Pediatric Radiography: Chapter 16

Question 1

what are the two most importatnt factors in pediatric radiography?

Answer 1

uccessfully completing pediatric radiographic studies starts with room preparation

• remove potential hazards, setting the technical components, and having immobilization devices available.

and the technologist’s attitude toward children

• background
• ​inability to follow instructions.
• the pediatric patient might be scared, confused, hurting, or a combination of all three.
• ​​ need to be handled with care and understanding
• taking the necessary time to talk to and build a rapport with the child.
• Explaining instructions to children in a way that they can understand is extremely important in developing trust and cooperation
• Age of Understanding and Cooperation varies from child to child
• a sense of trust, which begins at the first meeting between the patient and the technologist; the first impression that the child has of the technologist is everlasting and forges the bond of a successful relationship

Question 2

what should be considered in the first meeting with the pediatric patients

Answer 2

Introduction of Technologist

• • Introduce yourself as the technologist who will be working with the child
• Find out what information the attending physician has given to the parent and patient
• Explain what you are going to do and what your needs will be
• The technologist must try to build an atmosphere of trust in the waiting room before the patient is taken into the radiography room; this includes discussing the necessity of immobilization as a last resort if the child cannot cooperate

Evaluation of Parent’s Role

• The first meeting is also the time to evaluate the role of the parent or caregiver.
• 1.Parent is in room as an observer, lending support and comfort by his or her presence. 2. Parent actively participates, assisting with immobilization. 3. Parent is asked to remain in the waiting area and not accompany the child into the radiography room.
• This explanation includes instructions to the parent on correct immobilization techniques. Parental cooperation and effectiveness in assisting tend to increase with understanding how proper but firm immobilization improves the diagnostic quality of the image and reduces radiation exposure to the patient by reducing the chance of repeats
• if not –soliciting the help from another technologist or using immobilization devices is the next best option

Question 3

Pediatric patients generally include ———–through children up to ages ———–

Answer 3

infants

12 to 14.

Question 4

what is recomended to be used in case of pedriatric radiography, when it comes to toddlers and infants?

Answer 4

always use as short exposure times and as high mA as possible to minimize image blurring that may result from patient motion

Question 5

name some imobilization devices used in pediatric radiography

Answer 5

Examples of pediatric immobilizers are the Tam-em board, Pigg-O-Stat, Posi-Tot, and Papoose Boar

Question 6

what is pig on stat

Answer 6

The Pigg-O-Stat (Fig. 16.3A) is a commonly used immobilization apparatus for erect chest and abdomen procedures on infants and small children up to approximately age 5 years. The infant or child is placed on the small bicycle-type seat with the legs placed down through the opening. This seat is adjustable in height. Thearms are raised above the head, and the two clear plastic body clamps are adjusted firmly against each side of the body to prevent movement

Question 7

name som demobilization aid used in pediatric radiography

Question 8

describe Mummifying technique used to demobolize pediatric patients

Answer 8

Wrapping With Sheets or Towels (“Mummifying”) Using sheets or towels in “mummifying” or wrapping may be necessary to immobilize infants and some children up to 2 to 3 years old for certain radiographic procedures

Step 1. Place the sheet on the table folded in half or in thirds lengthwise, depending on the size of the patient.

Step 2. Place the patient in the middle of the sheet; place the patient’s right arm beside his or her body. Take the end of the sheet closest to the technologist and pull the sheet across the patient’s body tightly, keeping the arm next to the patient’s body.

Step 3. Place the patient’s left arm beside his or her body on top of the top sheet. Bring the free sheet over the left arm to the right side of the patient’s body and around under the body as needed.

Step 4. Complete the wrapping process by pulling the sheet tightly enough so that the patient cannot free the arms.

Question 9

explain the ossification factor in pediatric radiography ?

Answer 9

Bone Development

The bones of infants and small children go through various growth changes from birth through adolescence. The pelvis is an example of ossification changes that are apparent in children. As shown in Fig. 16.9, the divisions of the hip bone between the ilium, the ischium, and the pubis are evident. They appear as individual bones separated by a joint space, which is the cartilaginous growth region in the area of the acetabulum.

The heads of the femora also appear to be separated by a joint space that should not be confused with fracture sites or other abnormalities. These are normal cartilaginous growth regions

Question 10

what is epiphysis adn diaphysis?

Answer 10

Most primary centers of bone formation or ossification, such as centers involving the midshaft area of long bones, appear before birth. These primary centers become the diaphysis (shaft or body) (D) of long bones (Figs. 16.10 and 16.11). Each secondary center of ossification involves the ends of long bones and is termed an epiphysis (E). These centers of ossification are demonstrated on a PA radiograph of the hand of a 9-year-old in Fig. 16.10 and an anteroposterior (AP) radiograph of the lower limb of a 1-year-old in Fig. 16.11. Note the epiphyses at the ends of the radius and ulna and the metacarpals and phalanges (see small arrows)-

he epiphyses are the parts of bones that increase in size and appearance as a child grows, as is shown on the growth comparison radiographs (Figs. 16.12 to 16.15). These four knee radiographs show the changes in size and shape of the epiphyses of the distal femur and proximal tibia and fibula from age 3 years to age 12 years. At age 3 years, the epiphysis of the fibula is not yet visible, but by 12 years of age, it becomes obvious (see arrows). The size and shape of the larger epiphysis of the proximal tibia and distal femur also change dramatically from age 3 to age 12, as is evident on these knee radiographs

Question 11

what is metaphysis and epiphyseal plate ?

Answer 11

At the ends of the diaphysis are the metaphysis (M). The metaphysis is the area where bone growth in length occurs. The space between the metaphysis and the epiphysis is made up of cartilage known as the epiphyseal plate (EP). Epiphyseal plates are found until skeletal growth is complete on full maturity, which normally occurs at about 25 years of age

Question 12

at what age skeletal growth fully completes?

Answer 12

25

Question 13

what is ossification as factor in pediatric radiography

Answer 13

Technologists need to be familiar with bone development in infants and children and should recognize the appearance of these normal growth stages

Question 14

what is the other synonomous word used to refer to child abuse?

