Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?

OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >;12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention; therefore, the use of computed tomography scans may be questioned in this group. The results support the trend of more careful indications for cranial computed tomography scans for children with minor head trauma

Comparação entre a ressonância de corpo total e os métodos convencionais de imagem no estadiamento do linfoma de hodgkin em crianças e adolescentes

Objective: to compare whole-body magnetic resonance imaging (WB-MRI) with conventional imaging methods compared to a standard clinical-radiological follow-up in the staging of Hodgkin lymphoma (HL) in children and adolescents. Methods: We included 22 patients aged 5 to 21 years. The staging was performed by conventional imaging methods and WB-MRI. We considered conventional imaging computed tomography of the neck, chest, abdomen and pelvis and the cervical and / or abdominal ultrasound. The sensitivity of the methods in the staging of LH and the sensitivity and specificity in detecting the involvement of nodal and extranodal sites were calculated. The kappa statistic (?) was used to test the correlation between WB-MRI and conventional imaging methods in the staging of HL in relation to clinical-radiological follow up. Results: The correlation between WB-MRI and clinical-radiological follow-up to stage LH was excellent (? = 0.928) and between conventional imaging methods and clinical-radiological follow-up was good (? = 0.797) as well as between WB-MRI and conventional imaging methods (? = 0.729). WB-MRI showed sensitivity higher than conventional image methods for HL staging, but with no significant difference (95.5% and 86.4%, respectively). The WB-MRI and conventional methods showed similar sensitivity and specificity in the detection of nodal (99.1 and 100% vs. 97.3 and 100%, respectively) and extranodal involvement sites (90.5 and 98.7% vs. 90.5 and 99.4%, respectively). Conclusion: WB-MRI has excellent sensitivity in the staging of HL in children and adolescents, higher than conventional methods when compared to clinical- radiological standard reference, proving to be a safer alternative for this purpose mainly because it does not use ionizing radiation.Objetivo: comparar a ressonância magnética de corpo inteiro (WB-MRI - whole body magnetic resonance imaging) com os métodos convencionais de imagem, em relação a um padrão de acompanhamento clinicorradiológico, no estadiamento do linfoma de Hodgkin (LH) em crianças e adolescentes. Métodos: foram incluídos 22 pacientes com idade variando de 5 a 21 anos. O estadiamento dos pacientes foi realizado pelos métodos convencionais de imagem e pela WB-MRI. Foram considerados como métodos convencionais de imagem a tomografia computadorizada de pescoço, tórax, abdome e pelve e a ultrassonografia cervical e/ ou abdominal. Foram calculadas a sensibilidade dos métodos no estadiamento do LH e a sensibilidade e especialidade na detecção do acometimento de sítios nodais e extranodais. A estatística kappa (?) foi utilizada para testar a concordância entre a WB-MRI e os métodos convencionais de imagem no estadiamento do linfoma, em relação ao padrão clinicorradiológico. Resultados: a concordância entre a WB-MRI e o acompanhamento clinicorradiológico para o estadiamento do LH foi excelente (?=0,928) e entre os métodos convencionais de imagem e o acompanhamento clinicorradiológico foi boa (?=0,797), assim como entre a WB-MRI e os métodos convencionais de imagem (?=0,729). A WB-MRI demonstrou sensibilidade superior à dos métodos convencionais de imagem para o estadiamento, mas sem diferença significativa (95,5% e 86,4%, respectivamente). A WB-MRI e os métodos convencionais mostraram sensibilidade e especificidade semelhantes na detecção de acometimento dos sítios nodais (99,1 e 100% vs. 97,3 e 100%; respectivamente) e extranodais (90,5 e 98,7% vs. 90,5 e 99,4%; respectivamente). Conclusão: A WB-MRI apresenta excelente sensibilidade no estadiamento do LH em crianças e adolescentes, superior aos métodos convencionais quando comparada ao padrão de referência clinicorradiológico, demonstrando ser uma alternativa mais segura para essa finalidade, sobretudo por não utilizar radiação ionizante.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Evaluation of non-radiologist physicians' knowledge on aspects related to ionizing radiation in imaging

Objective: To assess the non-radiologist physicians' knowledge on the use of ionizing radiation in imaging. Materials and Methods: Cross-sectional study utilizing an anonymous questionnaire responded by physicians in clinical and surgical specialties, divided into two parts as follows: one including questions about the physicians' characteristics, frequency of imaging studies requests and participation in professional updating events, and another part including multiple choice questions approaching general knowledge about radiation, optimization principles and radioprotection. Results: From a total of 309 questionnaires, 120 (38.8%) were responded, 50% by physicians in surgical specialties and 50% in clinical specialties; respectively 45% and 2.5% of physicians responded that magnetic resonance imaging and ultrasonography use ionizing radiation. Overall, the average grade was higher for surgical specialists with no significant difference, except for the question about exposure in pregnant women (p = 0.047). Physicians who are professionally updated, particularly those attending clinical meetings (p = 0.050) and participating in teaching activities (p = 0.047), showed statistically superior knowledge about ionizing radiation as compared with others. Conclusion: The non-radiologist physicians' knowledge is heterogeneous and in some points needs to be improved. Multidisciplinary clinical meetings and teaching activities are important ways to disseminate information on the subject.Objetivo: Avaliar o conhecimento dos médicos não radiologistas sobre a utilização da radiação ionizante em exames de imagem. Materiais e Métodos: Estudo transversal, utilizando questionário anônimo, aplicado a médicos de especialidades clínicas e cirúrgicas, dividido em duas partes: uma com questões sobre as características dos médicos, frequência de solicitação de exames e de participação em eventos de atualização profissional, e outra com questões de múltipla escolha, abordando conhecimentos gerais sobre radiação, princípios de otimização e radioproteção. Resultados: De 309 questionários distribuídos, 120 (38,8%) foram respondidos, 50% por médicos de especialidades cirúrgicas e 50% clínicas; 45% e 2,5% dos médicos responderam, respectivamente, que a ressonância magnética e a ultrassonografia utilizam radiação ionizante. No geral, a média das notas foi maior nas especialidades cirúrgicas, sem diferenças significativas, exceto na questão sobre exposição em grávidas (p = 0,047). Os médicos que se atualizam profissionalmente mostraram conhecimento sobre radiação ionizante estatisticamente superior aos demais, principalmente os que frequentam reuniões clínicas (p = 0,050) e participam de atividades de ensino (p = 0,047). Conclusão: O conhecimento dos médicos não radiologistas sobre radiação ionizante é heterogêneo e em alguns pontos precisa ser melhorado. Reuniões clínicas multidisciplinares e atividades de ensino são importantes formas de disseminar informações sobre o tema