Publications by authors named "Brian Coley"

85 Publications

Thoughts on being a senior radiologist.

Authors:
Brian D Coley

Pediatr Radiol 2021 Jan 5. Epub 2021 Jan 5.

Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.

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http://dx.doi.org/10.1007/s00247-020-04932-6DOI Listing
January 2021

The use of a patient advocate to improve the experience in pediatric radiology.

Pediatr Radiol 2020 10 15;50(11):1499-1508. Epub 2020 Sep 15.

Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.

There is increasing emphasis on improving the patient experience with a shift to patient- and family-centered care throughout all areas of health care. In 2013, the American College of Radiology launched Imaging 3.0, an initiative aimed at encouraging and enabling radiologists to work on culture change to increase focus on appropriateness, efficiency, quality, safety and patient satisfaction. Many groups have subsequently used these and other tools to improve the overall patient experience, focusing on the entire imaging journey to include initial order placement, registration in the department, image acquisition, departure from the department, and how and when the patient and family receive the imaging results. In our department we have used multiple strategies and have applied quality-improvement methods and patient/family-centered care models to improve quality, safety and the patient experience. Most of these efforts have included team members across the department, including radiologists, technologists, quality-improvement personnel, managers and nurses. In addition, for the last 12 years, a key member of these teams has been our patient and family advocate (PFA). We describe the important role that a PFA can play in improving the patient and family experience in pediatric radiology.
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http://dx.doi.org/10.1007/s00247-020-04784-0DOI Listing
October 2020

Reply.

J Pediatr 2018 05 28;196:329-330. Epub 2018 Feb 28.

Cincinnati Children's Hospital Medical Center Cincinnati, Ohio; Department of Radiology University of Cincinnati College of Medicine.

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http://dx.doi.org/10.1016/j.jpeds.2018.01.019DOI Listing
May 2018

Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology.

J Ultrasound Med 2018 Jan;37(1):7-18

Eastern Virginia Medical School, Norfolk.

The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.
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http://dx.doi.org/10.1002/jum.14504DOI Listing
January 2018

Ultrasound imaging of renin-mediated hypertension.

Pediatr Radiol 2017 Aug 4;47(9):1116-1124. Epub 2017 Aug 4.

Department of Radiology, Division of Thoracoabdominal Imaging, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.

The incidence of primary (i.e. essential) hypertension in children and adolescents is increasing; however, secondary hypertension, with an identifiable cause, remains relatively common and might be treatable or even curable. Renovascular hypertension is an uncommon but important secondary cause of hypertension in the pediatric population that can be associated with substantial morbidity. In this article we discuss renin-mediated causes of hypertension in children and related complications, review renal Doppler ultrasound techniques for the evaluation of renin-mediated hypertension (including both direct and indirect assessments), and briefly appraise the literature pertaining to renal Doppler ultrasound and the assessment of pediatric hypertension. Finally, we describe a proposed role for renal Doppler ultrasound in the workup of suspected renin-mediated hypertension in children and adolescents.
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http://dx.doi.org/10.1007/s00247-017-3840-yDOI Listing
August 2017

Proceedings: Beyond Ultrasound First Forum on improving the quality of ultrasound imaging in obstetrics and gynecology.

Am J Obstet Gynecol 2018 01 6;218(1):19-28. Epub 2017 Jul 6.

Eastern Virginia Medical School, Norfolk, VA.

The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.
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http://dx.doi.org/10.1016/j.ajog.2017.06.033DOI Listing
January 2018

Quality measures and pediatric radiology: suggestions for the transition to value-based payment.

Pediatr Radiol 2017 Jun 23;47(7):776-782. Epub 2017 May 23.

Department of Radiology, Texas Children's Hospital, Houston, TX, USA.

Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject.
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http://dx.doi.org/10.1007/s00247-017-3857-2DOI Listing
June 2017

ACR Appropriateness Criteria Urinary Tract Infection-Child.

