Dose, image quality and spine modeling assessment of biplanar EOS micro-dose radiographs for the follow-up of in-brace adolescent idiopathic scoliosis patients.

Purpose: The aim of this study was to compare the radiation dose, image quality and 3D spine parameter measurements of EOS low-dose and micro-dose protocols for in-brace adolescent idiopathic scoliosis (AIS) patients. Methods: We prospectively included 25 consecutive patients (20 females, 5 males) followed for AIS and undergoing brace treatment. The mean age was 12 years (SD 2 years, range 8-15 years). For each patient, in-brace biplanar EOS radiographs were acquired in a standing position using both the conventional low-dose and micro-dose protocols. Dose area product (DAP) was systematically recorded. Diagnostic image quality was qualitatively assessed by two radiologists for visibility of anatomical structures. The reliability of 3D spine modeling between two operators was quantitatively evaluated for the most clinically relevant 3D radiological parameters using intraclass correlation coefficient (ICC). Results: The mean DAP for the posteroanterior and lateral acquisitions was 300 ± 134 and 433 ± 181 mGy cm2 for the low-dose radiographs, and 41 ± 19 and 81 ± 39 mGy cm2 for micro-dose radiographs. Image quality was lower with the micro-dose protocol. The agreement was "good" to "very good" for all measured clinical parameters when comparing the low-dose and micro-dose protocols (ICC > 0.73). Conclusion: The micro-dose protocol substantially reduced the delivered dose (by a factor of 5-7 compared to the low-dose protocol) in braced children with AIS. Although image quality was reduced, the micro-dose protocol proved to be adapted to radiological follow-up, with adequate image quality and reliable clinical measurements. These slides can be retrieved under Electronic Supplementary Material.No funding was secured for this study

EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.

Shwachman-Diamond syndrome (SDS) is a recessive disorder typified by bone marrow failure and predisposition to hematological malignancies. SDS is predominantly caused by deficiency of the allosteric regulator Shwachman-Bodian-Diamond syndrome that cooperates with elongation factor-like GTPase 1 (EFL1) to catalyze release of the ribosome antiassociation factor eIF6 and activate translation. Here, we report biallelic mutations in EFL1 in 3 unrelated individuals with clinical features of SDS. Cellular defects in these individuals include impaired ribosomal subunit joining and attenuated global protein translation as a consequence of defective eIF6 eviction. In mice, Efl1 deficiency recapitulates key aspects of the SDS phenotype. By identifying biallelic EFL1 mutations in SDS, we define this leukemia predisposition disorder as a ribosomopathy that is caused by corruption of a fundamental, conserved mechanism, which licenses entry of the large ribosomal subunit into translation.Medical Research Council, Bloodwise, Wellcome Trust, Ted’s Gang, The Connor Wright Shwachman Diamond Projec

Biopsies percutanées de tumeurs de l enfant : une étude rétrospective de l évolution et des déterminants de la performance diagnostique, 1986-2012

REIMS-BU Santé (514542104) / SudocSudocFranceF

Aspects scannographiques de l aspergillose pulmonaire chez l enfant (étude pilote à propos de 14 cas)

L aspergillose pulmonaire invasive (API) est une maladie opportuniste grave, mieux décrite radiologiquement chez l adulte que chez l enfant. Nous rapportons une étude rétrospective de tous les cas pédiatriques d API vus à l hôpital Trousseau de 2000 à 2005. L objectif était de décrire les lésions scannographiques pulmonaires initiales et sous traitement, de les comparer à celles vues chez l adulte et d analyser les facteurs de mauvais pronostic. La présence, le nombre et le siège des lésions ont été notés, leur taille mesurée et leur surface calculée. Nous avons inclus 14 patients dont 13 souffrant de leucémie aigue et un d aplasie médullaire idiopathique. Sept patients de cette série sont décédés. Le scanner thoracique initial montrait des nodules, un halo périnodulaire, des condensations parenchymateuses et des nodules excavés dans respectivement 71, 90, 35 et 7% de nos cas. L analyse de la littérature suggère chez l adulte une incidence respective des anomalies scannographiques pulmonaires de 85-96%, 61-100%, 15-31%, et 5-20%. L incidence des condensations parenchymateuses pulmonaires était supérieure dans le groupe des patients décédés. En conclusion, cette étude rétrospective suggère une incidence comparable des différentes anomalies scannographiques pulmonaires au cours de l API chez l enfant et chez l adulte. Elle confirme le mauvais pronostic de la présence des condensations parenchymateuses pulmonaires sur le scanner initial.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Convulsions néonatales précoces à terme (stratégie d'imagerie diagnostique et pronostique)

