Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 DOI 10.1007/s00247-014-2920-5


The Society for Pediatric Radiology introduced its new logo August 15, 2013. The logo communicates both the warmth of the Society community and the strength of the members’ commitment to excellent and thoughtful care of the pediatric patient.

The first official logo for the SPR was designed by Tamar Kahane Oestreich of Cincinnati, Ohio in 1985. Thank you, Mrs. Oestreich.

Founded in 1959 The Society for Pediatric Radiology 57th Annual Meeting & Postgraduate Course Presented by The Society for Pediatric Radiology JW Marriott Hotel Washington DC Washington, D.C. Postgraduate Course May 13–14, 2014 Annual Meeting May 14–17, 2014 Jointly sponsored by the American College of Radiology

This supplement was not sponsored by outside commercial interests; it was funded entirely by the Society’s own resources.


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Pediatr Radiol (2014) 44 (Suppl 1):S1–S253

The Society for Pediatric Radiology - Washington, D.C. May 13-17, 2014



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TABLE OF CONTENTS Welcome from SPR President, Richard A. Barth, MD ..................................................................................................................................................... S5 SPR 2014 Organization ...................................................................................................................................................................................................... S6 Continuing Medical Education .......................................................................................................................................................................................... S7 Maintenance of Certification .............................................................................................................................................................................................. S8 Objectives ........................................................................................................................................................................................................................... S8 Disclosure ........................................................................................................................................................................................................................... S9 Acknowledgements .......................................................................................................................................................................................................... S12 Program Schedule ............................................................................................................................................................................................................ S13 Catalog of Scientific Exhibits/Posters ............................................................................................................................................................................. S27 General Information Mission Statement ...................................................................................................................................................................................................... S33 Sites of Previous Meetings ......................................................................................................................................................................................... S33 Future Meetings .......................................................................................................................................................................................................... S33 Officers, Directors and Committees ........................................................................................................................................................................... S33 Gold Medalists ............................................................................................................................................................................................................ S40 Pioneer Honorees ........................................................................................................................................................................................................ S41 Presidential Recognition Award ................................................................................................................................................................................. S41 Honorary Members ..................................................................................................................................................................................................... S42 Past Presidents ............................................................................................................................................................................................................ S43 Singleton-Taybi Award ............................................................................................................................................................................................... S44 John A. Kirkpatrick Young Investigator Award ........................................................................................................................................................ S44 Walter E. Berdon and Thomas L. Slovis Awards ...................................................................................................................................................... S45 The SPR Research and Education Foundation Awards ............................................................................................................................................ S46 Social Events .................................................................................................................................................................................................................... S47 SPR 2014 Gold Medalist ................................................................................................................................................................................................. S48 SPR 2014 Pioneer Honoree ............................................................................................................................................................................................. S50 SPR 2014 Presidential Recognition Award ..................................................................................................................................................................... S51 SPR 2014 Honorary Member .......................................................................................................................................................................................... S52 SPR 2014 Singleton-Taybi Award ................................................................................................................................................................................... S53 John Caffey Awards ......................................................................................................................................................................................................... S54 Edward B. Neuhauser Lecturers ...................................................................................................................................................................................... S57 Postgraduate Course Abstracts ......................................................................................................................................................................................... S59 Scientific Papers ............................................................................................................................................................................................................... S68 Scientific Exhibits/Posters .............................................................................................................................................................................................. S148 Author Index by Abstract .............................................................................................................................................................................................. S235 Keyword Index by Abstract ........................................................................................................................................................................................... S245

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WELCOME ADDRESS Dear Colleagues, I look forward to greeting you in Washington, D.C., for what promises to be a very exciting 57th Annual Meeting of The Society for Pediatric Radiology. We are at a critical crossroads in radiology with many new imaging innovations on the horizon, but also a rapidly changing environment related to healthcare reform and diminished research funding. Our nation’s capital is an excellent venue for engaging in conversation on healthcare reform, which is the featured topic for the Neuhauser Lecture. The meeting program is designed to stimulate conversation on a range of topics important to our mission for advancing the care of children via imaging. The 2014, Edward B. Neuhauser Lecturer is Dr. Robert Pearl, Executive Director and CEO of The Permanente Medical Group, the largest medical group in the nation. At the time of our meeting the U.S. affordable healthcare act core components will have been enacted for several months and we will be in the early stages of understanding the impact of this legislation on the practice of medicine. Apropos to the times, the Neuhauser Lecture topic is: “The Future of American Medicine—The Impact of Health Care Reform”. Dr. Pearl is a respected thought leader on the topic of healthcare reform and the coming changes in the practice of medicine. The 2014 meeting theme will be “The Pediatric Radiologist Consultant: Bridging Patient Care and Innovation to Improve Child Health”. The program will emphasize the role of the pediatric radiologist as a consulting physician and the importance of close collaboration and communication with our clinician colleagues to assure optimal care of our pediatric patients. The meeting will build on the successful model from prior years with rich use of clinician speakers. It is imperative that we bridge our knowledge and exciting innovations in imaging with the needs of the clinician to answer their critical questions and work collaboratively to improve pediatric care via diagnostic imaging, image-guided therapy, and imaging research. The Postgraduate Course and workshop speakers will embrace the theme of the consulting role of the radiologist and will emphasize “what is the question to be answered” when performing an imaging study. The Meeting Curriculum Committee has put forth an extraordinary effort to assure an outstanding program on a broad range of pediatric imaging topics. The Postgraduate Course Directors, Drs. Peter Strouse and Shreyas Vasanawala have put together a program comprised of highly pertinent topics for the practicing pediatric radiologist. The Postgraduate Course will also showcase innovations in the educational method. The Course will incorporate the Khan Academy ( approach to education with focused 10-min presentations and dynamic interaction with attendees to assure that all are highly engaged in the educational experience. In Sal Khan’s words “I teach the way I wish I was taught”. In addition to the Khan Academy approach, the Course will provide an opportunity for SAM credits to be obtained through interactive sessions. I am excited to announce that the interactive sessions will showcase RSNA Diagnosis Live™ software enabling delivery of content and audience-response questions to your mobile device. Dr. Alex Towbin serves as the meeting’s Information Technology Medical Director and will oversee the innovative, interactive technology to assure a highly stimulating experience throughout the meeting. Drs. Sarah Milla, Ashok Panigrahy, and Mary Wyers are the Course Directors for the Annual Meeting’s workshops and special sessions. They have assembled an outstanding array of courses on a wide range of topics. New for this year’s meeting will be a challenging case session, which features a distinguished panel of SPR and international pediatric radiologists, who will discuss their approach to the diagnosis and management of challenging radiology cases. This will be the inaugural SPR meeting to support live streaming for offsite attendees, which will provide access and connect us to our WFPI colleagues located throughout the world. The Annual Meeting will also feature an ultrasound educational course organized by Dr. Brian Coley. The course will provide hands-on ultrasound training in basic and advanced ultrasound imaging techniques. Ultrasound is rapidly evolving as a point of service application and it is critical for pediatric radiologists to remain at the cutting edge of this technology to assure excellent care of our pediatric patients. Don’t miss the Reception and Annual Banquet, which will feature a special performance by the highly entertaining political satire group, “The Capitol Steps”. Back by popular demand is the SPR Research and Education Foundation Fun Run. Dr. Scott Dorfman has graciously agreed to organize this event. If you do not want to run, no problem—walkers are welcome! If you are not able to physically participate, you can support our onsite runners and walkers through sponsorship. Washington, D.C. is a great meeting venue within walking distance to the White House and Washington Mall. The meeting presents a great opportunity for you to spend time with your family, friends, or significant others and enjoy the numerous attractions, upscale nightlife, and excellent food venues. There will be ample opportunity for celebration and socialization. Please join us for SPR 2014 and embrace the Theme—Collaboration, Consultation, and of course, Celebration! Sincerely,

Richard A. Barth, MD President, The Society for Pediatric Radiology


SPR 2014 ORGANIZATION 2014 MEETING CURRICULUM COMMITTEE Richard A. Barth, MD, Chair Dianna M.E. Bardo, MD (3D Sessions) Jane E. Benson, MD (Education Session) Dorothy I. Bulas, MD (Education Session) Michael J. Callahan, MD (CT Protocol Session) Brian D. Coley, MD (Hands-on US and US Protocol Sessions) John J. Crowley, MD (Interventional Session) Laura Z. Fenton, MD (US Protocol Session) Marilyn J. Goske, MD (Education Session) Jeffrey C. Hellinger, MD (3D Sessions) Nadja Kadom, MD (Education Session) Rajesh Krishnamurthy, MD (MR Protocol Session) Edward Y. Lee, MD, MPH (Thoracic Imaging Session) Lisa H. Lowe, MD, FAAP (Education Session) Sarah S. Milla, MD (Sunrise Sessions) Beverley Newman, MBBCh, FACR (Thoracic Imaging Session) Ashok Panigrahy, MD (Sunrise Sessions) Marguerite T. Parisi, MD, MS Ed (Nuclear Medicine Session) John M. Racadio, MD (Interventional Session) Susan E. Sharp, MD (Nuclear Medicine Session) Dennis W. Shaw, MD (Neuroradiology Session) Lisa J. States, MD (Nuclear Medicine Session) Peter J. Strouse, MD, FACR (Postgraduate Course) Alexander J. Towbin, MD (Meeting Technology) Shreyas S. Vasanawala, MD, PhD (Postgraduate Course and MR Protocol Session) Sjirk J. Westra, MD (CT Protocol Session) Mary Wyers, MD (Sunrise Sessions) ABSTRACT REVIEW COMMITTEE - PAPERS Richard A. Barth, MD, Chair Dianna M.E. Bardo, MD Dorothy I. Bulas, MD Christopher I. Cassady, MD Teresa Chapman, MD, MA Taylor Chung, MD Brian D. Coley, MD Jonathan Dillman, MD James Donaldson, MD Lynn A. Fordham, MD Marilyn J. Goske, MD Mark Hogan, MD Diego Jaramillo, MD, MPH Nadja Kadom, MD Bernadette L. Koch, MD Rajesh Krishnamurthy, MD David B. Larson, MD, MBA M. Beth McCarville, MD Ashok Panigrahy, MD Marguerite T. Parisi, MD, MS Ed John M. Racadio, MD Anil Rao, MD Cynthia K. Rigsby, MD Keith J. Strauss, MSc Peter J. Strouse, MD, FACR Alexander J. Towbin, MD Andrew T. Trout, MD Teresa Victoria, MD, PhD Stephan D. Voss, MD, PhD

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Pediatr Radiol (2014) 44 (Suppl 1):S1–S253


ABSTRACT REVIEW COMMITTEE - SCIENTIFIC EXHIBITS/POSTERS M. Beth McCarville, MD, Chair Nadja Kadom, MD, Vice Chair Madhan Bosemani, MBBS Michael J. Callahan, MD Maria A. Calvo-Garcia, MD Michael P. D’Alessandro, MD Kassa Darge, MD, PhD Steven Don, MD R. Paul Guillerman, MD Fredric A. Hoffer, MD Thierry A.G.M. Huisman, MD Douglas H. Jamieson, MD J. Herman Kan, MD Geetika Khanna, MD Neha Kwatra, MD Maria F. Ladino-Torres, MD Jonathan M. Loewen, MD Craig S. Mitchell, DO, MA Helen R. Nadel, MD, FRCPC Daniel J. Podberesky, MD Janet R. Reid, MD Douglas C. Rivard, DO Ashley J. Robinson, MBChB Susan E. Sharp, MD Manrita K. Sidhu, MD Stephen F. Simoneaux, MD Aylin Tekes-Brady, MD Alexander J. Towbin, MD Kristen Yeom, MD

CASE OF THE DAY Debra L. Pennington, MD, Chair, Community Hospital Based Pediatric Radiologists Committee

jSPR Sheryl Tulin-Silver, MD and Matthew Winfeld, MD

CONTINUING MEDICAL EDUCATION Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the American College of Radiology and The Society for Pediatric Radiology. The American College of Radiology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Designation Statement (Postgraduate Course) The American College of Radiology designates this live activity for a maximum of 10.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Designation Statement (Annual Meeting) The American College of Radiology designates this live activity for a maximum of 23.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Technologists The American College of Radiology is approved by the American Registry of Radiologic Technologists (ARRT) as a Recognized Continuing Education Evaluation Mechanism (RCEEM) to sponsor and/or review Continuing Medical Educational programs for Radiologic Technologists and Radiation Therapists. The American College of Radiology designates this educational activity as meeting the criteria for up to 34.5 Category A credit hours of the ARRT.