J Am Coll Radiol 2017 May;14(5S):S362-S371

Specialty Chair, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Urinary tract infection (UTI) is common in young children and may cause pyelonephritis and renal scarring. Long-term complications from renal scarring are low. The role of imaging is to evaluate for underlying urologic abnormalities and guide treatment. In neonates there is increased risk for underlying urologic abnormalities. Evaluation for vesicoureteral reflux (VUR) may be appropriate especially in boys because of higher prevalence of VUR and to exclude posterior urethral valve. In children older than 2 months with first episode of uncomplicated UTI, there is no clear benefit of prophylactic antibiotic. Ultrasound is the only study that is usually appropriate. After the age of 6 years, UTIs are infrequent. There is no need for routine imaging as VUR is less common. In children with recurrent or complicated UTI, in addition to ultrasound, imaging of VUR is usually appropriate. Renal cortical scintigraphy may be appropriate in children with VUR, as renal scarring may support surgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2017.02.028DOI Listing
May 2017

ACR Appropriateness Criteria Back Pain-Child.

J Am Coll Radiol 2017 May;14(5S):S13-S24

Panel Chair, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.

It is now generally accepted that nontraumatic back pain in the pediatric population is common. The presence of isolated back pain in a child has previously been an indication for imaging; however, recently a more conservative approach has been suggested using clinical criteria. The presence of constant pain, night pain, and radicular pain, alone or in combination, lasting for 4 weeks or more, constitute clinical red flags that should prompt further imaging. Without these clinical red flags, imaging is likely not indicated. Exceptions include an abnormal neurologic examination or clinical and laboratory findings suggesting an infectious or neoplastic etiology, and when present should prompt immediate imaging. Initial imaging should consist of spine radiographs limited to area of interest, with spine MRI without contrast to evaluate further if needed. CT of the spine, limited to area of interest, and Tc-99m bone scan whole body with single-photon emission computed tomography may be useful in some patients. The addition of intravenous contrast is also recommended for evaluation of a potential neoplastic or infectious process. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2017.01.039DOI Listing
May 2017

ACR Appropriateness Criteria Fever Without Source or Unknown Origin-Child.

J Am Coll Radiol 2016 Aug 28;13(8):922-30. Epub 2016 Jun 28.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

The cause of fever in a child can often be determined from history, physical examination, and laboratory tests; infections account for the majority of cases. Yet in 20%, no apparent cause can be found, designated as fever without source (FWS). The yield of chest radiography in children with FWS is low, and it is usually not appropriate. However, in children with respiratory signs, high fever (>39°C), or marked leukocytosis (≥20,000/mm(3)), chest radiography is usually appropriate, as it has a higher yield in detecting clinically occult pneumonia. In newborns with FWS, there is higher risk for serious bacterial infection, and the routine use of chest radiography is controversial. In children with neutropenia, fever is a major concern. In some clinical circumstances, such as after hematopoietic stem cell transplantation, chest CT scan may be appropriate even if the results of chest radiography are negative or nonspecific, as it has higher sensitivity and can demonstrate specific findings (such as lung nodule and "halo sign") that can guide management. In a child with prolonged fever of unknown origin despite extensive medical workup (fever of unknown origin), diagnosis is usually dependent on clinical and laboratory studies, and imaging tests have low yield. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2016.04.028DOI Listing
August 2016

Lung Ultrasonography: A Viable Alternative to Chest Radiography in Children with Suspected Pneumonia?

J Pediatr 2016 09 16;176:93-98.e7. Epub 2016 Jun 16.

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.

Objective: To determine the interrater reliability (IRR) of lung ultrasonography (LUS) and chest radiography (CXR) and evaluate the accuracy of LUS compared with CXR for detecting pediatric pneumonia compared with chest computed tomography (CT) scan.

Study Design: This was a prospective cohort study of children aged 3 months to 18 years with a CXR and LUS performed between May 1, 2012, and January 31, 2014 with or without a clinical diagnosis of pneumonia. Four pediatric radiologists blinded to clinical information reported findings for the CXR and LUS images. IRR was estimated for 50 LUS and CXR images. The main outcome was the finding from CT ordered clinically or the probability of the CT finding for patients clinically requiring CT. Two radiologists reviewed CT scans to determine an overall finding. Latent class analysis was used to evaluate the sensitivity and specificity for findings (eg, consolidation) for LUS and CXR compared with CT.

