Download Free Medical Pediatric Radiology PowerPoint Presentation

Pediatric Radiology PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Radiology and Imaging, which is titled "Pediatric Radiology", to know about Pediatric Radiology.

Tags : Radiology, Imaging, Pediatric Radiology

Published on : Jul 28, 2021 | Views : 5501 | Downloads : 19

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Pediatric Radiology Imarzen V. Elepaño MD FPCR FUSP FCTMRISP CCD Dept Of Radiology UP-PGH
Slide 2-

Consent, immobilisation and health care law
Slide 3-

Children’s rights Perceptions of children‟s rights are not universally consistent and it was the goal of the United Nations Convention on the Rights of the Child 1989 to clarify children‟s rights. Three important articles for health care workers within this convention are identified
Slide 4-

Child. From the United Nations Convention on the Rights of the Article 3: In all actions concerning children, the best Article 12: Parties shall assure to the child who is capable interests of the child shall be a primary consideration. of forming his/her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with age and maturity of the child. Article 24: Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.
Slide 5-

Immobilisation versus restraint The term „restraint‟ is generally reserved for use within the mental health setting. The more general terminology used within health care is „immobilization‟.
Slide 6-

To immobilize a person is to render them fixed or incapable of moving whereas restraint is the forcible confinement, limitation or restriction
Slide 7-

European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics were issued. These guidelines state that patient positioning, prior to exposure to radiation, must be exact whether or not the patient co-operates. The guidelines advocate the use of physical restraints in the immobilization of young children and state that for infants, toddlers and young children, immobilization devices, properly applied, must ensure that the patient does not move and the correct projection is achieved
Slide 8-

Holding children still – a five-point model
Slide 9-

(1) Prepare child and guardian for procedure and explain their role (2) Invite guardian to be present (3) Use a specific room for painful procedures (4) Position child in a comforting manner (5) Maintain a calm and positive atmosphere
Slide 10-

Little research has been published that evaluates techniques in holding and comforting children, even though it is generally agreed that all health professionals working with children need education and training into the immobilization and distraction of children
Slide 11-

Prepare child and guardian Before the radiographic examination commences, both the child and guardian need to know why the examination is necessary, what the procedure will be and essentially what their role will be (i.e. what is expected of them).
Slide 12-

Invite guardian to be present The presence of a guardian within the examination room provides the child with security and it has been found that 99% of 5–12 year-olds believe that the presence of their guardian will help reduce pain and anxiety.
Slide 13-

Guardians are also able to : comfort the child in a familiar manner implement appropriate distraction techniques that can reduce the child‟s fear and anxiety, increase the child‟s co-operation and minimize the need for restraining devices.
Slide 14-

Position child in a comforting manner Lying supine within an unfamiliar environment increases the feeling of helplessness and loss of control in adults and children alike and increases patient anxiety.
Slide 15-

The need for „cuddles‟ and comfort throughout an imaging examination is not restricted to very young children and children as old as 7 or 8 years will prefer to sit across a guardian‟s lap or next to a guardian to gain comfort from their presence
Slide 16-

a) and (b) Sitting an older child next to the guardian allows them to feel comforted while still respecting their „older‟ status. The guardian can also assist with immobilization.
Slide 17-

a) and (b) Sitting the child across the guardian‟s lap is a natural and comforting position for older children and permits some adult assistance with positioning and immobilization. Note the guardian and child are seated to the side of the table.
Slide 18-

Seating a young child at the end of the table where they can „lean in‟ to the guardian is more comforting than being laid in the supine position and may be useful for examinations of the lower limb.
Slide 19-

a) and (b) The straddle hold is a natural, comforting position for young children and naturally allows the guardian to successfully immobilize the child and assist in positioning.
Slide 20-

(a) and (b) Projectors may be useful distraction tools within the x-ray room but care needs to be taken to ensure that they are positioned in a safe and appropriate place without electrical leads trailing across the room.
Slide 21-

Maintain a calm, positive atmosphere If you talk to a screaming child quietly and positively then eventually they will calm down. Anxiety levels in children and adults increase with the level of surrounding noise and therefore focusing on a calm and quiet voice can help reduce this anxiety.
Slide 22-

