Can a CT be Omitted in Pediatric Minor Head Trauma?

2017 ◽  
Vol 16 (01) ◽  
pp. 001-007
Author(s):  
Maria Sinzig ◽  
Eveline Achatz ◽  
Günter Fasching ◽  
Christoph Arneitz
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Head Trauma ◽  
Neurological Status ◽  
Ct Scans ◽  
Minor Head Trauma ◽  
Pediatric Ct ◽  
Ct Protocol ◽  
In Infants And Children

AbstractThis study aimed to evaluate the need for radiation exposure in pediatric minor head trauma. Symptomatic patients after minor head trauma were observed for at least 24 hours in a 13-month period. A computed tomography (CT) scan was performed on children with a depressed neurological status. Two hundred fourteen patients with a mean age of 9.3 years were included. An intracranial hemorrhage (ICH) was diagnosed in three (1.4%) patients. The overall CT rate was 10.7%. The study concluded that neuro-observation without initial CT scans is safe in infants and children following minor head trauma. Special pediatric CT protocol can limit radiation exposure.

scholarly journals Optimization of pediatric CT scans in a developing country

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fotso Eddy Kamdem ◽  
Samba Odette Ngano ◽  
Clemence Alla Takam ◽  
Alain Jervé Fotue ◽  
Serge Abogo ◽  
...  
Keyword(s):  
Developing Countries ◽  
Ionizing Radiation ◽  
Ct Scan ◽  
Developing Country ◽  
Head Trauma ◽  
Pediatric Patients ◽  
Ct Scans ◽  
Pediatric Ct ◽  
The Common ◽  
New Machine

Abstract Background The purpose of this study was to assess scan parameters and to propose strategies to optimize the examinations of children (from 0 to 15 years old) on adult scanners in developing countries. Methods A study was done in 2015 and 2018 on 312 pediatric patients to verify improved practices. The study of 2015 ended with proposed strategies. Dose and scan parameters were available for prospective dose analysis. These strategies were implemented in a study of 2018. Results Amount the CT examinations study in this paper, the common was head trauma (90 %). For every pediatric CT scan in 2015, a kV of 120 was used in the various hospitals. The mAs ranged from 57.75 to 283.33, slice thicknesses from 1.25 to 2.5 mm and pitch from 0.525 to 1.375 mm. In the study of 2018, implementing the strategy defined in the methodology and proposed in 2015: CTDIVol decreased by 21.27 % for children < 1 year, 31.97 % for children 1–4 years, 17 % for children 5–9 years. DLP also decreased by 25.14 %, 36.29 % and 19.85 % for children < 1 year, 1–4 years and 5–9 years respectively. Children were exposed to ionizing radiation on machines designed for adults, but now the doses received by children are reduced. Conclusions The reduction of doses during the pediatric CT examination is possible with the introduction of new optimization protocols or the acquisition of a new machine with a pediatric protocol.

scholarly journals Indications of Brain Computed Tomography Scan in Children Younger Than 3 Years of Age with Minor Head Trauma

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
İsmail Gülşen ◽  
Hakan Ak ◽  
Sevdegül Karadaş ◽  
İsmail Demır ◽  
Mehmet Deniz Bulut ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Ct Scan ◽  
Head Trauma ◽  
Time Interval ◽  
Minor Head Trauma ◽  
Malpractice Litigation ◽  
Brain Computed Tomography ◽  
To Receive ◽  
The Brain

Objective. To investigate the indications to receive brain computed tomography (CT) scan and to define the pathological findings in children younger than three years of age with minor head trauma in emergency departments.Methods. In this study, hospital case notes of 1350 children attending the emergency department of Bitlis State Hospital between January 2011 and June 2013 were retrospectively reviewed. 508 children under 3 years of age with minor head trauma were included in this study. We also asked 37 physicians about the indications for requiring CT in these children.Results. This study included 508 children, 233 (45,9%) of whom were female and 275 were male. In 476 (93,7%) children, the brain CT was completely normal. 89,2% of physicians asked in the emergency department during that time interval reported that they requested CT scan to protect themselves against malpractice litigation.Conclusion. In infants and children with minor head trauma, most CT scans were unnecessary and the fear of malpractice litigation of physicians was the most common reason for requesting a CT.

Requesting physicians’ knowledge of X-radiation exposure from computed tomography scan examinations: A case study of two Nigerian tertiary hospitals

2020 ◽  
Vol 3 ◽  
pp. 36-39
Author(s):  
Samson O. Paulinus ◽  
Benjamin E. Udoh ◽  
Bassey E. Archibong ◽  
Akpama E. Egong ◽  
Akwa E. Erim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ionizing Radiation ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Work Experience ◽  
Radiation Risk ◽  
Radiological Protection ◽  
X Ray ◽  
Tertiary Hospitals ◽  
Medical Exposure

