INTRODUCTION The purpose of this study was to investigate patient perceptions and acceptance of t... more INTRODUCTION The purpose of this study was to investigate patient perceptions and acceptance of the three whole-body imaging (WBI) modalities used for diagnosing myeloma; radiographic skeletal survey (RSS), low-dose whole-body computed tomography (LD-WBCT) and whole-body magnetic resonance imaging (WB-MRI). The secondary aim was to explore the factors affecting the acceptance of whole-body imaging for myeloma. METHODS 60 participants (median age = 58.5 years old) recruited from three NHS trusts and social media completed a survey in which they scored their experiences of each WBI modality on nine 5-point rating scales. Spearman's correlation coefficient, Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were used to compare scores between different WBI techniques. Participants were invited to provide additional open text responses for interpretation using thematic analysis. RESULTS All modalities demonstrated high levels of acceptability (median score = 4). WB-MRI was perceived as more stressful (p=<0.01) and claustrophobic (p=<0.01) than RSS and LD-WBCT. Thematic analysis showed patients understood the importance of imaging but had concerns about exacerbated pain and the results. WB-MRI was difficult to tolerate due to its duration. Respondents were averse to the physical manipulation required for RSS while remaining stationary was perceived as a benefit of LD-WBCT and WB-MRI. Staff interactions had both positive and negative effects on acceptance. CONCLUSIONS Despite the psychological and physical burdens of WBI, patients accepted its role in facilitating diagnosis. Staff support is vital for facilitating a positive whole-body imaging experience. Healthcare practitioners can improve WBI acceptance by understanding the burdens imposed by WBI and adopting the personalised care model. IMPLICATIONS FOR PRACTICE Patient experience can be improved by tailoring examinations to individual needs. RSS can be as burdensome as other WBI techniques and could be superseded by LD-WBCT or WB-MRI.
ObjectiveTo undertake an assessment of preferences as to how, where and by whom ultrasounds (US) ... more ObjectiveTo undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA group); and (2) patients being scanned for general abdominal conditions (general group).DesignA discrete choice experiment (DCE) questionnaire was administered to patients attending US appointments. Analysis of questionnaire responses used conditional logit models and included validity checks.SettingWest Midlands, England.Participants524 patients (223 in the AAA group and 301 in the general group) were recruited from the US outpatient department at University Hospital Coventry and Warwickshire.Outcome measuresCoefficients for attributes in relation to their reference levels.ResultsThe AAA group preferred to have their US performed in hospital while the general group had a preference for portable US at general practice surgeries. All patients had a strong preference for scanning by sp...
Novel approaches to quantitative analysis of neonatal bowel motility and vascularity. Purpose: Ne... more Novel approaches to quantitative analysis of neonatal bowel motility and vascularity. Purpose: Necrotising Enterocolitis (NEC) is the most common and serious acquired gastrointestinal disorder of the premature infant. Currently standard imaging for diagnosis and follow-up of NEC is the abdominal x-ray but early signs of NEC are neither sensitive nor specific. Distinguishing NEC from other acquired neonatal intestinal diseases (ANIDs) such as spontaneous intestinal perforation and septic ileus is often difficult. Bowel ultrasound has shown promise in detecting NEC but studies have been hampered by the subjective nature of visual assessment of the bowel. The purpose of our study is to develop objective semi-automated computer algorithms for evaluation of bowel wall motility and vascularity. Materials and Methods: Premature babies without NEC (n=9) were recruited to our feasibility study. Two operators independently acquired 2D cine-loops and 3D volumes with and without Doppler in 4 quadrants. Post-hoc analysis was performed of imaging quality. Customised software was developed using MatLab to randomly place multiple regions of interest over bowel loops, allowing sampling of Doppler intensity over time. Separate software was developed to assess the vectorial signature of bowel wall motility over time. Results: 47 quadrants were scanned in 9 infants by two operators; bowel wall motility and bowel content motility was analysable in 35 of these quadrants. All infants had at least one analyzable quadrant. Plots were generated of mean and maximum Doppler intensity over time and vectorial models of bowel motility were created. Conclusion: Quantitative assessment of bowel motility and vascularity is feasible with semi-automated software. We now plan to perform a pilot study of 50 premature infants to establish normative data for bowel vascularity and motility. These measures could be used to distinguish between NEC and other ANIDs and to detect early signs of NEC.