Answer 14

A radiographer is likely to be exposed to nonaccidental trauma of children, more commonly referred to as child abuse.

Question 15

at which age ranges child abuse range is the highest?

Answer 15

Most reported abuse occurs in children younger than 3 years old, with the highest victimization rates in those younger than 1 year old

Question 16

what are the duties of a radiagraphy technologist?

Answer 16

Radiology is an important tool in the diagnosis of child abuse cases. Technologists should have an understanding of the laws surrounding the reporting of child abuse in their specific location. Although the technologist may not initiate the reporting process, he or she is an important component. The technologist’s primary role is to obtain quality images and communicate effectively with the radiologist. Part of this communication involves obtaining a thorough history from the parents or guardians. If the mechanism of the pathology seen does not correlate with the history given, a stronger case for child abuse can be made

Question 17

what are the six types of chil abuse seen in pediatric radiography?

Answer 17

Classification Child abuse can be classified into six major types: 1. Neglect 2. Physical abuse 3. Sexual abuse 4. Psychological maltreatment 5. Medical neglect 6. Other2

Question 18

what does CML stand for?

what is ment by CML?

Answer 18

specific fractures have a high indication for child abuse, and the classic metaphyseal lesion (CML) is one such fracture. The CML is a fracture along the metaphysis that results in a tearing or avulsion of the metaphysis

Question 19

what are the other names for CML?

Answer 19

Other names for the CML include corner fracture (Fig. 16.16A) and bucket-handle fracture (Fig. 16.16B)

Question 20

what are the radiographic signs or indications for CML

Answer 20

based on their appearance and location. The CML will appear radiographically as a crescent-shaped osseous density adjacent to the avulsion fragment (arrows). The CML is caused by forces exerted on the metaphysis, such as pulling on an extremity or from holding a child around the thorax and shaking violently as seen in shaken baby syndrome

Question 21

name radiographic indication of child abuse?

Answer 21

1. the classic metaphyseal lesion (CML)
2. rib fracture
3. healing fractures

Question 22

what is rib fracture and in what ways is it a radiographic indication of child abuse?

Answer 22

Rib fractures, especially multiple and posterior, are a strong indicator of child abuse. The common mechanism for this is through shaken baby syndrome. When a child is held under the axillae and shaken, the amount of force exerted in the anterior to posterior direction is enough to fracture multiple ribs. This squeezing of the thorax allows for fractures at the costovertebral and costotransverse articulations. Additionally, squeezing can fracture the scapula and spinous process posteriorly and the sternum anteriorly, also strong indicators for child abuse.

Question 23

how does healing fractures can be a trace of child abuse?

Answer 23

The presence of multiple fractures in various stages of healing can also raise suspicion for child abuse. However, a thorough history may reveal these fractures to be pathologic in nature, such as fractures seen in osteogenesis imperfecta.

Question 24

what is the accepted method in imaging a child for suspected child abuse?

Answer 24

The accepted method in imaging a child for suspected child abuse is with the skeletal survey. The skeletal survey consists of the following:

• AP skull
• Lateral skull (to include c-spine)
• AP chest
• Lateral chest
• Right and left oblique thorax to include ribs
• AP abdomen to include pelvis
• Lateral lumbar spine
• AP humeri
• AP forearms
• PA hands
• AP femurs
• AP lower legs
• AP feet

The skeletal survey can assist in determining normal variants or disease versus child abuse. The technologist should obtain the best images possible while maintaining the ALARA (as low as reasonably achievable) principle owing to the number of exposures required.

Question 25

what is babygram method?

Answer 25

A technique known as the “babygram,” where a child is placed on the IR and the collimators opened to image as much as possible, is not an acceptable method.

Question 26

what are the alternative imaging modalities that can be used in imaging a child forsuspected child abuse?

Answer 26

Alternative Imaging Modalities

1. Computed tomography (CT) is very useful in the diagnosis of child abuse. The advantages of CT include the visualization of visceral damage, especially within the abdomen and head, and skeletal fractures. CT is a valuable tool in the diagnosis of brain injuries associated with child abuse, specifically injuries resulting from shaken baby syndrome. Because of the violent anterior and posterior shaking and lack of head support, the brain can strike the cranium both anteriorly and posteriorly, which can cause contusions (concussion) or hemorrhaging such as subdural hematomas. With the advent of multiple-slice helical scanners, detail has improved, but care must be taken to reduce the radiation dose. Pediatric-specific protocols should always be used.
2. MRI (magnetic resonance imaging) can assist in assessing soft tissue and central nervous system damage. However, because of the length of time required and the necessity for a child to remain motionless, MRI is not generally the modality of choice on the initial assessment.
3. Sonography is beneficial in imaging visceral damage such as hemorrhage and certain skeletal damage. A benefit of sonography is that ionizing radiation is not needed to obtain the images.
4. Nuclear Medicine is useful in assessing the healing bone. In cases of multiple fractures, some may be radiographically occult. Nuclear medicine can visualize the bone in its various stages of healing. Nuclear medicine is often used in conjunction with the skeletal survey if multiple fractures are found.

Question 27

what is Image Gently campaign ?

Answer 27

With the advent of digital imaging, a heightened concern for increased radiation dose to pediatric patients has emerged. In 2007, the Society for Pediatric Radiology collaborated with the American College of Radiology, American Society of Radiologic Technologists, and the American Association of Physicists in Medicine to begin a campaign to raise awareness of increased pediatric dose rate among imaging professionals and with the public. From that first meeting, the Image Gently campaign was launched. The campaign has examined dose rate in radiographic, fluoroscopic, and interventional imaging in addition to CT and has written protocols to reduce exposure during examinations. In radiography,

• eliminating the use of a grid on patient thickness less than 10 cm
• collimating to the field size of the part of interest
• increasing kV to decrease mAs (exposure)
• being consciously aware of the relationship of patient thickness, technique, and exposure value lead to reduction of dose for more radiosensitive pediatric patients. There is a wealth of information on pediatric imaging dose and suggestions for reducing exposure at the Image Gently website (www.imagegently.org)

Question 28

what consideration needs to be taken in order to minimize exposure dose in pediatric radiography?