Objective: Physicians who often request for computed tomography (CT) scan examinations are expected to have sound knowledge of radiation exposure (risks) to patients in line with the basic radiation protection principles according to the International Commission on Radiological Protection (ICRP), the Protection of Persons Undergoing Medical Exposure or Treatment (POPUMET), and the Ionizing Radiation (Medical Exposure) Regulations (IR(ME)R). The aim is to assess the level of requesting physicians’ knowledge of ionizing radiation from CT scan examinations in two Nigerian tertiary hospitals. Materials and Methods: An 18-item-based questionnaire was distributed to 141 practicing medical doctors, excluding radiologists with work experience from 0 to >16 years in two major teaching hospitals in Nigeria with a return rate of 69%, using a voluntary sampling technique. Results: The results showed that 25% of the respondents identified CT thorax, abdomen, and pelvis examination as having the highest radiation risk, while 22% said that it was a conventional chest X-ray. Furthermore, 14% concluded that CT head had the highest risk while 9% gave their answer to be conventional abdominal X-ray. In addition, 17% inferred that magnetic resonance imaging had the highest radiation risk while 11% had no idea. Furthermore, 25.5% of the respondents have had training on ionizing radiation from CT scan examinations while 74.5% had no training. Majority (90%) of the respondents were not aware of the ICRP guidelines for requesting investigations with very little (<3%) or no knowledge (0%) on the POPUMET and the IR(ME)R respectively. Conclusion: There is low level of knowledge of ionizing radiation from CT scan examinations among requesting physicians in the study locations.

Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents

2021 ◽  
pp. 000992282110096
Author(s):  
Hasan Aldinc ◽  
Cem Gun ◽  
Serpil Yaylaci ◽  
Erol Barbur
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Pediatric Patients ◽  
Positive Impact ◽  
Cranial Computed Tomography ◽  
Sufficient Information ◽  
Minor Head Trauma ◽  
Computed Tomography Imaging ◽  
Factors Affecting ◽  
X Ray

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.

Diagnostic Accuracy of Magnetic Resonance Imaging and Computed Tomography Scan in Young Athletes With Spondylolysis

2019 ◽  
Vol 58 (6) ◽  
pp. 671-676
Author(s):  
Amy M. West ◽  
Pierre A. d’Hemecourt ◽  
Olivia J. Bono ◽  
Lyle J. Micheli ◽  
Dai Sugimoto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Ct Scan ◽  
False Negative ◽  
False Negative Rate ◽  
Ct Scans ◽  
Resonance Imaging ◽  
Young Athletes ◽  
Negative Rate

The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (−) results while CT test showed 17 (+) and 5 (−) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.

scholarly journals Universal Sinus Computed Tomography Protocol for Diagnostic Imaging and Intraoperative Navigation

2015 ◽  
Vol 6 (3) ◽  
pp. ar.2015.6.0134 ◽  
Author(s):  
Joseph M. Hoxworth ◽  
Devyani Lal
Keyword(s):  
Computed Tomography ◽  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Intraoperative Navigation ◽  
Sinus Surgery ◽  
Successful Implementation ◽  
Potential Cost ◽  
Imaging Protocol ◽  
Imaging Guidance ◽  
Ct Protocol

Background Sinus computed tomography (CT) is performed for the diagnosis of paranasal sinus disease and to assess response to medical therapy. In addition, sinus CT is used for intraoperative imaging guidance. Multiple CTs increase cost and radiation exposure. Objective To determine potential cost savings and radiation dose reduction that result from the use of a single universal sinus CT protocol for diagnostic imaging and intraoperative navigation. Materials and Methods For sinus CT at the authors' institution, a single imaging protocol was begun and deemed acceptable by neuroradiologists and surgeons for diagnostic imaging and intraoperative guidance. The electronic medical record was queried over a 4-year period to determine the number of sinus CTs performed, dose-length products, referring providers' specialties, percentage of CTs used for intraoperative navigation, and the elapsed time between CT and surgery. Results A total of 6187 sinus CTs were performed by using a 64-detector scanner during the study period (2759 women and 3428 men; 53.6 ± 16.7 years [mean ± SD]), and 596 endoscopic sinus surgery cases used imaging guidance, for which all the CTs were deemed technically adequate. The mean dose-length product for the CTs was 338.4 ± 31.9 mGy-cm (mean ± SD). Of the 3702 sinus CTs ordered by nonotolaryngology providers, 167 surgeries with intraoperative navigation (4.5%) were performed. A higher percentage of CT referrals from sinus surgeons (23.9%) and other otolaryngology providers (11.4%) was used for imaging guidance (p < 0.0001). The time interval between sinus CT and surgery was greatest for nonotolaryngology providers (63.1 days, p < 0.01). Based on Medicare reimbursement, the total estimated saving was $147,628. Conclusions Adopting a single universal sinus CT protocol for diagnostic imaging and intraoperative navigation can be an effective means of decreasing cost and radiation exposure. However, successful implementation must take into account multiple practice-based considerations.