Haemorrhoidal disease is due to pathological change in anal cushions with associated symptoms. Fo... more Haemorrhoidal disease is due to pathological change in anal cushions with associated symptoms. Formed in embryonic life, anal cushions are the lip-like structures suspended in the anal canal by smooth muscle fibres arising from the conjoined longitudinal muscle layer. They contribute to resting anal pressure and form a compliant seal, preventing leakage of anal contents. Surgical management of haemorrhoids has rapidly developed over the last decade, and some of these techniques are reviewed.
International Paediatric Radiology, London, May 31, 2011
Purpose:1)To assess the referral pattern and demographics of the early puberty population to a la... more Purpose:1)To assess the referral pattern and demographics of the early puberty population to a large secondary care centre. 2)To assess the radiological and clinical characteristics of this population.
Methods & Materials:The study group was collated by identifying all female patients under 10 years of age who had a bone age radiograph or a pelvic ultrasound. Data was retrieved from the radiology information system from 01/01/2006 to 30/07/2010. Clinical data was retrieved from clinic letters on the hospital information system.
Results:132 patients were identified; 24 patients with full datasets had ultrasound features in advance of their chronological age. Following LHRH test and pelvic ultrasound, the diagnosis changed in 41.7% of these patients at the second clinic appointment. The precocious puberty group presented with early breast development (90.9%), pubic hair growth (81.8% ) and axillary hair growth (27.3%).
Final diagnoses were precocious puberty (45.8%), thelarche (16.7%), adrenarche (16.7%), early onset of normal puberty (12.5%), vulvovaginitis (4.2%), and concerns of precocious puberty (4.2%).
Chronological age at presentation in the precocious puberty group was 7.57 years, the thelarche group 5.25 years, the adrenarche group 7.13 years, and in the early puberty group 8.72 years. The difference between chronological and bone age, measured in standard deviations was 2.23 in the precocious puberty group, 2.46 in the thelarche group, 1.18 in the adrenarche group, and 0.92 in the early puberty group.
Pelvic ultrasound uterine appearances were pubertal in 45.5% of precocious puberty cases. In 66.7% of the early puberty cases a cavitary echo was identified. Ovarian appearances were advanced in 54.5% of the precocious puberty cases, 50% of thelarche cases, 75% of adrenarche cases and 100% of the early puberty cases.
Conclusions:1)An average of 28.8 patients per year are referred to our secondary care centre to exclude precocious puberty, with a prevalence of 8.33%. 2)81.1% of our population have a pelvic ultrasound, the role of which is mostly to confirm clinical diagnosis, however if appearances are pubertal then further tests are instigated.
European Society of Paediatric Radiology, Budapest, Jun 7, 2013
Title: Paediatric Thyroid Masses
Purpose & Objective
1) To assess the referral pattern and ... more Title: Paediatric Thyroid Masses
Purpose & Objective
1) To assess the referral pattern and demographics of thyroid masses in a paediatric population at a large secondary care centre.
2) To summarise the clinical and radiological characteristics of thyroid pathology in children.
3) To emphasise the role of imaging in management of thyroid disease.
Materials & Methods:
The study group was obtained by analysing the reports from all neck, thyroid, parotid and submandibular gland ultrasounds performed on all patients aged 16 years or less over a 7 year period.
Results:
500 children were scanned in total. The majority (n = 218, 43.6 %) showed lymphadenopathy. A total of 39 (7.8 %) patients had thyroid pathology including 11 with nodules. 5 patients underwent surgical resection of nodules (2 hyperplastic nodules, 2 benign adenomas, 1 parathyroid adenoma and 1 papillary carcinoma).
Other common diagnoses were diffuse goitres (1 %) and absent/ ectopic thyroid
(1 %). Less common diagnoses included Graves’ disease and thyroiditis (0.6 %).
Discussion & Conclusions:
We present the range of thyroid conditions presenting in a general paediatric population and their characteristic imaging appearances. All patients had at least one ultrasound and many were managed with ultrasound follow-up alone. Cross-sectional imaging and nuclear medicine scans were very infrequently performed. Characteristic ultrasound findings together with US FNA and clinical correlation were the mainstay of patient management, allowing a confident diagnosis in most cases.
British society of paediatric radiology, Oxford , Nov 7, 2014
Novel approaches to quantitative analysis of neonatal bowel motility and vascularity.
Purpose:... more Novel approaches to quantitative analysis of neonatal bowel motility and vascularity.
