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Pedriatic radiology

Pediatric techniques

 

Children are imaged with the same radiographic equipment as adults. Clinical exposure times require a modem multipulse generator. Conventional radiographic examinations (plain films, fluoroscopy) still comprise 80-85 % of all pediatric studies; the remainder is made up of ultrasound (8-12%), CT (3-5%), MRI (2-4%), nuclear medicine (2-4 %) and vascular/interventional procedures (0.5-1 %).

Angiographic examination of children has limited indications; most studies are for diagnosis and potential interventional therapy of cardiac and vascular malformations. Computed tomography (C T) is used to investigate neurologic disease, pediatric oncologic abnormalities, and acute cerebral or abdominal trauma. Magnetic resonance imaging (MRI) is used to investigate neurological abnormalities, pediatric oncologic disease, cardiovascular abnormalities, and complex musculoskeletal disease.

Special emphasis is given to reduction of radiation dose in radiologic examinations of children. Indications for examination must be well founded. Radiation protection is critical; lead shielding of the gonads is used whenever possible. The fundamental principle is that radiation of the pediatric patient should be minimized. Exposure is reduced by selecting studies based on a detailed history, performing only indicated studies, using non-ionizing radiation examinations (sonography, MRI) whenever possible, limiting the radiation dose of an examination, and shielding the gonads when feasible.

Examination of the gastrointestinal tract, kidneys, and liver in children up to 3 months of age requires no preparation. In older children, the same preparations should be used as for adults.

Conventional radiographic examinations and ultrasound (US) are performed without sedation or general anesthesia. Nuclear medicine (NM), CT, and MRI usually require sedation or general anesthesia in children below 7 years of age. However, even 3-year-old children who are

/upload/book of radiology/chapter15/nic_k15_655.jpg Figure 1.
Normal chest radiograph. 1-year-old male with cough. The heart, mediastinum and lungs are normal

cooperative and have had previous, non-painful radiologic examinations can sometimes be examined by these modalities without sedation. lnterventional procedures, which are frequently painful, should always be performed with heavy sedation or general anesthesia. It is frequently helpful to allow parents to be present during radiological examinations, if they wish. However, parents should not be permitted in the angiographic suite during complex diagnostic and interventional procedures.

 

Donald R. Kirks and Sven Laurin