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Radiology

This page has been copied directly from Old RefHelp 21/12/18 . It  is under review and has not undergone the full RefHelp review process

Royal Hospital for Sick Children

  • Plain Film         by appointment after phoning the department
  • USS                   by appointment
  • Fluoroscopy     by appointment
  • MR                     by appointment
  • Please note that these services are for children only (aged 0 to 16)  NOT adults.
  • Requests preferably by SCI Gateway (Royal Hospital for Sick Children>Clinical Radiology> Radiology protocol) or by post, or fax (0131 536 0260)
  • Please give enough clinical information to allow radiologists to judge whether an alternative investigation would be more appropriate. Extracted from ‘Making the Best Use of Clinical Radiology Services’ Ed 6, 2007, Royal College of Radiologists
IndicationInvestigationDiscussion
Head, neck & spine
Abnormal head appearances?hydrocephalusUSindicatedif fontanelle open,if already closed then MR indicated, would need a GA
Abnormal head appearances? craniosynostosisSXRspecialist investigation, only after discussionCT may be indicated
scalp/facial lumps & bumpsUSindicatedUS best initial investigation, radiologist will proceed to X-ray if indicated, or advise re further investigation.
HeadacheMRspecialist investigation, only after discussionpreferred to CT
?brain tumourMRSXRspecialist investigation, only after discussionnot indicatedsuspicious headaches, vomiting, failure to thrive, visual disturbance, abnormal neurologyshould be requested in tandem with referral to specialist centre
SinusitisX Ray sinusesCT sinusesnot indicated, except in very specific circumstancesunder 5 sinuses incompletely developed; mucosal thickening is a normal finding
neonatal torticollis without traumaUSindicatedcongenital torticollis to confirm sternocleidomastoid abnormality
Back painMRChoice of imaging is made after consultation.Persistent back pain in children may have an underlying cause and justifies investigation. Back pain with scoliosis or neurological signs merits MRI/CT.
sacral dimpleUSnot indicatedIn the newborn child, isolated sacral dimples and small pits which are <5 mm from the midline and <25 mm from the anus can be safely ignored
spinal dysraphism?US/MRUS under three monthsMR only if neurological signs, as requires a GA under 5 yearsA combination of two or more congenital midline skin lesions is a marker of occult spinal dysraphism.If these are present or associated congenital abnormalities, US of the neonatal lumbar spine is the investigation of choice. MRI is indicated when US is abnormal/equivocal, when there are neurological signs, or when there is a discharging lesion.
spina bifida occultaXR/MRnot indicatedA common variation and not in itself significant.
MSK
irritable hipUSXRindicatednot indicated initiallyUS will confirm presence of an effusion but will not discriminate sepsis from transient synovitis.
limpingUSXRMRIindicated, as for irritable hipafter discussion with radiologistXR, including a frog lateral view, is required if slipped upper femoral epiphysis or Perthes’ disease is suspected or if symptoms persist.
focal bone painXRMR/NMafter discussion with radiologistXR should be the first-line investigation, though MRI and NM are more sensitive than XR in detecting occult infection or fracture.
suspected hip dysplasiaUSXRindicatedonly in specific circumstancesUS is indicated for possible developmental dysplasia of the hip but not for routine screening.XR may be necessary in the older child.
Osgood-SchlatterXRUSonly in specific circumstancesafter discussion with radiologistAlthough bony radiological changes are visible in Osgood–Schlatter disease, they overlap with normal appearances.Associated soft-tissue swelling should be assessed clinically, not radiographically
lumps & bumpsUSindicatedUS usually the best initial investigation, radiologist will proceed to X-ray if indicated
Cardiothoracic
acute chest infectionCXRonly in specific circumstancesif symptoms persist despite treatment, or in severely ill children.If CXR shows simple pneumonia, routine follow-up CXR is not required.
recurrent productive coughCXRonly in specific circumstancesIn general, children with recurrent productive cough have CXRs that are normal or show peribronchial thickening.In these children repeat CXR is not indicated unless atelectasis is seen on the initial CXR.Children with suspected cystic fibrosis or immune deficiency require specialist referral.
