Bone complications in children with Gaucher disease

For paediatric patients with Gaucher disease, enzyme replacement therapy (ERT) has the potential to prevent the development of serious, irreversible skeletal complications. Analysis of skeletal data for paediatric patients receiving ERT must take into account the pubertal growth spurt and developmental changes in bone marrow composition. In a study conducted at the Burlo Garofolo Institute in Trieste, Italy, 10 paediatric patients have received ERT, and data are available for 3-9 years of follow-up. ERT was associated with a significant increase in the mean lumbar bone mineral density (BMD) Z score after 2 years of treatment (p=0.003). Skeletal growth rates increased among patients exhibiting growth delays. At the Gaucher Disease Treatment Center in Cincinnati, OH, USA, a total of 11 paediatric patients have been followed for 2 years or more of ERT. Of these 11 patients, 6 have demonstrated significant increases in lumbar BMD after 2 years of ERT; these patients tended to have lower BMD Z scores at the start of ERT. At the Children's Hospital of the Johannes-Gutenberg University in Mainz, Germany, 7 children with type 1 Gaucher disease presented with reduced BMD in the distal ulna, and after 18-24 months of ERT, these patients demonstrated increases in BMD at this site. The patients exhibiting growth retardation experienced growth acceleration during treatment. These studies suggest that ERT improves BMD and growth rates in paediatric patients with Gaucher disease. ERT in paediatric patients may have the potential to prevent serious skeletal complications such as fractures and vertebral compression later in life.     

Common tasks and problems in paediatric trauma radiology

Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology.     

Traumaradiologie beim Kind

The aim of this review article is to familiarize the reader with the specific paediatric conditions in trauma radiology. The article briefly describes the major pathophysiologic differences in childhood and the consecutive altered injury pattern. The standard radiological imaging protocol for various involved body regions and different trauma settings/varying queries is described, with suggestion for standardised diagnostic flow-charts in some typical settings. Special regard is given to radiation protection and the potential of newer imaging modalities such as ultrasound, multi-detector- and spiral CT as well as MRI in paediatric trauma patients. As such the paper hopefully provides some basic guidelines for general radiologists in peripheral hospitals who less often have to deal with paediatric queries.     

COVID-19: Impact on radiology departments and implications for future service design,service delivery,and radiology education

The pandemic caused by SARS-CoV-2 (severe adult respiratory distress syndrome Coronavirus-2) and its most severe clinical syndrome, COVID-19, has dramatically impacted service delivery in many radiology departments. Radiology (primarily chest radiography and CT) has played a pivotal role in managing the pandemic in countries with well-developed healthcare systems, enabling early diagnosis, triage of patients likely to require intensive care and detection of arterial and venous thrombosis complicating the disease. We review the lessons learned during the early response to the pandemic, placing these in the wider context of the responsibility radiology departments have to mitigate the impact of hospital-acquired infection on clinical care and staff wellbeing. The potential long-term implications for design and delivery of radiology services are considered. The need to achieve effective social distancing and ensure continuity of service during the pandemic has brought about a step change in the implementation of virtual clinical team working, off-site radiology reporting and postgraduate education in radiology. The potential consequences of these developments for the nature of radiological practice and the education of current and future radiologists are discussed.     

Paediatric interventional radiology

Paediatric interventional radiology (PIR) is a rapidly-growing subspecialty, which offers a wide range of procedures applicable to almost all areas of hospital paediatrics. There are many important differences between paediatric and adult practice in interventional radiology, including disease processes and treatment goals, anatomical considerations, periprocedural patient management, radiation exposure optimisation and legal aspects. The use of retrievable or absorbable interventional devices such as stents will probably become more widespread in PIR practice.Recent advances in the technology of imaging equipment have been accompanied by an increase in the complexity of the work done by the radiographer. These developments present challenges and opportunities related to training and maintenance of skills, staffing arrangements, and the potential for advanced practice. It is likely that specialisation in PIR will become a more common role for radiographers in the future.     

The imaging of coeliac disease and its complications

Coeliac disease is a malabsorption syndrome in which dietary gluten damages the small bowel mucosa. Gluten contains gliadin, the primary toxic component that is primarily found in wheat, barley and rye products. The initial diagnosis of coeliac disease is usually made by endoscopic biopsy of the jejunum although sometimes imaging features can suggest the diagnosis. Once a diagnosis is made, patients need to be diet compliant and monitored for potential complications. Many complications are more common when dietary compliance is poor. Complications include intussusception (usually intermittent), ulcerative jejunitis, osteomalacia, cavitating lymph node syndrome and an increased risk of malignancies such as lymphoma, adenocarcinoma and squamous cell carcinoma. Radiological evaluation is central in the evaluation of these complications. Imaging may assist both in the diagnosis and staging of complications as well as enabling radiological guided percutaneous biopsy for complications of coeliac disease such as lymphoma. As coeliac disease is a relatively common disorder, it is likely that most radiologists will encounter the disease and its potential complications. The aim of this review article is to discuss and illustrate the role of modern radiology in evaluating the many presentations of this complex disease.     