Purpose: Necrotising Enterocolitis (NEC) is the most common and serious acquired gastrointestinal disorder of the premature infant. Currently standard imaging for diagnosis and follow-up of NEC is the abdominal x-ray but early signs of NEC are neither sensitive nor specific. Distinguishing NEC from other acquired neonatal intestinal diseases (ANIDs) such as spontaneous intestinal perforation and septic ileus is often difficult. Bowel ultrasound has shown promise in detecting NEC but studies have been hampered by the subjective nature of visual assessment of the bowel. The purpose of our study is to develop objective semi-automated computer algorithms for evaluation of bowel wall motility and vascularity.
Materials and Methods: Premature babies without NEC (n=9) were recruited to our feasibility study. Two operators independently acquired 2D cine-loops and 3D volumes with and without Doppler in 4 quadrants. Post-hoc analysis was performed of imaging quality. Customised software was developed using MatLab to randomly place multiple regions of interest over bowel loops, allowing sampling of Doppler intensity over time. Separate software was developed to assess the vectorial signature of bowel wall motility over time.
Results: 47 quadrants were scanned in 9 infants by two operators; bowel wall motility and bowel content motility was analysable in 35 of these quadrants. All infants had at least one analyzable quadrant. Plots were generated of mean and maximum Doppler intensity over time and vectorial models of bowel motility were created.
Conclusion: Quantitative assessment of bowel motility and vascularity is feasible with semi-automated software. We now plan to perform a pilot study of 50 premature infants to establish normative data for bowel vascularity and motility. These measures could be used to distinguish between NEC and other ANIDs and to detect early signs of NEC.
With the advent of DGHAL and PPH, treatments that purport to work by disrupting the arterial supp... more With the advent of DGHAL and PPH, treatments that purport to work by disrupting the arterial supply of haemorrhoids, there has been resurgence in interest in the vascular theory of pathogenesis of haemorrhoids. Significant uptake of the new surgical approach, with decreased pain experienced by the patient post-operatively, but with uncertainty surrounding recurrence and complication rates, has not been matched by discussion or evaluation of how haemorrhoidal disease and successful outcome should be evaluated.
This thesis evaluates different approaches to the measurement of the burden of haemorrhoidal disease to the patient. A patient reported outcome measure was designed, administered and evaluated by the investigator. Reliability, reproducibility, validity, responsiveness and acceptability have been demonstrated.
Three-dimensional ultrasound was used to acquire volumetric data and power Doppler angiography from the anal canal, which was shown to be reliable. Measures of power Doppler angiography were shown to be significantly lower in healthy volunteers than in patients. This technique represents promising value as an outcome measure of haemorrhoidal disease. A dual isotope-surgical nuclear probe technique attempted to measure change in volume of haemorrhoids following rubber band liagtion, however consistent results were not obtained. Magnetic resonance imaging was able to demonstrate anal cushions and haemorrhoids, and the feasibility of this method has been demonstrated.
Radiology has an essential role in the diagnosis, characterisation, management and follow-up of b... more Radiology has an essential role in the diagnosis, characterisation, management and follow-up of both pneumonia and acute respiratory distress syndrome (ARDS). When imaging is used in conjunction with clinical and laboratory findings, the differential list can be significantly reduced. In the majority of cases, chest radiography provides more than adequate information to manage the patient with pneumonia or ARDS appropriately; however, CT is useful when there is a discrepancy between clinical findings and radiographic findings or when the patient fails to respond to empirical therapies. CT also has a particular role trying to optimise ventilation strategies in the patient with ARDS.
INTRODUCTION The purpose of this study was to investigate patient perceptions and acceptance of t... more INTRODUCTION The purpose of this study was to investigate patient perceptions and acceptance of the three whole-body imaging (WBI) modalities used for diagnosing myeloma; radiographic skeletal survey (RSS), low-dose whole-body computed tomography (LD-WBCT) and whole-body magnetic resonance imaging (WB-MRI). The secondary aim was to explore the factors affecting the acceptance of whole-body imaging for myeloma. METHODS 60 participants (median age = 58.5 years old) recruited from three NHS trusts and social media completed a survey in which they scored their experiences of each WBI modality on nine 5-point rating scales. Spearman's correlation coefficient, Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were used to compare scores between different WBI techniques. Participants were invited to provide additional open text responses for interpretation using thematic analysis. RESULTS All modalities demonstrated high levels of acceptability (median score = 4). WB-MRI was perceived as more stressful (p=<0.01) and claustrophobic (p=<0.01) than RSS and LD-WBCT. Thematic analysis showed patients understood the importance of imaging but had concerns about exacerbated pain and the results. WB-MRI was difficult to tolerate due to its duration. Respondents were averse to the physical manipulation required for RSS while remaining stationary was perceived as a benefit of LD-WBCT and WB-MRI. Staff interactions had both positive and negative effects on acceptance. CONCLUSIONS Despite the psychological and physical burdens of WBI, patients accepted its role in facilitating diagnosis. Staff support is vital for facilitating a positive whole-body imaging experience. Healthcare practitioners can improve WBI acceptance by understanding the burdens imposed by WBI and adopting the personalised care model. IMPLICATIONS FOR PRACTICE Patient experience can be improved by tailoring examinations to individual needs. RSS can be as burdensome as other WBI techniques and could be superseded by LD-WBCT or WB-MRI.
