Pediatric radiology

Radiation protection
Exposure to radiation can be harmful, no matter how much modern techniques and machines make it possible to reduce the radiant dose delivered below the threshold required by national regulations. The EOC is particularly vigilant about radiation protection, implementing the following measures in accordance with radiation protection ordinances adopted by the Federal Council to protect young patients:

• Conducting examinations whose requirements are appropriate and with correct indications (principle of radiological justification).
• Use of the lowest X-ray dose necessary for obtaining an X-ray that is interpretable for diagnosis, according to the ALARA (As Low As Reasonably Achievable) principle.
• Limitation of the area of the body to be examined, with use of filters and protection.
• Documentation of doses applied.
• Ongoing training of technical and medical personnel.

It should be mentioned that no risk has been demonstrated after exposure to low doses. For example, the exposure for an X-ray corresponds to the natural average exposure experienced during a 4-hour air travel. It is important that accompanying mothers report any pregnancy status so that more precautionary measures can be taken.

Principal indications.
In the pediatric setting, the following examinations are performed in accordance with specific indications after appropriate clinical-laboratory review by the pediatrician:

• Chest radiography: respiratory and rib cage pathologies, trauma.
• Abdominal radiography: occlusive pathologies and signs of acute abdomen.
• Babygram radiography: neonatal respiratory and abdominal pathologies.
• Orthopedic radiography (single segments, column in toto and pelvis under load, lower limbs and pelvis under load): trauma, lameness, scoliosis, pain, balance of metabolic and congenital pathologies interesting the skeletal system.

Required preparation
Prior to the conduct of the examination, hospital staff-with the possible help of parents-will remove clothing and external metal objects that could be projected on the radiograph, limiting its interpretation.

How it is performed
To carry out the examination under the best safety conditions, pads and straps may be used to prevent the little patient from moving and falling. During the examination, parents can stay by their little one's side to reassure him or her; radiology technicians will provide them with appropriate instructions. It is important that accompanying mothers report any pregnancy status so that more precautionary measures can be taken.

Ultrasound is a technique that allows, through the use of ultrasound emitted by a probe, the study of many parts of the body (brain and marrow in infants younger than 3 months, neck, chest, abdomen, soft tissue), without the use of radiation.

Preparation needed

• Abdominal ultrasound: the little one must be fasting (3 hours since last feeding for infants up to 3 months of age, 4 hours since last feeding bottle up to 1 year of age, 6 hours since last meal up to 3 years of age, and from the evening of the day before for examination scheduled in the morning after over 3 years of age).
• Pelvic ultrasound: full bladder depending on age and retention capacity.

It may be helpful to bring along a toy the little one is fond of or give him a pacifier during the examination.

How it is done
The radiologist will examine on a screen in a darkened room the images produced by a probe placed on your baby's body using a heated gel. The exam takes about 15 minutes but, depending on the cooperation of the little one and the type of exam, it can take longer. The presence of the parent talking to the baby can make him or her calmer.

Risks
Ultrasound is a risk-free examination. The team and parents are careful with the baby so that he or she does not fall off the couch. The acquisition of interpretable images may be limited by major movements of the baby or the evaluation of some organs by technical limitations (air, bone structures), so other imaging methods may need to be used.

CT (or CT) examination relies on the use of X-rays to obtain cross-sectional images of organs in order to study their shape, size, and density to detect abnormalities that cannot be studied with X-rays or ultrasonography.

Radiation protection
Exposure to radiation can be harmful, no matter how much modern techniques and machines make it possible to reduce the radiant dose delivered below the threshold required by national regulations. The EOC is particularly vigilant about radiation protection, implementing the following measures in accordance with radiation protection ordinances adopted by the Federal Council to protect young patients:

• Conducting examinations whose requirements are appropriate and with correct indications (principle of radiological justification).
• Use of the lowest X-ray dose necessary for obtaining an X-ray that is interpretable for diagnosis, according to the ALARA (As Low As Reasonably Achievable) principle.
• Limitation of the area of the body to be examined, with use of filters and protection.
• Documentation of doses applied.

Ongoing training of technical and medical personnel.

It is important that accompanying mothers report any pregnancy status so that more precautionary measures can be taken.

Preparation
It is important that the examination be performed with the child fasting if contrast is needed or to study the abdomen (3 hours from last feeding for infants up to 3 months of age, 4 hours from last feeding bottle up to 1 year of age, 6 hours from last meal up to 3 years of age, and from the evening of the day before for examination scheduled in the morning after over 3 years of age).