European obesity and the radiology department. What can we do to help?

Obesity is a chronic disease that is now a global epidemic. The numbers of obese people are exponentially rising in Europe, and it is projected that in Europe by 2010 there will be 150 million obese people. The obesity-related health crisis does not only affect adults, with one in four European children now overweight. Radiologists, both adult and paediatric, need to be aware of the magnitude of the problem, and obese patients cannot be denied radiologic evaluation due to their size. Missed diagnosis, appointment cancellation and embarrassing situations for patients when they are referred for a radiological examination for which they are not suitable are all issues that can be avoided if careful provision is made to accommodate the needs of the obese patient requiring radiologic evaluation. This paper will discuss the epidemiology of obesity and the role of radiology in the assessment of obesity and disorders of fat metabolism. The limitations obesity poses to current radiological equipment and how the radiologist can optimise imaging in the obese patient will be described. Dose reference levels and dose control are discussed. Examples of how obesity both hinders and helps the radiologist will be illustrated. Techniques and pre-procedural preparation to help the obese patient in the interventional suite are discussed.     

Asian Radiology Forum 2015 for Building an Asian Friendship: A Step toward the Vigorous Intersociety Collaboration in Asia

According to the reports presented at the Asian Radiology Forum 2015, organized by the Korean Society of Radiology (KSR) during the Korean Congress of Radiology (KCR) in September 2015 in Seoul, there is an increasing need to promote international exchange and collaboration amongst radiology societies in Asian countries. The Asian Radiology Forum was first held by KSR and the national delegates of Asian radiological partner societies, who attended this meeting with the aim of discussing selected subjects of global relevance in radiology. In 2015, current stands, pros and cons, and future plans for inter-society collaboration between each Asian radiological partner societies were primarily discussed. The Asian radiology societies have international collaborations with each other through various activities, such as joint symposia, exchange programs, social exchange, and international membership. The advantages of continuing inter-society collaboration in most of the Asian radiology societies include international speakers, diverse clinical research, and cutting edge technology; while limited range of financial and human resources, language barrier, differences in goals and expectations are claimed as disadvantages. With regard to the future, most of the Asian radiology societies focus on expanding partner societies and enhancing globalization and collaboration programs through various international meetings and exchange programs.     

A case of painful defect of unknown origin of the pediatric patella

An uncertain history of potential trauma versus possible developmental variants and disorders in childhood may cause differential diagnostic problems in pediatric radiology. We report the case of a 12-year old boy with an unclear unilateral defect of the patella and long-persisting complaints in his knee. The plain radiological and MRI morphology of this lesion are described and possible differential diagnoses are discussed.     

Postgraduate radiological education in Europe E.A.R. working group

In 1992 the Education Commission of the European Association of Radiology conducted a survey amongst its 27 members in order to obtain an overview of the current pattern of radiological education in Europe. Postgraduate radiological education in Europe varies considerably. Only 15 out of 22 countries (68%) require clinical training before the commencement of radiological training which may vary from 2 to 6 years. Obligatory attendance at theoretical courses is required in 9 out of 15 countries (60%); the duration of such obligatory courses varying from 30 to 1600 hours.Sub-specialisation is possible in 13 countries (56%) after education in general radiology. Neuroradiology is recognised as a sub-specialty of radiology in 11 countries and paediatric radiology in 9 countries. Other sub-specialties are officially recognised in 7 countries. Four to 35 doctors per 1,000,000 population are presently training in radiology. The number of recognised specialists in radiology varies between 33 and 153 per 1,000,000 population. Members of the E.A.R.working group: Prof. A. Baert — Leuven, Belgium; Prof. L. Dalla Palma —Trieste, Italy; Prof. G. Delorme — Bordeaux, France; Prof. L. Diankov — Sofia, Bulgaria; Prof. U. Erikson — Uppsala, Sweden; Prof. I. Isherwood — Manchester, UK (Dean, European College of Radiological Education); Prof. R. Passariello —Rome, Italy; Prof. P. E. Peters — Münster, Germany; Prof. H. Pokieser — Vienna, Austria; Prof. C. G. Standartskjöld-Nordenstam — Helsinki, Finland; Prof. J. P. Tessier — Paris, France (Chairman Education Commission); Dr. H. S. Thomsen — Copenhagen, DenmarkDrafting by. H. S. Thomsen     