Answer 28

• Reduction of repeat exposures
• avoiding “dose creep” are critical in pediatric imaging.

1. to reduce the incidence of motion artifact (blurriness)
   
   • Proper immobilization
   • high mA–short exposure time techniques
2. Accurate manual technique charts with patient body weights should be available.
3. Radiographic grids should be used only when the body part examined is more than 10 cm in thickness.
4. Each radiology department should keep a list of specific routines for pediatric imaging examinations, including specialized views and limited examination series, to ensure that appropriate projections are obtained and no unnecessary exposures are made

Question 29

what are the quidlines in pediatric radiography for use of gonadal protection?

Answer 29

Gonads of a child should always be shielded with contact-type shields, unless such shields obscure the essential anatomy of the lower abdomen or pelvic area

Question 30

how can radiography technologist releave parents fear when parents are concerned with the side effects and hazard of radiations?

Answer 30

Because parents often request shielding for their child’s gonads, they should be made aware of other safeguards used for radiation protection, such as close collimation, low dosage techniques, and a minimum number of exposures. To relieve parents’ fears, the technologist should explain in simple language the practice of radiation protection and the rationale behind it

Question 31

what guidlines and consideration is suggested in order to protect parents?

Answer 31

if parents are to be in the room,

• they must be supplied with lead aprons.
• If they are immobilizing the child and their hands are in or near the primary beam, they should also be given lead gloves
• If the mother or other female guardian is of child bearing age and wishes to assist in the procedure, the technologist must ask whether she is pregnant before allowing her to remain in the room during the radiographic exposure. If she is pregnant, she should not be allowed in the room and must stay in the waiting area.

Question 32

what Pre-Examination Preparation needs to be performed when a pediatric patient is to be imaged?

Answer 32

Pre-Examination Preparation

1. room preprations:
   
   • The necessary immobilization and shielding paraphernalia should be in place.
   • IRs and markers should be in place,
   • techniques should be set.
   • Specific projections should have been determined, which may require consultation with the radiologist.
   • If two technologists are working together, the responsibilities of each technologist during the procedure should be clarified.
     
     • The assisting technologist can set techniques, make exposures, and process the images. The primary technologist can position the patient; instruct the parents (if assisting); and position the tube, collimation, and required shielding.
2. Child Preparation
   
   • After the child is brought into the room and the procedure is explained to the child’s and parent’s satisfaction, the parent or technologist must remove any clothing, bandages, or diapers from the body parts to be radiographed. Removal of these items is necessary to prevent the items from casting shadows and creating artifacts on the radiographic image because of low exposure factors used for the patient’s small size.

Question 33

what are Digital Imaging Considerations guidlines when imaging infants or young children?

Answer 33

1. Collimation:
   
   • Four-sided collimation is important to ensure that the final image after processing is of optimal quality. Collimation also is required for accurate reading of the imaging plate or exposed field size.
2. Accurate centering:
   
   • Because of the way the image plate reader scans the exposed imaging plate in computed radiography, it is important that the body part and the central ray (CR) be accurately centered to the IR.
3. Exposure factors:
   
   • The ALARA principle must be followed, and the lowest exposure factors required to obtain a diagnostic image must be used.
   • For children, this also means that kV ranges recommended for the age and size of the patient should be used,
   • along with as high mA and short exposure times as possible to minimize the chance of motion artifact (blurriness).
   • Lower mAs values can produce quantum mottle when a higher kV is set
4. Post-processing evaluation of exposure indicator:
   
   • ​​After the image is processed and ready for viewing, it must be checked for an acceptable relative exposure indicator, to verify that
     
     • the exposure factors used were in the correct range and to ensure
     • an image of optimal quality with the least possible radiation dose to the patient.
5. Grid use:
   
   • If using direct digital imaging (digital radiography) receptors, the grid should be removed for body parts smaller than 10 cm.
   • Chest and abdomen images on smaller patients can be visualized appropriately without a grid; this reduces the exposure considerably

Question 34

when is CT a suitable imaging modaliting in pediatric radiography?

Answer 34

CT is used to produce cross-sectional images of body parts when:

• slight differences in soft tissue densities must be demonstrated.
  
  • Examples include CT scans of the head, which can visualize various soft tissue pathologies such as blood clots, cerebral edema, and neoplastic processes.
  • Chest pathology such as parenchymal lung disease can be demonstrated with high-resolution CT and the use of thin sections.
  • Renal CT scans have largely replaced intravenous urography studies in diagnostic radiography.
  • Helical CT permits faster scanning without respiratory motion. This is especially advantageous for radiography of the chest in pediatric patients, for whom holding their breath for multiple-level scans becomes a problem.
  • Helical CT allows for three-dimensional reconstruction of images, which is useful for demonstrating vascular lesions without introducing contrast media (noninvasive); this provides a significant advantage with pediatric patients.

Question 35

what are recommended consideration for Reducing Pediatric Dose During CT when imaging a pediatric patient ?

Answer 35

Reducing Pediatric Dose During CT

Although the benefits of properly performed CT examinations almost always outweigh the risks for an individual child, unnecessary exposure is associated with unnecessary risk. Minimizing radiation exposure from pediatric CT, whenever possible, is always desirable. Image Gently provides examples of CT protocols that can be used to reduce pediatric dose at http://imagegently.org/Procedures/ComputedTomography.aspx.

It is important that the CT technologist remember the following in regard to pediatric scanning:

1. Perform only necessary CT examinations:
   
   1. When appropriate, use other modalities such as ultrasound or magnetic resonance imaging.
2. Adjust exposure parameters for pediatric CT based on:
   
   1. ​​Child size:
      
      • Guidelines based on individual size/weight parameters should be used.
   2. Region scanned:
      
      • The region of the body scanned should be limited to the smallest necessary area.
   3. Organ system scanned:
      
      • Lower mA and/or kVp should be considered for skeletal or lung imaging, and some CT angiographic and follow-up examinations.
3. Scan resolution:
   
   • The highest quality images (i.e., those that require the most radiation) are not always required to make diagnoses

Question 36

what are the application of sonography in pediatric radiography and what are its benefits in coparison with other modalities?