ObjectiveTo undertake an assessment of preferences as to how, where and by whom ultrasounds (US) ... more ObjectiveTo undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA group); and (2) patients being scanned for general abdominal conditions (general group).DesignA discrete choice experiment (DCE) questionnaire was administered to patients attending US appointments. Analysis of questionnaire responses used conditional logit models and included validity checks.SettingWest Midlands, England.Participants524 patients (223 in the AAA group and 301 in the general group) were recruited from the US outpatient department at University Hospital Coventry and Warwickshire.Outcome measuresCoefficients for attributes in relation to their reference levels.ResultsThe AAA group preferred to have their US performed in hospital while the general group had a preference for portable US at general practice surgeries. All patients had a strong preference for scanning by sp...
Novel approaches to quantitative analysis of neonatal bowel motility and vascularity. Purpose: Ne... more Novel approaches to quantitative analysis of neonatal bowel motility and vascularity. Purpose: Necrotising Enterocolitis (NEC) is the most common and serious acquired gastrointestinal disorder of the premature infant. Currently standard imaging for diagnosis and follow-up of NEC is the abdominal x-ray but early signs of NEC are neither sensitive nor specific. Distinguishing NEC from other acquired neonatal intestinal diseases (ANIDs) such as spontaneous intestinal perforation and septic ileus is often difficult. Bowel ultrasound has shown promise in detecting NEC but studies have been hampered by the subjective nature of visual assessment of the bowel. The purpose of our study is to develop objective semi-automated computer algorithms for evaluation of bowel wall motility and vascularity. Materials and Methods: Premature babies without NEC (n=9) were recruited to our feasibility study. Two operators independently acquired 2D cine-loops and 3D volumes with and without Doppler in 4 quadrants. Post-hoc analysis was performed of imaging quality. Customised software was developed using MatLab to randomly place multiple regions of interest over bowel loops, allowing sampling of Doppler intensity over time. Separate software was developed to assess the vectorial signature of bowel wall motility over time. Results: 47 quadrants were scanned in 9 infants by two operators; bowel wall motility and bowel content motility was analysable in 35 of these quadrants. All infants had at least one analyzable quadrant. Plots were generated of mean and maximum Doppler intensity over time and vectorial models of bowel motility were created. Conclusion: Quantitative assessment of bowel motility and vascularity is feasible with semi-automated software. We now plan to perform a pilot study of 50 premature infants to establish normative data for bowel vascularity and motility. These measures could be used to distinguish between NEC and other ANIDs and to detect early signs of NEC.
Haemorrhoidal disease is due to pathological change in anal cushions with associated symptoms. Fo... more Haemorrhoidal disease is due to pathological change in anal cushions with associated symptoms. Formed in embryonic life, anal cushions are the lip-like structures suspended in the anal canal by smooth muscle fibres arising from the conjoined longitudinal muscle layer. They contribute to resting anal pressure and form a compliant seal, preventing leakage of anal contents. Surgical management of haemorrhoids has rapidly developed over the last decade, and some of these techniques are reviewed.
International Paediatric Radiology, London, May 31, 2011
Purpose:1)To assess the referral pattern and demographics of the early puberty population to a la... more Purpose:1)To assess the referral pattern and demographics of the early puberty population to a large secondary care centre. 2)To assess the radiological and clinical characteristics of this population.
Methods & Materials:The study group was collated by identifying all female patients under 10 years of age who had a bone age radiograph or a pelvic ultrasound. Data was retrieved from the radiology information system from 01/01/2006 to 30/07/2010. Clinical data was retrieved from clinic letters on the hospital information system.
Results:132 patients were identified; 24 patients with full datasets had ultrasound features in advance of their chronological age. Following LHRH test and pelvic ultrasound, the diagnosis changed in 41.7% of these patients at the second clinic appointment. The precocious puberty group presented with early breast development (90.9%), pubic hair growth (81.8% ) and axillary hair growth (27.3%).
