Planetary health: an imperative for pediatric radiology.

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.

Changes to pediatric brain tumors in 2021 World Health Organization classification of tumors of the central nervous system.

New tumor types are continuously being described with advances in molecular testing and genomic analysis resulting in better prognostics, new targeted therapy options and improved patient outcomes. As a result of these advances, pathological classification of tumors is periodically updated with new editions of the World Health Organization (WHO) Classification of Tumors books. In 2021, WHO Classification of Tumors of the Central Nervous System, 5th edition (CNS5), was published with major changes in pediatric brain tumors officially recognized including pediatric gliomas being separated from adult gliomas, ependymomas being categorized based on anatomical compartment and many new tumor types, most of them seen in children. Additional general changes, such as tumor grading now being done within tumor types rather than across entities and changes in definition of glioblastoma, are also relevant to pediatric neuro-oncology practice. The purpose of this manuscript is to highlight the major changes in pediatric brain tumors in CNS5 most relevant to radiologists. Additionally, brief descriptions of newly recognized entities will be presented with a focus on imaging findings.

Gadolinium retention: should pediatric radiologists be concerned, and how to frame conversations with families.

Gadolinium retention in the brain and other organs has recently been identified by imaging and confirmed histologically. No direct clinical effects of gadolinium retention, which occurs after gadolinium-based contrast agent (GBCA) administration for MRI, have been scientifically accepted at this time. However, there is understandable concern among medical professionals and the public about the potential effects of gadolinium retention, particularly in the brain. Part of this concern might stem from the identification of nephrogenic systemic fibrosis caused by GBCAs in people with severe renal failure in 2006. This article briefly describes the characteristics of GBCAs; reviews and differentiates gadolinium retention, nephrogenic systemic fibrosis, and "gadolinium deposition disease" or "gadolinium toxicity"; and discusses societal guidelines and current usage in children. With the belief that GBCAs should not be withheld for appropriate indications in the absence of evidence of its potential risks, we offer a framework for determining when GBCA use is appropriate and suggestions for discussing its risks and benefits with children and their families.

The Effects of Race, Primary Language, Insurance and Other Factors on Time to Pediatric Outpatient MRI Completion: A Retrospective Cohort Study.

RATIONALE AND OBJECTIVES: Disparities in healthcare access in the United States have been associated with race and ethnicity, as well as socioeconomic factors. Because delays in imaging may result in delayed diagnosis or clinical management, we are evaluating practices within our radiology department in hopes of decreasing disparities in access to imaging. The objective of this study is to determine the disparities in time to outpatient MRI scheduling and completion by race, ethnicity, primary language, socioeconomic status, insurance and other factors at a tertiary children's hospital. METHODS: After Institutional Review Board approval, we retrospectively extracted data from all outpatient MRI exams completed at our center between 10/5/2020 and 8/31/2022. Collected data included sex, age, race/ethnicity, primary language, medical complexity, insurance type, address, need for anesthesia, ordering specialty, and order acuity. We determined times to MRI scheduling or completion using mixed effects Cox regression models and determined associations between unadjusted and fully adjusted models. RESULTS: We analyzed 14,002 completed outpatient MRI orders from 9714 unique patients. 56.2% were White, 19.2% Hispanic, 8.4% Asian, 4.5% Black/African-American, 1.4% American Indian/Alaska Native, 0.7% Native Hawaiian/Pacific Islander, 5.7% two or more races/ethnicities, and 3.8% "Other." In fully adjusted models, there was no significant association between race/ethnicity and time to MRI scheduling and completion. In fully adjusted models, time to completion of MRI was slower among those with Medicaid (adjusted hazard ratio [95% confidence interval] of 0.92 [0.87, 0.98]), a primary language other than English (0.90 [0.82, 0.99]), non-complex chronic illness (0.72 [0.67, 0.79]), complex chronic illness (0.72 [0.67, 0.78]) and need for anesthesia (0.75 [0.71, 0.79]). CONCLUSION: At our tertiary children's hospital, time to completion of outpatient MRI was not associated with race, but was greater among those with Medicaid insurance, whose primary language was not English, and needing anesthesia. Advocating for faster prior authorization by Medicaid, utilizing our hospital's live interpreter phone number for scheduling, and incorporating greater child life support to decrease anesthesia use are considerations for decreasing these disparities, although surveying patients and families most impacted by these discrepancies will be important to identify the most promising interventions. DATA AVAILABILITY STATEMENT: Data are not publicly available to preserve individuals' privacy due to IRB restrictions. Data may be available upon reasonable request by contacting the corresponding author.