ABSTRACT
Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.
ABSTRACT
Objective:To understand the current situation of CT radiation dose in children all over our country, and to explore the diagnostic reference level (DRL) of CT in children.Methods:The radiation dose reports of pediatric CT examination were collected end to November 30, 2021 and divided into five age groups: 0-1 month,>1 month-4 years,>4-10 years,>10-14 years and >14-18 years. There were 9 scanning item such as head, nasal sinus, temporal bone, neck, chest, abdomen, head enhanced CT, chest enhanced CT and abdomen enhanced CT. In each item, volume CT dose index (CTDI vol) and dose length product (DLP) were selected as radiation dose parameters, the 75% percentile were selected for DRL. The DRL results of head, chest and abdomen were compared with the DRL published by Chinese Society of Radiology and European Commission. Results:From March 2019 to November 2021, a total of 33 hospitals in 23 provinces were collected, including 20 children′s specialized hospitals, 11 women′s and children′s hospitals and 2 general hospitals, including 19 135 children′s CT scans. The DRL of 45 subgroups according to 5 age groups and 9 scanning items were obtained. The DRL results showed that the CTDI vol in five age groups was 26.9-42.8 mGy, and the DLP was 347-694 mGy·cm for head; 3.5-8.0 mGy, 54-293 mGy·cm for chest; and 6.3-13.2 mGy, 155-564 mGy·cm for abdomen. The DRL of the age group >4-10 years group in this investigation was agreed to the DRL of Chinese Society of Radiology. Compared with the European guidelines, there was little difference in the radiation dose of head scan, while the radiation dose of chest and abdomen in the young age group increased significantly. Conclusion:This survey reveals the radiation dose level distribution of children CT in our country. The radiation dose level of some items was inconsistent with the DRL of relevant international organizations. So our own DRL is needed to be set up according to the actual clinical reality of our country as a guideline.
ABSTRACT
Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.
ABSTRACT
Objective:To demonstrate whether image quality and measurement accuracy of vessel wall thickening could be improved using a deep learning image reconstruction (DLIR) algorithm in children with Takayasu arteritis.Methods:From September 2019 to April 2020, 32 patients with Takayasu arteritis underwent low-dose contrast-enhanced CT with 100 kVp in Beijing Children′s Hospital were enrolled retrospectively. The raw data were reconstructed at 0.625 mm slice thickness using the filtered back projection (FBP), 50% adaptive statistical iterative reconstruction-V (ASIR-V) at 50% (50%ASIR-V), ASIR-V at 100% (100%ASIR-V) and DLIR. Subjective evaluation including the image quality of vessel wall identification, overall image noise and diagnostic confidence were evaluated using a 5 points scales by 2 observers. Objective evaluation including the thickness and standard deviation of vessel wall were measured, then the coefficient of variation (CV) was calculated. The CT value and noise of aorta were measured to calculate the contrast to noise ratio (CNR) of image. Friedman test was used to compare the differences of subjective scores among the four groups, and the analysis of variance of random blocks was used to compare the differences of objective measurement indices.Results:In terms of subjective score results, there was no significant difference between 100%ASIR-V and DLIR of overall image noise ( P>0.05), and the image scores of the two groups were higher than those of FBP and 50%ASIR-V (all P<0.05). The vessel wall identification and diagnostic confidence of DLIR were higher than those of other images (all P<0.05). The objective measurement results showed that the standard deviation and CV of vessel wall thickness in DLIR were significantly lower than those in other images (all P<0.05). There was no significant difference in vascular noise, muscle noise and CNR between 100%ASIR-V and DLIR (all P>0.05), which were lower than those in FBP and 50%ASIR-V (all P<0.05). Compared with 50%ASIR-V, the CV of DLIR was reduced by 22.9%, and the CNR was increased by 46.8%. Conclusion:DLIR can improve the overall image quality of CECT in children with Takayasu arteritis and the measurement accuracy of vascular wall, making it possible to further reduce the radiation dose.
ABSTRACT
Objective@#To provide data references for Nuss procedure biomechanics research, and to understand morphological pathological changes in children with pectus excavatum.@*Methods@#A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution. The anterior rib width(RW), anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient. The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic. The measurement indexes were compared between healthy children and children with pectus excavatum.@*Results@#The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm). Children with pectus excavatum compared with healthy children, the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P<0.05), the 3rd and 4th RT were greater than healthy children (P<0.05).@*Conclusion@#The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research. By morphology contrast, it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function.
ABSTRACT
Objective To provide data references for Nuss procedure biomechanics research,and to understand morphological pathological changes in children with pectus excavatum.Methods A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution.The anterior rib width(RW),anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient.The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic.The measurement indexes were compared between healthy children and children with pectus excavatum.Results The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm).Children with pectus excavatum compared with healthy children,the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P ＜ 0.05),the 3rd and 4th RT were greater than healthy children (P ＜ 0.05).Conclusion The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research.By morphology contrast,it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function.