MAINTENANCE OF CERTIFICATION Qualified on December 10, 2014, the Postgraduate Course as well as the Saturday Education, Interventional, Neuroradiology, Nuclear Medicine and Thoracic Imaging sessions meet the ABR’s criteria for a self-assessment (SAM) activity in the ABR Maintenance of Certification (MOC) Program.

OBJECTIVES The Society for Pediatric Radiology Annual Meeting and Postgraduate Course will provide pediatric and general radiologists with an opportunity to do the following: 1. 2. 3. 4. 5. 6.

Summarize the most current information on state of the art pediatric imaging and the practice of pediatric radiology. Describe and apply new technologies for pediatric imaging. Describe and apply basic principles for implementing quality and safety programs in pediatric radiology. Discuss trends in research concerning the care and imaging of pediatric patients. Identify common challenges facing pediatric radiologists, and possible solutions. Evaluate and apply means of minimizing radiation exposure during diagnostic imaging and image guided therapy.

At the conclusion of the experience, participants should have an improved understanding of the technologies discussed, increasing awareness of the costs and benefits of diagnostic imaging in children and of ways to minimize risks, and an improved general knowledge of pediatric radiology, especially as it interfaces with clinical decision making.

(2012) 44 42 (Suppl 1):S1–S253 1):S142–S149 Pediatr Radiol (2014)


DISCLOSURE In compliance with ACCME requirements and guidelines, the ACR has developed a policy for review and disclosure of potential conflicts of interest, and a method of resolution if a conflict does exist. The ACR maintains a tradition of scientific integrity and objectivity in its educational activities. In order to preserve this integrity and objectivity, all individuals participating as planners, presenters, moderators and evaluators in an ACR educational activity or an activity jointly sponsored by the ACR must appropriately disclose any financial relationship with a commercial organization that may have an interest in the content of the educational activity. The following planners, presenters, and evaluators have disclosed no financial interests, arrangements or affiliations in the context of this activity: Presenters Alyssa M. Abo, MD N. Scott Adzick, MD, MMM Evelyn Y. Anthony, MD Sudha A. Anupindi, MD George S. Bisset, MD Sarah D. Bixby, MD M. Ines Boechat, MD, FACR Debra Boyer, MD Stephen D. Brown, MD Patricia E. Burrows, MD Timothy M. Cain, MBBS Michael J. Callahan, MD Christopher I. Cassady, MD Nancy A. Chauvin, MD Govind B. Chavhan, MD, DNB, DABR Ellen M. Chung, MD Robert H. Cleveland, MD Harris L. Cohen, MD Laurie S. Conklin, MD Jesse Courtier, MD Heike E. Daldrup-Link, MD, PhD Alan Daneman, MBBCh, FRCPC Kassa Darge, MD, PhD Gabrielle deVeber, MD Jonathan R. Dillman, MD Michael A. DiPietro, MD James Donaldson, MD Lane F. Donnelly, MD Mary T. Donofrio, MD, FAAP, FASE, FACC John P. Dormans, MD, FACS Kirsten Ecklund, MD Georges El Fakhri, PhD Monica Epelman, MD Hedieh K. Eslamy, MD Judy A. Estroff, MD Kate A. Feinstein, MD Laura Z. Fenton, MD

S10 Lynn A. Fordham, MD Stéphanie Franchi-Abella, MD Donald P. Frush, MD, FACR Laurent Garel, MD Brian S. Garra, MD Michael S. Gee, MD, PhD Michael J. Gelfand, MD Maryam Ghadimi Mahani, MD Damien Grattan-Smith, MBBS S. Bruce Greenberg, MD R. Paul Guillerman, MD H. Theodore Harcke, MD, FACR, FAIUM Dianne M. Hater Shilpa V. Hegde, MBBS Marta Hernanz-Schulman, MD, FAAP, FACR Mark J. Hogan, MD Franz Wolfgang Hirsch, MD Danny R. Hughes, PhD Thierry A. G. M. Huisman, MD Allison M. Jackson, MD, MPH, FAAP Hollie A. Jackson, MD Diego Jaramillo, MD, MPH Neil D. Johnson, MBBS Nadja Kadom, MD Amy Kao, MD S. Pinar Karakas, MD Sue C. Kaste, DO Geetika Khanna, MD, MS Bernadette L. Koch, MD Anastassios C. Koumbourlis, MD, MPH Gary E. Hartman, MD, MBA Shailee V. Lala, MD Tal Laor, MD Bernard F. Laya, DO Lisa H. Lowe, MD, FAAP Jeffrey Lukish, MD John D. MacKenzie, MD Massoud Majd, MD Gerald A. Mandell, MD Prakash Masand, MD An N. Massaro, MD Martha M. Munden, MD Jonathan G. Murnick, MD, PhD Jaishree Naidoo, FCRad (Diagn) (SA), Dip Paed Rad (UCT) Dilp S. Nath, MD Rutger A. J. Nievelstein, MD, PhD Mary C. Ottolini, MD, MPH Catherine M. Owens, MRCP, FRCR Robert Pearl, MD Jeannette M. Perez-Rossello, MD Andrada R. Popescu, MD Sumit Pruthi, MD Anil Rao, MD Janet R. Reid, MD Cynthia K. Rigsby, MD Hans G. Ringertz, MD, PhD Derek J. Roebuck, FRANZCR Nabile M. Safdar, MD, MPH

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Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 Pallavi Sagar, MD Charles P. Samenow, MD, MPH Guy H. Sebag, MD Victor Seghers, MD, PhD Sabah Servaes, MD Jeff Sestokas, MAEd Susan E. Sharp, MD William E. Shiels, II, DO Richard M. Shore, MD Billie L. Short, MD Manohar Shroff, MD, FRCPC Ethan A. Smith, MD Stephanie E. Spottswood, MD, MSPH A. Luana Stanescu, MD Lisa J. States, MD Keith J. Strauss, MSc, FAAPM, FACR Raymond Sze, MD George A. Taylor, MD, FACR Paul Thacker, MD Richard B. Towbin, MD Donald A. Tracy, MD S. Ted Treves, MD Andrew T. Trout, MD Andy Tsai, MD, PhD Gilbert Vézina, MD Teresa Victoria, MD, PhD Stephan D. Voss, MD, PhD Daniel B. Wallihan, MD Michele M. Walters, MD Sjirk J. Westra, MD Andrew M. Zbojniewicz, MD Planning Committee/Presenter Teresa Chapman, MD (Content reviewer) Brian D. Coley, MD John J. Crowley, MD Marilyn J. Goske, MD Edward Y. Lee, MD, MPH Sarah S. Milla, MD Ashok Panigrahy, MD Beverley Newman, MBBCh, FACR Marguerite T. Parisi, MD, MS Ed John M. Racadio, MD Dennis W. Shaw, MD Peter J. Strouse, MD, FACR Shreyas S. Vasanawala, MD, PhD

Planning Committee Richard A. Barth, MD Angela R. Davis, CAE Mary Wyers, MD


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The presenters and content reviewer listed below have disclosed the following relevant financial relationships. All potential conflicts have been resolved. Name Dorothy I. Bulas, MD Taylor Chung, MD Rajesh Krishnamurthy, MD David B. Larson, MD, MBA Helen R. Nadel, MD Alexander J. Towbin, MD

Disclosure GE and Philips, Paid Consultant Philips, Honoraria and Speaker’s Bureau Philips Electronics, Research Support Radimetrics/Bayer, Intellectual Rights, Consulting IAEA, Consultant for Pediatric Nuclear Medicine Amirsys, Royalties and Merge, Shareholder

The scientific presenters at the 2014 Annual Meeting have indicated their applicable disclosures at the end of their abstracts. No statement indicates the authors have nothing to disclose.

ACKNOWLEDGEMENTS The Society for Pediatric Radiology gratefully acknowledges the support of the following companies in presenting the 57th Annual Meeting and Postgraduate Course: Platinum GE Healthcare Philips Healthcare Siemens Healthcare Toshiba America Medical Systems Exhibitors Agfa HealthCare Elsevier EOS imaging Guerbet LLC Hitachi Aloka Medical Imorgon Medical, LLC Kubtec Digital X-ray LMT Lammers Medical Technology GmbH Merge Healthcare PACSGEAR Pediatric Radiology of America (A Division of Aris Teleradiology) As of March 14, 2014

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PROGRAM SCHEDULE The Society for Pediatric Radiology Postgraduate Course 2014

Peter J. Strouse, MD, FACR and Shreyas S. Vasanawala, MD, PhD, Course Directors The Pediatric Radiologist Consultant: Bridging Patient Care and Innovation to Improve Child Health Supported in part by an educational grant from Bayer HealthCare Pharmaceuticals, Inc. Tuesday, May 13, 2014 7:00–8:00 a.m. 7:00 a.m.–5:00 p.m. 7:45–7:50 a.m. 7:50–8:00 a.m. 8:00–9:50 a.m. 8:00–8:10 a.m. 8:10–8:20 a.m. 8:20–8:30 a.m. 8:30–8:40 a.m. 8:40–8:50 a.m 8:50–9:00 a.m. 9:00–9:10 a.m. 9:10–9:20 a.m. 9:20–9:50 a.m. 9:50–10:10 a.m. 10:10 a.m.–12:00 p.m. 10:10–10:20 a.m. 10:20–10:30 a.m. 10:30–10:40 a.m. 10:40–10:50 a.m. 10:50–11:00 a.m. 11:00–11:10 a.m. 11:10–11:20 a.m. 11:20–11:30 a.m. 11:30 a.m.–12:00 p.m.

