Normal thyroid volume measurements

Case of the week: Presacral mass in a 3 year old

Double click to view cine

Ganglioneuroblastoma

New device for mandibular distraction

Dr Grant Fairbanks is using a new device for mandibular distraction.
It is threaded but not ratcheted and therefore can unscrew, losing ground.
He will be obtaining followup radiographs to check the distraction every 2-3 weeks on patients and would like an AP like the image attached as well as bilateral obliques with the interested side flat against the cassette to minimize magnification and obtain a reproducible measurement. The obliques may need a little cephalic angulation to prevent superimposition of the hardware. He is interested in the distance between the two plates. Their inner margins mark the edges of the osteotomy.
Attached is a sample Powerscribe macro if you like.

[] []
Clinical History: [<Pierre Robin syndrome, micrognathia, mandible distractors>]
Findings: Status post bilateral mandibular distraction. [<An enteric tube is present.>] [<There is no evidence of breakage of the hardware or loosening of the screws.>]
Distraction
Left: [] mm
Right: [] mm.
Impression: [<There is no evidence of loosening or breakage of the hardware.>]
Code [<20>]

Thanks to Bill Andolsek, DO

Case of the Week: 20 month old male with a specific bone finding

 Leukemic lines in a patient with Juvenile Myelomonocytic Leukemia (JMML)

Case of the week: 22 year old male with known neurological abnormality

Alexander disease

Sedation Services for Medical Imaging - baskinhj@gmail.com

Sedation Nurse Practitioner Services for Medical Imaging

In House Hours: (physically present in Medical Imaging)

Mon-Fri: 0630-1700

Sat: 07:30-1300

On-Call Hours:

Sat: 1300-1600
Sun: 07:30-1600

To schedule sedation during On-Call hours:

1. Page the Sedation NP on call: 801-339-6578

2. NP will get the patient info from the radiologist and will call and consult with ordering physician. NP will assess via telephone if patient is an appropriate candidate for sedation. If not, NP will tell the ordering physician that they should consult anesthesia for other sedation options.

3. If NP feels patient is a sedation candidate, the NP will call and coordinate an imaging start time between the MRI/nuc med technologist and the radiology sedation nurse. NP will triage sedation imaging studies along with hospital wide sedation needs.

4. Sedation recovery will be provided by radiology sedation RN. NP will be available by pager following imaging study for any additional sedation recovery issues.

5. Radiologists will notify the sedation NP as soon as the request for a sedated procedure has been received

6. PICU and NICU patients needing MRI studies afterhours and weekends generally provide their own sedation. Generally, this is adequate sedation

GA Sedation for Urgent/Emergent MRI studies:

- A few Holidays during the year. Page sedation NP to determine if they are working on a specific holiday.

- weekdays between 1700 and overnight

- weekends between 1600 and overnight

- Ordering physician will have to consult for GA sedation (Via smartweb, hospital operator, or OR front desk 662-2750) Since radiologist does not know the clinical details of a patient, it is most appropriate that the decision to use GA for sedation comes from the ordering physician

- Have MRI tech coordinate imaging time with anesthesiologist

- Radiology sedation RN are not involved with GA sedation

- This GA sedation protocol for urgent imaging studies should include ER patients requiring imaging during these hours

Case of the Week: Hard left supraclavicular mass

Bilateral C7 cervical ribs. The left C7 cervical rib abnormally articulates with the left first thoracic rib, explaining the palpable mass of concern.

Liver volumes

Noda et al. Liver volume in children measured by computed tomography. Pediatric Radiology (1997) vol. 27 (3) pp. 250-2

Spleen volumes

Schlesinger et al. Volume of the spleen in children as measured on CT scans: normal standards as a function of body weight. AJR American journal of roentgenology (1993) vol. 160 (5) pp. 1107-9

Femoral/tibial torsion studies

,

Regarding Femoral/tibial torsion studies:

Dr. Stevens would like us to: 

1) Use the screen layout that I show in the second and third attachments 

2) Save our measurements when closing the study

3) Use the macro below

Also, please read the note on the first attachment regarding how he'd like us to measure the femoral neck.