Final diagnoses were precocious puberty (45.8%), thelarche (16.7%), adrenarche (16.7%), early onset of normal puberty (12.5%), vulvovaginitis (4.2%), and concerns of precocious puberty (4.2%).
Chronological age at presentation in the precocious puberty group was 7.57 years, the thelarche group 5.25 years, the adrenarche group 7.13 years, and in the early puberty group 8.72 years. The difference between chronological and bone age, measured in standard deviations was 2.23 in the precocious puberty group, 2.46 in the thelarche group, 1.18 in the adrenarche group, and 0.92 in the early puberty group.
Pelvic ultrasound uterine appearances were pubertal in 45.5% of precocious puberty cases. In 66.7% of the early puberty cases a cavitary echo was identified. Ovarian appearances were advanced in 54.5% of the precocious puberty cases, 50% of thelarche cases, 75% of adrenarche cases and 100% of the early puberty cases.
Conclusions:1)An average of 28.8 patients per year are referred to our secondary care centre to exclude precocious puberty, with a prevalence of 8.33%. 2)81.1% of our population have a pelvic ultrasound, the role of which is mostly to confirm clinical diagnosis, however if appearances are pubertal then further tests are instigated.
European Society of Paediatric Radiology, Budapest, Jun 7, 2013
Title: Paediatric Thyroid Masses
Purpose & Objective
1) To assess the referral pattern and ... more Title: Paediatric Thyroid Masses
Purpose & Objective
1) To assess the referral pattern and demographics of thyroid masses in a paediatric population at a large secondary care centre.
2) To summarise the clinical and radiological characteristics of thyroid pathology in children.
3) To emphasise the role of imaging in management of thyroid disease.
Materials & Methods:
The study group was obtained by analysing the reports from all neck, thyroid, parotid and submandibular gland ultrasounds performed on all patients aged 16 years or less over a 7 year period.
Results:
500 children were scanned in total. The majority (n = 218, 43.6 %) showed lymphadenopathy. A total of 39 (7.8 %) patients had thyroid pathology including 11 with nodules. 5 patients underwent surgical resection of nodules (2 hyperplastic nodules, 2 benign adenomas, 1 parathyroid adenoma and 1 papillary carcinoma).
Other common diagnoses were diffuse goitres (1 %) and absent/ ectopic thyroid
(1 %). Less common diagnoses included Graves’ disease and thyroiditis (0.6 %).
Discussion & Conclusions:
We present the range of thyroid conditions presenting in a general paediatric population and their characteristic imaging appearances. All patients had at least one ultrasound and many were managed with ultrasound follow-up alone. Cross-sectional imaging and nuclear medicine scans were very infrequently performed. Characteristic ultrasound findings together with US FNA and clinical correlation were the mainstay of patient management, allowing a confident diagnosis in most cases.
British society of paediatric radiology, Oxford , Nov 7, 2014
Novel approaches to quantitative analysis of neonatal bowel motility and vascularity.
Purpose:... more Novel approaches to quantitative analysis of neonatal bowel motility and vascularity.
Purpose: Necrotising Enterocolitis (NEC) is the most common and serious acquired gastrointestinal disorder of the premature infant. Currently standard imaging for diagnosis and follow-up of NEC is the abdominal x-ray but early signs of NEC are neither sensitive nor specific. Distinguishing NEC from other acquired neonatal intestinal diseases (ANIDs) such as spontaneous intestinal perforation and septic ileus is often difficult. Bowel ultrasound has shown promise in detecting NEC but studies have been hampered by the subjective nature of visual assessment of the bowel. The purpose of our study is to develop objective semi-automated computer algorithms for evaluation of bowel wall motility and vascularity.
Materials and Methods: Premature babies without NEC (n=9) were recruited to our feasibility study. Two operators independently acquired 2D cine-loops and 3D volumes with and without Doppler in 4 quadrants. Post-hoc analysis was performed of imaging quality. Customised software was developed using MatLab to randomly place multiple regions of interest over bowel loops, allowing sampling of Doppler intensity over time. Separate software was developed to assess the vectorial signature of bowel wall motility over time.
Results: 47 quadrants were scanned in 9 infants by two operators; bowel wall motility and bowel content motility was analysable in 35 of these quadrants. All infants had at least one analyzable quadrant. Plots were generated of mean and maximum Doppler intensity over time and vectorial models of bowel motility were created.
Conclusion: Quantitative assessment of bowel motility and vascularity is feasible with semi-automated software. We now plan to perform a pilot study of 50 premature infants to establish normative data for bowel vascularity and motility. These measures could be used to distinguish between NEC and other ANIDs and to detect early signs of NEC.
