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Donald P. Frush, M.D.
Division Of Pediatric Radiology,
Duke University Medical
Center
Computed tomography is an extremely important diagnostic tool. However,
obtaining diagnostic information is extremely dependent on optimizing
technique. CT in children can be quite complicated given the unique
considerations found with the large variation in size (e.g., < 1.0 - > 100
kg) and the special needs children have. Each aspect of designing and
performing pediatric CT will be discussed and organized by categories
consisting of (1) patient preparation, (2) oral and IV contrast material,
and (3) CT parameters.
Patient Preparation:
Strategies to maximize the compliance of children will be addressed. Age
specific breath hold strategies will be provided. Sedation can be a
necessary component of pediatric CT and brief discussion of sedation, as
well as alternative techniques (having parents present, swaddling, feeding
infants, use of multidetector CT) will be provided. The benefits of fast
multidetector CT for minimizing sedation needs will be emphasized.
Oral and Intravenous Contrast Material:
Types, and amounts of oral contrast media will be presented, including
alternates (water, other fluids) in children who often will not drink
routine contrast material. Advantages and disadvantages (e.g., masking
mucosal enhancement, mural abnormalities, aspiration risk particularly in
the trauma setting, and artifacts) of oral contrast will also be discussed.
Rectal contrast administration has a limited role and is not routine for any
condition (including appendicitis) in our practice. Amounts, types, and
techniques (manual bolus versus power injector; rates of administration;
delays; use of bolus tracking software) of contrast administration which
provide optimal enhancement of vessels and organs in children will also be
presented. While conventional (slice-by slice) methods will be addressed,
techniques of administration with helical CT will be emphasized.
CT
Parameters:
By attending to the indications, and size of the child, appropriate
size-based scanning will provide maximum diagnostic information with minimum
amount of radiation risk to the child. Size-based parameters will be
presented and techniques to minimize radiation exposure, including a
color-coded approach, will be reviewed.
FIGURES
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Fig 1a - Excellent Contrast Neck
Chest Abdomen Pelvis CT |
Fig 1B – Excellent Contrast Neck
Chest Abdomen Pelvis CT |
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Fig 2 – Normal CT Angiography
6 year old |
Fig 3 – Abnormal Bowel Wall Enhancement |
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