suspected inhaled foreign bodyCXRindicatedCXR is indicated, though often normal.Expiratory XR not indicated as the characteristic air-trapping is rarely presentIf there is clinical suspicion of an inhaled foreign body, bronchoscopy is mandatory.
wheezeCXRonly in specific circumstancesCXR usually normal or shows features of uncomplicated asthma or bronchiolitis, e.g. hyperinflation or peribronchial cuffing.CXR may be useful in guiding patient management in those with fever or localised chest signs
acute stridorlateral neck XRonly in specific circumstancesEpiglottitis and croup are clinical diagnoses.  In an unstable airway, XR is contra-indicated.Lateral neck XR may be of value in children with a stable airway in whom an obstructing foreign body or retropharyngeal abscess is possible
heart murmurCXRonly in specific circumstancesSpecialist referral is needed; cardiac echocardiography is more likely to be indicated than CXR
GI
projectile vomiting in infantsUSindicatedUS can confirm the presence of hypertrophic pyloric stenosis, especially where clinical findings are equivocal.
recurrent vomitingbarium meal/follow-throughonly in specific circumstancesRecurrent vomiting in children has many causes, many of which cannot be diagnosed radiologically.An upper GI contrast study is not indicated for the diagnosis of simple reflux. Where significant gastro-oesophageal reflux has been shown on pH studies, an upper GI contrast study may be indicated to exclude a structural abnormality such as hiatus hernia or malrotation.If there are other associated clinical symptoms/signs—e.g, bile-stained vomit—the case for contrast studies is much stronger to exclude malrotation.
persistent neonatal jaundiceUSNMspecialist investigationspecialist investigationPrompt (<6 weeks) investigation is essential. The absence of dilatation in the intrahepatic bile duct does not exclude obstructive cholangiopathy.Hepatobiliary scintigraphy with Tc-99m-labelled IDA derivatives is used but cannot confirm biliary atresia if there is no bowel activity. Requires specific preparation
acute abdominal painUSAXRindicatedonly in specific circumstancesThere are many causes of acute abdominal pain. US can be helpful in further assessment but needs to be guided by clinical findings.AXR is rarely of value and is best performed under specialist guidance. Generally AXR is not undertaken before US.
constipationAXRonly in specific circumstancesThere is a wide variation in the amount of faecal residue shown on AXR and correlation with constipation has not been proven.AXR can help specialists in the management of intractable constipation.
palpable abdominal or pelvic massUSindicatedIndicated in the assessment of all suspected abdominal masses. Further investigation will be determined following the US
GU
continuous wettingUSNMMRIVUindicatedonly in specific circumstancesonly in specific circumstancesnot indicatedIn toilet-trained girls with a history of continuous dribbling/wetting, an ectopic infrasphincteric ureter must be excluded.US of the whole renal tract including the bladder and pelvis is recommended.Imaging of the urinary tract in children with solely night-time enuresis is of limited value.To locate an abnormal kidneyMRI of the lumbosacral spine is indicated in children with abnormal neurology or skeletal examination; those with bladder wall thickening/trabeculation shown on US; those with neuropathic vesicourethral dysfunction on video-urodynamics; and may also be of value in locating a dysplastic kidney or dysplastic occult moiety when US and DMSA imaging have failed.MRI urography, if available, is an alternative to IVU.
impalpable testisUSindicatedUS is used in the location of the testis within the inguinal canal.
significant fetal renal pelvis dilatationUSindicatedUS should take place post-partum at 72 hours and again at 4–6 weeks.Other imaging investigations, including micturating cystourethrogram and diuretic renography, should be used as per local protocol.
proven UTIUSMCUGNMAXRindicatedonly in specific circumstancesonly in specific circumstancesnot indicatedShould be requested in tandem with referral to specialist service, if this is planned.Most patients should remain on prophylactic antibiotics pending the results of investigations.The age of the patient also affects decisions.Radiation should be minimised

Last Updated on Wednesday, 30 May 2012 08:56