The radiologist’s role in managing paediatric liver transplantation: personal experience with 40 patients

PURPOSE: The aim of our study was to evaluate the radiologist's role in managing paediatric orthotopic liver transplantation (OLT) through a retrospective review of our experience in diagnosing and treating post-OLT complications. MATERIALS AND METHODS: Forty children (mean age 4.6 years) underwent 44 OLTs over 71 months. The follow-up period (mean 724 days) was divided into three phases: hospital stay, up to three months after discharge and subsequent period. The number and type of radiological examinations, radiologically detectable complications and interventional procedures were analysed. RESULTS: Most examinations were carried out with ultrasound (US) (859/931 of all radiological studies performed during the first two phases, 92.3%). Colour-Doppler US enabled early detection and treatment of all vascular complications (9/40, 22.5% of patients; 13 complications in nine patients, eight arterial and five portal complications; 1.4 for each patient with complications). Computed tomography (CT) or angiography was very rarely employed. US also detected biliary complications (11 patients, 27.5%: three cases of segmental ducts excluded from the anastomosis, four cases of stenosis of the biliodigestive anastomosis, one lithiasis, three stenoses associated with lithiasis), which were successfully managed in 75% of the cases treated with interventional radiology procedures (percutaneous bilioplasty and/or lithotripsy). At the time of writing this paper, the patient survival rate was 100%, and the organ survival rate was 91% (40/44). There were four re-transplantations: three due to hepatic artery thrombosis and one to biliary stenosis with lithiasis. CONCLUSIONS: The radiologist's role is fundamental for early sonographic diagnosis of post-OLT complications in children. Vascular complications are often associated in a single patient, and early treatment may improve the prognosis. Interventional radiology represents a safe and effective treatment for many biliary complications.     

Use of small bowel imaging for the diagnosis and staging of Crohn's disease--a survey of current UK practice

Objectives

This study used a postal survey to assess the current use of small bowel imaging investigations for Crohn’s disease within National Health Service (NHS) radiological practice and to gauge gastroenterological referral patterns.

Methods

Similar questionnaires were posted to departments of radiology (n = 240) and gastroenterology (n = 254) identified, by the databases of the Royal College of Radiologists and British Society of Gastroenterologists. Questionnaires enquired about the use of small bowel imaging in the assessment of Crohn’s disease. In particular, questionnaires described clinical scenarios including first diagnosis, disease staging and assessment of suspected extraluminal complications, obstruction and disease flare. The data were stratified according to patient age.

Results

63 (27%) departments of radiology (20 in teaching hospitals and 43 in district general hospitals (DGHs)) and 73 (29%) departments of gastroenterology replied. These departments were in 119 institutions. Of the 63 departments of radiology, 55 (90%) routinely performed barium follow-though (BaFT), 50 (80%) CT, 29 (46%) small bowel ultrasound (SbUS) and 24 (38%) small bowel MRI. BaFT was the most commonly used investigation across all age groups and indications. SbUS was used mostly for patients younger than 40 years of age with low index of clinical suspicion for Crohn’s disease (in 44% of radiology departments (28/63)). MRI was most frequently used in patients under 20 years of age for staging new disease (in 27% of radiology departments (17/63)) or in whom obstruction was suspected (in 29% of radiology departments (18/63)). CT was preferred for suspected extraluminal complications or obstruction (in 73% (46/63) and 46% (29/63) of radiology departments, respectively). Gastroenterological referrals largely concurred with the imaging modalities chosen by radiologists, although gastroenterologists were less likely to request SbUS and MRI.

