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Pediatric radiology

Introduction

Pediatric radiology or diagnostic imaging (radiography, ultrasonography, nuclear medicine, CT, or MRI) is a specialized clinical science and technique developed to facilitate effective diagnostic radiologic examinations of infants, children, and adolescents. Pediatric diagnostic imaging is distinguished from adult applications of the modalities by technical factors, equipment, protection, immobilization, and methods of communication with children and their parents. The diagnostic process is distinctive to pediatric disease.

Outpatient

Child safety
The amount of radiation for routine radiographic examinations in children is less than that required for adults and is relatively small. CT exams in children also are done with a reduced amount of radiation.

 

Parent (guardian) participation and safety
Usually one parent (guardian) is allowed in the x-ray room during the exam at the discretion of the radiologist. A family member who is pregnant will not be allowed in the x-ray room in order to protect against unnecessary radiation exposure to the unborn baby. Please inform the technologist before the x-ray exam of your child if you are pregnant

Preparations for pediatric radiographic/fluoroscopic exams - inpatient

Pediatric esophagram (barium swallow)

Purpose and description
The esophagus is made visible on x-ray by the ingestion of a contrast agent (usually barium). Several x-ray pictures will be obtained during swallowing. In some instances, the contrast agent is introduced into the esophagus by means of a small tube.

NOTE: Barium may cause transient constipation. This may be relieved after completion of the examination by encouraging water or fruit juices as allowed. A physician should be notified if constipation persists.

Instructions and preparations
During the examination, the infant or child will be attended by the x-ray technologist and the radiologist. One parent may be allowed in the room as permitted by the radiologist. It is important that the child's stomach be empty before the examination. Preparation required is as follows:

Age:Preparation:
Newborn to 2 years:Nothing by mouth for three (3) hours before the examination.
Age 2 to adolescence:Nothing by mouth from midnight the night before the examination.

Pediatric upper gastrointestinal examintion (UGI); including small bowel series -inpatient

Purpose and description
This is an examination of the organs of the gastrointestinal tract. The organs visualized on x-ray pictures after the child drinks a contrast agent--usually barium. During the examination several x-ray pictures will be taken of the esophagus, the stomach and the small bowel.

NOTE: Barium may cause transient constipation. This may be relieved after completion of the examination by encouraging water or fruit juices as allowed. A physician should be notified if constipation persists.

Instructions and preparations
During the examination the infant or child will be attended by the x-ray technologist, radiology nurse, and the radiologist. One parent may be allowed in the room under the supervision of the technologist, radiology nurse, and/or radiologist. In order to get the best x-rays, it is important that the stomach and small bowel be empty of food. Preparation required is as follows:

Age:Preparation:
Newborn to 2 yearsNothing by mouth for a least four (4) hours before the examination.
Age 2 years through adolescence:Nothing by mouth from midnight the night before the examination, or for at least eight (8) hours prior to the examination.

Pediatric barium enema (standard colon X-ray exam) -inpatient

 

Purpose and description
The barium enema is for the purpose of seeing and examining the large bowel on x-ray pictures. The large bowel is filled with barium administered through a rectal tube. During barium filling and after emptying, x-ray pictures are made.

NOTE: Barium may cause constipation. This may be relieved after completion of the examination by forcing clear liquids or fruit juices, as allowed. A physician should be notified if constipation persists.

Instructions and preparations
During the examination the infant or child will be attended by the x-ray technologist, and the radiologist. One parent may be allowed in the room under the supervision of the technologist, radiology nurse, and/or radiologist.

*If an upper gastrointestinal examination also is to be scheduled for this patient, the colon examination is to be done first. Allow one day between the two examinations.

Preparation is not indicated for the following situations:

  1. Suspected Hirschsprung's disease
  2. Suspected intussusception
  3. Acute diarrhea
Age:Preparation:
Newborn through 2 years:No preparation necessary.
Age 3-8 years: Castor oil or NEOLOID at bedtime. See chart for dose. May substitute one 5 mg Dulcolax tablet by mouth.

At 6:00 a.m. the morning of the examinatio

Give one 10 mg Dulcolax suppository per rectum.

