BACKGROUND: Radiation from CT (computerized tomography), poses risk of radiation associated cancer. Studies indicate a cumulative dose of 50mGy triples the risk of leukemia and a dose of 60mGy triples the risk of brain tumors in children. This study aimed to assess the application of “Justification and Optimization Principles of ALARA (As Low As Reasonably Achievable)” in pediatric CT.METHOD: A prospective cross-sectional study was conducted from December 2017 to July 2018 G.C at Tikur Anbessa Specialized Hospital. CT request forms were reviewed. All pediatric patients listed for CT were included. The collected data were analyzed using SPSS version 25.RESULTS: Four hundred and twenty nine CT requests were reviewed, 246 (57.3%) were males and 183(42.7%) were females; 52(12.1%) were less than 1 year old, 153(35.7%) between 1 to 5 years, 113(26.3%) between 5 to 10 years and 111(25.8%) 10 to 14 years old. On the other hand, 28(6.5%) scan requests were rejected based on the ALARA justification principle, and from these, in 11(39.2%) MRI was recommended instead of CT, in 6(21.42%) US was recommended. Review of previous CT helped to reject 4(14.28%). Review of prior chest radiographs helped in rejecting 2(7.14%) requests. For 5(17.8%) and 19(4.4%), requests were optimized by applying principles of optimization to reduce received dose from CT.CONCLUSION: Overall, 47(11%) patients were protected from unnecessary radiation exposure by applying the principles of ALARA. The use of other alternating imaging modalities is vital in pediatric patients who are more radiosensitive and have longer time to manifest radiation induced injury.
BACKGROUND: Fibrodysplasia ossificans progressiva (FOP), also known as Myositis ossificans progressiva or Munchmeyer's disease, is an extremely rare and disabling genetic condition of congenital skeletal malformations and progressive heterotopic ossification (HO). The disease is characterized by congenital skeletal anomalies and progressive ectopic bone formation in connective tissues such as ligaments, muscles and tendons. The disease has an incidence of about 1 in 2 million population.CASE DETAILS: We report a case of a 2-year and 8-month old male child with an initial diagnosis of soft tissue sarcoma based on fine needle aspiration (FNAC) of neck swelling.CONCLUSION: Fibroplasia ossificans progressive (FOP) characteristically manifests with bilateral malformation of the great toe and progressive heterotopic ossification (HO). Clinicians and radiologists should be aware of these to prevent permanent disability.KEYWORDS: Fibroplasia ossificans progressive, myositis ossificans
Characteristic magnetic resonance imaging (MRI) findings in patients with chronic kernicterus are bilateral and symmetric T2-weighted hyperintensities in the globus pallidus. We report 4 cases of infants with clinical, laboratory, and MRI findings of kernicterus in this case series. This is the first MRI report of kernicterus in Ethiopia. Awareness of the disease is raised in this report, and the role of magnetic resonance in detecting signal abnormalities associated with kernicterus in the globus pallidi is underscored. We recommend MRI to be part of the investigation in neonates with jaundice.
Background In 2008, there were no pediatric radiologists in Ethiopia, a country of 100 million people. The radiology residency programs lacked training in pediatric imaging acquisition and interpretation. Objective We established an accredited local pediatric radiology fellowship program in Ethiopia. Methods With assistance from US faculty from the Children's Hospital of Philadelphia, Ethiopian radiologists created a 2-year fellowship training program in a university-based Ethiopian radiology residency program that incorporated formal lectures and seminars, case tutorials, journal clubs, teleradiological conferences, paper presentations, and online courses from collaborating institutions. Formal accreditation of the program was achieved from the university, and core values were established to ensure sustainability and self-sufficiency. The Ethiopian institution provided funding for the fellows, and US faculty volunteered their time. Results In 2015, 2 radiologists were recruited to the new fellowship; after graduation in 2017, they formed the first pediatric radiology section at the Ethiopian institution. Three new fellows were recruited in 2019, and the program is now self-sustaining. Pediatric imaging training has also been added to the radiology residency. Conclusions Establishing a pediatric radiology fellowship in a country with high need but little existing faculty expertise is feasible through outreach efforts.
BackgroundMost congenital anomalies of the urinary tract present with hydronephrosis. Some are physiological while others pathological. Ultrasound, micturating cyst urethrography, dynamic renal scintigraphy, intravenous urography, dynamic and static magnetic resonance urography are used for examination. Currently, renal arterial Doppler resistance index is used as complimentary mechanism. This study assesses our experience in resistive index measurement in differentiating obstructive from non-obstructive hydronephrosis in children.MethodsA cross-sectional study of forty-two infants and children (<14 years) with hydronephrosis were enrolled using consecutive sampling. Ultrasonography to assess the degree of hydronephrosis and avoiding cystourethrogram were used for the diagnosis of vesicoureteral reflux and posterior urethral valve. Intravenous urogram and surgery were used to confirm causes for obstructive hydronephrosis. Doppler ultrasonography assessed both kidneys to determine mean resistive index for both obstructive and non-obstructive hydronephrosis as well as nonobstructive kidneys. Independent t test was used for analysis at p< 0.005.ResultsThe major cause for obstructive hydronephrosis was pelviuretheric junction obstruction (47.6%) followed by posterior urethral valve (16.7%). For non-obstructive hydronephrosis, vesicoureteral reflux was the main cause followed by prune belly syndrome. The mean resistive index for non-hydronephrotic kidneys was 0.6654 ±0.053, for nonobstructive hydronephrotic ones was 0.6825 ± 0.06668 and obstructive ones was 0.7791 ± 0.11977. The mean resistive index difference between the obstructive and non-obstructive hydronephrosis was 0.09661 with standard error of difference 0.02443. The difference was statistically significant (P-<0.001). A mean RI ROC curve showed sensitivity, specificity and accuracy of 71.1%, 81.2%, 75.4% respectively (p=0.003).ConclusionThis study has shown that the mean renal arterial resistive index was significantly higher in obstructive hydronephrotic kidneys than non-obstructive hydronephrotic kidneys. This can be a valuable tool for diagnosis and follow-up after intervention.
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