n CME : Your SA Journal of CPD - Paediatric radiology : what's hot and what's not : main article

Volume 24, Issue 6
  • ISSN : 0256-2170



Comparative X-ray views are rarely indicated. <BR>Skull X-ray should not be performed as a routine for trauma. <BR>If there is any clinical indication for imaging the head in the trauma setting, it should be performed with non-contrast CT scanning. <BR>The value of sinus radiographs in children is limited for diagnosis, detection of complications and planning treatment. <BR>Children with sinus complaints should be treated empirically without imaging except when there are features of a complication. <BR>X-rays of orbits, optic canal, mastoids, petrous bones and pituitary fossa are of little use. When an abnormality is shown, it requires further characterisation. CT or MRI is indicated in all cases, and should be requested in the first instance. <BR>Neck trauma in children < 8 years of age should initially be imaged with a lateral c-spine X-ray only. Odontoid, frontal and oblique views are of limited value and not only increase the radiation burden, but also confuse the findings. <BR>There is still a significant role for plain radiographs in imaging the spinal column, particularly in South Africa. <BR>X-rays of the pelvis are not very useful for assessing developmental dysplasia of the hip in children prior to ossification of the femoral heads. Ultrasound of the hips, however, especially in neonates, is an excellent way of obtaining both static and dynamic images. <BR>Even though the lateral chest radiograph is not in routine use in the UK, it is still considered valuable for detecting TB lymphadenopathy and is currently used extensively in south Africa. <BR>Repeat fluoroscopy to evaluate voiding after removal of the catheter in boys is no longer considered necessary for diagnosing posterior urethral valves and control films have all but been eliminated. <BR>Diagnosis of intussusception should be made on ultrasound. <BR>Ultrasound should be the diagnostic method of choice for hypertrophic pyloric obstruction. <BR>Intravenous urography / pyelography is avoided by paediatric radiologists worldwide as it delivers a high radiation dose. Indications include the need to view calyces or ectopic ureteric insertions (e.g. in duplex kidneys with enuresis). <BR>IVU no longer falls within the arsenal for the imaging of UTI. However, ultrasound should be performed in all cases to determine if there is hydronephrosis, calculus or anomaly. <BR>Multislice CT is now commonly used in paediatric practice. <BR>A combination of CT for anatomical localisation and FDG positron emission tomography (PET) is allowing for accurate determination of tumour response to therapy and sites of metabolic activity for biopsy in oncology. <BR>MRI should be the panacea for all imaging requirements in children. it offers excellent contrast resolution (even in the absence of excessive fat planes, as needed for good CT images) without any radiation.

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