Continental Breakfast Registration Welcome and Introduction Richard A. Barth, MD Course Overview Peter J. Strouse, MD, FACR and Shreyas S. Vasanawala, MD, PhD BODY IMAGING TECHNIQUES: PRACTICAL ADVICE FOR CLINICALWORK Taylor Chung, MD and Shreyas S. Vasanawala, MD, PhD, Moderators How Should Image Quality be Evaluated in CT? David B. Larson, MD, MBA How to Perform a Contrast Enhanced PET/CT? Stephan D. Voss, MD, PhD How to Get the Lowest Dose in Abdominal CTA? Beverley Newman, MBBCh, FACR How Do I Get the Highest Resolution MRA? Taylor Chung, MD What is a b Value and How Should I Choose It? Govind B. Chavhan, MD, DNB, DABR Can 3 T Be Used for Fetal MRI? Teresa Victoria, MD, PhD When Should Eovist and Ablavar Be Used? Shreyas S. Vasanawala, MD, PhD How Do I Optimize Doppler Ultrasound Images and Waveforms? Marta Hernanz-Schulman, MD, FAAP, FACR Q&A with RSNA Diagnosis Live™ Break THORACIC IMAGING: FOCUS ON THE LUNGS Robert H. Cleveland, MD and Edward Y. Lee, MD, MPH, Moderators Cystic Fibrosis Update & Scoring: What Does the Pulmonologist Want to Know? Robert H. Cleveland, MD Children’s Interstitial Lung Disease (ChILD) 2014 Catherine M. Owens, MRCP, FRCR How Do I Perform a Dynamic Airway CT in Infants and Children? S. Bruce Greenberg, MD Update on Pulmonary Embolus in Children: What Does the Radiologist Need to Know? Pallavi Sagar, MD Pediatric Lung Neoplasms: Understanding Underlying Genetic Causes R. Paul Guillerman, MD Using SSDE to Manage Thoracic CT Radiation Dose in Children Keith J. Strauss, MSc, FAAPM, FACR HRCT in Pediatric Patients: When & How? Shilpa V. Hegde, MBBS MRI of the Lungs and Airways: Current Practical Imaging Approach Edward Y. Lee, MD, MPH Q&A with RSNA Diagnosis Live™


S14 12:00–1:15 p.m. 1:15–3:05 p.m.

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4:45–5:15 p.m. 5:15 p.m.

Lunch GASTROINTESTINAL IMAGING: FOCUS ON THE PANCREAS & BOWEL Kassa Darge, MD, PhD and Jonathan R. Dillman, MD, Moderators How to Perform & Interpret a Secretin MRCP? Andrew T. Trout, MD Which Pancreatic Ductal Variants Predispose to Pancreatitis? Sudha A. Anupindi, MD What are the Imaging Signs of Pancreatic Ductal Trauma? Michael J. Callahan, MD How to Distinguish Acute Inflammation from Chronic Fibrosis in Crohn’s Disease? Ethan A. Smith, MD How to Image and Classify Perianal Fistulae? Jonathan R. Dillman, MD How to Interpret a Pelvic MRI After Rectal Pullthrough? Alexander J. Towbin, MD What is the Role of Ultrasound in Intestinal Malrotation? Alan Daneman, MBBCh, FRCPC What is Known About Radiation Issues in Imaging of IBD? Kassa Darge, MD, PhD Q&A with RSNA Diagnosis Live™ Break GENITOURINARY IMAGING: FOCUS ON GONADAL RADIOLOGY Lane F. Donnelly, MD and S. Pinar Karakas, MD, Moderators What is the Role of Imaging in Testicular Trauma and its Follow-up? Laura Z. Fenton, MD Torsion of the Testis: What is the Role of Doppler and What are Concerning Flow Patterns? Lynn A. Fordham, MD How and When Should a Radiologist Reduce Testicular Torsion? Laurent Garel, MD When and How to Find the Undescended Testicle: To Search or Not to Search? Kate A. Feinstein, MD Intersex States/Gonadal Dysgenesis: What is the Role of Gonadal Imaging? Ellen M. Chung, MD What is the Best Imaging Modality for Torsion of the Ovary/Fallopian Tube? S. Pinar Karakas, MD Pediatric Adnexal Masses: If, When, and What Constitutes Appropriate Follow-Up? Evelyn Y. Anthony, MD What is the Imaging Contribution to the Diagnosis of PCOS? Dorothy I. Bulas, MD Q&A with RSNA Diagnosis Live™ Adjourn

Wednesday, May 14, 2014 6:00 a.m.

SPR Research and Education Foundation Fun Run—Underwritten by Texas Children’s Hospital

1:15–1:25 p.m. 1:25–1:35 p.m. 1:35–1:45 p.m. 1:45–1:55 p.m. 1:55–2:05 p.m. 2:05–2:15 p.m. 2:15–2:25 p.m. 2:25–2:35 p.m. 2:35–3:05 p.m. 3:05–3:25 p.m. 3:25–5:15 p.m. 3:25–3:35 p.m. 3:35–3:45 p.m. 3:45–3:55 p.m. 3:55–4:05 p.m. 4:05–4:15 p.m. 4:15–4:25 p.m. 4:25–4:35 p.m. 4:35–4:45 p.m.

7:00–8:00 a.m. 7:00 a.m.–5:00 p.m. 7:50–8:00 a.m. 8:00–9:50 a.m. 8:00–8:10 a.m. 8:10–8:20 a.m. 8:20–8:30 a.m.

(Entrance fee is $25 and includes a T-shirt) Continental Breakfast Registration Welcome and Announcements Peter J. Strouse, MD, FACR and Shreyas S. Vasanawala, MD, PhD MUSCULOSKELETAL IMAGING: FOCUS ON ONCOLOGY Diego Jaramillo, MD, MPH and John D. MacKenzie, MD, Moderators Radiographic and CT Characterization of Aggressive Bone Lesions Tal Laor, MD MRI Characterization of Bone Lesions Diego Jaramillo, MD, MPH Staging and Assessment of Treatment Response in Osteosarcoma and Ewing Sarcoma Kirsten Ecklund, MD

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 8:30–8:40 a.m. 8:40–8:50 a.m. 8:50–9:00 a.m. 9:00–9:10 a.m. 9:10–9:20 a.m. 9:20–9:50 a.m. 9:50–10:10 a.m. 10:10 a.m.–12:00 p.m. 10:10–10:20 a.m. 10:20–10:30 a.m. 10:30–10:40 a.m. 10:40–10:50 a.m. 10:50–11:00 a.m. 11:00–11:10 a.m. 11:10–11:20 a.m. 11:20–11:30 a.m. 11:30 a.m.–12:00 p.m. 12:00 p.m.

MRI of Bone Marrow Nancy A. Chauvin, MD Whole Body MRI with DWI for Tumor Staging and Surveillance Jesse Courtier, MD Strategies to Image Around Hardware After Limb Salvage Surgery John D. MacKenzie, MD Osteonecrosis in BMT & Oncology Patients Sue C. Kaste, DO MSK Tumor Imaging—What the Pediatric Orthopedic Surgeon Wants to Know John P. Dormans, MD, FACS Q&A with RSNA Diagnosis Live™ Break & Exhibits CHILD ABUSE & NOT CHILD ABUSE: FOCUS ON RADIOGRAPHY Jeannette M. Perez-Rossello, MD and Peter J. Strouse, MD, FACR, Moderators Classic Metaphyseal Lesion-Micro-CT/Histopathologic Correlation Andy Tsai, MD, PhD Differential Diagnosis of Metaphyseal Fractures Sabah Servaes, MD Rickets Richard M. Shore, MD Rib Fractures: Location and Mechanisms Paul K. Kleinman, MD Imaging of the Skull: Is that a Fracture? Peter J. Strouse, MD, FACR Dating of Fractures Michele M. Walters, MD What is the Role for Follow-up Skeletal Surveys? Jeannette M. Perez-Rossello, MD What Does the Child Abuse Physician Need to Know & How to Tell Us Allison M. Jackson, MD, MPH, FAAP Q&A with RSNA Diagnosis Live™ Adjourn Postgraduate Course

The Society for Pediatric Radiology Annual Meeting Program 2014

Richard A. Barth, MD, Program Director Sarah S. Milla, MD, Ashok Panigrahy, MD and Mary Wyers, MD, Workshop Directors The Pediatric Radiologist Consultant: Bridging Patient Care and Innovation to Improve Child Health

Wednesday, May 14, 2014 12:05–1:15 p.m. 12:05–1:15 p.m.

12:05–1:15 p.m.

1:20 p.m.

Lunch 3D Read with the Experts Lunch (advance registration required; attendance is limited) Dianna M.E. Bardo, MD and Jeffrey C. Hellinger, MD, Moderators Supported by GE Healthcare, Philips Healthcare, Siemens Healthcare, Vital MR Protocol Lunch Session (advance registration required; attendance is limited) Shreyas S. Vasanawala, MD, PhD and Rajesh Krishnamurthy, MD, Moderators Supported by GE Healthcare, Philips Healthcare, Siemens Healthcare, Toshiba America Medical Systems Session Topics: Diffusion for Oncologic Applications, MR Angiography and Volumetric Spin Echo Welcome Richard A. Barth, MD


S16 1:30–2:30 p.m.

2:30–3:30 p.m.

3:30–3:50 p.m. 3:50–5:10 p.m. 3:50–4:10 p.m. 4:10–5:10 p.m. PA-001 PA-002 PA-003 PA-004 PA-005

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6:15–7:30 p.m.

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 Edward B. Neuhauser Lecture The Future of American Medicine—The Impact of Health Care Reform Robert Pearl, MD Executive Director and CEO The Permanente Medical Group, Kaiser Permanente Oakland, California M&M Cases: Stump the Experts George A. Taylor, MD, FACR, Moderator Panelists: Donald P. Frush, MD, Marta Hernanz-Schulman, MD, FAAP, FACR, Neil D. Johnson, MBBS, Catherine M. Owens, MRCP, FRCR, Hans G. Ringertz, MD, PhD and Guy H. Sebag, MD Breaks & Exhibits Scientific Session I-A: Oncology & Nuclear Medicine (concurrent) Stephan D. Voss, MD, PhD and Rutger A.J. Nievelstein, MD, PhD, Moderators Whole Body Staging of the Pediatric Oncology Patient Heike E. Daldrup-Link, MD, PhD Scientific Papers—Oncology & Nuclear Medicine 4:10 Lin Does Surveillance Imaging of Childhood Rhabdomyosarcoma Improve Patient Survival? 4:20 Lyons Prognostic Value of Image-Defined Risk Factors in High-Risk Neuroblastoma 4:30 Guillerman The DICER1 Pleuropulmonary Blastoma Family Tumor and Dysplasia Syndrome (PPB-FTDS): Role of the Pediatric Radiologist in Diagnosis and Screening 4:40 Nguyen MR imaging patterns of leukemia and lymphoma 4:50 McCarten Retrospective review of bone changes in Hodgkin Lymphoma utilizing CT, 18F FDG-PET, 99m Tc-MDP bone scan and MRI from Children’s Oncology Group intermediate stage protocol AHOD0031. 5:00 Mhlanga Does contrast-enhanced CT (CECT) provide additional information to low dose CT/PET in pediatric Hodgkin Lymphoma? Scientific Session I-B: Gastrointestinal (concurrent) Alan Daneman, MBBCh, FRCPC and Ethan A. Smith, MD, Moderators Some Updated Clinical and Biological Perspectives of Neuroblastoma Anthony Sandler, MD Scientific Papers—Gastrointestinal 4:10 Serai Assessment of Hepatic Fibrosis in Pediatric Chronic Liver Disease with MR Elastography 4:20 Smith Ultrasound-Derived Shear Wave Speed Correlates with Liver Fibrosis in Children 4:30 Munden Acoustic Structural Quantification as a Potential Biomarker of Steatosis and Fibrosis in Pediatric Liver Disease 4:40 Gwal Reference Values of MRI measurements of the normal bile ducts and pancreatic duct in children 4:50 Brown Pediatric MRCP: Evaluation of the Pancreatic Duct 5:00 Fernandes Prussian Blue Nanoprobes for MRI-based Imaging of Eosinophilic Esophagitis Adjourn Awards Ceremony • Gold Medalist • Pioneer Honoree • Presidential Recognition Award • Honorary Member • Singleton-Taybi Award • Heidi Patriquin Award • Jack O. Haller Award Welcome Reception

Thursday, May 15, 2014 6:45–8:00 a.m. 6:30 a.m.–5:00 p.m. 7:00–8:20 a.m.

