the CT FOV, of which five (2%, reader 1) and 21 (5%, reader 2) constituted a missed pathologic finding. The most common one was cardiomegaly detected on a nonchest CT scout view. Additional pathologic findings included fracture, metastasis, avascular necrosis or subluxation of the humeral head, dilated bowel, and thoracic aortic dilatation. The most common false-positive finding was cardiomegaly. CONCLUSION: In a small percentage of cases, review of the CT scout view will disclose significant pathologic findings not included in the CT FOV. The results of this study support the routine inspection of the scout view, especially for the detection of pathologic findings in anatomic regions not imaged by CT.

The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams.

The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam's indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.

Radiation safety for the speech-language pathologist.

It is the responsibility of the medical Speech-Language Pathologist (SLP) who performs video-assisted fluoroscopy of swallowing (VFSS) to be aware of guidelines, recommendations, and preventive measures to reduce radiation to oneself and the patient. Established parameters to reduce radiation during videofluoroscopy include keeping the exposure time brief, using lead aprons and other shielding, and maximizing the distance from the source of radiation. The purpose of this study was to measure radiation exposure to SLPs in the clinical setting and to provide practical recommendations to keep radiation exposure as low as reasonably achievable. Our study measured radiation exposure to six SLPs practicing in an acute-care university hospital. We monitored the radiation received during 130 examinations, 102 of which were of the pharynx only and the other 28 included pharynx and intrathoracic viscera. Individual times were documented, and average doses per exam were calculated from dosimetry badges worn on the lead apron of the SLP doing inpatient exams. Average fluoroscopy time per procedure was 165 s. Average radiation to the dosimeter worn on the front of the lead apron at chest level was 0.15 mR (0.0015 mGy) per procedure. SLPs stood behind the lead shield during fluoroscopy when feasible. Our measurements document the practical importance of reducing radiation exposure to health-care personnel by increasing the distance from the source of radiation and by shielding. While recommendations are not new, details of the findings may help guide and reinforce good radiation safety practice.

A case-control comparison of lingual tonsillar size in children with and without Down syndrome.

OBJECTIVES/HYPOTHESIS: Lingual tonsillar hypertrophy is a common cause of persistent obstructive sleep apnea following adenotonsillectomy in the pediatric population and may be more prevalent in patients with Down syndrome (DS). We sought to quantify lingual tonsil size in pediatric DS patients and compare these findings to those of nonsyndromic children using cervical spine (c-spine) radiographs. STUDY DESIGN: Case control study. METHODS: Retrospective review of c-spine radiographs from 105 pediatric DS patients and 89 age- and gender-matched non-DS controls was conducted. Films performed for possible airway compromise or trauma were excluded. Lingual tonsil size and narrowest lumen diameter of the nasopharynx, oropharynx, and hypopharynx were measured. RESULTS: Radiographically identifiable lingual tonsillar tissue was identified in 34% of children with DS and 30% of controls (P = .21); lingual tonsillar hypertrophy (≥10 mm) was seen in 5% and 0% respectively (P = .074). Nasopharyngeal diameter was smaller in patients with DS compared to controls (5.2 mm vs. 6.3 mm, P = .026), whereas lingual tonsil size was significantly larger in DS patients (2.1 mm vs. 0.8 mm, P = .0008). In multivariate analysis, lingual tonsil size was positively correlated with increasing age in the DS population (r = 0.38, P < .0001) but not in controls. CONCLUSIONS: Lingual tonsillar enlargement is more common in patients with DS than in controls, with an increased prevalence in older DS patients. C-spine radiographs are routinely carried out in these children and appear to be useful in identifying lingual tonsillar hypertrophy. Further trials should be carried out to compare c-spine findings and physical exam or magnetic resonance imaging to validate this method of evaluation.