ABSTRACT
Objective By measuring the thoracic cage index with chest X-ray film in 3-17 years old healthy children,analyzing the bivariate correlations with age,to provide the reference data for evaluating and following up of chest wall deformity.Methods A retrospective study was conducted for 450 cases of health physical examination from May 2013 to March 2016 in our institution.The anterior intercostal space width(IS),the anterior rib width(RW),and thickness of the rib in the middle(RT) on the right side of 3-7 ribs have been measured in each patient.Statistical describing for each measurement index has been made,and Pearson correlation analysis was used to analyze the correlation between measurement values and ages.Results Each measurement index is strong positive correlated with age (0.6 ＜ r ＜ 0.8,P ＜ 0.05).Conclusion The anterior intercostal space width,the anterior rib width and the thickness of the ribs in the middle have a growing trend with age in children.It is indeed a useful way to measure thoracic cage data by using the chest X-ray film quantitative evaluation method.The measured values can be used as reference indexes.
ABSTRACT
CT has been widely used in clinic for its rapid,simple and non-invasive characteristics.How to reduce radiation dose,especially in children during CT has become a topical subject.Iterative reconstruction (IR) technique can reduce radiation dose of CT in children,in combination of low tube voltage can further reduce radiation dose possibly.The application of IR combined with low tube voltage technology in low dose CT in children were reviewed in this article.
ABSTRACT
Objective To assess the feasibility of low concentration contrast medium (270 mgI/ml) and low radiation dose (100 kV) for enhanced CT scanning in infants and young children abdominal CT examination.Methods Ninety children with abdomen tumors or abdominal injuries who underwent contrast-enhanced CT examination were selected.The patients were divided into 3 groups (each n＝ 30):Group A with tube voltage of 120 kV for non-contrast enhanced and parenchymal phase scanning and iodixanol contrast-medium (320 mgI/ml);group B with tube voltage of 100 kV for non-contrast enhanced and parenchyrnal phase scanning and iodixanol contrast-medium (270 mgI/rnl);group C with tube voltage of 100 kV for non-contrast enhanced and parenchymal phase scanning and iodixanol contrast-medium (270 mgI/ml).The 4-point scale was used to evaluate the quality of parenchymal phase imaging.The standard difference (SD) of CT value in subcutaneous fat,SNR and CNR of liver parenchyma,splenic parenchyma,renal cortical,renal vein,and abdominal aorta were measured at parenchymal phase,and CT dose index of volume (CTDI,ol),dose length product (DLP) and effective dose (ED) were recorded.The data were statistically analyzed among 3 groups.Results There was no significant difference of SNR,CNR nor objective scores of liver parenchyma,splenic parenchyma,renal cortical,renal vein and abdominal aorta among 3 groups (all P＞0.05).The differences of CTDIvol,DLP and ED among 3 groups were statistically significant (all P＜0.01).The CTDIvol had no statistical difference between group B and group C (P ＝ 0.001,0.002),DLP (P ＝ 0.013,0.004) and ED (P ＝ 0.03,＜0.001) of group A had statistical difference with those of group B and C.Conclusion CNR of the abdominal image can be guaranteed using low concentration contrast medium (270 mgI/ml) combined with 100 kV tube voltage for CT scanning of infants and young children,therefore satisfying clinical diagnostic requirements.
ABSTRACT
Objective To explore the value of adaptive statistical iterative reconstruction (ASIR) and a sharp recon kernel to obtain high resolution pulmonary images in low-dose pediatric chest CT scans.Methods Totally 42 children underwent low-dose chest CT scans with ASIR were included.Age dependent noise index (NI) was used for dose optimization:NI=12 for 0-12 months old,NI=15 for ＞1 2 years old,NI=17 for 3-6 years old and NI=20 for ≥7 years old.Images were reconstructed to 0.625 mm using different recon kernels:Soft,Standard,Lung,and Chest kernel.ASIR blending was varied from 0 100％ to provide balanced image noise and spatial resolution.Two radiologists independently evaluated images for normal lung structures,abnormal CT findings and image noise on a 5 point scale with 3 being clinically acceptable.The best kernel,as well as the match with the best ASIR weight were analyzed statistically.Results CT images with lung kernel and ASIR 60％ were rated substantially better than those kernel.Conclusion ASIR 60％ with a sharp lung kernel can significantly improve image quality in low dose pediatric chest CT scans.
ABSTRACT
Objective@#To analyze the vascular distribution of palmar digital arteries in congenital syndactyly through CT angiography and its significance for operation design.@*Methods@#From January 2012 to May 2016, 67 cases with congenital syndactyly were divided into simple, complex and syndrome type(Poland syndrome). Preoperative angiography was performed to reconstruct 3-D distribution of digital arteries.@*Results@#33 cases with 48 pairs simple syndactyly had relatively normal distribution and diameter of digital arteries, but the 7 case with 11 pairs complex syndactyly had only one palmar digital artery in 4 pairs, and two arteries in 4 pairs with decreased arteries diameter. 25 cases with Poland syndrome and 66 pairs of snydactyly had normal distribution of digital arteries with relatively small diameter.@*Conclusions@#Angiography is not necessary for simple type syndactyly, but should be performed in patients with III and IV Poland syndrome and complex type to analyze the vascular distribution within the syndactyly and give help for operative design.