Results: Of the 132 patients in the cohort, 36 (27%) had CT performed for a clinical reason. Pneumonia was clinically documented in 47 patients (36%). The IRR for lung consolidation was 0.55 (95% CI, 0.40-0.70) for LUS and 0.36 (95% CI, 0.21-0.51) for CXR. The sensitivity for detecting consolidation, interstitial disease, and pleural effusion was statistically similar for LUS and CXR compared with CT; however, specificity was higher for CXR. The negative predictive value was similar for CXR and LUS.

Conclusions: LUS has a sufficiently high IRR for detection of consolidation. Compared with CT, LUS and CXR have similar sensitivity, but CXR is more specific for findings indicating pneumonia.
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http://dx.doi.org/10.1016/j.jpeds.2016.05.033DOI Listing
September 2016

Worldwide Argus II implantation: recommendations to optimize patient outcomes.

BMC Ophthalmol 2016 May 6;16:52. Epub 2016 May 6.

Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.

Background: A position paper based on the collective experiences of Argus II Retinal Prosthesis System investigators to review strategies to optimize outcomes in patients with retinitis pigmentosa undergoing retinal prosthesis implantation.

Methods: Retinal surgeons, device programmers, and rehabilitation specialists from Europe, Canada, Middle East, and the United States were convened to the first international Argus II Investigator Meeting held in Ann Arbor, MI in March 2015. The recommendations from the collective experiences were collected. Factors associated with successful outcomes were determined.

Results: Factors leading to successful outcomes begin with appropriate patient selection, expectation counseling, and preoperative retinal assessment. Challenges to surgical implantation include presence of staphyloma and inadequate Tenon's capsule or conjunctiva. Modified surgical technique may reduce risks of complications such as hypotony and conjunctival erosion. Rehabilitation efforts and correlation with validated outcome measures following implantation are critical.

Conclusions: Bringing together Argus II investigators allowed the identification of strategies to optimize patient outcomes. Establishing an on-line collaborative network will foster coordinated research efforts to advance outcome assessment and rehabilitation strategies.
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http://dx.doi.org/10.1186/s12886-016-0225-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858839PMC
May 2016

Saving the starfish: World Federation of Pediatric Imaging (WFPI) development, work to date, and membership feedback on international outreach.

Pediatr Radiol 2016 Apr 18;46(4):452-61. Epub 2016 Mar 18.

Departments of Radiological Sciences and Pediatrics, David Geffen School of Medicine at UCLA, 757 Westwood Blvd., Los Angeles, CA, 90095, USA.

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http://dx.doi.org/10.1007/s00247-016-3587-xDOI Listing
April 2016

Emergency Department Use of Computed Tomography for Children with Ventricular Shunts.

J Pediatr 2015 Dec 23;167(6):1382-8.e2. Epub 2015 Oct 23.

Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Objectives: To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision.

Study Design: Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient- and hospital-level covariates and CT utilization.

Results: The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received ≥10 CTs, accounting for 37.2% of all ED visits with a CT. The mean number of CTs per patient varied nearly 20-fold across hospitals; the individual hospital accounted for the most variation in CT utilization. The median (IQR) cumulative effective radiation dose was 7.2 millisieverts (3.6-14.0) overall, and 33.4 millisieverts (27.2-43.8) among patients receiving ≥10 CTs.

Conclusions: A CT scan was obtained in half of ED visits for children with a ventricular shunt, with wide variability in utilization by hospitals. Strategies are needed to identify children at risk of shunt malfunction to reduce variability in CT utilization and radiation exposure in the ED.
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http://dx.doi.org/10.1016/j.jpeds.2015.09.024DOI Listing
December 2015

Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children.

Pediatrics 2015 Sep;136(3):e573-81

Background: Many studies have demonstrated a rise in computed tomography (CT) utilization in abstract children's hospitals. However, CT utilization may be declining, perhaps due to awareness of potential hazards of pediatric ionizing radiation, such as increased risk of malignancy. Th e objective is to assess the trend in CT utilization in hospitalized children at freestanding children's hospitals from 2004 to 2012 and we hypothesize decreases are associated with shifts to alternate imaging modalities.

