Radiology

Question 1

Why is imaging children more sensitive than adults?

Answer 1

Lifetime to manifest changes
Tissues more radiosensitive
RT dose is cumulative over a lifetime

Question 2

How is RT risk minimised?

Answer 2

Only image if medical benefit
Lowest amount RT for adequate images for the size of the child
Avoid multiple scans
Only image indicated area
Obtain outside images (referrals)
Use alternative imaging modality

Question 3

When is contrast not used in CT scanning?

Answer 3

Head

Bone

Question 4

What are the requirements for a CT?

Answer 4

Child must stay still

If chest CT: Must breath hold

Question 5

What can fluoroscopy be used for?

Answer 5

Videofluroscopy: Swallow & aspiration
Interventional: Lines, metal work, catheters
Barium swallow/enema: GI tract pathology

Question 6

When is USS first line imaging?

Answer 6

Brain: Usually neonates
Spine
Chest: Pleural effusions, empyema
Abdo/pelvis
Neck
Hips
Vascularity & blood flow (dopplers)
Lumps & bumps

Question 7

What are the disadvantages of MRI?

Answer 7

Long: 20-90mins (1image set takes several minutes)
Claustrophobia
Movement artefact
Sedation/GA
Contrast administration
Breath holding

Question 8

When is a GA used in imaging?

Answer 8

Clinician led but usually:
MRI <6y
CT <3y
Risk of GA vs RT vs Expected benefit

Question 9

When should a head CT be done within 1hour?

Answer 9

1 of the following:
Suspicion of non-accidental injury
Post-traumatic seizure
GCS <14 or under 1y GCS <15
At 2hr GCS <15
Open/depressed skull#/ tense fontanelle
Focal neuro deficit
Signs of basal skull #: Panda eyes, Battle's sign
<1y bruising, swelling, laceration >5cm

>1 of the following:
LOC >5mins
Abnormal drowsiness
>3 Vomiting
Dangerous mechanism of injury
>5mins amnesia

Question 10

What are the criteria for a C-Spine CT?

Answer 10

GCS <13 on initial assessment
Patient intubated
Focal peripheral neuro signs
Paraesthesia in upper/lower limbs
Definitive diagnosis of cervical spine needed (surgery)
Plain Xray show injury
Plain Xray difficult/inadequate
Strong clinical suspicion

Question 11

When may observing a child with a head injury lead to a rapid head CT?

Answer 11

Only 1 of minor RFs for CT means 4hrs of monitoring
If during monitoring:
GCS <15, Further vomiting, further episode of drowsiness
CT <1 hour

Question 12

Why do criteria need to be met for a C-Spine CT?

Answer 12

There is an inc risk of thyroid ionising radiation & lower risk of neck injury