Introduction : la survenue de convulsions chez le nouveau-né à terme pose deux problèmes : quelle en est la cause et quel est le pronostic neurologique pour l'enfant ? Les techniques d'imagerie prennent une place primordiale pour répondre à ces questions. Au moment de l'étude il n'existe aucune stratégie d'imagerie consensuelle. L'objectif de ce travail est de proposer un schéma d'exploration radiologique. Patients et méthodes : 16 nouveau-nés à terme, hospitalisés dans le service de néonatologie pour des convulsions ont été inclus dans notre étude rétrospective. Le recueil de données a porté sur les données cliniques, biologiques et électroencéphalographiques. Les imageries disponibles ont été relues par un radiopédiatre. Résultats : 8 enfants sont atteints d'une encephalopathie hypoxo-ischémique (EHI), 7 d'un accident vasculaire cérébral (AVC) ischémique et 1 hémorragique, 4 patients ont des séquelles neurologiques (suivi de 4 mois à 5 ans). Toutes les échographies tranfontanellaires (ETF) sont anormales. Le scanner a été réalisé chez 13 patients, avec une mauvaise sensibilité dans le cadre des EHI. Une imagerie par résonance magnétique (IRM) a été réalisée chez 8 patients en période néonatale, dont 5 ont posé le diagnostic. Les 3 IRM réalisées dans le cadre d'un suivi montrent des lésions séquellaires. Conclusion : confrontés aux données de la littérature, nos résultats confirment l'intérêt de la réalisation précoce d'une ETF, complétée la première semaine de vie par une IRM avec des séquences de diffusion, des séquences conventionnelles et une spectroscopie par résonance magnétiqueIntroduction : neonatal seizures in full term newborns raise two questions : what is the cause of and what is the neurodevelopmental outcome for the child ? Neuroimaging study is essential to answer these questions. No neuroimaging strategy was consensual at the time of the study. The aim of our work is to establish the neuroimaging modalities which contribute to diagnosis and prognostic assessments. Patients and methods : our retrospective study included 16 full term newborns who were admitted to neonatal unit of Armand Trousseau Hospital because they presented with seizures within the first week of life. Clinical, biological and electroencephalogram data were collected. Available cerebral scans were reviewed by a radiologist. Results : 8 children were diagnosed with neonatal hypoxic ischemic encephalopathy (HIE), 7 were diagnosed with ischemic cerebral infarction and 1 was diagnosed with haemorrhagic brain lesions. All cranial ultrasonographies (CUS) were abnormal. Cerebral computed tomography (CT) was realised in 13 children with a poor sensibility to diagnose HIE. 8 children had neonatal magnetic resonance (MR) imaging which made diagnosis in 5 cases and were normal in 3 other cases. 4 children had an abnormal neurodevelopmental outcome (follow-up ranged from 4 months to 5 years). None of them had a later cerebral imagery. 3 children had a MRI as follow-up : scans showed scarred brain lesions of initial injury. Conclusion : our results are agreed with conclusion of others studies. After seizures, the children have to be examined with an early CUS with Doppler study ; next with conventional and diffusion-weighted MR imaging, and MR spectroscopy, ideally between day 2 and 5 after seizuresPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prenatal and paediatric imaging needs you!