With the advent of DGHAL and PPH, treatments that purport to work by disrupting the arterial supp... more With the advent of DGHAL and PPH, treatments that purport to work by disrupting the arterial supply of haemorrhoids, there has been resurgence in interest in the vascular theory of pathogenesis of haemorrhoids. Significant uptake of the new surgical approach, with decreased pain experienced by the patient post-operatively, but with uncertainty surrounding recurrence and complication rates, has not been matched by discussion or evaluation of how haemorrhoidal disease and successful outcome should be evaluated.
This thesis evaluates different approaches to the measurement of the burden of haemorrhoidal disease to the patient. A patient reported outcome measure was designed, administered and evaluated by the investigator. Reliability, reproducibility, validity, responsiveness and acceptability have been demonstrated.
Three-dimensional ultrasound was used to acquire volumetric data and power Doppler angiography from the anal canal, which was shown to be reliable. Measures of power Doppler angiography were shown to be significantly lower in healthy volunteers than in patients. This technique represents promising value as an outcome measure of haemorrhoidal disease. A dual isotope-surgical nuclear probe technique attempted to measure change in volume of haemorrhoids following rubber band liagtion, however consistent results were not obtained. Magnetic resonance imaging was able to demonstrate anal cushions and haemorrhoids, and the feasibility of this method has been demonstrated.
Radiology has an essential role in the diagnosis, characterisation, management and follow-up of b... more Radiology has an essential role in the diagnosis, characterisation, management and follow-up of both pneumonia and acute respiratory distress syndrome (ARDS). When imaging is used in conjunction with clinical and laboratory findings, the differential list can be significantly reduced. In the majority of cases, chest radiography provides more than adequate information to manage the patient with pneumonia or ARDS appropriately; however, CT is useful when there is a discrepancy between clinical findings and radiographic findings or when the patient fails to respond to empirical therapies. CT also has a particular role trying to optimise ventilation strategies in the patient with ARDS.
There are multiple methods available for skeletal age determination in the paediatric endocrine p... more There are multiple methods available for skeletal age determination in the paediatric endocrine population. Only two methods, using left hand and wrist x-rays are in frequent clinical use, however Greulich & Pyle is based on data collated between 1931 and 1942 and Tanner Whitehouse uses data from as far back as 1949. We present the initial results of an automated software model of shape and textural analysis of the physes of the knee.
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Methods & Materials:The study group was collated by identifying all female patients under 10 years of age who had a bone age radiograph or a pelvic ultrasound. Data was retrieved from the radiology information system from 01/01/2006 to 30/07/2010. Clinical data was retrieved from clinic letters on the hospital information system.
Results:132 patients were identified; 24 patients with full datasets had ultrasound features in advance of their chronological age. Following LHRH test and pelvic ultrasound, the diagnosis changed in 41.7% of these patients at the second clinic appointment. The precocious puberty group presented with early breast development (90.9%), pubic hair growth (81.8% ) and axillary hair growth (27.3%).
Final diagnoses were precocious puberty (45.8%), thelarche (16.7%), adrenarche (16.7%), early onset of normal puberty (12.5%), vulvovaginitis (4.2%), and concerns of precocious puberty (4.2%).
Chronological age at presentation in the precocious puberty group was 7.57 years, the thelarche group 5.25 years, the adrenarche group 7.13 years, and in the early puberty group 8.72 years. The difference between chronological and bone age, measured in standard deviations was 2.23 in the precocious puberty group, 2.46 in the thelarche group, 1.18 in the adrenarche group, and 0.92 in the early puberty group.
Pelvic ultrasound uterine appearances were pubertal in 45.5% of precocious puberty cases. In 66.7% of the early puberty cases a cavitary echo was identified. Ovarian appearances were advanced in 54.5% of the precocious puberty cases, 50% of thelarche cases, 75% of adrenarche cases and 100% of the early puberty cases.
Conclusions:1)An average of 28.8 patients per year are referred to our secondary care centre to exclude precocious puberty, with a prevalence of 8.33%. 2)81.1% of our population have a pelvic ultrasound, the role of which is mostly to confirm clinical diagnosis, however if appearances are pubertal then further tests are instigated.
Purpose & Objective
1) To assess the referral pattern and demographics of thyroid masses in a paediatric population at a large secondary care centre.
2) To summarise the clinical and radiological characteristics of thyroid pathology in children.
3) To emphasise the role of imaging in management of thyroid disease.