Answer 36

Sonography

1. A major advantage of sonography or ultrasound for pediatric patients is
   
   • the lack of ionizing radiation exposure; this is especially important for children and pregnant women.
2. The role of ultrasound in pediatric radiology includes
   
   • assisting in neurosurgical procedures, such as
     
     • shunt tube placement or
     • examination of intracranial structures on infants with open fontanels.
   • Sonography is used to diagnose:
     
     • congenital hip dislocation in newborns and young infants.
     • It is effective in diagnosing pyloric stenosis, which frequently can eliminate the need for an upper gastrointestinal (GI) study. It is used on children with sickle cell anemia to image the major blood vessels and to check for signs of vascular spasm that may indicate an impending cerebrovascular accident.
     • A newer form of sonography is three-dimensional fetal ultrasound, which facilitates earlier diagnosis of potential genetic abnormalities by allowing better visualization of soft tissue, such as facial and head features and shapes

Question 37

what is main disadvantage MRI for imaging pediatric patients?

how this can be tackled?

Answer 37

Longer examination times compared with CT are a major disadvantage of MRI for pediatric use, and sedation is commonly recommended.

Question 38

how can we deal the long examination time in MRI whn imaging a pediatric patient?

Answer 38

1. sedation
2. newer rapid imaging techniques, such as
   
   • echo planar imaging,
     
     • a very fast MRI technique, allow for thoracic and cardiac evaluations in which breath holding and vascular motion are a problem, especially with infants and young children.
   • MRI is an effective tool for evaluating and staging tumors. It is also used when new onset of pediatric seizures occurs.
3. Functional MRI is used along with clinical evaluation to study and diagnose functional brain diseases and disorders.
   
   • For adults, these include
     
     • Alzheimer’s disease
     • Parkinson’s disease.
   • In children, these include
     
     • disorders that affect how young children can function at home or in school, such as
       
       • attention-deficit/hyperactivity disorder,
       • Tourette’s syndrome (multiple motor tics),
       • autism (compulsive and ritualistic behavior).

Question 39

what applications can nuclear medisin have in pediatric imaging

Answer 39

Nuclear medicine procedures can be used for various organ function studies. In addition, nuclear medicine can be used to identify radiographically occult fractures and fractures in various stages of healing.

Question 40

why should technologists be familiar with certain pathologies that are unique to newborns (neonates) and young children?

Answer 40

Technologists should be familiar with certain pathologies that are unique to newborns (neonates) and young children.

1. Pediatric patients cannot describe their symptoms,
2. optimal procedures or projections should be performed correctly the first time without repeats.
3. Being familiar with pathologic indications, as noted on patient records,
   
   • provides the technologist with information that can suggest how the patient should be handled and what precautions should be taken.
   • This information is also important for deciding what technique adjustments are needed for images of optimum quality and for ensuring that the correct procedures or projections are performed

Question 41

what are the most common Clinical Indications: Pediatric Chest

Answer 41

1. Aspiration (mechanical obstruction)
   
   • ​​AP and lateral chest
   • AP and lateral upper airway for obstruction
2. ​Asthma
   
   • ​PA and lateral chest
3. ​Croup (viral infection)
   
   • ​PA and lateral chest and AP and lateral upper airway
4. ​Cystic fibrosis (may develop meconium ileus)
   
   • PA and lateral chest
5. Epiglottitis (acute respiratory obstruction)
   
   • AP and lateral chest and lateral upper airway
6. ​Hyaline membrane disease or respiratory distress syndrome (primarily in premature infants)
   
   • PA and lateral chest
7. Meconium aspiration syndrome (newborns)
   
   • ​AP and lateral chest (possible pneumothorax)

Question 42

what are the most common Clinical Indications for Pediatric Skeletal System

Answer 42

1. Craniostenosis (craniosynostosis)
   
   • ​​AP and lateral skull
2. Developmental dysplasia of hip or congenital dislocation of hip
   
   • Sonography, AP hip
3. Idiopathic juvenile osteoporosis
   
   • ​​Bone survey study or AP of bilateral upper or lower limbs (−) slight decrease
4. Osteochondrodysplasia Achondroplasia
   
   • ​​Bone survey study of long bones ​
5. Osteochondrosis Kohler’s Legg-Calvé-Perthes Osgood-Schlatter Scheuermann’s
   
   • AP (possible oblique) and lateral projections of affected limbs
   • Navicular (foot) Hip
   • Tibia (proximal)
   • Spine (kyphosis)
6. ​Osteogenesis imperfecta
   
   • ​​Bone survey, including AP and lateral skull (−), significant decrease, up to 50%
7. ​Infantile osteomalacia (rickets)
   
   • ​​AP lower limbs (−) moderate decrease, depending on severity and age
8. ​Salter-Harris fractures
   
   • ​​AP (possible oblique) and lateral projections of affected limbs
9. Spina bifida Meningocele Myelomeningocele Spina bifida occulta
   
   • ​​Prenatal sonography, PA and lateral spine, and CT or MRI of affected region
10. Talipes (clubfoot)
    
    • AP and lateral foot (Kite method)

Question 43

what are the most common Clinical Indications for Pediatric Abdomen

Answer 43

1. Atresias (clausura)
   
   • ​​AP abdomen or GI series, or both
2. ​Hematuria
   
   • ​​Sonography
3. ​Hirschsprung’s disease (congenital megacolon)
   
   • ​​AP abdomen or GI series (frequently requires a colostomy), or both
4. Intestinal obstruction
   
   • Ileus
   • Intussusception
   • Meconium ileus
   • Volvulus
     
     • Acute abdomen series and small bowel series or barium enema
5. ​​Necrotizing enterocolitis
   
   • ​​Acute abdomen series
6. ​Polycystic kidney disease
   
   • ​​​​Sonography, CT, or MRI
7. ​Pyelonephritis
   
   • ​​Sonography
8. Hypertrophic pyloric stenosis
   
   • ​​Upper GI series or ultrasound, or both
9. Tumors:
   
   • Neuroblastoma
   • Wilms’ tumor
     
     • ​Radiographic studies of affected body part, CT, sonography
10. ​​Urinary tract infection
    
    • ​VCUG
11. ​Vesicoureteral reflux
    
    • ​​VCUG or nuclear medicine

Question 44

what other complication aspiration mechanical obstruction can cause?