Methods: Multicenter cross-sectional study of children admitted to 33 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between January 1, 2004, and December 31, 2012. The rates of CT, ultrasound, and MRI for the top 10 All-Patient Refined Diagnosis Related Groups (APR-DRGs) for which CT was performed in 2004 were determined by billing data. Rates of each imaging modality for those top 10 APR-DRGs were followed through the study period. Odds ratios of imaging were adjusted for demographics and illness severity.

Results: For all included APR-DRGs except ventricular shunt procedures and nonbacterial gastroenteritis, the number of children imaged with any modality increased. CT utilization decreased for all APR-DRGs (P values , .001). For each of the APR-DRGs except seizure and infections of upper respiratory tract, the decrease in CT was associated with a significant rise in an alternative imaging modality (P values # .005).

Conclusions: For the 10 most common APR-DRGs for which children received CT in 2004,a decrease in CT utilization was found in 2012. Alternative imaging modalities for 8 of the diagnoses were used.
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http://dx.doi.org/10.1542/peds.2015-0995DOI Listing
September 2015

ACR Appropriateness Criteria Vomiting in Infants up to 3 Months of Age.

J Am Coll Radiol 2015 Sep 5;12(9):915-22. Epub 2015 Aug 5.

Riley Hospital for Children, Indiana University, Indianapolis, Indiana.

Vomiting is a commonly reported symptom in infants less than three months of age. There are a multitude of pathologies to consider, both within and outside the gastrointestinal tract. In addition to conducting a thorough history and physical examination, a clinician formulates a reasonable differential diagnosis by consideration of two main factors: the infant's age and the characterization of the vomit as bilious or nonbilious. In this endeavor, the clinician is able to determine if an imaging study is needed and, if so, the urgency of the request. A review of the appropriate imaging evaluation of vomiting infants in the newborn to three-month-old age group is provided by organizing the discussion around the following three clinical scenarios: bilious vomiting, intermittent nonbilious vomiting since birth, and new-onset bilious vomiting. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2015.05.023DOI Listing
September 2015

ACR Appropriateness Criteria head trauma--child.

J Am Coll Radiol 2014 Oct 20;11(10):939-47. Epub 2014 Aug 20.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Head trauma is a frequent indication for cranial imaging in children. CT is considered the first line of study for suspected intracranial injury because of its wide availability and rapid detection of acute hemorrhage. However, the majority of childhood head injuries occur without neurologic complications, and particular consideration should be given to the greater risks of ionizing radiation in young patients in the decision to use CT for those with mild head trauma. MRI can detect traumatic complications without radiation, but often requires sedation in children, owing to the examination length and motion sensitivity, which limits rapid assessment and exposes the patient to potential anesthesia risks. MRI may be helpful in patients with suspected nonaccidental trauma, with which axonal shear injury and ischemia are more common and documentation is critical, as well as in those whose clinical status is discordant with CT findings. Advanced techniques, such as diffusion tensor imaging, may identify changes occult by standard imaging, but data are currently insufficient to support routine clinical use. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2014.07.017DOI Listing
October 2014

The simple sacral dimple: diagnostic yield of ultrasound in neonates.

Pediatr Radiol 2015 Feb 5;45(2):211-6. Epub 2014 Jul 5.

Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,

Background: Although spinal cord tethering is known to be associated with certain clinical syndromes and cutaneous stigmata, its incidence in healthy infants with simple sacral dimples has not been thoroughly evaluated.

Objective: Our objective was to determine the frequency of tethered cord in otherwise healthy patients with simple sacral dimples.

Materials And Methods: We reviewed the lumbar spine US reports of all healthy neonates referred for a simple sacral dimple during a 12-year period at two children's hospitals. A sonogram was considered abnormal for a conus medullaris terminating below the L2-L3 disc space, decreased conus or nerve root motion, an abnormal filum terminale, or for the presence of an intraspinal mass, osseous dysraphism, or a sinus leading to the thecal sac. The medical records of patients with abnormal screening sonograms were reviewed to determine the final clinical outcome.