May have one glass of juice and one to two slices of toast (may have butter and jelly) for breakfast. Nothing by mouth after breakfast until the examination is completed. No chewing gum from the time the preparation is begun until the examination is complete.
 Inpatient
Age 9 through adolescence:

Castor Oil or NEOLOID at bedtime. May substitute two 5 mg Dulcolax tablets by mouth.

  1. At 6:00 a.m. the morning of the examination, give one 10 mg Dulcolax suppository per rectum.
  2. May have one glass of juice and two slices of toast (may have butter and jelly) for breakfast. Nothing by mouth after breakfast until the examination is completed.
  3. No chewing gum from the time the preparation is begun until the examination is complete.

Chart the following dosages based on the patient's weight

PATIENT'S WEIGHTNeoloid* or castor oil dose
2 - 20 poundsNone
26 - 32 pounds1 ounce
34 - 40 pounds1 ounce
42 - 58 pounds1 ounce
60 - 80 pounds 1 ounces
82 -123 pounds2 ounces
125 pounds 2 ounces

*Neoloid is a better tasting castor oil emulsion.

Pediatric colon exam for intussusception

 

  1. Usually performed as an emergency.
  2. No preparation.

Pediatric colon exam for congenital megacolon (Hirschsprung's disease)

 

  1. No colon preparation of any type.
  2. No dietary restrictions.

Pediatric colon: colostomy barium enema - inpatient

  1. No preparation unless specified.

Pediatric barium air-contrast enema - inpatient

(Air-contrast colon x-ray exam)

Purpose and description
This exam is for the child who has bleeding per rectum or when there is question of polyps.

To get the best x-ray pictures, it is important that the preparation instructions below be followed.

  1. Starting on the morning ____________ (3 days before the exam, your child may eat foods as per the attached "Low residue diet."
  2. On the night of _____________ (2 days before the examination, insert a Dulcolax suppository in the child's rectum according to age, as outlined below. Repeat this on the night of ______________ (the night before the examination).

Newborn to 6 months No preparation

6 months to 2 years Child should drink generous amounts of liquids, especially fruit juice--see "Clear liquid diet" attached --the day before the exam.

Nothing to eat or drink after midnight on the day of the exam. On the morning of the exam at 6:00 a.m., insert one half of a 10 mg Dulcolax suppository into the rectum. Take child to toilet for bowel movement in about 20 minutes.

2 years to18 years - Generous amounts of fluids the day before the exam. Give NEOLOID (flavored castor oil) at 4:00 p.m. the day before the exam as follows:

2-5 yrs 2 tsp of NEOLOID

5-8 yrs 1 tbls of NEOLOID

8-18 yrs 2 tbls of NEOLOID

Nothing to eat or drink after midnight on the day of the exam. On the morning of the exam at 6:00 a.m., insert one 10 mg DUCOLAX suppository into the rectum. Take child to toilet for bowel movement in about 20 minutes. The exam takes about one hour. After the exam is finished, your child may eat normally.

Low residue diet

Recommended foods

*Applicable for inpatient/outpatient preparations

Mild products: Skim, 2%, buttermilk, whole, and chocolate milk, yogurt without fruit, low-fat cheeses, such as moz.zarella, ricotta, Muenster, cottage, or farmer cheeses.

Meat and meat substitutes: Tender beef, ham, lamb, liver, poultry, or veal that is baked, broiled, pan-broiled, or stewed; fresh or froz.en fish without bones, canned tuna or salmon, cooked shellfish; eggs prepared without added fat.

Combination dishes/soups: Casseroles made with allowed foods; strained soups, bouillon, broth, and soups made with allowed foods.

Starches: French, Vienna, Italian, refined white, and rye breads without seeds; crackers, biscuits, french toast, and pancakes (fat-free) fried in teflon pan; plain hard rolls, rusk, and zwieback; cooked cereals--farina, Cream of Wheat, Cream of Rice, Malt-o-Meal; dry cereals --any made from defined wheat, corn, rice or oat; mashed and scalloped potatoes, baked and boiled white potatoes without skins (with limited fat and milk); macaroni, noodles, white rice, and spaghetti.

Fruits/fruit juices: All strained juices and nectars except prune juice. Limit to two servings per day of the following: peeled, canned or cooked fruit without seeds, including apricots, peaches, and pears. Fresh fruit, including bananas, cantaloupe, watermelon, honeydew melon, and papaya.

