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
| Indication | Investigation | Discussion | |
| Head, neck & spine | |||
| Abnormal head appearances?hydrocephalus | US | indicated | if fontanelle open,if already closed then MR indicated, would need a GA |
| Abnormal head appearances? craniosynostosis | SXR | specialist investigation, only after discussion | CT may be indicated |
| scalp/facial lumps & bumps | US | indicated | US best initial investigation, radiologist will proceed to X-ray if indicated, or advise re further investigation. |
| Headache | MR | specialist investigation, only after discussion | preferred to CT |
| ?brain tumour | MRSXR | specialist investigation, only after discussionnot indicated | suspicious headaches, vomiting, failure to thrive, visual disturbance, abnormal neurologyshould be requested in tandem with referral to specialist centre |
| Sinusitis | X Ray sinusesCT sinuses | not indicated, except in very specific circumstances | under 5 sinuses incompletely developed; mucosal thickening is a normal finding |
| neonatal torticollis without trauma | US | indicated | congenital torticollis to confirm sternocleidomastoid abnormality |
| Back pain | MR | Choice 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 dimple | US | not indicated | In 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/MR | US under three monthsMR only if neurological signs, as requires a GA under 5 years | A 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 occulta | XR/MR | not indicated | A common variation and not in itself significant. |
| MSK | |||
| irritable hip | USXR | indicatednot indicated initially | US will confirm presence of an effusion but will not discriminate sepsis from transient synovitis. |
| limping | USXRMRI | indicated, as for irritable hipafter discussion with radiologist | XR, including a frog lateral view, is required if slipped upper femoral epiphysis or Perthes’ disease is suspected or if symptoms persist. |
| focal bone pain | XRMR/NM | after discussion with radiologist | XR should be the first-line investigation, though MRI and NM are more sensitive than XR in detecting occult infection or fracture. |
| suspected hip dysplasia | USXR | indicatedonly in specific circumstances | US is indicated for possible developmental dysplasia of the hip but not for routine screening.XR may be necessary in the older child. |
| Osgood-Schlatter | XRUS | only in specific circumstancesafter discussion with radiologist | Although 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 & bumps | US | indicated | US usually the best initial investigation, radiologist will proceed to X-ray if indicated |
| Cardiothoracic | |||
| acute chest infection | CXR | only in specific circumstances | if symptoms persist despite treatment, or in severely ill children.If CXR shows simple pneumonia, routine follow-up CXR is not required. |
| recurrent productive cough | CXR | only in specific circumstances | In 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 body | CXR | indicated | CXR 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. |
| wheeze | CXR | only in specific circumstances | CXR 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 stridor | lateral neck XR | only in specific circumstances | Epiglottitis 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 murmur | CXR | only in specific circumstances | Specialist referral is needed; cardiac echocardiography is more likely to be indicated than CXR |
| GI | |||
| projectile vomiting in infants | US | indicated | US can confirm the presence of hypertrophic pyloric stenosis, especially where clinical findings are equivocal. |
| recurrent vomiting | barium meal/follow-through | only in specific circumstances | Recurrent 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 jaundice | USNM | specialist investigationspecialist investigation | Prompt (<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 pain | USAXR | indicatedonly in specific circumstances | There 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. |
| constipation | AXR | only in specific circumstances | There 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 mass | US | indicated | Indicated in the assessment of all suspected abdominal masses. Further investigation will be determined following the US |
| GU | |||
| continuous wetting | USNMMRIVU | indicatedonly in specific circumstancesonly in specific circumstancesnot indicated | In 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 testis | US | indicated | US is used in the location of the testis within the inguinal canal. |
| significant fetal renal pelvis dilatation | US | indicated | US 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 UTI | USMCUGNMAXR | indicatedonly in specific circumstancesonly in specific circumstancesnot indicated | Should 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