7:00–7:10 a.m.

Continental Breakfast Registration Sunrise Sessions (concurrent) IMPACT OF MRI AND CT IMAGING ON MANAGEMENT OF CHD Rajesh Krishnamurthy, MD, Moderator Newborn with Congenital Heart Disease Prakash Masand, MD

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 7:10–7:20 a.m. 7:20–7:30 a.m. 7:30–7:40 a.m. 7:40–7:50 a.m. 7:50–8:15 a.m. 8:15–8:20 a.m.

7:00–7:20 a.m. 7:20–7:40 a.m. 7:40–8:00 a.m. 8:00–8:20 a.m.

7:00–7:20 a.m. 7:20–7:40 a.m. 7:40–8:00 a.m. 8:00–8:20 a.m.

7:00–7:15 a.m. 7:15–7:45 a.m. 7:45–7:55 a.m. 7:55–8:05 a.m. 8:05–8:20 a.m. 7:00–8:20 a.m.

8:30–10:40 a.m. 8:30–8:50 a.m. 8:50–10:40 a.m. PA-013 PA-014 PA-015 PA-016 PA-017 PA-018 PA-019 PA-020 PA-021

Pre Glenn Evaluation in Single Ventricle Andrada R. Popescu, MD Repaired Tetralogy of Fallot S. Bruce Greenberg, MD s/p Arterial Switch Procedure for d-TGA Taylor Chung, MD Anomalous Aortic Origin of the Coronary Arteries Rajesh Krishnamurthy, MD MRI and CT for Surgical Decision Making in CHD: Where Do They REALLY Make a Difference? Dilip S. Nath, MD Question and Answer IMPROVING COMMUNICATION AND QUALITY David B. Larson, MD, MBA, Moderator Diagnostic Errors Lane F. Donnelly, MD Communicating with Parents About Radiation Risk: Doctor, Is a CT Scan Safe for My Child? Marilyn J. Goske, MD Establishing a Radiology Department Quality Improvement Program David B. Larson, MD, MBA Question and Answer FRIENDLY DEBATES: PEDIATRICIANS AND RADIOLOGISTS UNITE James Donaldson, MD, Moderator Point of Care Ultrasound—Who Should be Doing Ultrasound? William E. Shiels, II, DO vs. Alyssa M. Abo, MD Pediatric Lumps and Bumps: Ultrasound or MRI? Harris L. Cohen, MD vs. Thierry A. G. M. Huisman, MD Renal Artery Stenosis-MRA, CTA, US or IR? James Donaldson, MD vs. Ethan A. Smith, MD Question and Answer REVIEWING FOR PEDIATRIC RADIOLOGY Peter J. Strouse, MD, FACR, Moderator Introduction: Overview of the Review Process Peter J. Strouse, MD, FACR Evaluation of a Manuscript, Section by Section Brian D. Coley, MD, Cynthia K. Rigsby, MD and Geetika Khanna, MD, MS From a Reviewer’s Perspective: How I Approach a Review Alexander J. Towbin, MD What Happens After Review: How to Make Your Reviews Most Helpful to the Editors Peter J. Strouse, MD, FACR Question and Answer CT PROTOCOL SESSION (advance registration required; attendance limited) Michael J. Callahan, MD and Sjirk J. Westra, MD, Moderators Supported by GE Healthcare, Philips Healthcare, Siemens Healthcare and Toshiba America Medical Systems Session Topics: General Dose Considerations, Chest, Abdomen Scientific Session II-A: Neuroradiology (concurrent) Sarah S. Milla, MD and Dennis W. Shaw, MD, Moderators Neuroimaging During and After Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy An N. Massaro, MD Scientific Papers—Neuroradiology 8:50 Verhey Rate of agreement for manual and automated techniques for determination of new T2 lesions in children with multiple sclerosis and acute demyelination 9:00 Verhey MRI Features Distinguish Monophasic ADEM from MS: Findings from a Canadian Cohort of Children with Incident CNS Demyelination 9:10 Nagaraj Improved cerebral perfusion following open heart surgery in newborns with complex congenital heart disease 9:20 Jerdee Faster Pediatric MRI 9:30 Hercher Reduced field-of-view EPI diffusion tensor imaging of the spine for CNS tumors 9:40 Bireley The Spectrum of Neuroimaging and Clinical Findings in Children with Optic Nerve Hypoplasia: Should SOD Be DNR? 9:50 Hayes Altered Neural Activation in Children with Sports-Related Concussion Revealed with fMRI 10:00 Klobuka Diffusion and Perfusion Correlates of Heterogeneous Treatment Response in Peptide-Based Pediatric Glioma Immunotherapy 10:10 Januzis Radiation Dose to the Lens of the Eye for Neuroradiology CT Protocols in Pediatric Patients


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PA-033 PA-034 8:30–10:40 a.m. 8:30–8:50 a.m.

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Does near infrared spectroscopy (NIRS) as marker of brain autoregulation correlate with apparent diffusion coefficient scalars in neonates who were treated with brain cooling for perinatal hypoxic ischemic injury (HII)? 10:30 Josephs Neonatal retropharyngeal cysts: Imaging, surgical and pathologic considerations. Scientific Session II-B: Cardiovascular (concurrent) Lorna P. Browne, MD and Cynthia K. Rigsby, Moderators What’s New in Fetal Cardiac Diagnosis and Treatment Mary T. Donofrio, MD, FAAP, FASE, FACC Scientific Papers—Cardiovascular 8:50 Hsiao Simultaneous 4D phase-contrast velocity and signal dispersion rendering may improve qualitative and quantitative evaluation of tricuspid and pulmonary regurgitation in repaired Tetralogy of Fallot 9:00 Popescu A Comparison of Standard MRA using Extracellular Contrast with Respiratory and ECG triggered Gradient Echo MRA Imaging using Blood Pool Contrast 9:10 Rigsby Safety of a Blood Pool Contrast Agent in Children and Young Adults 9:20 Krishnamurthy Biomechanical Differences between Functional Single Left and Right Ventricles in Pediatric Population: A MRI based Comparison of Myocardial Strain and Torsion in an Asymptomatic Cohort 9:30 Atweh Comparison of Two Single Breath-held 3D Cine Steady-State Free Precession with 2D Breath-held acquisition (BH-SSFP) in unsedated patients with single ventricles 9:40 Krishnamurthy Unsupervised free-breathing 3-dimensional imaging of morphology, function and flow in congenital heart disease (CHD) under 30min: pilot study 9:50 Malone Clinical evaluation of a novel MR angiographic protocol in congenital heart disease (CHD) using time resolved imaging and free-breathing steady state imaging following administration of blood pool contrast agent (BPCA) 10:00 Krishnamurthy Inter -Observer Variability in Manual Measurement of Aortic Root Dimensions in Pediatric Patients: Benefits of using a Semi-Automated Tool 10:10 Biko High-Resolution Sub-mm Coronary MRA for the evaluation of patients with Anomalous Coronary Artery—Visualization of the Intramural Segment 10:20 Krishnamurthy Biomodeling and Fitting Studies for Total Artificial Heart Implantation in Children 10:30 Luhar Magnetic Resonance Venography in Pediatric Patients with Chronic Kidney Disease: Initial Experience with Ferumoxytol. Scientific Session II-C: ALARA (concurrent) Timothy M. Cain, MBBS and Marilyn J. Goske, MD, Moderators Recent Trends in CT Dose and Image Quality Optimization: What the Practicing Radiologist Needs to Know David B. Larson, MD, MBA Scientific Papers—ALARA 8:50 Goske Quality Improvement Registry in CT Scans in Children (QuIRCC) Pediatric Diagnostic Reference Levels (DRL) compared to Adult-focused Facilities in the American College of Radiology (ACR) Dose Index Registry(DIR) 9:00 Goske Quality Improvement Registry in CT Scans in Children (QuIRCC): Diagnostic Reference Levels for Pediatric Chest CT 9:10 Brinkley Effects of Automatic Tube Potential Selection on Radiation Dose, Image Quality and Lesion Detectability in Pediatric Abdominopelvic CT and CTA: A Phantom Study. 9:20 Zhu Dual energy compared to single energy CT scans in pediatric patients: dose neutral or not? 9:30 Samei Comprehensive Image Quality Phantom for Pediatric and Adult CT Imaging 9:40 Derderian Increased Organ Dose in Overlapped Upper Abdomen CT Scans of Chest and Abdomen/Pelvis 9:50 Thomas Parental Perception of Potential Risk associated with Ionizing Radiation Exposure from Computed Tomography 10:00 Zucker Impact of California CT Dose Reporting Requirements: Survey of Radiologists

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PA-045 10:40–11:00 a.m. 11:00 a.m.–12:00 p.m.