Distraction tools The use of distraction techniques within health care is growing greater in prominence and the experts in the use of distraction and play are play specialists. Alternatively, various pieces of equipment designed to distract children are available but care must be taken before purchase to ensure that they are easy to use and operate. Whatever the distraction tools used, it is essential that they be used only within the examination room to maintain their novelty value and maximize their effectiveness.
Slide 23-

Radiation protection Radiation protection in diagnostic radiography is essential if medical exposure to ionizing radiation is to be maintained at a level of minimal acceptable risk. The concept of risk is an important one and it is essential that we reduce risks to patient and staff through the justification, optimization and limitation of radiation exposures
Slide 24-

Patient positioning Incorrect positioning is the most frequent cause of inadequate radiographic image quality in paediatrics and should not be used as an excuse for substandard image quality
Slide 25-

Field size and beam limitation Inappropriate field size is a common fault in paediatric radiographic technique and its correction is an effective method of reducing unnecessary dose to the patient. Correct beam limitation requires the radiographer to apply precise knowledge of external anatomical landmarks to the paediatric patient being examined. Reiterate the importance of accurate collimation to the area of interest as a method of reducing dose
Slide 26-

Protective shielding For all paediatric examinations, the consistent use of lead rubber to shield that part of the body in immediate proximity to the diagnostic field is essential.
Slide 27-

Understanding Radiation and Its Effect on Children
Slide 28-

Every day each of us receives 1 millirad of radiation from environmental sources. The biggest contribution to environmental radiation comes from radon gas, which is a decay product in the uranium series. However, the largest source of radiation exposure resulting from human activity is diagnostic X-rays.
Slide 29-

Since radiation is ubiquitous in our environment, why are we concerned about medical radiation? Firstly, the background dose is much lower than that of CT. There have never been proven deleterious effects secondary to “normal” background radiation.
Slide 30-

Of those effects caused by radiation (genetic mutations, carcinogenesis, and cell death), the one we are most concerned about is carcinogenesis. There are a lot of data for radiation- induced cancer, both incidence and mortality
Slide 31-

The incidence of cancer is 2–2.5 times greater than the mortality. The biological effects of radiation are greatest on the faster-growing organisms – the fetus, infant, and young child. The thyroid gland, breast tissue, and gonads are organs with increased sensitivity in growing children.
Slide 32-

A second factor in children‟s vulnerability to radiation carcinogenesis is the life-long cumulative effect of radiation. The younger the patient and the more times he/she is exposed to radiation, the higher the probability of cancer.
Slide 33-

The third factor which explains why children are at the greatest risk of radiation carcinogenesis is the fact that it takes a long time to develop a cancer and that children have the longest life span remaining after exposure.
Slide 34-

The chest and upper respiratory tract Chest radiography is the most frequently performed paediatric plain film examination1 and may be requested to : assist in establishing a preliminary diagnosis, or to monitor the progression of a respiratory condition and assess the effectiveness of any implemented treatment.
Slide 35-

Despite the relative frequency , it is still regarded as one of the most clinically challenging examinations to perform adequately and, as a result, many chest radiographs are of reduced image quality, in particular those undertaken on children under 6 years of age3
Slide 36-

Chest Examinations in Children a normal lung volume. volume are: Normal inspiratory chest a Frontal examination reveals The criteria for a normal lung (a) less than one-third of the heart is projected below the hemidiaphragm; (b) the diaphragm is rounded, and the sixth or seventh anterior rib (ar) intersects the diaphragm; and (c) the lungs are air-filled (black).
Slide 37-

rotated film as evidenced by (cl) symmetrically positioned, right pedicles (arrow), and This is a properly positioned, non- (1) comparative anterior ribs equidistant from the pedicles (p), (2) medial aspects of the clavicles (3) the carina approximates the (4) no difference in aeration between the two sides. The film was taken with the patient erect, as shown by the air–fluid level in the stomach (arrowhead)
Slide 38-

b Lateral examination confirms normal aeration of the lungs. Note that the vertebral bodies (vb) get blacker as we go from superior to inferior. The patient is slightly rotated as you can see the ribs on each side (arrows)
Slide 39-

Technical Factors Technical problems in pediatric radiology are caused by: A largely by uncooperative children. The young patients are not feeling well, the environment is strange, and they may as a result be quite frightened.
Slide 40-