Results: During the study period 3,991 infants underwent screening sonography. Of these, 107 were excluded because of the presence of other medical conditions. Of the remaining 3,884 healthy infants, 133 (3.4%) had an abnormal sonogram. Five (0.13%) of these infants were lost to follow-up; 52 subsequently had normal follow-up imaging; 49 had a low conus without other signs of tethering; 18 had a fatty filum; 2 had decreased conus motion; 2 had both a low conus and a fatty filum. None of these infants underwent surgery. Only the remaining 5/3,884 (0.13%) infants underwent surgical intervention (95% CI: 0-0.27%), and 4/5 were found to have a tethered cord intraoperatively.

Conclusion: The risk of significant spinal malformations in asymptomatic, healthy infants with an isolated simple sacral dimple is exceedingly low.
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http://dx.doi.org/10.1007/s00247-014-3110-1DOI Listing
February 2015

Vascular delivery of rAAVrh74.MCK.GALGT2 to the gastrocnemius muscle of the rhesus macaque stimulates the expression of dystrophin and laminin α2 surrogates.

Mol Ther 2014 Apr 22;22(4):713-24. Epub 2013 Oct 22.

1] Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio, USA [2] Centers for Gene Therapy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.

Overexpression of GALGT2 in skeletal muscle can stimulate the glycosylation of α dystroglycan and the upregulation of normally synaptic dystroglycan-binding proteins, some of which are dystrophin and laminin α2 surrogates known to be therapeutic for several forms of muscular dystrophy. This article describes the vascular delivery of GALGT2 gene therapy in a large animal model, the rhesus macaque. Recombinant adeno-associated virus, rhesus serotype 74 (rAAVrh74), was used to deliver GALGT2 via the femoral artery to the gastrocnemius muscle using an isolated focal limb perfusion method. GALGT2 expression averaged 44 ± 4% of myofibers after treatment in macaques with low preexisting anti-rAAVrh74 serum antibodies, and expression was reduced to 9 ± 4% of myofibers in macaques with high preexisting rAAVrh74 immunity (P < 0.001; n = 12 per group). This was the case regardless of the addition of immunosuppressants, including prednisolone, tacrolimus, and mycophenolate mofetil. GALGT2-treated macaque muscles showed increased glycosylation of α dystroglycan and increased expression of dystrophin and laminin α2 surrogate proteins, including utrophin, plectin1, agrin, and laminin α5. These experiments demonstrate successful transduction of rhesus macaque muscle with rAAVrh74.MCK.GALGT2 after vascular delivery and induction of molecular changes thought to be therapeutic in several forms of muscular dystrophy.
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http://dx.doi.org/10.1038/mt.2013.246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982494PMC
April 2014

Safety of contrast-enhanced ultrasound in children for non-cardiac applications: a review by the Society for Pediatric Radiology (SPR) and the International Contrast Ultrasound Society (ICUS).

Pediatr Radiol 2013 Sep 11;43(9):1063-73. Epub 2013 Jul 11.

Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.

The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.
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http://dx.doi.org/10.1007/s00247-013-2746-6DOI Listing
September 2013

Effect of nutritional rehabilitation on gastric motility and somatization in adolescents with anorexia.

J Pediatr 2013 Sep 13;163(3):867-72.e1. Epub 2013 Apr 13.

Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA.

Objective: To examine gastric function, as well as the presence of somatic complaints, anxiety symptoms, and functional gastrointestinal disorders (FGIDs), in adolescents with anorexia nervosa (AN) before and after nutritional rehabilitation.

Study Design: Sixteen females with AN and 22 healthy controls with similar demographic profiles were included. Gastric emptying (measured as residual gastric volume) and gastric accommodation (measured as postprandial antral diameter) were assessed with abdominal ultrasonography. Participants completed the Children's Somatization Inventory (CSI), the Screen for Child Anxiety-Related Emotional Disorders, and the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version. All testing was repeated 3-4 months later.

Results: Body mass index in the AN group improved over time (P = .012). Fasting gastric parameters were similar in the 2 groups. Maximum postprandial antral diameter was significantly greater in controls compared with the AN group (P = .008). Only adolescents with AN demonstrated a significant increase in maximum postprandial diameter at repeat testing (P = .009). There was no difference in residual gastric volume between the 2 groups. Initial CSI scores were higher in adolescents with AN (P < .0001), including higher scores for nausea and abdominal pain. CSI scores were significantly lower in adolescents with AN (P = .035). Initial scores on the Screen for Child Anxiety-Related Emotional Disorders were significantly higher in adolescents with AN (P = .0005), but did not change over time. Adolescents with AN met significantly more criteria for FGIDs (P = .003).