Materials & Methods:
The study group was obtained by analysing the reports from all neck, thyroid, parotid and submandibular gland ultrasounds performed on all patients aged 16 years or less over a 7 year period.
Results:
500 children were scanned in total. The majority (n = 218, 43.6 %) showed lymphadenopathy. A total of 39 (7.8 %) patients had thyroid pathology including 11 with nodules. 5 patients underwent surgical resection of nodules (2 hyperplastic nodules, 2 benign adenomas, 1 parathyroid adenoma and 1 papillary carcinoma).
Other common diagnoses were diffuse goitres (1 %) and absent/ ectopic thyroid
(1 %). Less common diagnoses included Graves’ disease and thyroiditis (0.6 %).
Discussion & Conclusions:
We present the range of thyroid conditions presenting in a general paediatric population and their characteristic imaging appearances. All patients had at least one ultrasound and many were managed with ultrasound follow-up alone. Cross-sectional imaging and nuclear medicine scans were very infrequently performed. Characteristic ultrasound findings together with US FNA and clinical correlation were the mainstay of patient management, allowing a confident diagnosis in most cases.
Purpose: Necrotising Enterocolitis (NEC) is the most common and serious acquired gastrointestinal disorder of the premature infant. Currently standard imaging for diagnosis and follow-up of NEC is the abdominal x-ray but early signs of NEC are neither sensitive nor specific. Distinguishing NEC from other acquired neonatal intestinal diseases (ANIDs) such as spontaneous intestinal perforation and septic ileus is often difficult. Bowel ultrasound has shown promise in detecting NEC but studies have been hampered by the subjective nature of visual assessment of the bowel. The purpose of our study is to develop objective semi-automated computer algorithms for evaluation of bowel wall motility and vascularity.
Materials and Methods: Premature babies without NEC (n=9) were recruited to our feasibility study. Two operators independently acquired 2D cine-loops and 3D volumes with and without Doppler in 4 quadrants. Post-hoc analysis was performed of imaging quality. Customised software was developed using MatLab to randomly place multiple regions of interest over bowel loops, allowing sampling of Doppler intensity over time. Separate software was developed to assess the vectorial signature of bowel wall motility over time.
Results: 47 quadrants were scanned in 9 infants by two operators; bowel wall motility and bowel content motility was analysable in 35 of these quadrants. All infants had at least one analyzable quadrant. Plots were generated of mean and maximum Doppler intensity over time and vectorial models of bowel motility were created.
Conclusion: Quantitative assessment of bowel motility and vascularity is feasible with semi-automated software. We now plan to perform a pilot study of 50 premature infants to establish normative data for bowel vascularity and motility. These measures could be used to distinguish between NEC and other ANIDs and to detect early signs of NEC.
This thesis evaluates different approaches to the measurement of the burden of haemorrhoidal disease to the patient. A patient reported outcome measure was designed, administered and evaluated by the investigator. Reliability, reproducibility, validity, responsiveness and acceptability have been demonstrated.
Three-dimensional ultrasound was used to acquire volumetric data and power Doppler angiography from the anal canal, which was shown to be reliable. Measures of power Doppler angiography were shown to be significantly lower in healthy volunteers than in patients. This technique represents promising value as an outcome measure of haemorrhoidal disease.
A dual isotope-surgical nuclear probe technique attempted to measure change in volume of haemorrhoids following rubber band liagtion, however consistent results were not obtained. Magnetic resonance imaging was able to demonstrate anal cushions and haemorrhoids, and the feasibility of this method has been demonstrated.
Methods & Materials:The study group was collated by identifying all female patients under 10 years of age who had a bone age radiograph or a pelvic ultrasound. Data was retrieved from the radiology information system from 01/01/2006 to 30/07/2010. Clinical data was retrieved from clinic letters on the hospital information system.
Results:132 patients were identified; 24 patients with full datasets had ultrasound features in advance of their chronological age. Following LHRH test and pelvic ultrasound, the diagnosis changed in 41.7% of these patients at the second clinic appointment. The precocious puberty group presented with early breast development (90.9%), pubic hair growth (81.8% ) and axillary hair growth (27.3%).
Final diagnoses were precocious puberty (45.8%), thelarche (16.7%), adrenarche (16.7%), early onset of normal puberty (12.5%), vulvovaginitis (4.2%), and concerns of precocious puberty (4.2%).
Chronological age at presentation in the precocious puberty group was 7.57 years, the thelarche group 5.25 years, the adrenarche group 7.13 years, and in the early puberty group 8.72 years. The difference between chronological and bone age, measured in standard deviations was 2.23 in the precocious puberty group, 2.46 in the thelarche group, 1.18 in the adrenarche group, and 0.92 in the early puberty group.