Preliminary evaluation of the chest radiograph should assess these technical factors: ● The degree of inspiration: lung volume ● The position of the patient: extent of rotation and posture of the patient ● How the film was obtained ● Adequacy of the exposure
Slide 41-

Lung Volume The radiographic examination of the chest begins with frontal and lateral roentgenographs taken after deep inspiration
Slide 42-

If the child has taken a shallow breath: the heart may appear enlarged, the vessels may coalesce to give a false impression of an opacity, especially in the region of the bases and hila, and sometimes the radiograph has a hazy quality due to the influx of blood and lack of aerated lung.
Slide 43-

Position of the Patient The position of the patient is determined by rotation and posture (lying, sitting, or standing). The child‟s posture is important.
Slide 44-

When the patient is supine, the vascular supply to the upper and lower lobes is equal since gravity has no effect. When the child is sitting or standing, gravity plays a significant role, and the upper-lobe vessels are less distended than the lower-lobe vessels (one-third to two- thirds size).
Slide 45-

One can determine an erect film by looking at the air–fluid level in the stomach and at changes in the pulmonary vasculature.
Slide 46-

c–e These three films are in varying degrees of inspiration: c is an optimal inspiration; d is acceptable but less than average with the 5th anterior rib at the diaphragm; e shows complete expiration with almost a white-out of the lungs. It is important to appreciate the degree of inspiration so one can make an accurate determination of any pathology
Slide 47-

The rotated chest – asymmetric clavicles, differences in aeration , heart projected over one hemithorax and not the other, asymmetric ribs when relating the anterior rib to the pedicle The ribs are visible and not the spinous process
Slide 48-

How the Film Was Obtained The third major technical factor to keep in mind is how the film was obtained. Greater magnification occurs when structures, such as the heart, are farther from the film. When the X-ray beam passes through the patient from back to front [a posterior–anterior (PA) projection], the heart is closer to the film and is less magnified.
Slide 49-

Conversely, if the X-ray beam enters the front of the patient‟s chest, passes through the back and onto the film [an anterior– posterior (AP) projection], the magnified heart and great vessels may give the impression of cardiomegaly.
Slide 50-

tube target distance Effect of patient position and the a Patient in supine position, with approximately 46 in. (ca 1.2 m) between the X-ray tube and the film. Upper-lobe vessels (arrow) are equal in size to those of the lower lobe (arrow). The heart is magnified. There is a central venous catheter in place b Patient is erect and 6 ft (ca 1.8 m) from the X-ray tube. It is difficult to see the upper lobe vessels, but the lower lobe vessels are easily seen
Slide 51-

Adequacy of Exposure Be sure that the film is properly exposed or the digital image is windowed and leveled properly You can tell this on the frontal film by examining the vertebral column behind the heart. If you can see the detailed spine and pedicle through the heart and can also see the pulmonary vessels in the peripheral lung, the exposure is correct. If you see only the spine but not the pulmonary vessels, the film is too dark (overexposed).
Slide 52-

Adequacy of exposure b This is an underexposed examination. The film is white, and you can barely see the surgical sutures (arrow) in the sternum and cannot see the spine at all frontal examination; c This is a (overexposed) Note how on the poorly exposed film the pedicles can be seen (arrow), but you cannot see peripheral lung markings
Slide 53-

Summary A thorough radiographic work-up should include the following, in order of priority: ● Good erect, nonrotated inspiratory frontal and lateral chest films ● Inspiratory and expiratory films (if foreign body is suspected, there is persistent hyperexpansion or atelectasis ) and/or fluoroscopy of the chest to observe mediastinal shift and diaphragmatic excursion (decubitus films may help) ● Specialized magnification high-kV films of the airway, if the air passage itself needs evaluation ● An esophagram in any unexplained airway disease ● MR or CT for mediastinal masses ● High-resolution CT for complete work-up of unusual or questionable pulmonary parenchymal abnormalities
Slide 54-

