A review of cross-sectional imaging, ultrasound and nuclear medicine utilization patterns in paediatric patients in Ireland, 2003–12

O’Connor, Michelle; Ryan, John; Foley, Shane

doi:10.1259/bjr.20140767

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…Although some of this increase is likely the re- sult of referral patterns, the increased ease and prevalence of neuroimaging also likely contributed to the rise in cases. [20][21][22] MRI utilization has increased fourfold in the US and Canada, going from 16 cases per 1000 person-years in 2000 to 64 cases per 1000 person-years in 2016, 23 and we suspect iLGG will be encountered more frequently in the future by all neurosurgical oncologists. Given our findings, we believe these tumors can be safely removed and patients can benefit from early surgical intervention.…”

Section: Discussionmentioning

confidence: 86%

Surgical management of incidentally discovered low-grade gliomas

Gogos

Young

Pereira

et al. 2021

Journal of Neurosurgery

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OBJECTIVEAlthough most patients with low-grade glioma (LGG) present after a seizure, a small proportion is diagnosed after neuroimaging is performed for a sign or symptom unrelated to the tumor. While these tumors invariably grow, some surgeons argue for a watchful waiting approach. Here, the authors report on their experience in the surgical treatment of patients with incidental LGG (iLGG) and describe the neurological outcomes, survival, and complications.METHODSRelevant cases were identified from a prospective registry of patients undergoing glioma resection at the University of California, San Francisco, between 1997 and 2019. Cases were considered iLGG when the lesion was noted on imaging performed for a reason unrelated to the tumor. Demographic, clinical, pathological, and imaging data were extracted from the electronic medical record. Tumor volumes, growth, and extent of resection were calculated from pre- and postoperative volumetric FLAIR sequences.RESULTSOne hundred thirteen of 657 (17.2%) first-time resections for LGG were for incidental lesions. The most common reasons for the discovery of an iLGG were headaches (without mass effect, 34.5%) or trauma (16.8%). Incidental tumors were no different from symptomatic lesions in terms of laterality or location, but they were significantly smaller (22.5 vs 57.5 cm3, p < 0.0001). There was no difference in diagnosis between patients with iLGG and those with symptomatic LGG (sLGG), incorporating both molecular and pathological data. The median preoperative observation time for iLGG was 3.1 months (range 1 month–12 years), and there was a median growth rate of 3.9 cm3/year. Complete resection of the FLAIR abnormality was achieved in 57% of patients with incidental lesions but only 23.8% of symptomatic lesions (p < 0.001), and the residual volumes were smaller for iLGGs (2.9 vs 13.5 cm3, p < 0.0001). Overall survival was significantly longer for patients with incidental tumors (median survival not reached for patients with iLGG vs 14.6 years for those with sLGG, p < 0.0001). There was a 4.4% rate of neurological deficits at 6 months.CONCLUSIONSThe authors present the largest cohort of iLGGs. Patient age, tumor location, and molecular genetics were not different between iLGGs and sLGGs. Incidental tumors were smaller, a greater extent of resection could be achieved, and overall survival was improved compared to those for patients with sLGG. Operative morbidity and rates of neurological deficit were acceptably low; thus, the authors advocate upfront surgical intervention aimed at maximal safe resection for these incidentally discovered lesions.

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Section: Discussionmentioning

confidence: 86%

Surgical management of incidentally discovered low-grade gliomas

Gogos

Young

Pereira

et al. 2021

Journal of Neurosurgery

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“…The number of diagnostic radiologic procedures performed worldwide increased dramatically in the past decades, resulting in an increased effective annual dose per-capita. 5 These temporal changes were also seen in children, [6][7][8][9] although some studies report a stabilization in CT exams performed since approximately 2000. 6,9 In the pediatric population, radiation exposure dose is of greater importance due to increased relative risk for radiation-related cancer than in adults.…”

Section: Introductionmentioning

confidence: 93%

Pediatric low-dose head CT: Image quality improvement using iterative model reconstruction

et al. 2023

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Purpose To evaluate the differences in pediatric non-contrast low-dose head computed tomography (CT) between filtered-back projection and iterative model reconstruction using objective and subjective image quality evaluation. Methods A retrospective study evaluated children undergoing low-dose non-contrast head CT. All CT scans were reconstructed using both filtered-back projection and iterative model reconstruction. Objective image quality analysis was performed using contrast and signal-to-noise ratios for the supra- and infratentorial brain regions of identical regions of interest on the two reconstruction methods. Two experienced pediatric neuroradiologists evaluated subjective image quality, visibility of structures, and artifacts. Results We evaluated 233 low-dose brain CT scans of 148 pediatric patients. There was a ∼2-fold improvement in the contrast-to-noise ratio between gray and white matter in the infra- and supratentorial regions ( p < 0.001) using iterative model reconstruction compared to filtered-back projection. The white and gray matter signal-to-noise ratio improved more than 2-fold using iterative model reconstruction ( p < 0.001). Furthermore, radiologists graded anatomical details, gray-white matter differentiation, beam hardening artifacts, and image quality using iterative model reconstructions as superior to filtered-back projection reconstructions. Conclusion Iterative model reconstructions had better contrast-to-noise and signal-to-noise ratios with fewer artifacts in pediatric CT brain scans using low-dose radiation protocols. This image quality improvement was demonstrated in the supra- and infratentorial regions. This method thus comprises an important tool for reducing children’s exposure while maintaining diagnostic capability.

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“…A few studies revealed that the quantity of MRI scanners and utilization increased rapidly in many countries, such as the United States (3), Canada (4,5), South Korea (6), and Ireland (7). Research conducted by Luyang He(8) found a high growth rate of absolute device number in China, but the overutilization and underutilization of MRI scanners might coexist.…”

Section: Introductionmentioning

confidence: 99%

Utilization and influencing factors of Magnetic Resonance Imaging in Three Provinces in China

Jiang

Yan

Chen

2022

Preprint

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Background: The annual utilization of Magnetic resonance imaging (MRI) can show trends in the hospital setting and the policy implications. The Chinese government launched a new health care system reform in 2009. The reform focused on reconstructing the public hospitals and expanding primary health care. The objective of this paper is to describe the utilization of MRI services in three provinces of China during the nine years from 2009 to 2017 after the health care system reform and identify the influencing factors.Methods: We collected data from the information system and the database of 46 sample hospitals in three provinces. The approval of the research ethics board was not required as the study involved no individual patient information. The panel data was constructed to calculate the utilization rate. The research team also built the random-effects and the fixed-effect model to analyze the relevant factors.Results: The utilization of MRI services in China increased from 2009 to 2017. The average utilization rate of MRI equipment in the outpatient and emergency was 1.07%, which was relatively stable and far less than that of hospitalization (18.89%). Panel regression analysis indicates that the number of MRI equipment and beds significantly impacts utilization.Conclusion: The study demonstrated a sharply increasing trend of MRI utilization in China since the new medical reform, and also of waiting time brings both clinical benefits and financial burden. It will be possible to set up regional image centers, which may improve the efficiency of existing idle devices, and alleviate the problem of long waiting in tertiary hospitals.

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A review of cross-sectional imaging, ultrasound and nuclear medicine utilization patterns in paediatric patients in Ireland, 2003–12

Cited by 6 publications

References 25 publications

Surgical management of incidentally discovered low-grade gliomas

Surgical management of incidentally discovered low-grade gliomas

Pediatric low-dose head CT: Image quality improvement using iterative model reconstruction

Utilization and influencing factors of Magnetic Resonance Imaging in Three Provinces in China

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