Vegetables: Vegetable juices in unlimited quantity; canned or cooked vegetables--limited to two cup serving per day of the following: asparagus, green beans, wax beans, string beans, pumpkin, seeded squash, spinach, tomato sauce, puree, and paste.

Fats and oils: In limited amounts only: crisp bacon, butter, oils, cream, dry cream substitute, margarine, mayonnaise, shortenings, smooth salad dressings, and sour cream.

Desserts: Custards, gelatin, puddings, plain cookies and cakes, sherbets; pastry without nuts or prohibited fruits, ice milk.

Beverages: Fruit-flavored drinks, carbonated beverages, coffee, decaffeinated coffee, and tea.

Miscellaneous: Sugar, syrup, honey, jelly, hard candy, gumdrops, marshmallows; ground or finely chopped herbs and spices, salt, flavoring extracts, ketchup, chocolate, white sauce, soy sauce, vinegar, mustard, gravy from meat juices skimmed off fat.

Sample menus

BreakfastLunchDinner
4 oz. strained orange juice4 oz. chicken noodle soup
2 soda crackers
4 oz. tomato juice
1 scrambled egg2 oz. broiled beef patty on3 oz. baked chicken (meat only)
C Rice Krispies1 white bun with ketchupC whipped potatoes
1 slice white toast with
1 tsp margarine
C canned beansC canned pears
8 oz. skim milk 4 oz. orange sherbet
jelly 8 oz. skim milk
sugar  

Afternoon snackEvening snack 
5 vanilla wafersroast beef sandwich on white bread 
6 oz. strained pineapple juice6 oz. lemonade 

Clear liquid diet

*Applicable for inpatient/outpatient preparations.

 

Allowed foods

  1. Broth
    1. clear broth
    2. bouillon
  2. Strained fruit juices
    1. apple
    2. grape
    3. cherry
    4. cranberry
    5. cranapple
    6. grapefruit
    7. Juicy Juice
  3. Other beverages
    1. fruit drinks
    2. Gatorade
    3. carbonated beverages
    4. Kool-aid
    5. lemonade (made from powdered mix or strained juice)
    6. Coffee (includes decaffeinated coffee)
    7. tea
    8. water, ice
  4. Desserts
    1. plain flavored gelatin
    2. fruit ice
    3. Popsicle
    4. slush
  5. Miscellaneous
    1. sugar
    2. salt

 

Guidelines at various ages

Age:Preparation:
Under the age of 8 months:

Glucose water, Gatorade, diluted apple or apple/cherry juice

Age 8-11 months:

Same as above
Age 12 months and older:Any foods listed in allowed foods


Sample menu

BreakfastLunchTeam
Broth, 6 ouncesBroth, 6 ouncesBroth, 6 ounces
Gelatin, cupGelatin, cupGelatin, cup
Apple juice, 6 ouncesJuicy Juice, 4 ouncesApple Juice 4 ounces
1 Popsicle Fruit ice, 4 ounces1 Popsicle
   
Afternoon snackEvening snack 
Popsicle 8 ounces of 7-UP 

Pediatric intravenous urogram preparation - inpatient

(IVU/kidney x-ray)

Purpose and description

The purpose of this x-ray is to examine the kidneys, the ureters, and the bladder on x-ray pictures. This examination will be conducted by the radiologist, radiology nurse and the x-ray technologist in the radiology department. Following a preliminary x-ray picture of the abdomen, the doctor will inject a contrast agent intravenously. The contrast agent will pass from the blood to the kidneys, the ureters and bladder. Additional x-rays of the abdomen will be made. The examination may last an hour or sometimes longer. One parent may be allowed in the room under the supervision of the technologist, radiology nurse, and/or radiologist.

Instructions and preparations

Age:Preparation:
Newborn to 6 months:1. None.
Age 6 months through 2 years:1. No solid food for four hours prior to the examination. No more than one glass of clear liquid within four hours of the examination
2. One half of a 10 mg Dulcolax suppository per rectum at bedtime the night before the examination.
3. At 6:00 a.m. the morning of the examination, give one half of a 10 mg Dulcolax suppository per rectum.
Age 3-8 years:

1. No solid food for four hours prior to the examination. No more than one glass of clear liquid within four hours of the examination.