Prior to the conduct of the examination, hospital staff, with possible help from parents, will remove clothing and external metallic objects that could generate artifacts on the images, limiting their interpretation. During the examination, parents can stay by their little one's side to calm him or her; radiology technicians will provide them with appropriate instructions. Seeing an examination being performed on their child may induce anxiety for parents, should they not wish to remain beside their little one, they can wait in the waiting room, radiology staff will take care of the little one and keep them informed of the progress of the examination.

Sedation
Depending on age and contrast use, it may be necessary to require total immobility through the use of sedation, for which the pediatrician or, if necessary, the anesthesiologist with his or her team will administer and supervise the child during the examination.

How it is performed
So that the little one does not move, the use of bands and pads may be necessary. If necessary, contrast injection will be through the use of a needle or catheter, placed, depending on age, by radiology technicians or pediatric nurses. Patches or local anesthetic creams may be used to reduce pain. During or after the contrast injection, images will be acquired. The examination time is very rapid.

Risks
In rare cases, contrast may cause a hematoma at the injection site, or it may extravasate out of the vein. Contrast intolerance manifests itself in warm sensation or nausea. True allergy or urticaria is rare. If the child has known allergic reactions or has already had allergies to contrast, it should be reported to the technician or physician. The little one will be kept under observation after the examination if he or she has received contrast; if he or she presents late (at home) with redness on the skin or respiratory distress, it is important to contact and report them to the pediatrician.

Magnetic resonance imaging is an examination that allows visualization of various body districts without the use of ionizing radiation, but by exploiting the magnetic properties of the body placed in a magnetic field.

Main indications
MRI makes it possible to study abnormalities not visible on plain X-rays, in ultrasound or with CT examination.

Preparation
Because the examination is performed within a magnetic field, it will be necessary to notify the pediatrician and hospital staff prior to the examination of the presence of any conditions such as: dental or hearing aids, implanted pacemakers, heart valves, defibrillators, neuromodulators, drug infusion pumps and/or additional electrical devices in the body, vascular clips, prostheses and/or metal objects inside the body, tattoos, orthopedic, eye or head surgery. It is important to report previous adverse reactions to paramagnetic contrast medium. All of these conditions need to be discussed, as they may contraindicate the examination or require important accommodations.
It is important that the examination be performed with the child fasting if contrast is needed or to study the abdomen (3 hours from last feeding for infants up to 3 months of age, 4 hours from last bottle feeding up to 1 year of age, 6 hours from last meal up to 3 years of age, and from the evening of the day before for examination scheduled in the morning after over 3 years of age).Because the examination can take 15 to 50 minutes, it is recommended to have the bladder emptied before starting.

Before the examination takes place, hospital staff, with possible help from parents, will remove clothing and external metal objects that might interfere with the magnetic field. During the exam, parents can stay by their little one's side to reassure him or her, and radiology technicians will make sure that the parent himself or herself has no contraindications for remaining in close proximity to the magnetic field. Seeing their child perform an examination can induce anxiety for parents: if they do not wish to remain next to their little one, they can wait in the waiting room; radiology staff will take care of the little one and keep them informed of the progress of the examination.

Sedation
It is necessary for the little patient to be still during the performance of the examination. In infants younger than 3 months of age, immobility can be achieved with the use of restraint techniques, subject to natural falling asleep following feeding, so it will be required not to feed the little one in the 3 hours prior to the appointment and to breastfeed him or her immediately before the start of the MRI.
In children older than 3 months to about 6 years of age (depending on the degree of cooperation and from possible claustrophobia), sedation techniques are necessary, so the pediatrician will request the examination with the assistance of the anesthesiologist and his team. A prior visit will then be scheduled with the anesthesiologist, who will safely administer sedation on the day of the exam and monitor the child during and after the exam.
It is important to report if the child has had a cold or cough, a condition for which precautionary measures will be taken.

How it is performed
So that the little one does not move, the use of bands and pads may be necessary. If necessary, contrast injection will be through the use of a needle or catheter, placed according to age by radiology technicians or pediatric or anesthesia nurses. Patches or local anesthetic creams may be used to reduce pain. Before, during, or after contrast injection, images will be acquired in sequences of several minutes, during which noise will be produced and immobility will be required. The examination time is quite long: 15 to 50 minutes.

Risks
The risks of an MRI examination are minimal. Rarely, contrast may cause, at the injection site, a hematoma or may extravasate out of the vein. Contrast intolerance manifests itself in warm sensation or nausea. True allergy or urticaria has rarely been described. If the child has known allergic reactions, or has already had contrast allergy, they should still be reported to the technician or physician. The child will be kept under observation after the examination if he or she has received contrast. If he or she presents late, after returning home, with redness on the skin or respiratory distress, it is important to contact the pediatrician. Some complications are caused by the presence of metal in or around the patient, so it is of utmost importance to report it beforehand.