Respiratory system Airway abnormalities
Slide 55-

ppt slide no 55 content not found
Slide 56-

ppt slide no 56 content not found
Slide 57-

ppt slide no 57 content not found
Slide 58-

Respiratory distress in the newborn
Slide 59-

ppt slide no 59 content not found
Slide 60-

ppt slide no 60 content not found
Slide 61-

ppt slide no 61 content not found
Slide 62-

ppt slide no 62 content not found
Slide 63-

Pulmonary infection
Slide 64-

ppt slide no 64 content not found
Slide 65-

Thoracic tumours
Slide 66-

ppt slide no 66 content not found
Slide 67-

ppt slide no 67 content not found
Slide 68-

Abdominal Imaging
Slide 69-

The abdominal examination should include a minimum of three views: supine, prone, and erect. One can think of the air in the abdomen as contrast medium; the purpose of obtaining three views is to move air into different loops of bowel so that the maximal quantity of bowel can be visualized.
Slide 70-

The value of air as contrast medium by utilizing three views a Supine roentgenograph in this 15- year-old girl with abdominal pain reveals multiple air-filled loops of bowel in the midabdomen but little gas within the rectum b An erect film reveals that the base of the lungs is clear, and there is no free air under the diaphragm. There is gas in the hepatic flexure, transverse colon, and splenic flexure c Prone examination reveals gas in the rectum (R), ascending (A), and descending (D) colon. The predominant pattern is that of colonic gas. The small bowel is not distended, and there is no evidence of obstruction
Slide 71-

The upper gastrointestinal series a The stomach is visualized in multiple positions so that contrast agent moves through the fundus (F), body (B), and antrum (A). The mucosal pattern is smooth and regular without any disruption. Peristaltic waves can be deduced by the various shapes of the stomach, noted on multiple films as well as at fluoroscopy b Oblique view shows to advantage the contraction at the antrum (A) and the pyloric channel (P). The duodenal bulb (D) is triangular and smooth. The duodenum is partially filled c Further along in the study, the duodenum is entirely visualized, and the ligament of Treitz (arrow), behind the stomach, is at the level of the duodenal bulb. Note the four portions of the duodenum (1, 2, 3, 4). The jejunal mucosal pattern appears feathery and unobstructed proximal stomach to the jejunum d Drawing of the frontal view of the e Drawing of the lateral projection. Duodenum parts 1–4. E, esophagus; F, fundus; B, ody; A, antrum
Slide 72-

Small bowel follow-through a A film taken 30 min after the upper portion of the gastrointestinal tract was viewed reveals that the proximal half of the small bowel is now filled. The demarcation between the jejunum and ileum is difficult to see, but bowel is filled on both the right and left sides of the midline. The loops are not significantly separated b, c A 1.5-h film (b) shows that contrast has advanced into the right ascending colon (C); the feathery pattern of the jejunum is still visible. In c the terminal ileum is demonstrated by compressing it with a balloon paddle and taking a spot film. This method helps evaluate the cecum,ileocecal valve, and terminal ileum. CE, cecum
Slide 73-

Normal barium enema a Frontal view of the barium-filled colon shows the midline rectum (R), tortuous sigmoid (S), and rather smoothwalled descending colon (D). The haustrated transverse colon (T), ascending colon (A), and the cecum (C) are also identified. Reflux into the terminal ileum (TI) is present b Lateral projection affords a good view of the rectum and its proximity to the sacrum c Postevacuation films show the bowel almost totally collapsed, with no filling defects. The thin, tubular, bariumfilled appendix is seen in the right lower quadrant (arrow)
Slide 74-

The female urethra a Filled bladder with catheter in place again reveals the central position of the bladder without any mass impinging on its wall b, c On voiding, as seen on this oblique view, the posterior aspect of the bladder becomes slightly irregular. The urethra is much shorter in a female and often displays a “carrot-top”or “spinning- top”deformity (C). There is often reflux into the vagina when the patient voids in the recumbent position (asterisk) d The female urethra
Slide 75-

The normal excretory urogram (EU) a Prone coned-down view shows the nephrogram effect. The kidneys are homogeneous, and there is little contrast material in the collecting systems. Occasionally such a film is taken 1–2 min after injection; the collecting systems are then seen to better advantage. On this initial film the renal axis is noted with the upper pole being closer to the spine than the lower pole.The renal contours are evaluated and should be smooth without scarring or indentations b This 5-min film reveals the renal collecting system – the calyces and infundibula leading to the renal pelvis and ureter. Any deviation or blunting of the collecting system is seen at this time. The renal pelvis then tapers into the ureter. The ureters pass inferiorly, crossing the margins of the transverse processes of the vertebrae. The bladder is separate from the pubic bones because it is partially filled. A 10-min frontal film is usually obtained to view the entire system to see if there has been any change secondary to osmotic load c The normal intrarenal anatomy as see on the EU
Slide 76-

