15 research outputs found

    Pediatric musculo-skeletal trauma : What is unique and what not to miss

    No full text

    Redefining the structure of structured reporting in radiology

    Get PDF
    Structured reporting is advocated as a means of improving reporting in radiology to the ultimate benefit of both radiological and clinical practice. Several large initiatives are currently evaluating its potential. However, with numerous characterizations of the term in circulation, “structured reporting” has become ambiguous and is often confused with “standardization,” which may hamper proper evaluation and implementation in clinical practice. This paper provides an overview of interpretations of structured reporting and proposes a clear definition that differentiates structured reporting from standardization. Only a clear uniform definition facilitates evidence-based implementation, enables evaluation of its separate components, and supports (meta-)analyses of literature reports

    Structured CT reporting improves accuracy in diagnosing internal herniation after laparoscopic Roux-en-Y gastric bypass

    No full text
    Objectives: To confirm that structured reporting of CT scans using ten signs in clinical practice leads to a better accuracy in diagnosing internal herniation (IH) after gastric bypass surgery, compared with free-text reporting. Methods: In this prospective study, CT scans between June 1, 2017, and December 1, 2018, were included from a cohort of 2606 patients who had undergone laparoscopic gastric bypass surgery between January 1, 2011, and January 1, 2018. The CT scans were made for a suspicion of IH and structured reports were made using a standardised template with ten signs: (1) swirl sign, (2) small-bowel obstruction, (3) clustered loops, (4) mushroom sign, (5) hurricane eye sign, (6) small bowel behind the superior mesenteric artery, (7) right-sided anastomosis, (8) enlarged nodes, (9) venous congestion, and (10) mesenteric oedema. Furthermore, an overall impression of IH likelihood was given using a 5-point Likert scale. CT scans performed in 2011 until 2017, without structured reporting, were included for comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated using two-way contingency tables; the chi-square test was used for calculating p value. Reoperation and 3-month follow-up were used as reference. Results: A total of 174 CT scans with structured reporting and 289 CT scans without structured reporting were included. Sensitivity was 81.3% (95% CI, 67.7–94.8%) and 79.5% (95% CI, 67.6–91.5%), respectively (p = 0.854); specificity was 95.8% (95% CI, 92.5–99.1%) and 88.6% (95% CI, 84.6–92.6%), respectively (p = 0.016); PPV was 81.3% (95% CI, 67.7–94.8%) and 55.6% (95% CI, 43.3–67.8%), respectively (p = 0.014); NPV was 95.8% (95% CI, 92.5–99.1%) and 96.0% (95% CI, 93.5–98.6%), respectively (p = 0.909); and accuracy was 93.1% (95% CI, 88.0–96.2%) and 87.2% (95% CI, 82.7–90.7%), respectively (p = 0.045). Conclusion: Structured reporting for the diagnosis of internal herniation after gastric bypass surgery improves accuracy and can be implemented in clinical practice with good results. Key Points: • Ten signs are used to aid CT diagnosis of internal herniation after gastric bypass surgery. • Structured reporting increases specificity and positive predictive value and thereby prevents unnecessary reoperations in patients without internal herniation. • Structured reporting by means of a standardised template can help less experienced readers

    Ribs

    No full text
    Rib fractures in paediatric patients usually result from static loading (compression) or dynamic impact loading (direct impact trauma to the ribs). In young children rib fractures are usually caused by static loading, while in mobile older children and in adolescents rib fractures are usually caused by dynamic impact loading. However, it should be noted that still there is no clear understanding of what forces and mechanisms of injury are exactly required to produce rib fractures. This is mainly because in vivo experiments in children are impossible. The information on trauma mechanism reflects what is accepted as plausible in medical science.This chapter describes the circumstances under which rib fractures occur before, during and after birth with emphasis on the difference between accidental and non-accidental (inflicted) injury.In addition, penetrating chest trauma is discussed, as well as diseases and normal variants that can simulate (healed) rib fractures.</p

    Ribs

    No full text
    Rib fractures in paediatric patients usually result from static loading (compression) or dynamic impact loading (direct impact trauma to the ribs). In young children rib fractures are usually caused by static loading, while in mobile older children and in adolescents rib fractures are usually caused by dynamic impact loading. However, it should be noted that still there is no clear understanding of what forces and mechanisms of injury are exactly required to produce rib fractures. This is mainly because in vivo experiments in children are impossible. The information on trauma mechanism reflects what is accepted as plausible in medical science.This chapter describes the circumstances under which rib fractures occur before, during and after birth with emphasis on the difference between accidental and non-accidental (inflicted) injury.In addition, penetrating chest trauma is discussed, as well as diseases and normal variants that can simulate (healed) rib fractures.</p

