39 younger children, and more task-focused interaction was used with older children. 13.5. Immobilization of children in pediatric radiography Presenter: Heli Heikkilä, Finland Authors: Anja Henner, Mira Uusitalo, Heli Heikkilä Introduction: Radiographers have to utilize good communication skills especially in pediatric imaging. It is difficult to reach child’s confidence in a very short time and radiographers face many challenges every day when undertaking pediatric examinations. One of the most testing of these is that of a strong-willed uncooperative child who refuses to keep still for an examination. A successful, diagnostic examination could be described as one which achieves diagnostic quality images, without image degradation due to patient movement but should also exclude mental or physical detriment to the patient. The first and most important way to calm the child is good communication with the child and family. Radiographer must be aware of the typical features of child’s development. Child may have previous unpleasant experiences or she/ he might be afraid of pain, loss etc. When imaging newborns, radiographer needs always ancillaries to keep to baby in position although it is sad that only as a last resort should restraining techniques be used Methods: Different tools and the use of them for immobilization of small children are introduced. Tools like small metallic beads inside a fabric bag, line, ribbons and strings, tape and supporting pillows of foam rubber are used to immobilize small children. Results: Different size of fabric bags witch are filled only partly with metallic beads. The weight of the metallic beads is lying on the table, not on the child. With lines the hands are easy to keep motionless and the metallic bead bags can be used as press. Supporting pillows of foam rubber are useful e.g to keep the child’s head motionless. Wide tape is useful in hand and foot examinations. Lead aprons are useful to keep small children in position and same time they protect the child from radiation. 13.6. Advanced Paediatric Imaging: A View of the Past Ten Years Presenter: Michelle O'Connor, University College Dublin, Ireland Authors: Michelle O'Connor, John Ryan, Shane Foley Introduction: The use of advanced diagnostic imaging has increased considerably over the past two decades. Advanced imaging modalities used in paediatric radiology include; ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine (NM). Technological advances in imaging have led to a higher quality of care and reduced patient morbidity and mortality. While there are many benefits to diagnostic imaging, there are also some risks worth considering. Modalities such as CT and nuclear medicine involve ionising radiation and radioactive material. Children are at higher risk of developing radiation-induced cancers than adults because their developing tissues are more sensitive to radiation. Their likelihood of repeat examinations and longer life expectancy allow additional time for the emergence of detrimental effects. To date, initiatives such as the Image Gently campaign by the Alliance for Radiation Safety in Paediatric Imaging have been established to increase awareness of the opportunities to promote radiation protection when imaging children. In order to successfully develop further initiatives and monitor the success of existing initiatives, it is necessary to analyse the trends in diagnostic imaging over time. Longitudinal studies on the use of paediatric imaging involving radiation have been examined in Australia and the United States. Such literature in Europe is sparse and out-dated. This research investigated; 1) population-based trends in the use of advanced medical imaging in children in Ireland from 2003-2012; 2) its use across age groups and gender; and 3) the most commonly performed procedures within each specialist modality. Methods: A retrospective cohort analysis study was carried out in paediatric hospitals within Ireland (N=3). CT, MRI, NM and US annual examination data and demographic patient data from 2003-2012 was obtained from the Radiology Information Systems (RIS). Results: 224,173 imaging procedures were carried out on 84,511 patients, 68% of which were ultrasound, 15% MRI, 11% CT and 6% NM. MRI (+280%) and CT (+80%) saw the largest increases in use, followed by US (+70%) and NM (+10%). Most examinations were performed on children aged 0-3 years., with no tendency towards either sex. Imaging rates increased with age in CT and MRI. Regions most frequently imaged included the abdomen (ultrasound), head (MRI and CT), and kidneys (NM). 