Congenital dislocation of the hip: Optimal screening strategies in 2014

AbstractA prospective multi-centre nationwide study of patients with congenital dislocation of the hip (CDH) diagnosed after 3 months of age was conducted with support from the French Society for Paediatric Orthopaedics (Société Française d’Orthopédie Pédiatrique [SoFOP]), French Organisation for Outpatient Paediatrics (Association Française de Pédiatrie Ambulatoire [AFPA]), and French-Speaking Society for Paediatric and Pre-Natal Imaging (Société Francophone d’Imagerie Pédiatrique et Prénatale [SFIPP]). The results showed inadequacies in clinical screening for CDH that were patent when assessed quantitatively and probably also present qualitatively. These findings indicate a need for a communication and educational campaign aimed at highlighting good clinical practice guidelines in the field of CDH screening. The usefulness of routine ultrasound screening has not been established. The findings from this study have been used by the authors and French National Health Authority (Haute Autorité de Santé [HAS]) to develop recommendations about CDH screening. There is an urgent need for a prospective randomised multi-centre nationwide study, which should involve primary-care physicians

Optimisation en scanographie pédiatrique

The Department of radiology of the Hospital Trousseau (Paris) and IRSN have initiated in 2007 a detailed analysis of doses delivered to children undergoing CT examinations. This study involved three types of CT examination (chest, abdomen + pelvis and petrosal bones) and three age groups (new born to 1 year, 4 to 6 years and 9 to 11 years). A first analysis of doses was realised on a six months period of activity at the end of 2006. It stated that the standardized protocols of the scanner, that satisfied the relevant dosimetric requirements, were regularly modified by the operator to acquire the CT slides: the practice among the department was heterogeneous and the mean values of DLP were systematically higher than those recommended. The whole staff of the department has been informed of these first results and made aware of optimization of delivered doses. The standardized protocols of the scanner have been optimized. A second analysis, similar to the first one, was conducted in 2008. It showed the harmonization of the practice among the department, a significant decrease in the mean DLP (-50% for chest CT) and the respect for the dosimetric requirements for the three examinations concerned. © EDP Sciences, 2010.En 2007, le service de radiologie de l’Hôpital Trousseau (Paris) et l’IRSN ont initié une analyse détaillée des doses délivrées lors d’examens scanographiques chez l’enfant. Cette étude a porté sur trois types d’examen (thorax, abdomen-pelvis et rochers) et trois tranches d’âge (nouveau né à 1 an, 4 à 6 ans et 9 à 11 ans). Une première analyse des doses a été réalisée a posteriori sur l’activité du second semestre 2006. Elle a montré que les protocoles d’acquisition du scanner, qui satisfaisaient aux recommandations dosimétriques en vigueur, étaient mal respectés dans le service : les pratiques étaient hétérogènes et les valeurs moyennes de PDL supérieures aux recommandations. Après ces premiers résultats, une action de sensibilisation à l’optimisation des doses a été menée auprès du personnel et les protocoles d’acquisition du scanner ont été optimisés. L’analyse dosimétrique reprise en 2008 suivant le schéma de 2006 a montré une harmonisation des pratiques au sein du service, une diminution significative des PDL moyens (-50 % par exemple en scanographie thoracique) et le respect systématique des recommandations dosimétriques pour les trois examens étudiés

Patient dose evaluation in computed tomography: A French national study based on clinical indications

International audiencePurpose. A national survey was performed to assess patient dose indicators based on clinical indication and on patient morphology for most common adult computed tomography (CT) examinations in France. Methods. Seventeen groups of clinical indications (GCIs) for diagnostic CT in adult patients were considered based on their frequency and on image quality requirements. Data was collected for 15-30 consecutive examinations performed between 2015 and 2017, per CT scanner and GCI. Distributions of total examination Dose-Length Product (DLP) and Volume CT Dose Index (CTDIvol) were assessed for each GCI as a function of patient gender or patient Body Mass Index (BMI) for head/neck and trunk examinations, respectively.Results. 6610 examinations were analysed. Median total exam DLP values were higher for men compared to women patients for head and neck examinations: difference ranged from 6% for ear trauma indication (577 vs 543 mGy·cm, p=0.01) to 35% for brain tumour GCI (1472 vs 1093 mGy·cm, p<0.01). For trunk examinations, total exam DLP increased consistently with patient’s BMI. For normal-BMI patients, median CTDIvol and DLP differed significantly between different GCIs for single-phase CT of the chest (3 mGy and 112 mGy·cm, respectively, for chronic obstructive pulmonary disease group vs 5.8 mGy and 207 mGy·cm for pulmonary embolism group, p<0.05) and of the abdomen-pelvis (5.6 mGy and 284 mGy·cm, respectively, in renal colic group vs 9.5 mGy and 463 mGy·cm in occlusive syndrome group, p<0.05). Conclusion. This study provides morphological- and clinical-based patient dose indicators in CT as a practical tool for clinical practices optimisation

Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France

International audienceBackground Recent epidemiological results suggested an increase of cancer risk after receiving computed tomography (CT) scans in childhood or adolescence. Their interpretation is questioned due to the lack of information about the reasons for examination. Our objective was to estimate the cancer risk related to childhood CT scans, and examine how cancer-predisposing factors (PFs) affect assessment of the radiation-related risk. Methods The cohort included 67 274 children who had a first scan before the age of 10 years from 2000 to 2010 in 23 French departments. Cumulative X-rays doses were estimated from radiology protocols. Cancer incidence was retrieved through the national registry of childhood cancers; PF from discharge diagnoses. Results During a mean follow-up of 4 years, 27 cases of tumours of the central nervous system, 25 of leukaemia and 21 of lymphoma were diagnosed; 32% of them among children with PF. Specific patterns of CT exposures were observed according to PFs. Adjustment for PF reduced the excess risk estimates related to cumulative doses from CT scans. No significant excess risk was observed in relation to CT exposures. Conclusions This study suggests that the indication for examinations, whether suspected cancer or PF management, should be considered to avoid overestimation of the cancer risks associated with CT scans. © 2015 Cancer Research UK