Answer 44

Aspiration (mechanical obstruction) is

• most common in small children when foreign objects are swallowed or aspirated into the air passages of the bronchial tree.
• The obstruction is most likely to be found in the right bronchus because of bronchus size and the angle of divergence.
• Obstruction can cause other disease processes such as atelectasis and bronchiectasis

Question 45

what are pediatric clinical indication for asthma

Answer 45

Asthma is

• most common in children
• generally is caused by
  
  • anxiety
  • allergies.
• Airways are narrowed by stimuli that do not affect the airways in normal lungs.
• _increase in the radiodensity of lung fields (low attenuation)_because
  
  • Breathing is labored,
  • increased mucus in the lungs
  • however, chest radiographs frequently appear normal

Question 46

at which age is primarily croup seen in children?

Answer 46

Croup (primarily seen in children 1 to 3 years old)

Question 47

what causes croup?

symptoms

treatment

imagin diagnosis

radiographic sign

Answer 47

Croup (khorosak)/laryngotracheobronchitis​ is caused by ​a viral infection.

It is evidenced by

• labored breathing
• a harsh dry cough that frequently (but not always) is accompanied by fever.

It is treated most commonly with antibiotics.

AP and lateral radiographs of the neck and upper airway may be requested to demonstrate characteristically smooth but tapered narrowing of the upper airway (“steeple sign”), which is most obvious on the AP projection

Question 48

what is Cystic Fibrosis

causes

symptoms

imaging diagnosis

radiographic sign

Answer 48

Cystic fibrosis is an inherited disease in which secretions of heavy mucus cause progressive “clogging” of bronchi and bronchioles,

which may be demonstrated on chest radiographs as increased radiodensities in specific lung regions.

Hyperinflation of the lung results from blocked airways.

Symptoms in the lungs generally are not obvious at birth but may develop later.

it can also blocks pancreas and bile duct

Question 49

what is epiglottitis

causes

complications

examination

Answer 49

Epiglottitis (supraglottitis)

• Bacterial infection of the epiglottis is most common in children 2 to 5 years old but may also affect adults.
• Epiglottitis is a serious condition that can rapidly become fatal (within hours of onset); it results from:
  
  • blockage of the airway caused by swelling.
• Examination:
  
  • usually must be performed in an emergency department by a specialist who is using a laryngoscope; the airway can be reopened by inserting an endotracheal tube or by performing a tracheostomy (opening through the front of the neck). A physician or other attendant should accompany the patient during any radiographic procedure to ensure that the airway remains open

Question 50

what is Hyaline membrane disease

its modern name

most common among?

causes

radiographic sign

Answer 50

Hyaline membrane disease, Now called respiratory distress syndrome, this condition still is commonly known as hyaline membrane disease in infants.

This is one of the most common indications for chest radiographs in newborns, especially premature infants.

In this emergency condition,

• the alveoli and capillaries of the lung are injured or infected, resulting in leakage of fluid and blood into the spaces between alveoli or into the alveoli themselves.
• developmental insufficiency of pulmonary surfactant production and structural immaturity in the lungs
• The normally air-filled spaces are filled with fluid, which can be detected radiographically as increased density throughout the lungs in a granular pattern

Question 51

what is Meconium aspiration syndrome

causes

complication

Answer 51

Meconium aspiration syndrome

During the birth process, the fetus under stress may pass some meconium stools into the amniotic fluid, which can be inhaled into the lungs.

Meconium aspiration may result in blockage of the airway, causing the air sacs to collapse, which may cause a lung to rupture, creating a pneumothorax or atelectasis.

Question 52

what is Craniostenosis (craniosynostosis)

Answer 52

Craniostenosis (craniosynostosis) refers to a deformity of the skull caused by premature closure of skull sutures. The type of deformity depends on which sutures are involved. The most common type involves the sagittal suture and results in AP (front to back) elongation of the skull

Question 53

Developmental dysplasia of hip

Answer 53

Developmental dysplasia of hip

In developmental dysplasia of the hip, the femoral head is separated by the acetabulum in the newborn (see Fig. 16.52). The cause of this defect is unknown; it is more common in girls, in infants born in breech (buttocks first), and in infants who have close relatives with this disorder.

Ultrasound is commonly used to confirm dysplasia in newborns. Frequent hip radiographs may be required later; gonadal shielding is important when x-rays are performed.

Question 54

what is Idiopathic juvenile osteoporosis

Answer 54

Idiopathic juvenile osteoporosis (in which bone becomes less dense and more fragile) occurs in children and young adults

Question 55

what is Osteochondrodysplasia

name two types of this disease

Answer 55

Osteochondrodysplasia refers to a group of hereditary disorders in which the bones grow abnormally, most often causing dwarfism or short stature.

• Osteochondrosis primarily affects the epiphyseal or growth plates of long bones, resulting in pain, deformity, and abnormal bone growth

1. Achondroplasia is the most common form of short-limbed dwarfism. Because this condition results in decreased bone formation in the growth plates of long bones, the upper and lower limbs usually are short with a near-normal torso length.
2. Kohler’s bone disease causes inflammation of bone and cartilage of the navicular bone of the foot. It is more common in boys, beginning at age 3 to 5 years, and rarely lasts more than 2 years

Question 56

what is Legg-Calvé-Perthes disease

Answer 56

Legg-Calvé-Perthes disease

disease leads to abnormal bone growth at the hip (head and neck of femur). It affects children 5 to 10 years old; the femoral head first appears flattened and then later appears fragmented. It usually affects only one hip and is more common in boys.

Question 57

what is Osgood-Schlatter disease

Answer 57

Osgood-Schlatter disease causes inflammation at the tibial tuberosity (tendon attachment). It is more common in 5- to 10-year-old boys and usually affects only one leg.