Pelvic ultrasound uterine appearances were pubertal in 45.5% of precocious puberty cases. In 66.7% of the early puberty cases a cavitary echo was identified. Ovarian appearances were advanced in 54.5% of the precocious puberty cases, 50% of thelarche cases, 75% of adrenarche cases and 100% of the early puberty cases.
Conclusions:1)An average of 28.8 patients per year are referred to our secondary care centre to exclude precocious puberty, with a prevalence of 8.33%. 2)81.1% of our population have a pelvic ultrasound, the role of which is mostly to confirm clinical diagnosis, however if appearances are pubertal then further tests are instigated.
Purpose & Objective
1) To assess the referral pattern and demographics of thyroid masses in a paediatric population at a large secondary care centre.
2) To summarise the clinical and radiological characteristics of thyroid pathology in children.
3) To emphasise the role of imaging in management of thyroid disease.
Materials & Methods:
The study group was obtained by analysing the reports from all neck, thyroid, parotid and submandibular gland ultrasounds performed on all patients aged 16 years or less over a 7 year period.
Results:
500 children were scanned in total. The majority (n = 218, 43.6 %) showed lymphadenopathy. A total of 39 (7.8 %) patients had thyroid pathology including 11 with nodules. 5 patients underwent surgical resection of nodules (2 hyperplastic nodules, 2 benign adenomas, 1 parathyroid adenoma and 1 papillary carcinoma).
Other common diagnoses were diffuse goitres (1 %) and absent/ ectopic thyroid
(1 %). Less common diagnoses included Graves’ disease and thyroiditis (0.6 %).
Discussion & Conclusions:
We present the range of thyroid conditions presenting in a general paediatric population and their characteristic imaging appearances. All patients had at least one ultrasound and many were managed with ultrasound follow-up alone. Cross-sectional imaging and nuclear medicine scans were very infrequently performed. Characteristic ultrasound findings together with US FNA and clinical correlation were the mainstay of patient management, allowing a confident diagnosis in most cases.
Purpose: Necrotising Enterocolitis (NEC) is the most common and serious acquired gastrointestinal disorder of the premature infant. Currently standard imaging for diagnosis and follow-up of NEC is the abdominal x-ray but early signs of NEC are neither sensitive nor specific. Distinguishing NEC from other acquired neonatal intestinal diseases (ANIDs) such as spontaneous intestinal perforation and septic ileus is often difficult. Bowel ultrasound has shown promise in detecting NEC but studies have been hampered by the subjective nature of visual assessment of the bowel. The purpose of our study is to develop objective semi-automated computer algorithms for evaluation of bowel wall motility and vascularity.
Materials and Methods: Premature babies without NEC (n=9) were recruited to our feasibility study. Two operators independently acquired 2D cine-loops and 3D volumes with and without Doppler in 4 quadrants. Post-hoc analysis was performed of imaging quality. Customised software was developed using MatLab to randomly place multiple regions of interest over bowel loops, allowing sampling of Doppler intensity over time. Separate software was developed to assess the vectorial signature of bowel wall motility over time.
Results: 47 quadrants were scanned in 9 infants by two operators; bowel wall motility and bowel content motility was analysable in 35 of these quadrants. All infants had at least one analyzable quadrant. Plots were generated of mean and maximum Doppler intensity over time and vectorial models of bowel motility were created.
Conclusion: Quantitative assessment of bowel motility and vascularity is feasible with semi-automated software. We now plan to perform a pilot study of 50 premature infants to establish normative data for bowel vascularity and motility. These measures could be used to distinguish between NEC and other ANIDs and to detect early signs of NEC.
This thesis evaluates different approaches to the measurement of the burden of haemorrhoidal disease to the patient. A patient reported outcome measure was designed, administered and evaluated by the investigator. Reliability, reproducibility, validity, responsiveness and acceptability have been demonstrated.
Three-dimensional ultrasound was used to acquire volumetric data and power Doppler angiography from the anal canal, which was shown to be reliable. Measures of power Doppler angiography were shown to be significantly lower in healthy volunteers than in patients. This technique represents promising value as an outcome measure of haemorrhoidal disease.
A dual isotope-surgical nuclear probe technique attempted to measure change in volume of haemorrhoids following rubber band liagtion, however consistent results were not obtained. Magnetic resonance imaging was able to demonstrate anal cushions and haemorrhoids, and the feasibility of this method has been demonstrated.