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Archives of Disease in Childhood.... Jun 2019The identification of an abdominal mass in a child, either coincidental or symptomatic, may be due to a tumour. An abdominal tumour may present with life-threatening... (Review)
Review
The identification of an abdominal mass in a child, either coincidental or symptomatic, may be due to a tumour. An abdominal tumour may present with life-threatening symptoms, requiring prompt assessment and management. Although the discovery of such a finding usually warrants inpatient transfer or outpatient referral to the tertiary oncology centre, the initial evaluation, management and communication with the family by the general paediatrician is crucial. A thorough history and examination, which includes an organised, structured approach to abdominal masses, is paramount. The anatomical location of the mass, age of the patient and the presence of any associated symptoms or signs must be considered together in order to formulate a list of potential differential diagnoses and guide the next appropriate investigations. This article aims to guide general paediatricians through the assessment and initial management of a child presenting with an abdominal mass suspected to be a tumour.
Topics: Abdominal Neoplasms; Biomarkers, Tumor; Child; Communication; Humans; Medical History Taking; Pediatrics; Physical Examination; Professional-Family Relations; Radiography, Abdominal
PubMed: 30733241
DOI: 10.1136/archdischild-2018-315270 -
Canadian Association of Radiologists... Nov 2021Ultra-low radiation dose computed tomography (CT) abdominal tomography was introduced in our institution in 2016 to replace standard abdominal radiography in the...
OBJECTIVE
Ultra-low radiation dose computed tomography (CT) abdominal tomography was introduced in our institution in 2016 to replace standard abdominal radiography in the investigation of emergency department patients. This project aims to ascertain whether investigation of emergency department patients using ultra-low radiation dose CT abdominal tomography complies with original indication guidelines and/or if there has been any "indication creep" 3 years after inception.
METHODS
Retrospective, quality assurance project with research ethics waiver. A review of 200 consecutive patients investigated with CT abdominal tomography between February and May 2017 was performed. This was compared with 200 consecutive patients investigated between February and May 2019. Data analyzed included patient demographics, indication for scan, as well as scan and patient outcomes.
RESULTS
In the 2017 group, 29/200 scans were noncompliant with approved indication guidelines. In the 2019 group, 30/200 scans were also noncompliant. There was no statistically significant difference between groups ( < .05) regarding the use of approved indications. Forty of 200 scans performed in 2017 revealed additional findings which are not specifically addressed on the reporting template. Forty-one of 200 scans in 2019 revealed these findings.
CONCLUSIONS
There has been no "indication creep" for CT abdominal tomography over time.
Topics: Aged; Emergency Service, Hospital; Female; Guideline Adherence; Humans; Male; Quality Assurance, Health Care; Radiation Dosage; Radiography, Abdominal; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 32903020
DOI: 10.1177/0846537120951078 -
Abdominal Radiology (New York) Sep 2017Prior work has demonstrated marked growth in the volume of abdominal imaging performed by radiologists. However, decisions to pursue imaging are largely driven by...
PURPOSE
Prior work has demonstrated marked growth in the volume of abdominal imaging performed by radiologists. However, decisions to pursue imaging are largely driven by referring providers. In this study, we take the novel approach of investigating abdominal imaging utilization patterns by referring provider specialty.
METHODS
Data on imaging services were obtained from the 2014 DocGraph Medicare Referring Provider Utilization for Procedures (MrPUP) public use file. MrPUP contains aggregated transaction data for combinations of unique referring provider and service code. Imaging services were classified by modality and body region using the Neiman Institute Types of Service (NITOS). Each referring provider's specialty was determined using Medicare Physician Compare. Abdominal imaging ordering patterns were summarized by referring specialty.
RESULTS
The final dataset included 5,824,754 abdominal imaging transactions. The most common ordering specialties of abdominal imaging were as follows: (1) internal medicine; (2) urology; (3) emergency medicine; (4) family practice; and (5) gastroenterology. The most common ordering specialties by abdominal imaging modality were emergency medicine for CT; gastroenterology for MRI and nuclear medicine; and internal medicine for ultrasound and radiography. While numerous specialties commonly ordered abdominal radiography and CT, urologists also commonly ordered retroperitoneal ultrasound and retrograde urography, and gastroenterologists also commonly ordered abdominal ultrasound, abdominal MRI, and esophagrams. Internal medicine, family practice, and emergency medicine providers ordered a much broader mix of imaging, including many non-abdominal imaging examinations.
CONCLUSION
Referring specialty abdominal imaging ordering patterns are varied but distinct. Awareness of these patterns may facilitate focused educational and policy initiatives to improve abdominal imaging appropriateness and utilization.
Topics: Humans; Medicine; Radiography, Abdominal; Referral and Consultation; United States
PubMed: 28361225
DOI: 10.1007/s00261-017-1121-8 -
Seminars in Ultrasound, CT, and MR Aug 2017In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic... (Review)
Review
In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic tool for both screening and diagnosis. In addition to trauma, acute chest syndromes often warrant emergent computed tomographic angiography, looking for etiologies such as aortic aneurysms or complications of aortic aneurysms, or both, pulmonary emboli, as well as other acute vascular process like aortic dissection and Takayasu aortitis. With continued improvements in diagnostic imaging, computed tomographic angiography of the chest, abdominal and pelvis proves to be an effective modality to image the aorta and other major vascular structures.