•

Question 58

what is Scheuermann’s disease

Answer 58

Scheuermann’s disease is a relatively common condition in which bone development changes of the vertebrae result in kyphosis (humpback). Scheuermann’s disease is more common in boys, beginning in early adolescence

Question 59

Osteogenesis imperfecta

Answer 59

Osteogenesis imperfecta is a hereditary disorder in which the bones are abnormally soft and fragile. Infants with this condition may be born with many fractures, which can result in deformity or dwarfism or both. Sutures of the skull are unusually wide, containing many small wormian bones

Question 60

what is Infantile osteomalacia (rickets)

Answer 60

Infantile osteomalacia (rickets) In infantile osteomalacia, developing bones do not harden or calcify, causing skeletal deformities. The most common sign is bowed legs, with bowing of the bones of the distal femur and the tibia and fibula as seen on radiographs of the entire lower limbs

Question 61

what is Salter-Harris fractures

Answer 61

Salter-Harris fractures involve the epiphyseal plates. They can be classified based on the location of the fracture and the involvement of surrounding anatomy. There are nine classifications; however, the most common are types I through V

1. Type I: transverse fracture along the epiphyseal plate; this may involve slipping of the epiphyses such as seen with slipped capital femoral epiphyses (SCFE)
2. Type II: fracture through the metaphysis and epiphyseal plate
3. Type III: fracture through the epiphyseal plate and epiphysis
4. Type IV: fracture through the metaphysis, epiphyseal plate, and epiphysis
5. Type V: compression fracture of the epiphyseal plate

Question 62

what is Spina bifida

Answer 62

Spina bifida

In spina bifida, the posterior aspects of the vertebrae fail to develop, exposing part of the spinal cord. Spina bifida can be discovered before birth by ultrasound or by clinical tests of the amniotic fluid.

Various degrees of severity exist:

1. Meningocele is a more common and severe form of spina bifida that involves the protrusion of the meninges through the undeveloped opening of the vertebrae. The cerebrospinal fluid–filled bulge under the skin is called a meningocele.
2. Myelomeningocele
   
   • In myelomeningocele, the most severe type of spina bifida, the meninges and spinal cord protrude through the opening. This condition is most serious when it occurs in the cervical region and causes major physical handicaps, deterioration of kidney function, and frequently an associated hydrocephalus (water on the brain).
3. Spina bifida occulta is a mild form of spina bifida that is characterized by some defect or splitting of the posterior arch of the L5-S1 vertebrae without protrusion of the spinal cord or meninges (membranes covering the spinal cord and brain)

Question 63

Talipes (clubfoot)

Answer 63

Talipes (clubfoot) is a congenital deformity of the foot that can be diagnosed prenatally with the use of real-time ultrasound. It also is commonly evaluated radiographically in an infant with frontal and lateral projections of each foot. (The Kite method )

Question 64

what is Atresias (or clausura)

Answer 64

Atresias (or clausura) is a congenital condition that requires surgery because an opening to an organ is absent. One example is an anal atresia (imperforate anus), in which the anal opening is absent at birth. Other examples are biliary, esophageal, duodenal, mitral, and tricuspid atresias

Question 65

what is Hematuria

Answer 65

Hematuria

Blood in urine, or hematuria, may be caused by various conditions, such as cancer of the kidneys or bladder (intermittent bleeding), kidney stones, kidney cysts, or sickle cell disease (an inherited blood disease in which the red blood cells are crescent-shaped or sickle-shaped and deficient in oxygen)

Question 66

what is Hirschsprung’s disease

Answer 66

Hirschsprung’s disease (congenital megacolon) In Hirschsprung’s disease, a congenital condition of the large intestine, nerves that control rhythmic contractions are missing. This serious condition results in severe constipation or vomiting. It usually is corrected surgically by connecting the distal portion of the normal part of the large intestine to an opening in the abdominal wall (colostomy).

Question 67

what is Intestinal obstruction

what are the causes of this disease

Answer 67

Intestinal obstruction

In adults, intestinal obstruction is caused most frequently by fibrous adhesions from previous surgery. In newborns and infants, it is caused most often by birth defects such as intussusception, volvulus, or meconium ileus

1. Ileus,
   
   • which also is called paralytic ileus or adynamic ileus, is an intestinal obstruction that is not a mechanical obstruction (e.g., a volvulus or an intussusception), but rather an obstruction caused by lack of contractile movement of the intestinal wall.
2. Intussusception is
   
   • a mechanical obstruction that is caused by the telescoping of a loop of intestine into another loop. It is most common in the region of the distal small bowel (ileus).
3. Meconium ileus is a mechanical obstruction whereby the intestinal contents (meconium) become hardened, creating a blockage. This can be found in conjunction with cystic fibrosis
4. Volvulus is a mechanical obstruction that is caused by twisting of the intestine itself

Question 68

what is Necrotizing enterocolitis

Answer 68

Necrotizing enterocolitis is

• inflammation of the inner lining of the intestine that is caused by injury or inflammation.

It occurs most often in premature newborns and may lead to tissue death (necrosis) of a portion of the intestine. This condition may be confirmed with plain radiographs of the abdomen that show gas produced by bacteria inside the intestinal wall

Question 69

what is Polycystic kidney disease

Answer 69

Polycystic kidney disease (infantile or childhood) In polycystic kidney disease, an inherited renal condition, many cysts form in the kidney, causing enlarged kidneys in infants and children. Generally, this disease is fatal without dialysis or kidney transplants if it affects both kidneys

Question 70

what is Pyelonephritis

Answer 70

Pyelonephritis is a bacterial infection of the kidneys that is most commonly associated with or is caused by vesicoureteral reflux of urine from the bladder back into the kidneys.