Conclusion: Adolescents with AN have impaired gastric accommodation that improves after nutritional rehabilitation, have significantly more somatic complaints, and meet more criteria for anxiety disorders and FGIDs. After nutritional rehabilitation, somatization improves and FGIDs become less common, but symptoms of anxiety persist.
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http://dx.doi.org/10.1016/j.jpeds.2013.03.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923459PMC
September 2013

The Argus II epiretinal prosthesis system allows letter and word reading and long-term function in patients with profound vision loss.

Br J Ophthalmol 2013 May 20;97(5):632-6. Epub 2013 Feb 20.

NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK.

Background: Retinal prosthesis systems (RPS) are a novel treatment for profound vision loss in outer retinal dystrophies. Ideal prostheses would offer stable, long-term retinal stimulation and reproducible spatial resolution in a portable form appropriate for daily life.

Methods: We report a prospective, internally controlled, multicentre trial of the Argus II system. Twenty-eight subjects with light perception vision received a retinal implant. Controlled, closed-group, forced-choice letter identification, and, open-choice two-, three- and four-letter word identification tests were carried out.

Results: The mean±SD percentage correct letter identification for 21 subjects tested were: letters L, T, E, J, F, H, I, U, 72.3±24.6% system on and 17.7±12.9% system off; letters A, Z, Q, V, N, W, O, C, D, M, 55.0±27.4% system on and 11.8%±10.7% system off, and letters K, R, G, X, B, Y, S, P, 51.7±28.9% system on and 15.3±7.4% system off. (p<0.001 for all groups). A subgroup of six subjects was able to consistently read letters of reduced size, the smallest measuring 0.9 cm (1.7°) at 30 cm, and four subjects correctly identify unrehearsed two-, three- and four-letter words. Average implant duration was 19.9 months.

Conclusions: Multiple blind subjects fitted with the Argus II system consistently identified letters and words using the device, indicating reproducible spatial resolution. This, in combination with stable, long-term function, represents significant progress in the evolution of artificial sight.
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http://dx.doi.org/10.1136/bjophthalmol-2012-301525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632967PMC
May 2013

Is it time for a dedicated pediatric MRI ACR accreditation program?

J Am Coll Radiol 2013 Apr 12;10(4):274-8. Epub 2012 Dec 12.

Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

Participation in ACR accreditation programs has become an essential practice for adult and pediatric imaging centers across the country. The responsibility for these ACR programs is vested in the Commission on Quality and Safety, 1 of 7 operational commissions in the ACR. The MRI Accreditation Program evaluates the qualifications of personnel, quality control programs, MR safety policies, and image quality specific to MRI. Currently, the ACR MRI Accreditation Program is designed primarily to evaluate adult MRI practices, which are in many ways not applicable to pediatric applications and facilities. In this article, the authors describe the difficulties faced during the ACR MRI Accreditation Program at a dedicated children's hospital and offer suggested changes for the process.
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http://dx.doi.org/10.1016/j.jacr.2012.07.011DOI Listing
April 2013

Ultrasound-guided corticosteroid injection therapy for juvenile idiopathic arthritis: 12-year care experience.

Pediatr Radiol 2012 Dec 2;42(12):1481-9. Epub 2012 Sep 2.

Department of Radiology and The Children's Radiological Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.

Background: Intra-articular corticosteroid injections are a safe and effective treatment for patients with juvenile idiopathic arthritis. The potential scope of care in ultrasound-guided corticosteroid therapy in children and a joint-based corticosteroid dose protocol designed to optimize interdisciplinary care are not found in the current literature.

Objective: The purpose of this study was to report the spectrum of care, technique and safety of ultrasound-guided corticosteroid injection therapy in patients with juvenile idiopathic arthritis and to propose an age-weight-joint-based corticosteroid dose protocol.

Materials And Methods: A retrospective analysis was performed of 198 patients (ages 21 months to 28 years) referred for treatment of juvenile idiopathic arthritis with corticosteroid therapy. Symptomatic joints and tendon sheaths were treated as prescribed by the referring rheumatologist. An age-weight-joint-based dose protocol was developed and utilized for corticosteroid dose prescription.

