Fundamentals of Pediatric Radiology. Lane F. Donnelly, MD. Philadelphia, Pa: Harcourt Health Sciences, ISBN: Softcover, $; pp . Pediatric imaging: the fundamentals/Lane F. Donnelly. 1st ed. p. ; cm. Most pediatric radiologists are very happy with their illnesses, as compared to elderly adults. both their jobs Top 3 Differentials in Radiology () [PDF] [ UnitedVRG]. View all volumes in this series: Fundamentals of Radiology Written by Lane F. Donnelly, MD, Fundamentals of Pediatric Imaging, 2nd Edition, covers the.
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neuro applications while nearly high quality DONNELLY PEDIATRIC RADIOLOGY PDF ifab me Fundamentals of Pediatric Radiology by Lane F Donnelly. by Lane F. Donnelly MD (Author). out of 5 stars 24 customer reviews Fundamentals of Pediatric Imaging (Fundamentals of Radiology) $ (7) In Stock. Donnelly ())×D.P. Frush ×S. M.. O'Hara ×G.S. Bisset III. Department of Radiology,. Section of Pediatric Radiology, Box ,. Duke University Medical Center.
Radiology is the only medical discipline that is defined by the imaging approach to a medical problem rather than by an organ system or disease process [ 3 ]. This creates some unique issues, and perhaps contributes to our tendency to publish descriptive research, rather than working at the top of the pyramid. Although these retrospective reviews, technical feasibility studies, and case reports have value, their scientific validity is variable. RCDBS randomized controlled double-blind studies, RCS randomized controlled studies But the absence of ascension to the top may be a failing of our training as much as the plight of our specialty.
One of the things I have discovered over the years is that our training in the performance of quality research is deficient. This lack of training has created a dearth of mentors in the pediatric research arena. It is easy to throw in the towel. Each chapter covers a particular system such as gastrointestinal, hepatobiliary, vascular intervention, infertility and several others.
The first chapter includes general topics such as analgesia and sedation during interventional procedures and the thorny issue of patient consent.
CASE 1: SURFACTANT DEFICIENCY DISEASE
Each chapter includes an explanation of each procedure, which includes patient preparation, possible complications and outcome. A section providing suggested patient information sheets for each procedure is included at the end of each chapter.
The book has several good points. It is well laid out, easy to read and procedures are clearly and succinctly explained. The pictures are of good quality and complement the text well. Patient information and explanation of a procedure are very important before any invasive procedure.
The patient information sheets at the end of each section are a good idea but as they stand are probably not adequate and would benefit from some simple diagrams to aid patient understanding. Also, the outcome section is variable with percentages included for some procedures but not for others.
In the introduction section, the authors state that this book is aimed at general radiologists, clinicians and general practitioners. Pre-registration house officers and senior house officers who are involved in the preparation and aftercare of patients who have had interventional procedures will find this book particularly useful and easy to understand.
With the advent of outpatient and day-case procedures, general practitioners are increasingly involved in the care of patients undergoing interventional procedures and they too will find this book a useful source of information. The length of the region of of and the significance of a particular imaging interest to be imaged is variable, and the lengths finding in a child is dramatically different from of the patients veins are variable.
Physiologic the identical imaging finding when it is seen parameters such as the patients cardiac output in an adult. In addition, the diseases that affect are also more variable in children than in adults. These factors affect parameters such as the time Therefore, the differential diagnosis and signifi- between contrast injection and the onset of cance of a particular imaging finding in a scanning as well as choices in contrast adminis- 2-month-old infant may differ dramatically tration technique hand bolus versus power from those determined by the identical imaging injector.
Slice thickness should be smaller in finding in a year-old child. We will touch here States alone. This poor safety record would be on radiation safety because it is germane to the equivalent of the airline industrys having pediatric radiology.
Children are much more a large passenger plane crash in the United sensitive to the potential harmful effects of States every single day! If this were the case, radiation than are adults, and they also have we would probably think twice about flying.
Therefore, attention to radia- system. If looked at from the patients perspec- tion safety in all areas of pediatric radiology is tive, even more important to them than Heal paramount. CT delivers higher doses of radia- me quality of care and Be nice to me cus- tion than other diagnostic imaging modalities. No higher priority exists than and even whether a risk absolutely exists are patient safety.
However, some research- Many institutions have developed programs ers estimate the increased risk that a young to improve patient safety, but they have shown child might develop cancer related to an mixed results. In other words, for every CT training for all clinical employees.
Such training scans of the abdomen you perform in children, has previously been successful in markedly you will be causing cancer in one child. Given reducing errors in high-performance industries the number of CT scans performed in children, such as aviation and nuclear power.
This train- that number, if true, is astounding! Therefore, ing emphasizes three behavioral expectations: it is essential for all radiologists to practice 1 make a personal commitment to safety; dose-reduction techniques in pediatric CT.