10:30 Jung Break & Exhibits Scientific Session III-A: Public Policy, Healthcare, Education, Technology (concurrent) Neil D. Johnson, MBBS and Janet R. Reid, MD, Moderators How Physicians Can Become More Effective Teachers Mary C. Ottolini, MD, MPH Scientific Papers—Public Policy, Healthcare, Education, Technology 11:20 Yaniv A Cost Effective High Fidelity Fluoroscopy Simulator 11:30 Benya Evaluation of Simulation Education to Improve Performance of Fluoroscopic Upper Gastrointestinal Exams in Infants with Bilious Emesis 11:40 Shekhar Integration of high-speed single- and multi-modality deformable image registration with clinical PACS 11:50 Donnelly Reliable and Efficient Supply Chain Management in Pediatric Radiology—Implementation of a 2-Bin Demand Flow System Scientific Session III-B: Genitourinary (concurrent) Damien Grattan-Smith, MBBS and Donald A. Tracy, MD, Moderators How Does Functional MR Urography Help Pediatric Urologists? Stephen A. Zderic, MD Scientific Papers—Genitourinary 111:20 Cerrolaza Hydronephrosis Severity Diagnosis From Ultrasound Imaging Biomarkers 111:30 Grattan-Smith Evaluation of Works-In-Progress package for MR urography post-processing 111:40 Pugmire Automated assessment of 3-compartment renal function using Factor Analysis of Dynamic Sequences (FADS) in MR Urography (MRU) 111:50 Hammer Pediatric UPJ Obstruction—Can MR Urography Identify Crossing Vessels and Do They Matter? Lunch jSPR and AAWR Joint Luncheon (advanced registration required) A Panel Discussion—Research: How We Do It Moderator: Sarah S. Milla, MD Panelists: Heike E. Daldrup-Link, MD, PhD, Marilyn J. Goske, MD, Tal Laor, MD and Susan E. Sharp, MD Ultrasound Protocol Session (advance registration required; attendance limited) Brian D. Coley, MD and Laura Z. Fenton, MD, Moderators Supported by GE Healthcare, Philips Healthcare, Siemens Healthcare and Toshiba America Medical Systems Session Topics: Contrast Applications, Elastography, Musculoskeletal Community Based Pediatric Radiologists Lunch (advance registration required) Scientific Session IV-A : Gastrointestinal (concurrent) Kate A. Feinstein, MD and Michael S. Gee, MD, PhD, Moderators Update on Pediatric Inflammatory Bowel Disease: Questions to be Answered by Imaging Laurie S. Conklin, MD Scientific Papers—Gastrointestinal 1:50 Kulkarni Should Routine UGIs Include Screening for Swallowing Dysfunction? 2:00 Gaffney Title: Diagnostic yield of the upper gastrointestinal (UGI) series in the pediatric outpatient setting: Low enough to say no? 2:10 Serai Retrospective Comparison of GRE T2* and SE T2 Analysis Methods for Estimating Liver Iron Content 2:20 Ruangwattanapaisarn Faster Pediatric 3T Abdominal Single Shot MRI: Comparison between Conventional and Flip Angle Modulated Single Shot Fast Spin Echo sequences 2:30 Potnick Fast Pediatric 3D Free Breathing Abdominal Dynamic Contrast Enhanced MRI with High Spatiotemporal Resolution 2:40 Koning Contrast Enhanced Magnetic Resonance Evaluation of Acute Appendicitis in the Pediatric Population: Efficacy of a Novel Imaging Protocol 2:50 Didier Accuracy of Diagnosing Pediatric Acute Appendicitis with ReducedCTDIvol CT Using Iterative Reconstruction: A Comparison with Traditional Weight-Based FBP

11:00–11:20 a.m. 11:20 a.m.–12:00 p.m. PA-046 PA-047

PA-048 PA-049 11:00 a.m.–12:00 p.m. 11:00–11:20 a.m. 11:20 a.m.–12:00 p.m. PA-050 PA-051 PA-052 PA-053 12:00–1:30 p.m. 12:00–1:30 p.m.

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12:00–1:30 p.m. 1:30–3:40 p.m. 1:30–1:50 p.m. 1:50–3:40 p.m. PA-054 PA-055 PA-056 PA-057

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Monitoring Radiation Exposures from Pediatric CT in Child Visits to Pediatric and Adult-focused Emergency Departments Development of a comprehensive risk assessment methodology for pediatric patients undergoing all types of imaging examinations using ionizing radiation The recent trend of pediatric CT dose in Korea

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253

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Determination of CT enterographic and MR enterographic imaging biomarkers of active Crohn disease in pediatric patients 3:10 Cerrolaza Quantitative Imaging Biomarkers of Chron’s Disease 3:20 Greer Can MRE screen for perianal disease in pediatric IBD? 3:30 Ayyala Comparison of hand versus mechanical administration of intravenous contrast: Quality of Abdominal CTA in pediatric patients. Scientific Session IV-B: Chest (concurrent) Beverley Newman, MBBCh, FACR and R. Paul Guillerman, MD, Moderators Update on ECMO: A Clinician’s Perspective Billie L. Short, MD Scientific Papers—Chest 1:50 White Postnatal Chest CT Findings after Left Congenital Diaphragmatic Hernia (CDH) Repair. 2:00 Compton Main Pulmonary Artery:Aorta Diameter Ratio in Normal Children on MDCT 2:10 Nevrekar Pulmonary Hypertension in Children: CMR with Phase Contrast Imaging to Identify Prognostic Indicators 2:20 Halula Establishing accuracy of airway measurements via CT in pediatrics 2:30 Martelius Correlation of lung ultrasound artefacts to chest CT in children 2:40 Dunnavant Chest Radiographic Features of Human Metapnueumovirus Infection in Pediatric Patients 2:50 Zhao Going Beyond the Haller Index: Model-based Costal Cartilage Estimation for Surgical Planning of Pectus Excavatum 3:00 Breen Clinical Significance of Incidental Pulmonary Nodules Detected on Abdominal CT in Pediatric Patients 3:10 Zucker Radiologist Compliance with California CT Dose Reporting Requirements: Review of Pediatric Chest CT 3:20 Kino Minimum CTA Radiation Dose and the Impact of Iterative Reconstruction in Children: a Prospective Randomized Trial 3:30 Schooler Evaluation of contrast administration site effectiveness when performing hand administration of intravenous contrast for thoracic CT angiography in pediatric patients Break & Exhibits Scientific Session V-A: Neuroradiology (concurrent) Ashok Panigrahy, MD and Bernadette L. Koch, MD, Moderators Update on Low Grade Pediatric Glioma Eugene Hwang, MD Scientific Papers—Neuroradiology 4:20 Palasis Neuroimaging Evaluation in Children Under Two Years of Age with Suspected Non Accidental Trauma: Impact of Early Brain and Cervical Spine MRI 4:30 Flom Optimizing A FAST-MR Protocol for Abusive Head Trauma Screening 4:40 Altinok Evaluation of Ruptured thrombosed bridging veins by Susceptibility Weighted Imaging in Non Accidental Trauma 4:50 Beavers MR Detection of Retinal Hemorrhages: Correlation with Graded Ophthalmologic Exam 5:00 Bosemani Diffusion tensor imaging of the brainstem in children with achondroplasia 5:10 Olson Are those dots important? Focal susceptibility on Gradient Echo imaging: incidence and potential significance in pediatric brain tumor patients following whole brain radiation 5:20 Sharma Diffusion Weighted MR Imaging in Retinoblastoma Scientific Session V-B: Genitourinary (concurrent) Kassa Darge, MD, PhD and Anil G. Rao, DMRD, DNB, Moderators Voiding Function and Dysfunction - What Can Pediatric Radiologists Tell Us? Stephen A. Zderic, MD Scientific Papers – Genitourinary 4:20 Darge Forty-five extravesical ectopic ureters: morphological and functional MR urography (fMRU) findings 4:30 Johnson Nationwide emergency department imaging practices for pediatric urolithiasis patients: room for improvement 4:40 Orth Renal ultrasound for infants under 2months of age with a first febrile urinary tract infection 4:50 Back In-vitro Optimization of a New US Contrast Agent for Intravesical Administration in Children 5:00 Darge Intra- and interobserver variability of functional MR urography (fMRU) analysis results

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5:30 p.m.


S21 Clinical and Imaging Features of Tuberous Sclerosis Complex/Autosomal Dominant Polycystic Kidney Disease: A Unique Genetic Disorder Outcome’s Predictors of Children With Primary Non Refluxing Megaureter Prenatally Detected

Friday, May 16, 2014 6:45–8:00 a.m. Continental Breakfast 6:30 a.m.–5:00 p.m. Registration 7:00–8:20 a.m. Sunrise Sessions (concurrent)

7:00–7:20 a.m. 7:20–7:40 a.m. 7:40–8:00 a.m. 8:00–8:20 a.m.

7:00–7:20 a.m. 7:20–7:40 a.m. 7:40–8:00 a.m. 8:00–8:20 a.m. 7:00–8:20 a.m.

7:00–7:40 a.m. 7:40–8:20 a.m.

7:00–7:20 a.m. 7:20–7:40 a.m. 7:40–8:00 a.m. 8:00–8:20 a.m.

7:00–7:20 a.m. 7:20–7:40 a.m. 7:40–8:00 a.m.

ADVANCED BODY MRI Damien Grattan-Smith, MBBS, Moderator MR Urography-Current Technique and Practice Damien Grattan-Smith, MBBS MR Enterography—Technique, Pearls and Pitfalls Shailee V. Lala, MD MR Elastography: How and When to Do It Daniel B. Wallihan, MD Question and Answer THE WORLD FEDERATION OF PEDIATRIC IMAGING (WFPI) M. Ines Boechat, MD, FACR, Moderator Volume Sweep Imaging and Worldwide Opportunities for Rural Outreach Brian S. Garra, MD Worldwide TB: What the Radiologist Needs to Know Bernard F. Laya, DO Chest Ultrasound for Pediatric TB Jaishree Naidoo, FCRad (Diagn) (SA), Dip Paed Rad (UCT) Question and Answer EDUCATION & COMMUNICATION: THE ART AND PRACTICE OF COMMUNICATION IN PEDIATRIC RADIOLOGY: AVIDEO-BASED, INTERACTIVE APPROACH Stephen D. Brown, MD, Moderator Bernadette L. Koch, MD and Dianne M. Hater, Co-Moderators Communicating Bad News Medical Error Disclosure FETAL Christopher I. Cassady, MD, Moderator Fetal Brain Imaging Hollie A. Jackson, MD 3T Fetal Imaging & Safety Teresa Victoria, MD, PhD Fetal Brain MRI-Perspective of a Fetal Neurologist Adré J. du Plessis, MBChB Question and Answer MUSCULOSKELETAL Tal Laor, MD, Moderator Adolescent Hip Pain Jeffrey L. Hanway, MD Radiology of the Adolescent Hip Sarah D. Bixby, MD MRI of the Adolescent Hip: Advanced Techniques Nabile M. Safdar, MD, MPH

S22 8:00–8:20 a.m. 8:30–10:50 a.m.