This examination is based on the principle of having the young patient drink a liquid containing a product visible on X-ray, studying the passage through the digestive tract.

Principal indications
Search for malformative or functional abnormalities of the esophagus, stomach, and intestines that are not visible with other imaging methods. This examination is not indicated first-line for the identification of gastro-oesophageal reflux.

Preparation
It is necessary for the small patient to present fasting, without eating or drinking in the 6 hours before the examination. For infants and toddlers under 1 year of age, fasting for at least 3 hours before the examination is sufficient. The mother will bring with her two bottles, one empty and one ready with milk dosed as usual, to give to the baby after the exam.

How it is performed
Contrast is a nontoxic product, which will be mixed with water if necessary. Swallowing requires cooperation from the little patient, if a parent if desired can stay close to their little one, being careful not to interpose themselves between the X-ray tube and the child. Contrast is normally administered on X-ray control (fluoroscopic or fluorographic), and it will be necessary to move the child to different positions to best study the gastrointestinal tract.
If the child does not swallow spontaneously and if indicated, it may be necessary for contrast to be administered into the esophagus or stomach through a nasal probe placed on the young patient by nurses in the pediatrics department.

Risks
The risks associated with this examination are rare, mainly related to the possibility of passage into the airway by inhalation or through a malformation such as a fistula. In all cases, the staff of the pediatrics department are ready to offer support.
Risks with regard to irradiation are limited by the filter of the radiologist who accepts the examination only in case of correct indications, a low radiant dose, and measures to limit irradiation to the study area. It is important that accompanying mothers report any pregnancy status so that more precautionary measures can be taken.

At the end of the examination.
The ingested contrast will be excreted in the stool, which depending on the type of product administered may be white for a few days. If upon returning home the child coughs and has a fever call the pediatrician or go to the pediatric emergency room.

This examination involves rectally administering contrast to study the anatomy and motility of the colon and the terminal portion of the small intestine. It may allow the treatment of intestinal invagination.

Preparation
For the study of the bowel to be possible, it is sometimes necessary for it to be evaluable without feces, so prior treatment with laxatives may be required.

How it is performed
During contrast administration, serial radiographs are acquired in the various incidences and in different positions. During the examination, parents can stay by their baby's side to calm him or her; radiology technicians will provide them with any appropriate instructions. It is important for accompanying mothers to report any pregnancy status so that more precautionary measures can be taken.
Seeing an examination being performed on their baby may induce anxiety for parents; if they do not wish to remain next to the baby, they can wait in the waiting room; radiology staff will take care of the baby and keep them informed of the progress of the examination.

Risks
Risks are rare; sometimes the child may experience cramping during contrast administration. Perforations or peritonitis are very rare events. Risks as far as irradiation is concerned are limited by the radiologist's filter that accepts the examination only in case of correct indications, by a low radiant dose, by measures to limit irradiation to the study area.

At the end of the examination.
The contrast may not be completely evacuated, and after one or two days the child may have, depending on the product used, liquid or whitish stools. It may take 4 or 5 days for the baby to evacuate again; this is not constipation, but the time it takes for the colon to fill.

This examination is performed as a complementary budget to ultrasound in children with urinary tract infections or with prenatal diagnosis of urinary dilatation. It consists of filling the bladder through a thin probe with contrast visible on radiographs.
The goal is to recognize two frequent abnormalities in the child predisposing to infections: reflux and malformations of the urethra, which cannot be diagnosed by ultrasound. Diagnosis allows medical or surgical treatment to be undertaken, thus enabling the kidneys to be protected. Cystography allows a study of bladder function and micturition issues.

How it is performed
The child is admitted to pediatrics so that a probe can be placed that will allow contrast to pass into the bladder. Probing is a procedure that causes discomfort, but it is not painful; depending on age, the child's cooperation may be helpful. If he or she is agitated, administration of a mild sedative by nurses and medical specialists may help with catheter placement.
During the examination, parents can stay by their baby's side to calm him or her; radiology technicians will provide them with any appropriate instructions. It is important for accompanying mothers to report any pregnancy status so that more precautionary measures can be taken.
Seeing an examination being performed on one's baby may induce anxiety for parents; if they do not wish to remain next to the baby, they can wait in the waiting room; radiology staff will take care of the baby and keep them informed of the progress of the examination. Serial radiographs are acquired at the time of bladder filling and during urination. Images during urination, after removing the probe, are important in the male to well examine the urethra.

Risks
The risks of this examination are rare: urinary tract infections, bleeding, and urinary retention.
At home, the little one may complain of discomfort during urination, related to irritation from passing the probe. If the little one complains of burning and has a fever, it is important to consult the pediatrician.