13.7. Doses to newborns in chest x-ray examination in PICU Presenter: Anja Henner, Oulu University of Applied Sciences, Finland Authors: Minna Tikkanen, Kirsti Matila, Anja Henner Introduction: Digital imaging gives new possibilities to post process an exposed x-ray and decrease the need for retakes or extra exposures: e.g., edge enhancement to copies of neonatal chest radiographs helps to identify small pneumothoraxes and vascular catheters and gives increased contrast and the possibility to transfer images quickly via teleradiology to a specialized pediatric radiologist. Routine daily chest radiographs may give new information to the pediatricians in 50% of the cases of very low birth weight infants. The most common examinations are chest or chest and abdomen. The risk from one neonatal radiograph is low. However, the benefit versus risk of each radiograph is important and must be checked carefully. Radiation effects are cumulative and some children may have dozens of x-rays (even more than one hundred) and they may have also CT and nuclear medicine examinations. The smaller the newborn is the more x-rays are usually taken in follow up purposes. That is why the doses to newborns have to be followed up regularly. Materials: Doses in pediatric intensive care unit were collected and compared to doses collected in the beginning of this century. This current data was performed by Shimadzu Mobile Art Evolution system installed in 2011. Focal spot is 0.7 mm, filtration 2,5 mmAl, focus to detector distance 100 cm and babies are lying in incubator in intensive care unit. Results: Weight of the babies varied from 1,7 kg to 4,37 kg (mean 2,85 kg). Mean kVp used was 68,9kV (range from 66 kV to 72 kV) and mean mAs 0,75 (range from 0,63 mAs to 1 mAs). Mean S-value was 438,6 (range 247- 1240). DAP varied from 1 mGycm2 to 5 mGyCm2, mean 2,769 mGycm2. In the former data with CR system mean DAP was 3,5 mGycm2 (range 1,8 mGycm2-6,3 mGycm2). This data shows that the doses in PICU can be optimized and it is possible to decrease doses with DR compared to CR system. The radiation field size was not documented in this latter data but it seems that the DAP is lightly correlating on patient’s size. The scale of Svalue is varying widely. Pediatric radiologists have reported images and the image quality is good enough for diagnosis in all cases. More important is the image quality according the indication can looking only the given recommendation of exposure index (in chest in x-ray examination S-value from 200 to 600). The children may receive many xray examinations already as newborns, which is why dose optimization must be performed every time when using radiation. The total radiation dose should be followed up and recorded but that is not yet in use. 13.8. Agreement In Neonatal X-ray Interpretation: A Comparison Between Consultant Paediatric Radiologists And A Reporting Radiographer Presenter: Nick Woznitza, Homerton University Hospital & Canterbury Christ Church University, UK Authors: N Woznitza, K Piper, N Aladangady, K Iliadis, R Prakash & R Santos Introduction: X-rays are frequently used by clinicians to aid in patient diagnosis and management; infants which require specialised neonatal care are no exception. Accurate and prompt x-ray interpretation is of fundamental importance; however significant observer variation is reported in the literature. Increasing workloads in developed nations and limited specialized radiology resources in the developing world can act as barriers to the availability of a radiology report. In the United Kingdom, radiographer reporting is often used as a solution to manage radiology workload while maintaining a patient focused service. In order to influence patient care the radiology report needs to aid the clinician in arriving at an accurate diagnosis. A paucity of recent evidence exists in the literature related to this aspect of x-ray interpretation, particularly for radiographer produced x-ray reports. The paediatric literature reveals a small evidence base; the majority of studies examine agreement between radiologists and paediatricians in the interpretation and diagnosis of pneumonia in children. There is little research evidence which examines agreement in neonatal x-ray interpretation. Previous studies have examined pathology scoring systems rather than clinical reports produced in routine practice. Royal College of Radiologists and College of Radiographers guidance states that radiographers who interpret images must perform at a level comparable to radiologists; this hypothesis will be tested. If radiographers are trained to interpret neonatal x-rays and do so to a standard comparable to radiologists, they could provide additional reporting resource across healthcare settings worldwide.
ISRRT | Book Of Abstracts
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