Results: A total of 1,444 corticosteroid injections (1,340 joints, 104 tendon sheaths) were performed under US guidance. Injection sites included small, medium and large appendicular skeletal joints (upper extremity 497, lower extremity 837) and six temporomandibular joints. For patients with recurrent symptoms, 414 repeat injections were performed, with an average time interval of 17.7 months (range, 0.5-101.5 months) between injections. Complications occurred in 2.6% of injections and included subcutaneous tissue atrophy, skin hypopigmentation, erythema and pruritis.

Conclusion: US-guided corticosteroid injection therapy provides dynamic, precise and safe treatment of a broad spectrum of joints and tendon sheaths throughout the entire pediatric musculoskeletal system. An age-weight-joint-based corticosteroid dose protocol is effective and integral to interdisciplinary care of patients with juvenile idiopathic arthritis.
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http://dx.doi.org/10.1007/s00247-012-2487-yDOI Listing
December 2012

ACR Appropriateness Criteria® limping child--ages 0 to 5 years.

J Am Coll Radiol 2012 Aug;9(8):545-53

New York University Langone Medical Center, New York, NY, USA.

The appropriate imaging for pediatric patients (ages 0-5 years) being evaluated for limping depends on the clinical presentation, specifically, the presence of signs of infection, any localization of pain, and history of or suspected trauma. Common diagnoses causing limping in children are briefly reviewed, and recommended imaging techniques are discussed, including toddler's fracture, transient synovitis, septic arthritis, Legg-Calvé-Perthes disease, and osteomyelitis. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2012.04.017DOI Listing
August 2012

VCUG and the question of sedation.

Authors:
Brian D Coley

Pediatr Radiol 2012 Mar 30;42(3):284. Epub 2011 Dec 30.

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http://dx.doi.org/10.1007/s00247-011-2322-xDOI Listing
March 2012

ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis.

J Am Coll Radiol 2011 Nov;8(11):749-55

Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

The diagnostic imaging of patients presenting with right lower quadrant pain and suspected appendicitis may be organized according to age and gender and to the presence or absence of "classic" signs and symptoms of acute appendicitis. Among adult patients presenting with clinical signs of acute appendicitis, the sensitivity and specificity of CT are greater than those of ultrasound, with improved performance when CT is performed with intravenous contrast. The use of rectal contrast has been associated with decreased time in the emergency department. Computed tomography has also been shown to reduce cost and negative appendectomy rates. Both CT and ultrasound are also effective in the identification of causes of right lower quadrant pain unrelated to appendicitis. Among pediatric patients, the sensitivity and specificity of graded-compression ultrasound can approach those of CT, without the use of ionizing radiation. Performing MRI after inconclusive ultrasound in pregnant patients has been associated with sensitivity and specificity of 80% to 86% and 97% to 99%, respectively. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2011.07.010DOI Listing
November 2011

Image Gently: progress and challenges in CT education and advocacy.

Pediatr Radiol 2011 Sep 17;41 Suppl 2:461-6. Epub 2011 Aug 17.

Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH 45229-3039, USA.

Significant progress has been made in radiation protection for children during the last 10 years. This includes increased awareness of the need for radiation protection for pediatric patients with international partnerships through the Alliance for Radiation Safety in Pediatric Imaging. This paper identifies five areas of significant progress in radiation safety for children: the growth of the Alliance; the development of an adult radiation protection campaign Image Wisely™; increased collaboration with government agencies, societies and the vendor community; the development of national guidelines in pediatric nuclear medicine, and the development of a size-based patient dose correction factor by the American Association of Physicists in Medicine, Task Group 204. However, many challenges remain. These include the need for continued education and change of practice at adult-focused hospitals where many pediatric CT exams are performed; the need for increased emphasis on appropriateness of pediatric imaging and outcomes research to validate the performance of CT studies, and the advancement of the work of the first pediatric national dose registry to determine the "state of the practice" with the final goal of establishing ranges of optimal CT technique for specific scan indications when imaging children with CT.
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http://dx.doi.org/10.1007/s00247-011-2133-0DOI Listing
September 2011