Question 71

what is Hypertrophic pyloric stenosis

Answer 71

Hypertrophic pyloric stenosis is an overgrowth in the muscles of the pylorus causing narrowing or blockage at the pylorus or stomach outlet that occurs in infants, frequently resulting in repeated, forceful vomiting

Question 72

name two common types of cancer occurs in children and infants

Answer 72

Tumors (neoplasms) Malignant tumors (cancer) occur less frequently in children than in adults and are more curable in children

1. Neuroblastoma are associated with childhood cancer (generally children <5 years old). They occur in parts of the nervous system, most frequently the adrenal glands. This cancer is the second most common type in children.
2. Wilms’ tumor is a cancer of the kidneys of embryonal origin. It usually occurs in children younger than 5 years old. Wilms’ tumor is the most common abdominal cancer in infants or children, and it typically involves only one kidney

Question 73

what is Urinary tract infection

Answer 73

Urinary tract infection frequently occurs in adults and children and is caused by bacteria, viruses, fungi, or some type of parasite. Bacterial infections in newborns involving the bladder and urethra are most common in boys, but after age 1, they are more common in girls. A common cause of urinary tract infection in children is vesicoureteral reflux

Question 74

what is vesicoureteral reflux

Answer 74

Vesicoureteral reflux (VUR) is when the flow of urine goes the wrong way. This condition is more common among infants and young children. Urine, which is the liquid waste product from your body, normally flows one way. It travels down from the kidneys, then into tubes called the ureters and gets stored in your bladder

Vesicoureteral reflux causes a backward flow of urine from the bladder into the ureters and kidneys, increasing the chance of spreading infection from the urethra and bladder into the kidneys.

Question 75

what Differences might be among Children and infants

Answer 75

1. age
2. developmental changes
   
   • The chest and abdomen are almost equal in circumference in a newborn.
   • The pelvis is small and is composed more of cartilage than bone.
   • The abdomen is more prominent
   • the abdominal organs are higher in infants than in older children

Question 76

why is Accurate centering more difficult on pediatric pasient

Answer 76

developmental changes

Accurate centering may be difficult for technologists who are more used to radiographing adults and using the iliac crest and the anterior superior iliac spine as positioning landmarks, which for all practical purposes are nonexistent in a young child. As a child grows, bone and musculature develop, the body outline and characteristics become distinctive, and familiar landmarks are located more easily

Question 77

why is it difficult to distinguish on a radiograph between small and large bowels in infants and toddlers?

Answer 77

it is difficult to distinguish on a radiograph between small and large bowels in infants and toddlers because the haustra of the large bowel are not as apparent as in older children and adults. Also, little intrinsic body fat exists, so an outline of the kidneys is not as well seen as in adults. Even so, visualization of the soft tissues is important in children, and a good plain radiograph of the abdomen provides valuable diagnostic information. Radiologists commonly say that the gas in the GI tract may be the best contrast medium in evaluating the pediatric abdomen.

Question 78

why is the outline of the kidneys in pediatric pasient not as well seen as in adults

Answer 78

Also, little intrinsic body fat exists, so an outline of the kidneys is not as well seen as in adults. Even so, visualization of the soft tissues is important in children, and a good plain radiograph of the abdomen provides valuable diagnostic information. Radiologists commonly say that the gas in the GI tract may be the best contrast medium in evaluating the pediatric abdomen.

Question 79

what contrast medium is usually used for abdomen examination in infants

Answer 79

Even so, visualization of the soft tissues is important in children, and a good plain radiograph of the abdomen provides valuable diagnostic information. Radiologists commonly say that the gas in the GI tract may be the best contrast medium in evaluating the pediatric abdomen.

Question 80

what is the standard collimation in abdominal projections for pediatric pasient?

Answer 80

Precise collimation is important, and the diaphragm, symphysis pubis, and outer edges of the abdomen all should be included in a plain supine radiograph in a child. Radiographs of young children tend to look “flat,” and less contrast is seen than in radiographs of adults. This appearance is to be expected because bones are less dense, there is less fat, muscles are undeveloped, and the range of soft tissues is softer and less defined. Proper exposure factors must be chosen to ensure that subtle changes in soft tissues are not “burned out” at too high a kV.

Question 81

why is radiographs of young children tend to look “flat,” and less contrast is seen than in radiographs of adults? how can this be compensated?

Answer 81

Radiographs of young children tend to look “flat,” and less contrast is seen than in radiographs of adults. This appearance is to be expected because bones are less dense, there is less fat, muscles are undeveloped, and the range of soft tissues is softer and less defined. Proper exposure factors must be chosen to ensure that subtle changes in soft tissues are not “burned out” at too high a kV.

Question 82

how does the withhold feeding should be schedueled for GIT examination of pediatric pasients?

Answer 82

Patient history is important in evaluating pediatric patients because this assists the radiologist in deciding the order and type of radiographic procedures to be performed. When it is necessary to withhold feeding for an upper GI study, the examination should be scheduled early in the morning. Children become irritable when hungry, and technologists need to be understanding of the difficulties in having a young child fast and must be supportive of both parent and child before and during fluoroscopic examinations of the GI tract. Having the infant’s stomach empty is important not only because this ensures a good diagnostic upper GI study but also because infants, when hungry, are more likely to drink the barium

Length of fasting is determined by age; the older the child, the slower the gastric emptying. Infants younger than 3 months old should have nothing to eat or drink from 3 hours before the examination. Infants can have an early morning feed at 6:00 am and be scheduled for a barium swallow and upper GI study at 10:00 am

3 months NPO 3 hours before procedure

3 months to 5 years NPO 4 hours before procedure

≥5 years NPO 6 hours before procedure

Question 83

why is Having the infant’s stomach empty is important in GIT examination?

Answer 83

Having the infant’s stomach empty is important not only because this ensures a good diagnostic upper GI study but also because infants, when hungry, are more likely to drink the barium

Answer 84

• Good patient history important
• Early morning scheduling if feeding is withheld (problem of irritability with long fasting)
• Empty stomach required for GI study (hunger increasing likelihood that patient will drink barium) Lower GI Preparation
• Certain pediatric radiology departments no longer require a bowel preparation for pediatric patients before a lower GI or IVU study.
• the following preparation may be followed by select departments:
  
  • Patient history determines required preparation (certain clinical symptoms or diagnoses preclude any preparation)
  • Infant to 2 years old
    
    • No preparation required
  • 2 to 10 years old
    
    • Low-residue meal evening before
    • 1 bisacodyl tablet or similar laxative before bedtime evening before
    • If no bowel movement in morning, on advice of physician, Pedi-Fleet enema
  • 10 years old to adult
  • Low-residue meal evening before
  • 2 bisacodyl tablets or similar laxative evening before
  • If no bowel movement in morning, on advice of physician, Pedi-Fleet enema

IVU Preparation

• No solid food 4 hours before examination (to lessen risk for aspiration from vomiting)
• Drinking of clear liquids encouraged until 1 hour before examination

Question 85

what are the common lower GIT prosedures?