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 1: computed tomography

International audienceOBJECTIVES: To report on a dose survey conducted by the French societies of radiology and paediatric imaging (SFR and SFIPP) and the French public service expert in nuclear and radiological risks (IRSN), and to suggest new diagnostic reference levels (DRLs) for paediatric CT.METHODS: Dose reports concerning children aged 0-15 years and five CT procedures (brain, petrous bone, mediastinum, lung and abdomen-pelvis) performed in 2015-2016 were collected from 15 imaging departments on a voluntary basis. Volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded for at least 10 patients per procedure, per centre and per age group. New DRLs were calculated as the 3rd quartiles of the distributions of the median values.RESULTS: Results from 3253 CT examinations were obtained. The exposure levels observed were much lower than for the previous surveys (2007-2008 and 2010-2013) and among the lowest values currently published. A good homogeneity between facilities was also observed. New DRLs are proposed for each procedure and age group.CONCLUSIONS: This new survey contributes to the continuing optimisation process in French paediatric CT practice. Its results have been recently used to update the national paediatric CT DRLs.KEY POINTS: * New national diagnostic reference levels (DRLs) are proposed for several paediatric CT procedures. * The DRLs proposed for brain, chest and abdomen-pelvis procedures are among the lowest published worldwide

Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 2: plain radiography and diagnostic fluoroscopy

International audienceOBJECTIVES: To report on a dose survey conducted by the French societies of radiology and paediatric imaging (SFR and SFIPP) and the French public service expert in nuclear and radiological risks (IRSN), and to suggest new diagnostic reference levels (DRLs) for paediatric plain radiography and diagnostic fluoroscopy.METHODS: Dose reports concerning four radiography procedures and three diagnostic fluoroscopy procedures performed in 2015-2016 on children aged 0-15 years were collected from 16 imaging departments on a voluntary basis. Air kerma-area product (PKA) was recorded for at least 10 patients per procedure, per centre and per age group. New DRLs were calculated as the 3rd quartiles of the distributions of the median values.RESULTS: Results from 2249 radiography examinations and 1235 diagnostic fluoroscopy procedures were obtained. A noticeable variability in patient exposure between facilities was observed in diagnostic fluoroscopy and to a lesser extent in plain radiography. DRLs are proposed for each procedure and each age group.CONCLUSIONS: This study showed that the applicable national DRLs in plain radiography were obsolete and its results have been recently used by the French authorities to update them. In diagnostic fluoroscopy, large differences of doses were observed, even among departments accustomed to paediatric procedures. The new national DRLs will be useful for optimising diagnostic practice.KEY POINTS: * New national diagnostic reference levels (DRLs) are proposed for several paediatric procedures in plain radiography and diagnostic fluoroscopy. * Even between departments accustomed to paediatric procedures, substantial differences of practice were observed, especially in diagnostic fluoroscopy

Radiation Protection No. 185 European Guidelines on Diagnostic Reference Levels for Paediatric Imaging

The establishment and use of diagnostic reference levels (DRLs) have been recommended by the International Commission on Radiological Protection (ICRP) and required in the European Council Directive 2013/59/Euratom Basic Safety Standards (BSS). DRLs are a useful tool in the quest to optimise patient doses in diagnostic radiology and interventional radiology (IR). Particular attention should be paid to establishing and using DRLs in paediatric radiology because children have a higher risk (for some organs and body areas) compared to adults from the detrimental effects of radiation. A comprehensive European and worldwide review of DRLs for paediatric examinations (Section 5 and Annex C) has indicated that only a few countries have set DRLs for paediatric examinations and there is a complete lack of national DRLs for many examinations, in particular for all paediatric interventional procedures. Furthermore, the existing DRLs are often adopted from the old European Commission (EC) recommendations or from other countries, and only a few countries have based their DRLs on their own national patient dose surveys. In many countries, the initial DRLs have never been updated. Due to the huge variation of patient sizes among the paediatric population, several age, size or weight groups are needed to establish the DRLs, and there has been little consistency in grouping of the patients. Extensive patient dose surveys are needed to establish DRLs but there has been no detailed guidance on how to carry out and report such surveys in order to ensure consistent methods and comparability of the DRLs, in particular for reliable evaluation of DRLs for use at a European level.European Commissio