Delayed Epidural Hematoma Demonstrated by Computed Tomography

Neurosurgery ◽  
1982 ◽  
Vol 10 (4) ◽  
pp. 487-489 ◽  
Author(s):  
Z. Harry Rappaport ◽  
Itzchak Shaked ◽  
Rina Tadmor
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Head Trauma ◽  
Epidural Hematoma ◽  
Neurological Deterioration ◽  
Trauma Patients ◽  
The Face ◽  
High Level

Abstract A case of delayed visualization of an acute parietal epidural hematoma by computed tomography (CT) in a child is presented. The initial CT 2½ hours after injury was negative. After neurological deterioration, a repeat CT scan 8 hours postinjury demonstrated a parietal epidural hematoma and a small cerebellar hematoma. The case demonstrates the need for a high level of vigilance in head trauma patients even in the face of an initially negative CT scan.

scholarly journals The Effect of Contrast-enhanced Computed Tomography (CT) Scans on the Calculated Dose of Radiotherapy in a Thorax Phantom

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Athar Ehtiati ◽  
Payman Hejazi ◽  
Mohsen Bakhshandeh ◽  
Ali Jabbary Arfaee ◽  
Eftekhar Rajab Bolookat ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Media ◽  
Ct Scan ◽  
Treatment Planning ◽  
Tumor Volume ◽  
Ct Scans ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Despite the benefits of contrast-enhanced computed tomography (CT) scans in better tumor volume delineation, it can affect the accuracy of dose calculation in radiation therapy. This study examined this effect on a thorax phantom. Objectives: The influence of different variables including the concentrations of the Visipaque contrast media, tumor sizes, and CT scan energies on the dose measurement was examined. Methods: Transparent cylinders containing the contrast media were inserted in the lung area of the phantom and the CT scans were made. Non-enhanced CT scans were also acquired. Treatment planning using 2 opposite fields was performed on the CT scans and the doses were calculated in the treatment planning system. The results of the 2 sets of enhanced and non-enhanced CT scans were compared. Results: The correlation between concentration and the percentage of mean dose of the tumor volume was significant in 2 of the tumor sizes. The differences in the mean doses of the 2 plans were examined and more than 3% increase was observed in higher concentrations of the contrast media. Conclusions: According to this study, the suitable concentration of the contrast media administered and the CT scan energy should be considered. This would help to decrease the discrepancies between the calculated and delivered dose in radiotherapy treatments to a clinically acceptable level. The importance of time delays for CT scans after administration of the contrast media is emphasized.

scholarly journals Reducing radiation exposure in newborns with birth head trauma

2017 ◽  
Vol 5 (4) ◽  
pp. 24-30
Author(s):  
Irina A. Kriukova ◽  
Evgeniy Y. Kriukov ◽  
Danil A. Kozyrev ◽  
Semen A. Sotniкov ◽  
Dmitriy A. Iova ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Head Trauma ◽  
Bone Structure ◽  
Bone Fractures ◽  
Diagnostic Methods ◽  
Cranial Bone ◽  
X Ray ◽  
Reduce Radiation Exposure ◽  
Risk Of Cancer

Background. Birth head trauma causing intracranial injury is one of the most common causes of neonatal mortality and morbidity. In case of suspected cranial fractures and intracranial hematomas, diagnostic methods involving radiation, such as x-ray radiography and computed tomography, are recommended. Recently, an increasing number of studies have highlighted the risk of cancer complications associated with computed tomography in infants. Therefore, diagnostic methods that reduce radiation exposure in neonates are important. One such method is ultrasonography (US). Aim. We evaluated US as a non-ionizing radiation method for diagnosis of cranial bone fractures and epidural hematomas in newborns with cephalohematomas or other birth head traumas. Material and methods. The study group included 449 newborns with the most common variant of birth head trauma: cephalohematomas. All newborns underwent transcranial-transfontanelle US for detection of intracranial changes and cranial US for visualization of bone structure in the cephalohematoma region. Children with ultrasonic signs of cranial fractures and epidural hematomas were further examined at a children’s hospital by x-ray radiography and/or computed tomography. Results and discussion. We found that cranial US for diagnosis of cranial fractures and transcranial-transfontanelle US for diagnosis of epidural hematomas in newborns were highly effective. In newborns with parietal cephalohematomas (444 children), 17 (3.8%) had US signs of linear fracture of the parietal bone, and 5 (1.1%) had signs of ipsilateral epidural hematoma. Epidural hematomas were visualized only when US was performed through the temporal bone and not by using the transfontanelle approach. Sixteen cases of linear fractures and all epidural hematomas were confirmed by computed tomography. Conclusion. The use of US diagnostic methods reduced radiation exposure in newborns with birth head trauma. US methods (transcranial-transfontanelle and cranial) can be used in screening for diagnosis and personalized monitoring of changes in birth head trauma as well as to reduce radiation exposure.

scholarly journals Diagnostic and Clinical Management of Skull Fractures in Children

2016 ◽  
Vol 6 ◽  
pp. 47
Author(s):  
Christoph Arneitz ◽  
Maria Sinzig ◽  
Günter Fasching
Keyword(s):  
Hospital Stay ◽  
Head Trauma ◽  
Clinical Management ◽  
Skull Fracture ◽  
Neurological Symptoms ◽  
Ct Scans ◽  
Skull Fractures ◽  
X Rays ◽  
Minor Head Trauma ◽  
The Mean

Objective: The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma. Methods: We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period. Results: In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days. Conclusions: Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.

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