ABSTRACT
Objective To evaluate the feasibility of model-based iterative reconstruction (MBIR) in low-dose chest CT (80 kV) examination in children.Methods Forty-four children who had post-operation scoliosis and received low dose chest CT scans were included.The fix tube voltage was 80 kV,fix current was 50 mA.Images were reconstructed with MBIR (observation group).The pre-operation scan were used 120 kV and 50 mA for acquisition,and images were reconstructed with filtered back-projection (FBP) mehed (control group).The subjective quality of the images was independently evaluated by two radiologists.Objective noises in the muscle and lung field were measured,the SNR,CNR were calculated,and the CTDIvol was record.Results The subjective noise score in the observation group was significantly higher than that in the control group (P＜0.05).Objective noise reduced about 40.36％,SNR increased 72.37％,CNR increased 78.69％,CTDIvol decreased by 66.52％,all of which had statistical difference between both groups (all P＜0.001).Conclusion Low-dose chest CT (80 kV) examination in children can meet the requirements of diagnosis for children.
ABSTRACT
Objective To access the development of thoracic volume of pectus excavatum use of Nuss operation used CT-basedpulmonary volumetric evaluation.Methods 98 patients with pectus excavatum in Beijing Children's Hospital under Nuss operation were documented.All patients had CT scan pre-and postopration.The CT-scan's data were calculated as lung's volume by handdraw-layers summation method.The lung's volume result was compared,and enquiry the position in CT lung volume developmental scale.Results The lung's volume was elevated 28.3％ after operation.The development of thoracic volume was keep with age,70％ was maintained and 15％ was elevated.Conclusion Nuss operation can prevent the decrease of thoracic volume in pectus excavatum.
ABSTRACT
Objective To investigate the feasibility to reduce radiation doses on pediatric mutidetector abdominal CT using the adaptive statistical iterative reconstruction technique (ASIR) associated with automated tube current modulation technique(ATCM).Methods Thirty patients underwent abdominal CT with ATCM and the follow-up scan with ATCM cooperated with 40％ ASIR.ATCM was used with agedependent noise index (NI) settings: NI =9 for 0-5 year old and NI =11 for ＞ 5 years old for simple ATCM group,NI =11 for 0-5 year old and NI =15 for ＞5 years old for ATCM cooperated with 40％ ASIR group(AISR group).Two radiologists independently evaluated images for diagnostic quality and image noise with subjectively image quality score and image noise score using a 5-point scale.Interobserver agreement was assessed by Kappa test.The volume CT dose indexes (CTDIvol) for the two groups were recorded.Statistical significance for the CTDIvol value was analyzed by pair-sample t test.Results The average CTDIvol for the ASIR group was (1.38 ± 0.64) mGy,about 60％ lower than (3.56 ± 1.23) mGy for the simple ATCM group,and the CTDIvol of two groups had statistically significant differences.(t =33.483,P ＜ 0.05).The subjective image quality scores for the simple ATCM group were 4.43 ± 0.57 and 4.37 ±0.61,Kappa =0.878,P ＜ 0.01 (ASIR group: 4.70 ± 0.47 and 4.60 ± 0.50,Kappa =0.783,P ＜ 0.01),by two observers.The image noise score for the simple ATCM group were 4.03 ±0.56 and 3.83 ±0.53,Kappa =0.572,P ＜ 0.01 (ASIR group: 4.20 ± 0.48 and 4.10 ± 0.48,Kappa =0.748,P ＜ 0.01),by two observers.All images had acceptable diagnostic image quality.Conclusion Lower radiation dose can be achieved by elevating NI with ASIR in pediatric CT abdominal studies,while maintaining diagnostically acceptable images.
ABSTRACT
Objective To study the application CT scans in Nuss procedure for pectus excavatum. Metlhods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008 The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation, the deformity in relation with adjacent tissue and associated different disorder. Results Nuss procedure was successfully performed in all 648 patients. The preoperative CT scan showed medium deformity of the pectus excavatum in 73 cases ( 11.27% ) and severe deformity in 575 cases (88.73%). Morphologic classification of the pectus excavatum were symmetric type in 407cases (62.81% ) , eccentric type in 83( 12.81% ) ,and unbalanced type in 158( 24.38% ). 116 cases with pectus excavatum were associated with other different disorders, among them 55 cases ( 17.9% )were diagnosed by CT scan. 28 cases received stimultanously operation for their abnormalities. Conclusion CT scan is a useful tool for evaluation the deformity degree and morphology classification, direct the operation, reduce the complications and find other different disorders. It should be a routine examination before Nuss procedure.
ABSTRACT
nal abnormalities of pediatric heart diseases.