Topics: Abdomen; Computed Tomography Angiography; Emergencies; Emergency Service, Hospital; Humans; Pelvis; Radiography, Abdominal; Radiography, Thoracic; Thorax; Vascular Diseases
PubMed: 28865527
DOI: 10.1053/j.sult.2017.02.004 -
Radiologic Technology 2015
Topics: Diagnosis, Differential; Humans; Liver; Multiple Trauma; Radiography, Abdominal; Tomography, X-Ray Computed; Trauma Severity Indices; Wounds, Nonpenetrating
PubMed: 26377278
DOI: No ID Found -
The American Journal of Emergency... Jun 2020Abdominal radiographs are often obtained in ED patients with suspected constipation, although their utility in adults is not well understood. We sought to compare ED... (Observational Study)
Observational Study
BACKGROUND
Abdominal radiographs are often obtained in ED patients with suspected constipation, although their utility in adults is not well understood. We sought to compare ED management when an abdominal radiograph is and is not obtained.
METHODS
We performed a retrospective chart review study of adult ED patients with a chief complaint of constipation from 2010 through 2016. Trained abstractors recorded radiologic tests ordered, treatments received, and final diagnosis. We determined the physician interpretation of the abdominal radiograph and its use in clinical decision making.
RESULTS
Of 1142 eligible patients, 481 (42%) patients underwent abdominal radiography. Stool burden rated moderate or large was observed in 271 patients (46%). Sixteen patients (3%) were diagnosed with small bowel obstruction; 15/16 of these patients had high risk features such as old age, complex surgical history, history of small bowel obstruction, abdominal malignancy, or presented with vomiting or inability to pass flatus. Of the 197 patients with no or mild stool burden or normal radiograph, 109 (55%) were diagnosed with constipation and 89 (45%) received constipation treatment in the ED. Conversely, of the 271 patients with moderate or greater stool burden, 114 (42%) received no treatment for constipation in the ED and 104 (38%) were prescribed no discharge medications for constipation; 77 of these 271 patients (28%) were diagnosed with something other than constipation.
CONCLUSION
Plain abdominal radiography did not appear to significantly affect the ED management of patients presenting with constipation; it was common for patients to receive treatment that was in direct opposition to radiographic findings. Though a small number of patients had concerning diagnoses identified on plain radiography, the history and physical examination should have sufficiently excluded simple constipation, prompting an alternate diagnostic approach. Fecal loading on radiography does not preclude a more serious diagnosis. In conclusion, abdominal radiography appears to have low value in patients with constipation.
Topics: Adult; Aged; Clinical Decision-Making; Constipation; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Radiography, Abdominal; Reproducibility of Results; Retrospective Studies
PubMed: 31378409
DOI: 10.1016/j.ajem.2019.158377 -
Radiologic Technology 2015Intra-abdominal abscesses arise from complications of surgery and disease. Computed tomography (CT) facilitates abscess drainage procedures while reducing the risks and... (Review)
Review
Intra-abdominal abscesses arise from complications of surgery and disease. Computed tomography (CT) facilitates abscess drainage procedures while reducing the risks and costs associated with surgery. These procedures require collaboration to ensure positive patient outcomes. To perform their role in CT-guided intra-abdominal abscess drainage, radiologic technologists must understand patient care, instrumentation, imaging techniques, and underlying disease processes specific to the anatomical site. Once these considerations are grasped, CT technologists can help radiologists and administrators to determine cost-effective instrumentation and quality control specific to the patient and institution.
Topics: Abdominal Abscess; Drainage; Humans; Radiography, Abdominal; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26538228
DOI: No ID Found -
Seminars in Ultrasound, CT, and MR Apr 2018
Topics: Abdomen; Humans; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 29571549
DOI: 10.1053/j.sult.2018.02.001 -
AJR. American Journal of Roentgenology Aug 2017Interpretation of abdominal radiographs of children benefits from a firm knowledge of the congenital anomalies and pathologies unique to this patient population,... (Review)
Review
OBJECTIVE
Interpretation of abdominal radiographs of children benefits from a firm knowledge of the congenital anomalies and pathologies unique to this patient population, leveraged by a systematic approach. Interpretive errors place the patients and their families at risk for a delay in diagnosis, unnecessary additional imaging, a potential increase in the radiation burden, and possible psychologic trauma.
CONCLUSION
In this article, we describe the common and uncommon potential pitfalls in pediatric abdominal radiography, using several of our own interpretive errors as a framework while providing teaching points to help avoid these mistakes.
Topics: Adolescent; Child; Diagnostic Errors; Humans; Radiography, Abdominal; Risk Factors
PubMed: 28590770
DOI: 10.2214/AJR.17.17889 -
Abdominal Radiology (New York) Mar 2017Positron emission tomography (PET) or PET/computed tomography (CT) using F-3'-fluoro-3'-deoxythymidine (F-FLT) offers noninvasive assessment of cell proliferation in... (Review)
Review
Positron emission tomography (PET) or PET/computed tomography (CT) using F-3'-fluoro-3'-deoxythymidine (F-FLT) offers noninvasive assessment of cell proliferation in human cancers in vivo. The present review discusses the current status on clinical applications of F-FLT-PET (or PET/CT) in digestive and abdominal oncology by comparing with F-fluorodeoxyglucose (F-FDG)-PET (or PET/CT). The results of this review show that although F-FLT uptake is lower in most cases of digestive and abdominal malignancies compared with F-FDG uptake, F-FLT-PET can be used to detect primary tumors. F-FLT-PET has shown greater specificity for N staging than F-FDG-PET which can show false-positive uptake in areas of inflammation. However, because of the high background uptake in the liver and bone marrow, it has a limited role of assessing liver and bone metastases. Instead, F-FLT-PET will be a powerful tool for monitoring response to treatment and provide prognostic information in digestive and abdominal oncology.
Topics: Dideoxynucleosides; Digestive System Neoplasms; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiography, Abdominal; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 27770160
DOI: 10.1007/s00261-016-0947-9