New insights in cerebral findings associated with fetal myelomeningocele: a retrospective cohort study in a single tertiary centre

International audienceObjective: To investigate cerebral anomalies other than Chiari type 2 malformation in fetuses with myelomeningocele (MMC).Design: A retrospective cohort study in a single tertiary centre.Setting: A review of associated cerebral anomalies in cases with prenatal diagnosis of myelomeningocele.Population: Seventy cases of fetal myelomeningocele.Methods: Ultrasound and MRI images were blindly reviewed. Postnatal imaging and results of the postmortem results were also reviewed. The association between cerebral anomalies and the following ultrasound findings was measured: level of the defect, ventriculomegaly, microcephaly and fetal talipes.Main outcome measures: A microcephaly was observed in 32/70 cases (46%) and a ventriculomegaly was observed in 39/70 cases (56%). Other cerebral anomalies were diagnosed in 47/70 (67%).Results: Other cerebral anomalies were represented by 42/70 cases with abnormal CC (60%), 8/70 cases with perinodular heterotopia (PNH; 11%), 2/70 cases with abnormal gyration (3%). MRI performed only in fetal surgery cases confirmed the ulltrasound findings in all cases and provided additional findings in two cases (PNH). Risk ratios of fetal cerebral anomalies associated with MMC did not reach significance for microcephaly, ventriculomegaly, talipes or the level of the defect There was an overall good correlation between pre- and postnatal findings with a Kappa value of 0.79 [95% CI 0.57-1] and 82% agreement.Conclusion: Fetal brain anomalies other than Chiari type 2 malformation are frequently observed in fetuses with myelomeningocele, predominantly represented by CC anomalies. Whether these associated cerebral anomalies have an impact on selecting cases eligible for fetal surgery needs further evaluation.Tweetable abstract: Fetal cerebral anomalies other than Chiari type 2 malformation, microcephaly, and ventriculomegaly may be associated with MMC in up to 67% of the cases

Radioprotection des professionnels de santé en France : exposition, connaissances et habitudes – étude EXPERTS

IntroductionLes professionnels de santé exposés aux rayonnements ionisants (RI) représentent plus de la moitié de l’ensemble des travailleurs exposés aux RI artificiels en France. L’utilisation des RI en médecine s’est développé rapidement ces 10 dernières années, en raison de l’introduction de nouvelles pratiques diagnostiques et thérapeutiques. En parallèle, la radioprotection des travailleurs a progressé (lois, dispositifs et outils) dans le but de réduire leur exposition aux RI. L’étude EXPERTS (EXposition des Professionnels de santE aux RayonnemenTs ioniSants) a plusieurs objectifs, notamment d’étudier les connaissances et habitudes de ces professionnels vis-à-vis de la radioprotection – ce que propose de faire ce présent travail. Matériel et MéthodesL’étude EXPERTS a inclus tous les professionnels de santé ayant au minimum un enregistrement dosimétrique dans le Système d'Information de la Surveillance de l'Exposition aux Rayonnements Ionisants (SISERI) pour chaque année 2009, 2014 et 2019, dans l’un des neuf établissements participant à l’étude. Les professionnels ayant changé d’emploi entre 2009 et 2019 ont été exclus. Les caractéristiques socio-professionnelles ont été recueillies via SISERI et CHIMED© (logiciel dédié aux hôpitaux). Tous les professionnels ont été invités à compléter un questionnaire portant sur divers aspects de la radioprotection.Résultats293/1268 professionnels contactés ont répondu au questionnaire (taux de participation : 23%). Des différences dans les taux de réponse ont été notées seulement selon le métier et le service. Les répondants étaient âgés en moyenne de 39,2 (±8,1) ans en 2009, avec une majorité de femmes (59%), et 85% étaient des manipulateurs d'électroradiologie médicale, infirmiers, ou médecins. Parmi les répondants, 12% déclarent porter leur dosimètre rarement ou jamais, et 15% déclarent ne pas utiliser de moyens de protections : en cause, manque de temps ou moyens de protection/dosimètres jugés inadaptés, sans intérêt, ou en nombre insuffisant. 71% des agents se considèrent exposés aux RI, 82% se disent suffisamment informés des risques liés au RI, 86% jugent leur exposition à risque acceptable/négligeable, tandis que 26% souhaiteraient recevoir prochainement une formation en radioprotection. Les questions de culture sur les RI révèlent seulement 40% de bonnes réponses.ConclusionsCe résumé présente les résultats préliminaires des réponses au questionnaire diffusé dans l’étude EXPERTS. Ceux-ci confirment un port non-systématique du dosimètre chez les professionnels de santé, et une faible proportion de travailleurs n’utilisant pas de moyens de protections. Le caractère inadapté des tabliers, lunettes plombées, et dosimètres étant mis en cause. Quelques lacunes au niveau des connaissances dans le domaine des RI et des risques ont été montrées. Ces résultats encouragent de nouvelles formations en radioprotection auprès des travailleurs du secteur santé, et l’utilisation de matériels de protection plus ergonomique. A noter la non-réponse d’une partie importante de la population d’étude - les résultats de cette étude sont ainsi à interpréter avec prudence