2. One 10 mg Dulcolax suppository per rectum at bedtime the night before the examination.

3. One 10 mg Dulcolax suppository per rectum at 6:00 a.m. the morning of the examination.

Age 9-adolescence:

1. No solid food for four hours prior to the examination. No more than one glass of clear liquid within four hours of the examination.

2. Two 5 mg Dulcolax tablets by mouth at bedtime the night before the examination.

3. One 10 mg Dulcolax suppository per rectum at 6:00 a.m. the morning of the examination.

Pediatric voiding cystourethrogram

(VCUG/bladder X-ray)

Purpose and description
This examination is to check the child's bladder and its relationship to the ureters and the urethra. A small catheter must be inserted into the child's bladder. The bladder will be filled with a contrast agent which is visible on x-rays. The x-ray pictures are made during the filling of the bladder with the contrast agent and while the child is urinating.

Instructions and preparations
There is no preparation for this examination unless performed in conjunction with an IVU (see IVU preparation). During the examination the infant or child will be attended by the x-ray technologist, radiology nurse, and the radiologist. One parent may be allowed in the room under the supervision of the technologist, radiology nurse, and/or radiologist.

Pediatric computed tomography

(CT exam or CAT scan)

CT scans are special x-ray exams that produce cross-sectional images of the inside of the body using x-rays and a computer.

Pediatric abdomen and pelvis CT exams require your child to drink an x-ray opaque contrast liquid before the exam. Another x-ray opaque contrast liquid may be injected into your child's vein with your permission for certain CT exams.

After the CT exam is completed, a pediatric radiologist will give a written report to your doctor.

General preparations

No preparation is necessary for some pediatric CT exams that may not require intravenous contrast liquid.

Nothing to eat or drink for four to six hours before pediatric CT exams that may require intravenous contrast liquid. Younger children may need to be sedated.

Specific preparations--CT exams of abdomen and pelvis

Children 9 years and older: Obtain CT oral contrast drink from CT department. Nothing per mouth (liquids or solids) for four hours prior to the scheduled exam. Ninety minutes prior to the exam drink two glasses (16 oz.) of CT oral contrast drink. Thiry minutes prior to exam, drink one glass (8 oz.) or CT oral contrast drink.

Just prior to exam, drink 1/2 a glass (4 oz) of oral contrast drink.

0--1 month: No oral milk product or breast milk four hours prior to exam. Two (2) hours prior to exam, give 1/4 to 1/2 glass (2-4 oz) of CT oral contrast drink. Upon arrival in CT department, the child will be evaluated for sedation.

1 month--1 year: No solid or mild products or breast milk four hours before exam. Two (2) hours prior to exam give one glass (4-8 oz) of CT oral contrast drink by mouth. Upon arrival on CT department, the child will be evaluated for sedation.

1--5 years: Nothing to eat or drink six hours prior to exam. Three (3) hours prior to exam, give 1 to 1 and a 1/2 glasses (12 oz) of CT oral contrast drink by mouth. Upon arrival in CT department, the child will be evaluated for sedation.

6--8 years: Nothing to eat or drink 6 hours prior to exam. Forty five (45) minutes prior to exam, give 1 to 1 and a 1/2 glasses (12 oz) of CT oral contrast drink by mouth. Upon arrival in CT department, the child will be given an additional six to eight oz. of CT oral contrast drink about 15 minutes prior to the exam.

Pediatric ultrasound

(Sonogram or echogram)

Ultrasound or sonography produces images for diagnosis by using sound waves. A probe to which warm jelly is applied is moved along the part of the body being examined. No specific preparation is required for most ultrasound exams. Occasionally it will be helpful for the child to have a full urinary bladder in order to get a good exam of the pelvic organs and lower abdomen. Exceptionally, your doctor may inform you if special preparation is necessary.

 

Pediatric Magnetic Resonance Imaging (MRI)

MRI produces images by using magnetic waves. Your child will lie on a narrow table that moves into an enclosed chamber. It is not necessary to drink special liquid for preparing for MRI. However, it is sometimes necessary to give a special liquid by vein before some of the images are obtained. Sedation may be necessary before the MRI exam of younger children.

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