For each expectation, the employees cessary; using alternative diagnostic methods are taught behavioral techniques to aid them that do not utilize radiation, such as ultra- in error reduction.
Pocket Radiologist:Paediatric—Top 100 Diagnoses
The first is dispelling the performed. Because children are smaller than notion that physicians are independent practi- adults and need less radiation to create the tioners rather than key components of an inte- same signal-to-noise ratios, the tube current grated care-providing team.
No other industry in mA can be greatly reduced when imaging which there must be outstanding safety perfor- a small child. Other techniques include redu- mance allows this type of behavior. Second, cing kVp; using in-plane shielding for areas we need to create a culture in which people such as the eye, thyroid, and breasts; increas- are expected to and encouraged to speak up in ing beam pitch; and picking a CT manufac- the face of uncertainty.
The old culture of a med- turer that has put effort into dose-reducing ical hierarchy in which the physician is in charge technology. Medical staff, trainees, and even family members need to feel comfortable stopping Suggested Readings the line and asking for clarification if things dont seem right. Jt Comm J Qual Improv , Institute of Medicine: Crossing the quality chasm: a new Thrall JH: Quality and safety revolution in health care, health system for the 21st century, Washington, DC, Radiology , National Academy Press, Croup is a disease features between a pediatric and a general radi- of infants and young children; the peak inci- ologist is that a pediatric radiologist remembers dence occurs between 6 months and 3 years to look at the airway.
Problems with the airway of age.
Computed tomography in children with community-acquired pneumonia
The mean age at presentation of croup are much more common in children than in is 1 year of age. In children older than 3 years, adults.
For practical purposes, abnormalities of other causes of airway obstruction should be the airway can be divided into acute upper suspected. Croup is viral in cause and is usually a airway obstruction, lower airway obstruction benign, self-limited disease.
Redundant mucosa extrinsic compression, intrinsic obstruction , in the subglottic region becomes inflamed, obstructive sleep apnea OSA , and congenital swells, and encroaches upon the airway. The children present with a barky croupy Clinically, children with acute upper airway cough and intermittent inspiratory stridor. It usu- obstruction above the thoracic inlet tend to ally occurs following or during other symptoms present with inspiratory stridor, whereas chil- of lower respiratory tract infection.
Most children dren with lower airway obstruction below the with croup are managed supportively as outpa- thoracic inlet are more likely to present with tients, and the parents are managed by reassur- expiratory wheezing. However, the categoriza- ance.
Inhaled corticosteroids are becoming tion of a child with noisy breathing into one of a popular therapy in children with croup. The primary imaging and severity of illness. However, charac- teristic radiographic findings that indicate croup are best seen on frontal radiographs.
Normally, the subglottic airway. The most common causes of acute trachea appears rounded, with shoulders that upper airway obstruction in children include are convex outward Fig In croup, the inflammatory disorders and foreign bodies. Anatomic structures that The appearance has been likened to an are especially important to evaluate on radio- inverted V or a church steeple see Fig.
Lateral radiographs may demonstrate a narrowing or loss of definition of the lumen of the subglottic trachea see Croup Fig. Croup acute laryngotracheobronchitis is the The epiglottis and aryepiglottic folds appear most common cause of acute upper airway normal. Normal frontal radiograph of the airway. The sub- glottic airway demonstrates rounded shoulders white arrows that are convex outward.
Note the appearance and location of the pyriform recess black arrow on right pyriform recess. Children with epiglottitis are usually toxic appearing and present with an abrupt onset of stridor, dysphagia, fever, rest- lessness, and an increase in respiratory distress when recumbent.
The patients are typically older than those with croup; the classically described peak incidence occurs at age 3. A, Frontal radiograph showing symmetric subglottic narrowing arrows with loss of normal shouldering.It is easy to throw in the towel. We need to get past the bias that is inherent in many of our observational studies. As part of our program radiologist and the parent than between the radi- to improve and standardize our interactions with ologist and the patient. The most common causes of acute trachea appears rounded, with shoulders that upper airway obstruction in children include are convex outward Fig It usu- obstruction above the thoracic inlet tend to ally occurs following or during other symptoms present with inspiratory stridor, whereas chil- of lower respiratory tract infection.
Currently, there are pediatric life. Lateral radiographs may demonstrate a narrowing or loss of definition of the lumen of the subglottic trachea see Croup Fig. Medical staff, trainees, and even family members need to feel comfortable stopping Suggested Readings the line and asking for clarification if things dont seem right. Imaging general radiologists who must have a working examinations that are easily carried out in knowledge of a daunting amount of information, adults require special adjustments to be success- I believe that most pediatric radiologists feel com- fully achieved in children.
These limitations thy, patience, professionalism, and effective affect almost all pediatric imaging examinations: communication.