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253

Question and Answer Scientific Session VI-A: Interventional (concurrent) James Donaldson, MD and John M. Racadio, MD, Moderators 8:30–8:50 a.m. What’s New in the Management of Pediatric Appendicitis Gary E. Hartman, MD, MBA 8:50–10:50 a.m. Scientific Papers—Interventional PA-090 8:50 Patel Contrast induced nephropathy following high contrast dose angiographic procedures PA-091 9:00 Metwalli Orbital Lymphatic malformations: Does treatment with percutaneous bleomycin have promise? PA-092 9:10 Kukreja Venous thrombolysis in children under 24months PA-093 9:20 Chiramel Impact of endovascular treatment for extensive veno-occlusive deep vein thrombosis in the pediatric population. PA-094 9:30 Sharma Endovascular Management of Extensive Venous Thrombosis in Adolescent Patients-A Single Center Experience PA-095 9:40 Zahra IVC Filter Retrieval in Children: Experience in a Tertiary Pediatric Center PA-096 9:50 Kurzendorfer 3D Fusion of preprocedural MRI with intraprocedural C-arm CT for confirmation of bone biopsy location in pediatric interventional radiology PA-097 10:00 Hwang First Experience with iGuide Navigational Software Application for Bone Biopsies in Pediatric Interventional Radiology PA-098 10:10 Jawahar Clinical and surgical correlation of Hip MR Arthrographic findings in adolescents PA-099 10:20 Nguyen Clinical impact of diagnostic image guided hip steroid injections in CP patients with neuromuscular hip subluxation PA-100 10:30 Cornejo Utility of intra-arterial Verapamil injection in patients with posttraumatic vasospasm monitored by transcranial Doppler. PA-101 10:40 Davis The Management Challenges of Intra-Oral Sclerotherapy 8:30–10:50 a.m. Scientific Session VI-B: Musculoskeletal (concurrent) Tal Laor, MD and Rebecca Stein-Wexler, MD, Moderators 8:30–8:50 a.m. Pediatric Sports Injuries: What the Orthopedic Surgeon Needs from Radiology John F. Lovejoy, III, MD 8:50–10:50 a.m. Scientific Papers—Musculoskeletal PA-102 8:50 Ho-Fung MRI diagnosis of discoid lateral meniscus in children—Usefulness of morphometric values with arthroscopic and normal control group correlation. PA-103 9:00 Ntoulia Diffusion tensor imaging in evaluation of Anterior Cruciate Ligament microstructure. Preliminary data in children with normal ACL and children with ACL tears. PA-104 9:10 Githu 3D Isotropic Resolution Fast Spin-Echo Knee MR imaging—Diagnostic Performance Compared to Conventional MR Imaging at 1.5T. PA-105 9:20 Akyol Expected Knee MRI Findings in Symptomatic Children with Achondroplasia PA-106 9:30 Stewart Pediatric Traumatic Posterior Hip Dislocation: Emerging Role of MRI PA-107 9:40 Hill Prevalence and prognosis of osteonecrosis of the hips in children with Trichothiodystrophy with osteosclerosis. PA-108 9:50 Eghbal Indirect Shoulder Magnetic Resonance Arthrography: A Novel Technique for Identifying Labral Pathology in Young Patients PA-109 10:00 Ma Temporomandibular joint involvement in Juvenile Idiopathic Arthritis (JIA): Are there thresholds that distinguish normal from mild TMJ involvement? PA-110 10:10 Kim Quantitative Skeletal Muscle MR Imaging: MR spectroscopy (MRS) as a noninvasive biomarker to determine pathologic fatty infiltration: Comparison between boys with Duchenne muscular dystrophy (DMD) and healthy boys PA-111 10:20 Massey Does double reading skeletal surveys improve sensitivity of diagnosing nonaccidental trauma? PA-112 10:30 Chang Radiologist and CPT physician preferences for inclusion of computerized tabulations of multiple fractures in skeletal survey reports. PA-113 10:40 Wang Longitudinal Assessment of Bone Loss Using Quantitative Ultrasound in a Blood-Induced Arthritis Rabbit Model 10:50–11:10 a.m. Break & Exhibits 11:10 a.m.–12:30 p.m. Scientific Session VII-A: Public Policy, Healthcare, Education, Technology (concurrent) George S. Bisset, MD and Keith S. White, MD, Moderators 11:10–11:30 a.m. Payment for Value: The Practice of Radiology in a post-ACA World Danny R. Hughes, PhD 11:30 a.m.–12:30 p.m. Scientific Papers—Public Policy, Healthcare, Education, Technology PA-114 11:30 Heller Incorporating a radiology resident consultant into daily pediatric rounds: What is the value? PA-115 11:40 Zucker Added Value of Radiologist Consultation for Pediatric Ultrasound: Implementation and Survey Assessment PA-116 11:50 Hyatt No longer a holiday: Improving the pediatric radiology elective for medical students and pediatric housestaff PA-117 12:00 Back 5min Ultrasound: Validation of Point-of-Care Milestone learning in small aliquots PA-118 12:10 Back How and How Well Do Pediatric Radiology Fellows Learn Ultrasound? A National Survey. PA-119 12:20 Towbin Evaluating the transcription accuracy of a clinical speech recognition system

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11:10 a.m.–12:30 p.m. Scientific Session VII-B: Fetal (concurrent) Christopher I. Cassady, MD and Teresa Chapman, MD, MA, Moderators 11:10–11:30 a.m. Fetal Surgery for Lung Lesions N. Scott Adzick, MD, MMM 11:30 a.m.–12:30 p.m. Scientific Papers—Fetal PA-120 11:30 Estroff A normative spatiotemporal MRI template of human fetal brain growth in-utero PA-121 11:40 Estroff Volumetric reconstruction of fetal brain MRI on 3T versus 1.5T scanners PA-122 11:50 Evangelou Retrospective motion correction and signal recovery in MR Spectroscopy of the fetal brain PA-123 12:00 Mehollin-Ray Pre- and post-operative fetal MRI appearance of the brains and spines of patients with open neural tube defects who underwent in utero repair. PA-124 12:10 Rosines Correlation between spleen and stomach position by MR with the presence of a hernia sac in fetuses with left-sided congenital diaphragmatic hernia. PA-125 12:20 Afacan Preliminary results on measuring fetal lung maturation using diffusion weighted MRI at 3T 12:30–1:45 p.m. SPR Members’ Business Meeting & Lunch 1:45–3:55 p.m. Scientific Session VIII-A: Fetal (concurrent) Judy A. Estroff, MD and Teresa Victoria, MD, PhD, Moderators 1:45–2:05 p.m. Fetal Surgery for Myelomeningocele N. Scott Adzick, MD, MMM 2:05–3:55 p.m. Scientific Papers—Fetal PA-126 2:05 Otero Real-time Cine Magnetic Resonance Imaging of Swallowing Abnormalities in the Fetus with Head and Neck Pathology: Frequency and Patterns PA-127 2:15 Jennings Disorders of Sex Differentiation (DSD): The Radiologist’s Role in Prenatal Diagnosis PA-128 2:25 Ayyala Prenatal Observation of Echogenic Kidneys: What Have We Learned? PA-129 2:35 Seed MRI Shows Limited Mixing Between Systemic and Pulmonary Circulations in Fetal Transposition of the Great Arteries—A Potential Cause of In Utero Pulmonary Vascular Disease PA-130 2:45 Jadhav Novel approach for cardiovascular CT in neonates and infants using indication-based, first-pass contrast enhanced, ‘target-mode’ prospective EKG-gated volumetric imaging PA-131 2:55 Sammet An imaging strategy for lower dose cardiac CTA in infants PA-132 3:05 White Impact of Intravenous Radiographic Contrast Administration on Serum Creatinine in Neonates. PA-133 3:15 Patil Neonatal Necrotizing Enterocolitis: Quality of Reporting of Diagnostic Accuracy of Abdominal Ultrasound—A Systematic Review PA-134 3:25 Otero MR Imaging evaluation of liver lesions in children: Added Value of Hepatobiliary Contrast PA-135 3:35 Tun Cerebral ultrasound findings in neonates undergoing whole body hypothermia for hypoxic ischemic encephalopathy PA-136 3:45 Harcke Can Swaddling be done safely in Infants with and without DDH? 1:45–3:55 p.m. Scientific Session VIII-B: Oncology & Nuclear Medicine (concurrent) Geetika Khanna, MD, MS and Andrew T. Trout, MD, Moderators 1:45–2:05 p.m. PET/MR in Children: Early Successes and Challenges Franz Wolfgang Hirsch, MD 2:05–3:55 p.m. Scientific Papers—Oncology & Nuclear Medicine PA-137 2:05 Khanna Renal cell carcinoma in children and adolescents: a summary of imaging findings from the Children’s Oncology Group PA-138 2:15 Atweh MR Image Acquisition during the FDG Uptake Phase is Associated with an Increased Rate of False Positive Brain PET Examinations Performed on an Integrated PET-MR Scanner PA-139 2:25 Martinez-Rios Comparison of quantitation of tracer uptake and radiation dosage between PET/MRI and PET/CT in a pediatric population. PA-140 2:35 Lyons Comparison of standardarized uptake values (SUV) in normal structures between PET/CT and PET/MRI in a pediatric patient population PA-141 2:45 Lyons Qualitative [18F]-FDG PET image assessment using automatic three-segment MR attenuation correction versus CT attenuation correction in a pediatric population. PA-142 2:55 Krishnamurthy Quantitative Comparison of Attenuation Corrected FDG-PET Images Acquired on Integrated PET/MR and PET/CT Systems: Validation of an MR-based Attenuation Correction Algorithm PA-143 3:05 Robertson Pediatric PET-MR Registration for the Rest of Us! Validation of a Novel Software Based Solution for PET/MR Coregistration. PA-144 3:15 Towbin Fractures in Newly Diagnosed Hepatoblastoma Patients: Incidence and Imaging Features PA-145 3:25 Lee Patient Size-Specific k-factors for Pediatric and adult CT examinations PA-146 3:35 Goske Improving Patient Safety: Development of a Web-based Curriculum with Assessment to Promote Competency in “Child-sizing” Radiation Dose for Medical Professionals PA-147 3:45 Umstead Age based characterization of pediatric soft tissue masses of the hand, and value of added MRI following ultrasound. Break & Exhibits 3:55–4:15 p.m. 4:15–5:25 p.m. Scientific Session IX-A:Musculoskeletal (concurrent) Sarah D. Bixby, MD and Diego Jaramillo, MD, MPH, Moderators 4:15–4:35 p.m. Dx and Management of Legg Calve-Perthes What the Radiologist Needs to Know John F. Lovejoy, III, MD

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S24 4:35–5:25 p.m. PA-148 PA-149 PA-150 PA-151 PA-152 4:15–5:25 p.m. 4:15–4:35 p.m. 4:35–5:25 p.m. PA-153 PA-154 PA-155 PA-156 PA-157 5:25 p.m. 6:30–11:00 p.m.

Scientific Papers—Musculoskeletal 4:35 Fadell CT Outperfoms Radiographs at a Comparable Radiation Dose in the Assesment for Spondylolysis 4:45 Duan Clinical Value of Adipose Volume Measurements Obtained from Routine Body CT:Associations with Body Mass Index and Clinical Observations 4:55 Deng Characterization of Brown Adipose Tissues using MRI in the Pediatric Population—a Pilot Study 5:05 Chauvin Ultrasound of the Joints and Entheses in the Healthy Child 5:15 Bedoya Quantification of bone marrow involvement in Gaucher disease with proton MR Spectroscopy: correlation with bone marrow score, and clinical status Scientific Session IX-B: Interventional (concurrent) John J. Crowley, MD and Mark J. Hogan, MD, Moderators Innovative Techniques of Minimally Invasive Surgery Jeffrey R. Lukish, MD, FACS Scientific Papers—Interventional 4:35 Hawkins Pediatric liver transplant portal vein anastomotic stenosis: correlation between transabdominal ultrasound and percutaneous transhepatic portal venography. 4:45 Zahra Trans—Jugular Liver Biopsy (TJLB) in Children: A Single Institutional Experience 4:55 King Fluoroscopic maintenance of pediatric gastro-jejunostomy tubes: What is the radiation dose to the patient and the fluoroscopic operator’s hands? 5:05 Bisset Image-guided prediction of pseudocyst formation following traumatic pancreatic injury in children 5:15 Golriz MR imaging characteristics of focal nodular hyperplasia (FNH) of the liver in children. Adjourn Reception & Annual Banquet—Special Performance by Capitol Steps

Saturday, May 17, 2014 7:00–8:00 a.m. Continental Breakfast 7:00 a.m.–12:00 p.m. Registration 8:00 a.m.–12:00 p.m. NEURORADIOLOGY SESSION Neuro Session Part I Jason N. Nixon, MD and Gilbert Vézina, MD, Moderators 8:00–8:30 a.m. Epilepsy in Childhood Amy Kao, MD 8:30–9:00 a.m. MR Imaging in Pediatric Epilepsy Gilbert Vézina, MD 9:00–9:30 a.m. Challenging Cases in Epilepsy Jonathan G. Murnick, MD, PhD 9:30–9:45 a.m. Discussion 9:45–10:00 a.m. Break Neuro Session Part II Dennis W. Shaw, MD and Manohar Shroff, MD, FRCPC, Moderators 10:00–10:30 a.m.