Answer 85

Patient history determines the preparation for a lower GI examination. This examination is usually a single-contrast barium enema in children. Double-contrast enemas are performed less frequently than in adults and are used mainly to diagnose polyps in children

Question 86

what clinical symptoms does indictate that laxatives or enemas: should not be given to pedaitric pasients ?

Answer 86

Patients with the following clinical symptoms or conditions should not be given laxatives or enemas:

1. Hirschsprung disease
2. extensive diarrhea
3. appendicitis
4. obstruction
5. conditions in which the patient cannot withstand fluid loss

Question 87

what are the preprations for lower GIT examination for the following pediatric pasients ?

1. Newborn to 2 Years
2. Children 2 to 10
3. Children Older Than 10 Years to adult

Answer 87

1. Newborn to 2 Years
   
   • ​​no prepration
2. Children 2 to 10 Years​
   
   • A low-residue meal is given the evening before the examination
   • 1 bisacodyl tablet or similar laxative is given whole, with water, before bedtime the evening before the examination
   • if no bowel movement in the morning, a Pedi-Fleet enema possibly may be given on the advice of a physician
3. Children Older Than 10 Years to Adult
   
   • ​​A low-residue meal is given the evening before the examination;
   • 2 bisacodyl tablets or similar laxative is given whole, with water, before bedtime the evening before the examination;
   • if no bowel movement in the morning, a Pedi-Fleet enema possibly may be given on the advice of a physician.

Question 88

what are the preprations for intravenous urogram for pediatric pasients

Answer 88

1. Intravenous Urogram
   
   1. ​The preparation of children for intravenous urogram (IVU) is simple.
      
      1. No solid foods are given for 4 hours before the examination to diminish the risk for aspiration from vomiting.
      2. The patient should be encouraged to drink plenty of clear liquids until 1 hour before the examination.

Question 89

what room preprations need to be done before upper GI study of a pediatric pasient

Answer 89

Room Preparation

• The fluoroscopic procedure room should be prepared before the child is brought into the room.
• The table is placed in the horizontal position, and the fluoroscopic controls are set
• A cotton or disposable sheet should be placed over the table.
• Depending on the examination, the appropriate
  
  • barium or contrast media,
  • feeding bottle, nipple, straw,
  • feeding catheter,
  • syringe should be ready for use.
  • Suction and oxygen also should be readily available in the event of an emergency

Question 90

guidlines for barium prepration for upper GI tract study of pediatric pasients

Answer 90

Shielding

A section of 1-mm lead vinyl may be placed under the child’s buttocks to shield the gonads from scatter radiation if the fluoroscopy tube is under the tabletop.

Barium Preparation

• Liquid barium may be used according to a particular manufacturer’s instructions.
• The barium may have to be diluted for younger children and infants.
• Dilution is usually necessary when a feeding bottle is used, and it is helpful to widen the hole in the nipple with a sterile needle or scalpel so that the infant can feed more easily.
• The amount of barium for an upper GI study varies with the age of the child.
• Typical volumes range from 30 to 75 ml in infants to 480 ml in older adolescents. This can be adjusted based the discretion of the radiologist.

Question 91

what guidlines are recommended for Patient and Parent Preparation before upper GIT study of pediatric pasients?

Answer 91

Patient and Parent Preparation

• The parent should accompany the child into the procedure room before the study is started.
• A few minutes spent explaining the examination and how the equipment works is beneficial to both parent and child.
• The large equipment and strange noises that seem so normal to the technologist are terrifying to many young children.
• An explanation and demonstration of how the image intensifier is brought down over the chest and abdomen lessen fears that the child might have of being crushed.
• On the monitor, children can be shown how they can watch the “milk shake” going down into the stomach.
• arium procedures on children are usually performed with the patient lying down.
• Parents (if not pregnant) may be given a lead apron and gloves so that they can remain in the room during the fluoroscopic procedure.
• Holding the child’s hand and assisting the technologist in feeding the child reduces anxiety and helps in providing a supportive environment for both parent and child.
• Continual words of encouragement help the child with ingestion of the barium

Question 92

in what ways the barium can be given to pediatric pasient?

guidlines for drinking barium

Answer 92

• An infant drinks from a feeding bottle.
• An older child usually drinks through a straw, which prevents spillage-
• In some cases, a child may insist on drinking directly from a cup. This entails sitting the child up to drink and then lying the child down for fluoroscopy.
• If the esophagus must be outlined, barium paste can be spooned onto the palate or tongue.
• Another tactic is to squirt barium into the child’s mouth with a 10-mL syringe while gently holding the nose.
• If a child refuses to swallow the barium, it may be necessary for the radiologist to pass a nasogastric tube into the stomach

Question 93

Fluoroscopy Positioning Sequence upper GIT study

Answer 93

Radiologists follow a particular sequence of positions for a upper GI study

starting with the patient supine. This generally is followed by

• a left lateral,
• LPO,
• RAO,
• right lateral with the patient turned onto the right side; in this position, the stomach empties quickly. It is important to check the location of the duodenojejunal junction to rule out malrotation before the jejunum fills.
• The final position is prone. This is a standard procedure even in patients who do not have symptoms of malrotation

Question 94

Small Bowel Follow-Through sequence

Answer 94

Small Bowel Follow-Through

An AP or PA abdomen is taken at 20- to 30-minute intervals, either supine or prone, depending on the age and condition of the patient. Transit time is quite rapid in young children; the barium may reach the ileocecal region in 1 hour

Question 95

what are common the lower GIT studies for pediatric pasients?

Answer 95

Lower GI Tract Study—

Barium Enema Single-Contrast, Double-Contrast, or Air Enem

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