PS: The line about P. STEVENS in the macro is because Aoki does it differently.

_____________________________
Examination: [<Right>] MRI lower extremity without contrast limited. [] hours.

Comparison: Contralateral side.

History: Femoral anteversion. [<Lower extremity torsion.>]

Technique: Oblique PD axial images were obtained through the [left/right] hip. Native axial images were obtained through the hip, knee, and ankle.

Findings: 

No fracture, periosteal reaction, or other acute osseous abnormality is present in the visualized portions of the lower extremities. Soft tissues are normal appearing.

BY THE METHOD OF P. STEVENS AND B. NIXON,

lower extremity anteversion and torsion angles are calculated as listed below:

Impression: Femoral [<anteversion >] is [] degrees.  There is [] degrees femoral [<internal>] torsion and [] degrees tibial [<external>] torsion. Please see separate dictation of the contralateral limb.

_____________________________

Case of the week: 21 month old with stridor

Swallowed disk battery.

The ingestion of disk batteries is particularly important because saliva acts as an electrolyte bath, causing batteries to corrode and leak a solution of sodium or potassium hydroxide.  This caustic solution causes rapid destruction of the esophageal wall, extensive edema, and narrowing of the adjacent airway.

Head US and assessment of gestational age

Sagittal US views

Superior temporal sulcus (STS)                                           23 weeks

Saw tooth serrations STS (secondary sulcation)                     35 weeks

Cingulate sulcus (CS)                                                            29-30 weeks

Marginal branch of CS                                                           32 weeks

Long and short insular gyri                                                        39-40 weeks

          Left                                                                                40 weeks

          Right                                                                              39 weeks

Coronal US views

Superior frontal sulcus (SFS) – primary sulcation                    25 weeks

Secondary sulcation of SFS                                                 27 weeks

Adapted by Kevin Moore

Case of the week: 29 month old with elbow pain

Lateral condylar fracture.  The fracture line almost always extends into the unossified epiphyseal cartilage, and therefore these are Salter-Harris type 4 fractures, generally considered to be orthopedic urgencies.

Google Chrome links

Extensions

1. GMail checker: Adds a pop-up feature for checking/deleating/marking spam on your gmail account
2. EI Tab: Allows you to stay within Chrome's tabs and emulate Internet Explorer
3. Stylish: Allows you to change a site's appearance by adding styles available HERE

Themes:
     Allow you to change the way the browser looks (all black for radiologists!)

Case of the week: Toddler with knee pain

Discoid meniscus, probably macerated, but not flipped

Primary Children's On-Line Resources

Access PCMC on-line resources!

You need to use IE or Chrome with  THIS EI TAB EXTENSION:

Chrome Version: In-House Patient Traker 

Chrome Version: ER Patient Tracker
Chrome Version: HELP2

If you need to use Internet Explorer, then use these links:

In-House Patient Traker

ER Patient Tracker

Help2

Bone age determination in infants

Count the visible ossification centers as in the schematic above.  Blackened centers are the only ones that count.  Then use the chart above and the macro below:


Findings: Using the method described by Elgenmark (Acta Paediat. 33:1, 1946), a child aged [<>] months should have [<>] ossified growth centers. This child has [<>], [<within 2 standard deviations of mean.>]

Impression: [<Normal bone age.>]

Code 10

Codman Hakim programmable shunt valve pressure verification wheel

Risser Classification

The iliac crest apophysis is unossified until adolescence. 

At about 14 years, ossification begins on the anterolateral aspect of the iliac crest and continues posteromedially.

Fusion of the ossified apophysis begins around the age of 15 years and may not be complete until 25 years.

Skeletal dysplasia: An update

The skeletal dysostoses and dysplasias are now classified as "Genetic Skeletal Disorders," a nod towards our better understanding of the human genome and the genetic basis of disease.  Check out the new standard for classifying these disorders online at:

http://www.isds.ch/Nosology2006.html