Childhood Stroke Gabrielle deVeber, MD 10:30–11:00 a.m. Stroke Imaging in Childhood Manohar Shroff, MD, FRCPC 11:00–11:45 a.m. Case Presentations Sumit Pruthi, MD 11:45 a.m.–12:00 p.m. Discussion 8:00 a.m.–12:00 p.m. 7TH ANNUAL SPR EDUCATION SUMMIT Dorothy I. Bulas, MD and Marilyn J. Goske, MD, Moderators 8:00–8:05 a.m. Introduction Dorothy I. Bulas, MD 8:05–8:15 a.m. ABR Updates Lane F. Donnelly, MD 8:15–8:25 a.m. Milestone Updates Dorothy I. Bulas, MD

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 8:25–8:30 a.m. 8:30–9:15 a.m.

9:15–9:20 a.m. 9:20–10:00 a.m. 10:00–10:05 a.m. 10:05–10:35 a.m. 10:35–10:55 a.m. 10:35–10:40 a.m. 10:40–10:55 a.m.

10:55–11:10 a.m. 11:10–11:25 a.m. 11:25–11:45 a.m. 11:45–11:50 a.m. 11:50 a.m.–12:00 p.m. 8:00 a.m.–12:00 p.m. 8:00–8:30 a.m. 8:30–9:00 a.m. 9:00–9:30 a.m. 9:30–9:50 a.m. 9:50–10:20 a.m. 10:20–10:50 a.m. 10:50 a.m.–12:00 p.m. 8:00 a.m.–12:00 p.m. 8:00–8:30 a.m. 8:30–9:00 a.m. 9:00–9:30 a.m. 9:30–9:45 a.m. 9:45–10:15 a.m. 10:15–10:45 a.m. 10:45–11:15 a.m. 11:15 a.m.–12:00 p.m. 8:00 a.m.–12:00 p.m.

8:00–8:05 a.m. 8:05–8:20 a.m. 8:20–8:40 a.m.

Question and Answer The Expert Clinician: Transformative Online Education to Accelerate the Professional Development of Today’s Medical Professionals Jeff Sestokas, MAEd Question and Answer Physician Wellness: It’s More Than A Yoga Group! Charles P. Samenow, MD, MPH Question and Answer Break Patient Care: Critical Conversations RADPED: Teaching Communication Skills to Radiology Trainees Marilyn J. Goske, MD Sharing Difficult News with Patients and Families in the Radiology Department—A Program for Improving Communication Bernadette L. Koch, MD Systems-based Practice-(P)QI for trainees AND faculty! Nadja Kadom, MD Communication and Reporting Skills: What Clinicians Want Lisa H. Lowe, MD, FAAP Healthcare MBA (Minimal Business Acumen) for Radiology Fellows Raymond Sze, MD Question and Answer Closing Marilyn J. Goske, MD INTERVENTIONAL SESSION John J. Crowley, MD and John M. Racadio, MD, Moderators Management of Benign Biliary Strictures Stéphanie Franchi-Abella, MD New Developments in Renovascular Hypertension Derek J. Roebuck, MD Venous Malformations: How to Stay Out of Trouble and Not Undertreat Patricia E. Burrows, MD Break Management of Low Flow Vascular Lesions: Optimum Choice of Agents William E. Shiels, II, DO New Horizons Richard B. Towbin, MD Interventional Case Club John M. Racadio, MD THORACIC IMAGING SESSION Edward Y. Lee, MD, MPH and Beverley Newman, MBBCh, FACR, Moderators Thoracic Manifestations of Systemic Disease in Children: Imaging Clues to Diagnosis Anastassios C. Koumbourlis, MD, MPH and Beverley Newman, MBBCh, FACR Imaging Evaluation of Pediatric Airway and Lung Neoplasms: What Does the Clinician Need to Know? Paul Thacker, MD Pediatric Mediastinum: Clinical Correlation and Practical Imaging Assessment Maryam Ghadimi Mahani, MD Break Pediatric Thoracic Vascular Imaging: How I Do It Monica Epelman, MD Pediatric Lung Transplantation: Clinical Perspectives & Imaging Assessment Debra Boyer, MD and Edward Y. Lee, MD, MPH Risks and Benefits of Pediatric Thoracic CT: Updated Information for Clinicians Sjirk J. Westra, MD Question and Answer NUCLEAR MEDICINE SESSION Marguerite T. Parisi, MD, MS Ed, Moderator Susan E. Sharp, MD and Lisa J. States, MD, Co-Moderators Pediatric Dose Harmonization Project: An Update S. Ted Treves, MD Communicating with Parents and Referring Clinicians S. Ted Treves, MD Bone Scintigraphy-State of the Art Helen R. Nadel, MD


S26 8:40–9:00 a.m.

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Pediatric Diuresis Renography Massoud Majd, MD 9:00–9:20 a.m. Pediatric Gastrointestinal Scintigraphy Stephanie E. Spottswood, MD, MSPH Uncommonly Performed Pediatric Nuclear Medicine Procedures 9:20–9:50 a.m. 9:20–9:30 a.m. Ventilation/Perfusion Scans Lisa J. States, MD 9:30–9:40 a.m. NM Evaluation of CSF Shunts Hedieh K. Eslamy, MD 9:40–9:50 a.m. Lymphoscintigraphy Gerald A. Mandell, MD 9:50–10:00 a.m. Break 10:00–10:40 a.m. Oncologic Imaging Michael J. Gelfand, MD and Susan E. Sharp, MD 10:40–11:00 a.m. NM Infection Imaging in Children Marguerite T. Parisi, MD, MS Ed 11:00–11:20 a.m. FDG PET: Neurologic Applications A. Luana Stanescu, MD 11:20–11:40 a.m. PET-MR: Equipment, Technical and Imaging Considerations Georges El Fakhri, PhD, DABR 11:50 a.m.–12:00 p.m. PET/MR: Implementing a Clinical Program Victor Seghers, MD, PhD 8:00 a.m.–12:00 p.m. HANDS-ON ULTRASOUND SESSION (advanced registration required; attendance is limited) Brian D. Coley, MD, Moderator 8:00–9:15 a.m. Hip Dysplasia: DDH H. Theodore Harcke, MD, FACR, FAIUM and Michael A. DiPietro, MD 9:15–10:30 a.m. Musculoskeletal: Sports Medicine and Rheumatology Andrew M. Zbojniewicz, MD and Michael A. DiPietro, MD 10:30–10:45 a.m. Break 10:45 a.m.–12:00 p.m. Appendicitis: Complications and Mimicks Martha M. Munden, MD and Andrew T. Trout, MD 12:00 p.m. All Saturday Sessions Adjourn

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CATALOG OF SCIENTIFIC EXHIBITS/POSTERS The top 12 candidates for a Caffey Scientific Exhibit Award will present their work during one of the scheduled breaks at the Annual Meeting. Case Reports CR-001 Bandarkar CR-002 CR-003 CR-004 CR-005 CR-006

Loke Ratino Withdrawn Davis Farmakis

CR-007 CR-008 CR-009 CR-010 CR-011 CR-012 CR-013

Compton Cusack Alaref Withdrawn Lu Gupta Kovanlikaya

CR-014 Paltiel CR-015 Davignon CR-016 Natera CR-017 CR-018 CR-019 CR-020

Hayes Scrugham Zandieh Johnsen

CR-021 Herskovits CR-022 Jindal CR-023 CR-024 CR-025 CR-026

Qin Artunduaga Withdrawn Eslamy

Transcutaneous Sonography of Tonsils in the Pediatric Patient: a novel imaging technique to detect peritonsillar abscess. Software Segmentation and Rapid Prototyping of Congenital Heart Defects with Cardiac MRI images Multimodality Imaging Findings of Arterial Tortuosity Syndrome, a Case Series Cross My Heart: Case Series of Criss-Cross Congenital Heart Disease Neurofibromatosis Type 1 Arterial Vasculopathy Manifesting as a Superficial Peripheral Arterial Aneurysm in an Adolescent Sonographic: Pathologic Correlation of Pulmonary Lymphangectasia Ovarian torsion in the fetus—prenatal and postpartum imaging and management Infected cephalohematoma Torsion of an accessory hepatic lobe: Two cases in children Burkitts lymphoma of bowel mimicking Crohns disease on initial presentation Quantitative ADC measures as an imaging biomarker for fibrosis in pediatric Crohn’s disease: Preliminary experience Contrast-enhanced Ultrasound of Pediatric Abdominal Visceral Trauma: Initial Data Herniation of Meckel’s Diverticulum into a Ventriculoperitoneal Shunt Tract: An Unusual Shunt Complication Duodenal-pancreatic-duodenal intussusception in the setting of malrotation with a duodenal duplication cyst. Empty TPN: A Cautionary Case of Copper Deficiency Congenital portosystemic shunt: an important and overlooked cause of neonatal cholestasis—a case report Complications of Pediatric Liver Transplantation: Case Series and Pictorial Review. Radiologic, pathologic, and surgical correlation in unusual large and small bowel lead point intussusceptions: a case series A Case Series: Rare Extraosseous Manifestations of Langerhans Cell Histiocytosis Congenital Intrahepatic porto-systemic shunts; a case-based illustration of clinical manifestations, imaging findings and endovascular management Mesenteric Venolymphatic Malformation causing Small Bowel Obstruction in a Child Biliary rhabdomyosarcoma: Review of three cases

MR Enterography Technical Note: Slow Intravenous Infusion of Glucagon Diluted in D5W with an MR-Compatible Infusion Pump CR-027 Bittman The effective use of blueberry juice, pineapple juice and acai juice as negative contrast agents for MRCP in children at a large tertiary pediatric medical center. CR-028 Thomas You got to be KIDNEYing me?! A Pediatric Case Series of Rare Non-Wilms Tumors CR-029 Goldfisher Multi-modality Imaging Evaluation of Peritoneal Inclusion Cysts in the Pediatric Age Group CR-030 Aria The Changing Character of Urinary Infection in Children: Influence of No Circumcision CR-031 Vatsky Case Series: Endovascular Radiofrequency Ablation in the treatment of long segment lower extremity venous malformations in pediatric patients. CR-032 Shenoy-Bhangle Novel image guided treatment for local control of a recurrent plexiform schwannoma in a 3 year-old male. CR-033 Gaballah Mechanical embolectomy using the Solitaire FR revascularization device for acute arterial ischemic stroke in a pediatric ventricular assist device patient: A Case Report CR-034 McCarron Look, ma, no hands! Introducing the MIRA (MRI Interventional Robotic Assistant): a proof of concept for an MRI compatible, patient mounted robot for radiation-free arthrography and other percutaneous procedures CR-035 Bedford Additional value of C-arm CT in imaging patent ductus venosus (PDV) and its intra-procedural role in guiding endovascular occlusion.