    General Aspects of Fractures in Children

    No full text
    A fracture is a partial or complete disruption of the continuity of bone or cartilage, due to mechanical forces exceeding the strength of the bone or cartilage to withstand these forces.Fractures are common in children. In a large Swedish study, the overall annual incidence of fractures in children was 2.1% (2.6 for boys; 1.7 for girls). Most fractures in children are the result of accidental trauma and conventional radiography (x-rays) is by far the preferred modality to diagnose them. This chapter discusses the anatomy of the bones, types of fractures and the terminology to describe fractures in an unequivocal way. In addition, fractures are discussed in the context of the trauma mechanism, the circumstances under which a fracture occurs and the age of the patient. Any discrepancies between the type of fracture and the alleged trauma mechanism (history as provided by the parents) should arise suspicion of non-accidental injury, where in general the younger the child, the greater the probability of inflicted injuries.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Medical Instruments & Bio-Inspired Technolog

    Redefining the structure of structured reporting in radiology

    No full text
    Structured reporting is advocated as a means of improving reporting in radiology to the ultimate benefit of both radiological and clinical practice. Several large initiatives are currently evaluating its potential. However, with numerous characterizations of the term in circulation, “structured reporting” has become ambiguous and is often confused with “standardization,” which may hamper proper evaluation and implementation in clinical practice. This paper provides an overview of interpretations of structured reporting and proposes a clear definition that differentiates structured reporting from standardization. Only a clear uniform definition facilitates evidence-based implementation, enables evaluation of its separate components, and supports (meta-)analyses of literature reports

    Ultrasonography guided puncture and dilatation in membranous rectal atresia

    No full text
    Purpose: Rectal atresia (RA) is a rare type of anorectal malformation (ARM), occurring in 1–2% of ARM. Discussion remains on optimal treatment strategy for RA. The aim of this study was to present a minimally invasive method to treat patients with membranous RA: ultrasonography guided puncture and dilatation. Cases: Three children are described (1 female, and 2 male). All patients were diagnosed with membranous RA, and treated with ultrasonography guided puncture and dilatation within 48 hours after birth. The procedure was performed under sedation and was uncomplicated in all patients. Follow-up showed good bowel function in 2 of 3 patients. One patient had persistent constipation needing laxative treatment up to the age of 6 years. Conclusions: Rectal atresia is extremely rare, and little is known on optimal treatment methods. Ultrasonography guided puncture and dilatation is a minimally invasive technique to potentially adequately treat patients with membranous RA. In our patients, this treatment strategy has shown to be effective with good long-term outcomes regarding bowel function. Further research should be performed to further investigate optimal treatment for the different types of RA. Level of Evidence:

    Modelling growth curves of the normal infant’s mandible: 3D measurements using computed tomography

    Get PDF
    Objectives: Data on normal mandibular development in the infant is lacking though essential to understand normal growth patterns and to discriminate abnormal growth. The aim of this study was to provide normal linear measurements of the mandible using computed tomography performed in infants from 0 to 2 years of age. Material and methods: 3D voxel software was used to calculate mandibular body length, mandibular ramus length, bicondylar width, bigonial width and the gonial angle. Intra- and inter-rater reliability was assessed for these measurements. They were found to be sufficient for all distances; intra-class correlation coefficients were all above 0.9. Regression analysis for growth modelling was performed. Results: In this multi-centre retrospective study, 109 CT scans were found eligible that were performed for various reasons (e.g. trauma, craniosynostosis, craniofacial abscesses). Craniosynostosis patients had larger mandibular measurements compared to non-craniosynostosis patients and were therefore excluded. Fifty-one CT scans were analysed. Conclusions: Analysis showed that the mandible increases more in size vertically (the mandibular ramus) than horizontally (the mandibular body). Most of the mandibular growth occurs in the first 6 months. Clinical relevance: These growth models provide insight into normal mandibular development in the first 2 years of life. This reference data facilitates discrimination between normal and abnormal mandibular growth.</p
    corecore