Conclusion

BaFT remains the mainstay investigation for luminal small bowel Crohn’s disease, with CT dominating for suspected extraluminal complications. There has been only moderate dissemination of the use of MRI and SbUS.Crohn’s disease is a chronic inflammatory condition of the bowel that predominately affects the young and requires lifelong medical and often surgical therapy [1]. It affects approximately 60 000 people in the UK (around 1 in 1000), with between 3000 and 6000 new diagnoses made each year. Crohn’s disease can affect the digestive system anywhere from the mouth to the anus, but most commonly affects the small intestine and/or colon. Despite advances in technology, the small bowel remains relatively inaccessible to conventional endoscopic techniques. Thus, radiological imaging plays a major role in the assessment and diagnosis of both luminal small bowel disease and extra-enteric complications.Although barium fluoroscopy and CT remain the conventional tests used to investigate Crohn’s disease, both impart a significant radiation dose to patients [2,3]. This is of major importance given the relative youth of the patient population afflicted by Crohn’s disease [4]. The recently published European evidence-based consensus on the diagnosis and management of Crohn’s disease [5] states “the radiation burden from fluoroscopy and CT is considerable, so alternatives such as ultrasound and MRI should be considered when possible”. Advocates of ultrasound and particularly MRI suggest that these modalities could be the ideal “one stop shop” in Crohn’s disease imaging, allowing evaluation of luminal, mural and extramural disease. There is, however, a relatively small evidence base upon which to rationalise the implementation of new imaging technologies within the NHS, and the extent to which they have been disseminated into routine UK clinical practice is unclear. The purpose of the survey reported here was therefore to assess the current use of individual small bowel imaging investigations for Crohn’s disease within the National Health Service (NHS) radiological practice, and to gauge current gastroenterological referral patterns.     

Liver transplantation: role of the radiologic methods in the postoperative period]

Some complications of liver transplantation appear as aspecific clinical and blood test abnormalities; others--e.g., hepatic artery thrombosis in the immediate postoperative period and stenosis of the biliary anastomosis before T-tube removal--require early diagnosis. These considerations justify the need of frequent radiologic examination in both the complicated course and the follow-up. The authors report their experience in 59 adult patients submitted to liver transplantation for irreversible liver disease in advanced stage (49 with cirrhosis, 10 with HCC; 5 with cholestatic hepatopathy; 3 with fulminant hepatitis; 1 with Budd-Chiari syndrome; 1 with metastatic APUDoma). Two hundred and sixty-three radiological examinations were performed (Doppler US, CT, angiography and cholangiography) which showed numerous early and delayed complications: 13 of them were treated with interventional radiology maneuvers (US-or CT-guided percutaneous drainage of fluid collections, biliary drainage, bilioplasty, arterial transcatheter embolization). Our results demonstrate that diagnostic and operative radiology are essential for the success of liver transplantation; integrated imaging is particularly important in the diagnosis of complications, while interventional radiology techniques can be usefully employed in their treatment.     

Chest radiograph interpretation by medical students

AIM: To assess the ability of final year medical students to interpret conventional chest radiographs. MATERIALS AND METHODS: Ten conventional chest radiographs were selected from a teaching hospital radiology department library that were good radiological examples of common conditions. All were conditions that a medical student should be expected to recognize by the end of their training. One normal radiograph was included. The radiographs were shown to 52 final year medical students who were asked to describe their findings. RESULTS: The median score achieved was 12.5 out of 20 (range 6-18). There was no difference between the median scores of male and female students (12.5 and 12.3, respectively, p=0.82) but male students were more likely to be certain of their answers than female students (median certainty scores 23.0 and 14.0, respectively). The overall degree of certainty was low. On no radiograph were more than 25% of students definite about their answer. Students had received little formal radiology teaching (2-42 h, median 21) and few expressed an interest in radiology as a career. Only two (3.8%) students thought they were good at interpreting chest radiographs, 17 (32.7%) thought they were bad or awful. CONCLUSION: Medical students reaching the end of their training do not perform well at interpreting simple chest radiographs. They lack confidence and have received little formal radiological tuition. Perhaps as a result, few are interested in radiology as a career, which is a matter for concern in view of the current shortage of radiologists in the UK.     

Percutaneous abscess drainage in the UK: A national survey and single centre study

AIM: To establish the current practice for management of radiologically placed percutaneous drains for abdominal sepsis in the UK and prospectively study the management of radiologically placed drains at our institution. METHOD: A questionnaire on the management of radiologically placed drains was sent to all radiology departments on a Royal College of Radiologists database. We prospectively followed all drains placed by our radiology department for drainage of abdominal collections, over a 7-month period. RESULTS: A total of 210 questionnaires were sent for the national survey, of these 117 were returned (55.7%). The majority of departments (70.5%) reported that after drain insertion the clinical team took over daily management. Just over 5% of departments either formally managed the drain or obtained final outcome data. From October 2003 to April 2004 we followed 63 consecutive drains placed in 45 patients, for abdominal sepsis. Thirty-nine drains (61.9%) were curative and 17 (26.9%) drains failed. Three drains (4.8%) were placed for palliation, and four drains (6.4%) were placed in order to temporise prior to surgery. Forty-three (68.3%) drains had a successful primary outcome: success after secondary percutaneous abscess drainage (PAD) improved to 46 (73.0%) drains. Two (3%) major complications occurred. CONCLUSIONS: The current approach in the UK to management of radiologically placed drains differs significantly from that practised in the USA. The most common type of support offered by radiology departments in the UK is of informal advice and follow-up, with the clinical team managing the patient's drain. Observations in our hospital highlighted problems relating to drain management that may impact on the success of PAD. We suggest that more formal radiological support after PAD would improve communication and potentially improve outcomes.     