Signs or symptoms which may lead to imaging (listed alphabetically) Abdominal mass (Chap. 6) Abdominal–pelvic pain Acute (particularly right lower quadrant) Chronic (imaging only after clinical observation) Bowel obstruction Child abuse Constipation (chronic and severe except in neonates) Enuresis (imaging usually not necessary) Failure to thrive Gastrointestinal bleeding Gastrointestinal perforation Hematuria Jaundice of uncertain etiology Lymphadenopathy (systemic) Malformations including meningomyelocele Anorectal abnormalities Genital abnormalities Renal transplant Screen for monitoring spread of known tumor Screen for conditions/syndromes with abdominal components Aniridia (Wilms‟) Beckwith‟s syndrome (Wilms‟) Sickle cell disease (gallstones) Tuberous sclerosis (renal cysts and renal angiomyolipoma) Scrotal pain Systemic infection Trauma (with appropriate history and/or significant physical or laboratory findings) Urinary tract infection Vomiting
Slide 77-

Gastrointestinal tract
Slide 78-

Oesophagus
Slide 79-

ppt slide no 79 content not found
Slide 80-

Stomach and duodenum
Slide 81-

ppt slide no 81 content not found
Slide 82-

Small bowel
Slide 83-

ppt slide no 83 content not found
Slide 84-

(+) freeair, wriggler sign
Slide 85-

Colon
Slide 86-

ppt slide no 86 content not found
Slide 87-

ppt slide no 87 content not found
Slide 88-

Genitourinary tract
Slide 89-

Renal abnormalities Congenital
Slide 90-

ppt slide no 90 content not found
Slide 91-

ppt slide no 91 content not found
Slide 92-

Lower urinary tract abnormalities
Slide 93-

ppt slide no 93 content not found
Slide 94-

Genitourinary tumors
Slide 95-

ppt slide no 95 content not found
Slide 96-

Skeleton
Slide 97-

The second most frequent radiographic study, after the chest film, is that of the pediatric skeleton. The most common indication for such studies is of course trauma.
Slide 98-

Unique Features The skeleton of children is quite different from that of adults. The child‟s bones are obviously still growing, developing, and modeling; therefore, many ossification centers are constantly appearing and fusing with the main skeleton Because these ossification centers may appear fragmentedand may ossify in a multicentric fashion, they can easily simulate chip fractures. One should therefore obtain comparison views of the contralateral extremity if there is any question.
Slide 99-

Another unique difference between the child‟s and the adult‟s skeleton is the low incidence of dislocations (complete disruption of the joints with loss of contact between articulating surfaces) of otherwise normal joints Because of this resiliency children are more likely to have “incomplete fractures,” two of which have characteristic names – the greenstick fracture and the torus fracture.
Slide 100-

stages of development The normal elbow at different Note the appearance of the various ossification centers as ossified the child matures (see Table 7.1) a A 6-month-old. Capitellum (C) is b A 4-year-old. Radial head (arrow) and medial epicondyle (asterisk) have begun to ossify c An 8-year-old. Secondary centers of ossification are larger d A 15-year-old.Mature elbow with closure of the growth plates
Slide 101-

Common pediatric fractures a Greenstick fracture. The fracture appears to extend halfway through the diaphysis (arrow).Note the bowing of the radius and ulna b Torus fracture.Note the buckling at the medial aspect of the distal radius (arrow). Microscopic examination of both greenstick and torus fractures show trabecular disruption across the entire horizontal width of the bone
Slide 102-

Common Pediatric Problems Trauma Nonaccidental Injury(Child Abuse, Battered Child) Developmental Dysplasia of the Hip Osteomyelitis Bone Infarct Metabolic Disorders Bone Tumors- Benign Lesions vs Malignant Lesions Arthritides Congenital Abnormalities
Slide 103-

ppt slide no 103 content not found