Radiology is valuable to general practitioners; but who pays?

This study evaluated an open access general practitioner radiological service. Questionnaires were completed in 216 out of 250 cases both before and after radiological examination. Chests and specials (bariums, intravenous urography, ultrasound) were most often of diagnostic value when confirming normality, while other radiographs were more likely to be of value in assessing the severity of known disease (P less than 0.001). Patient therapy was altered in 31% of cases following receipt of the radiological report, and management was changed in 40%. In 25% of cases the patient was discharged on receipt of the report. In 28% of cases the report avoided a hospital referral. Special examinations were most likely (P less than 0.05) to avoid a referral. It is concluded that open access radiology is a considerable help with diagnosis and management, and substantially reduces out-patient referrals. The possible consequences for the acute services of providing a full general practitioner diagnostic service are discussed.     

Radiology trainees in the UK and Ireland: academic background,publication rates and research plans

To assess the level of achievement of current trainees, we investigated the academic qualifications, publication rates and future research plans of 240 radiology trainees in the UK and Ireland. All radiology trainees in the UK and Ireland were surveyed by a questionnaire enquiring about academic record and career ambitions. Our study shows that the level of academic achievement of radiology trainees is high, and provides interesting information concerning the current group of radiology trainees in these regions. It will be of interest both to radiology trainers and to doctors hoping to pursue a career in radiology. It also demonstrates that a potential recruitment crisis in academic radiology exists.To assess the level of achievement of current trainees, we investigated the academic qualifications, publication rates and future research plans of 240 radiology trainees in the UK and Ireland. Trainees interested in academia typically have experience of research, medical education or academic success. These factors were analysed in relation to radiology and the Walport report on future training of clinical academics.     

Radiology education: a glimpse into the future

The digital revolution in radiology continues to advance rapidly. There are a number of interesting developments within radiology informatics which may have a significant impact on education and training of radiologists in the near future. These include extended functionality of handheld computers, web-based skill and knowledge assessment, standardization of radiological procedural training using simulated or virtual patients, worldwide videoconferencing via high-quality health networks such as Internet2 and global collaboration of radiological educational resources via comprehensive, multi-national databases such as the medical imaging resource centre initiative of the Radiological Society of North America. This article will explore the role of e-learning in radiology, highlight a number of useful web-based applications in this area, and explain how the current and future technological advances might best be incorporated into radiological training.     

Konventionelle Dentalradiologie und Zukunftsperspektiven

Until recently, conventional dental radiology was performed by dentists and orofacial surgeons. Due to the rapid development of radiological technique, the demand of radiological advice is increasing. The radiologists see more and more dental patients in their daily routine. The aim of this article is to give an overview on established dental radiology and a glimpse into the future. Conventional dental radiology and digital radiography are presently in use. Intraoral technique comprises dental films, bite-wing views and occlusal radiographs. Panoramic views and cephalometric radiographs are done with extraoral technique. Digital radiography lacks all processes in behalf of film development. It leads to dose reduction and enables image manipulation.     

Key factors in the optimization of paediatric X-ray practice.

Justification of radiological requests, standardization of procedures and optimization of protection measures are key principles in the protection of individuals exposed to ionizing radiation for diagnostic purposes. Nowhere is this more pertinent than in the imaging of children and, following the recent introduction of the Ionising Radiation (Medical Exposure) Regulations, there is now a regulatory requirement for diagnostic radiology departments to demonstrate compliance with these principles. A study was undertaken to compare all aspects of paediatric radiological practice at two specialist and two non-specialist centres. An initial study involved analysis of nearly 3000 patient doses. The second phase of the project involved assessment of referral criteria, radiographic technique and approximately 100 radiographs at each centre by two consultant paediatric radiologists. While all radiographs were found to be diagnostically acceptable, major differences in technique were evident, reflecting the disparity in experience between staff at the specialist and non-specialist centres. The large number of sub-optimum films encountered at the latter suggests that there is a need for specific training of less experienced radiographic and clinical staff.