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S28 CR-036 Pimpalwar CR-037 Bedford CR-038 Bao CR-039 Josephs CR-040 Green CR-041 Jindal CR-042 CR-043 CR-044 CR-045 CR-046 CR-047 CR-048

Zahra Barnes Thomas Yadav Ilivitzki Patel Dunnavant

CR-049 CR-050 CR-051 CR-052 CR-053 CR-054 CR-055 CR-056 CR-057

Adeyiga Emerson Jamieson Khan Hayes Dizor Averill Whitehead Horst

CR-058 Saigal CR-059 CR-060 CR-061 CR-062 CR-063 CR-064 CR-065

Palasis Rogers Guimaraes Leake Cyriac Palasis Han Suyin

CR-066 Hegde CR-067 Singh CR-068 Eslamy CR-069 Eslamy CR-070 Lee CR-071 CR-072 CR-073 CR-074 CR-075 CR-076 CR-077 CR-078 CR-079 CR-080

Yadav Milks Adeyiga Zahiri Hoare Emerson Eklund Emerson Addicott Ghadimi Mahani CR-081 Rosenbaum CR-082 Withdrawn

Denver shunt malfunction: can replacement be avoided with minimally invasive innovative techniques? Role of doppler ultrasound imaging guidance in the treatment of angiographically occult traumatic arteriovenous fistula in a child. Novel technique using MRI/X-ray overlay to guide sclerotherapy for treatment of low-flow vascular malformations in children Congenital segmental ectasia of central venous structures: intervene or observe? Ultrasound guided muscle biopsy using a Vacuum Assisted Biopsy System (Vacora®) Endovascular management of a congenital intrahepatic porto systemic shunt using Amplatzer occlusion device in a 2months old infant Wire trapping and unwrapping; a rare complication of Trerotola device. M-Dixon: Fat Suppression Has Never Looked So Good CT Angiography changes practice: the surgical management of pediatric digital syndactyly Idiopathic chondrolysis of hip: MR Imaging spectrum with emphasis on early MRI features STERNAL PSEUDOTUMOR OF CHILDHOOD—DON’T TOUCH LESION When evaluating a joint, WATS not to like Intraoperative Ultrasound Use in Children with Brachial Plexus Birth Injury and Glenohumeral Instability: A Case Series Pelvic Fractures in Non-Accidental Trauma Comparison of CT and MRI for Evaluation of Glenoid Bone Loss in Pediatric Patients Prenatal Cortical Hyperostosis—Caffey Dysplasia Scurvy in an autistic child; early disease on MRI and Bone Scintigraphy can mimic an infiltrative process. Readout-Segmented EPI for Diffusion Imaging of the Pediatric Spine: an Illustrative Case Review Minimally Invasive MRI-guided Stereotactic Laser Thermal Ablation—A Step-by-Step Tutorial Fetal brain MRI findings of congenital cytomegalovirus infection with post-natal MRI correlation CNS Imaging Manifestations of Cornelia de Lange Syndrome Isolated Cranial Nerve and Cervical Nerve Root Enhancement in an Infant with Polymerase Gamma Mutation Mitochondrial Disease Utility of Susceptibility Weighted (SWI) and Constructive Interference in Steady State (CISS) Sequences in the Evaluation of Hydrocephalus in the Newborn Current T2* Based MRI Techniques and their Applications in Pediatric Neuroimaging Smoothing things over: Model based CT image iterative reconstruction approaches MR image quality Differentiating Prominent Subarachnoid Spaces from Isodense Subdural Collections seen on CT in Infants Melanotic Neuroectodermal Tumor of Infancy: A Case Report Childhood Primary Angiitis of the Central Nervous System presenting with bilateral panuveitis and anisocoria MR Imaging Manifestations of Epstein Barr Virus (EBV) Encephalitis in Children Traumatic Pseudoaneurysm causing Intracerebral Haemorrhage in a Child: The importance of CT angiography in blunt head trauma. Pediatric Crossed Cerebellar Diaschisis: A case report and review of the pathophysiology Non visualization of dural sinuses in the setting of posterior fossa epidural collection- Are the sinuses compressed or thrombosed? Imaging Dietl’s crisis (intermittent ureteropelvic junction obstruction) with renal ultrasound and nuclear medicine renogram Novel use of a disposable pressure transducer for intracranial pressure measurement for nuclear medicine CSF shunt studies The use of 18F-Fluoro-Deoxy-Glucose Fused Positron Emission Tomography CT in Detecting Recurrent Hepatoblastoma at a large tertiary Children’s Hospital Inflammatory Myofibroblastic Tumor: ‘Pseudo’ tumor Or ‘Real’ Tumor? Unique Imaging Characteristics of Primary Pediatric Lymphoma of Bone: A Case Series Extranodal Rosai-Dorfman Disease of the Pediatric Female External Genitalia Primary mature teratoma presenting as an adrenal tumor in an Infant. Anaplastic Lymphoma—an unusual presentation and a diagnostic dilemma. An Introduction to PPB: A Case Report of Pleuropulmonary Blastoma MRI abdomen/pelvis in pediatrics: Is DWI part of your routine protocol? The Great Imitator: A Case Report of Congenital Syphilis Traumatic Handle Bar Injury with Aortic Disruption Imaging of Hepatopulmonary syndome, a case report Pulmonary artery sling with type IIa tracheobronchial anomaly and imperforate anus

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253


Educational Exhibits EDU-001


EDU-002 EDU-003 EDU-004 EDU-005 EDU-006 EDU-007 EDU-008

Agarwal Kunam Ayyala Aamir Farmakis Withdrawn Constantino

EDU-009 EDU-010 EDU-011 EDU-012 EDU-013

Hoare Blask Deaver Nagaraj Chan



EDU-015 EDU-016 EDU-017 EDU-018 EDU-019 EDU-020 EDU-021 EDU-022 EDU-023 EDU-024 EDU-025 EDU-026

Tenenbaum Withdrawn Ngo Aamir Liang Brown Decter Peterson Gowdy Yoo Gowdy McGraw





How low can we go? Iterative Reconstruction Techniques to achieve pediatric CT radiation dose less than 1 mSv. Auto mAs and Auto kVp: Improving Child Size Parameters for Dose Reduction Radioisotope Imaging: Strategies to Decrease Radiation Exposure in Pediatric Patients Multi-modality Imaging of Vascular Anomalies in Alagille Syndrome in Children: A Pictorial Review Pediatric cardiac devices: Review of imaging features and complications Perspectives in state-of-the-art vascular MR imaging with blood pool contrast agent Cardiac CT with 3D Segmentation of Congenital Aortic Arch Anomalies: A Pictorial Review with Surgical Correlation Congenital Brain Tumours—Antenatal and Postnatal Imaging Features Prenatal Imaging of the Gastrointestinal Tract with Postnatal Imaging Correlation Imaging the Prenatal Spine: Dysraphism and Beyond The Dandy-Walker Spectrum: Fetal MR findings with postnatal correlation Common Genitourinary Fetal MRI Diagnoses with Postnatal Imaging Correlation: What Clinicians Need to Know Common Thoracic Fetal MRI Diagnoses with Postnatal Imaging Correlation: What Clinicians Need to Know 3 T Fetal MRI: Review of Safety and Benefits Pictorial Review of Proper and Improper Enteric Tube Placement Imaging pediatric peritoneal pathology: Beyond the misty mesentery Appendicitis or Not Appendicitis: Imaging Acute Right Lower Quadrant Pain in Children Pictorial Review of Pancreatic Duct Anomalies seen on Pediatric MRCP Imaging of Complications of Enteric Tubes in Children More than Appendicitis: An Ultrasound Pictorial Review Pictorial Review of Acquired Abnormalities of the Biliary Tree MR Enterography of Pediatric Inflammatory Bowel Disease and its Complications- A Pictorial review. Pictorial Review of Congenital Bile Duct Abnormalities with Clinical and Pathological Correlation Pediatric Liver Masses: A Pictorial Review with Emphasis on Ultrasound, Computed Tomographic and Magnetic Resonance Appearance MR Enterography: Differences Between Active Chron’s Disease and Ulcerative Colitis in Pediatric Population MR Enterography: How to Recognize Post Treatment Changes in Chron Disease in Pediatic Population? Pediatric Liver Masses—Multimodality Evaluation with Pathologic Correlation



EDU-030 EDU-031 EDU-032

Shaikh Breen Kocaoglu

EDU-033 EDU-034

Phewplung Thompson

EDU-035 EDU-036 EDU-037 EDU-038 EDU-039

Kricun Rubio Yoo Deshmukh Hancock

Pictorial Essay in Performing Barium Enemas The Role of Imaging in Pediatric Bladder Augmentation Split-Bolus MR urography: Synchronous visualization of obstructing vessels and collecting system in children. The Why, When and How of Magnetic Resonance Urography Radiographic Features of Uncommon Benign and Malignant Bladder Abnormalities that Present with Hematuria Imaging of the Genitourinary Tract during VCUG in the Pediatric Population: A Pictorial Review Beyond Torsion: Common and Uncommon Entities Encountered in Acute Pediatric Scrotal Evaluation Evaluation of Renal/Urinary Anomalies with MR Urography. Pediatric Cystic Renal Disease: Review of pathology, imaging features, mimics and differential diagnosis. The Pediatric Renal Lesion—A logical approach to a not uncommon diagnostic finding.

EDU-040 EDU-041 EDU-042

Shruti Nguyen Krishnamurthy

Pictorial Review of Disease seen on MR Urogram Bubbly Badness in the Pediatric Genitourinary System. Capsular, Conceptual and Continuing Education in Pediatric Cardiovascular Imaging

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S30 EDU-043


EDU-044 EDU-045 EDU-046 EDU-047 EDU-048 EDU-049 EDU-050

Sze Reid Chiramel Sharma Sharma Griggs Jadhav

EDU-051 EDU-052 EDU-053 EDU-054 EDU-055 EDU-056 EDU-057 EDU-058 EDU-059

Johnsen Blumer Hull Aquino Soliman Vatsky McMahan Silva Sharafinski

EDU-060 EDU-061 EDU-062 EDU-063 EDU-064 EDU-065 EDU-066 EDU-067 EDU-068 EDU-069 EDU-070 EDU-071 EDU-072 EDU-073 EDU-074 EDU-075 EDU-076 EDU-077 EDU-078 EDU-079 EDU-080 EDU-081 EDU-082 EDU-083

Yam Withdrawn Grissom Alaref Liang Bartlett Joshi Winfeld Drake Bosemani Hayes Hendi Muthusami Nguyen Withdrawn Kelly Le Bailey Ledford Vorona Holwerda Whitehead Kricun Maki



EDU-085 EDU-086 EDU-087 EDU-088 EDU-089 EDU-090 EDU-091 EDU-092 EDU-093 EDU-094 EDU-095

Kricun Reddy Kricun Gill Ledford Hurteau-Miller Gadde Withdrawn Shaikh Zahra Yoo

EDU-096 EDU-097 EDU-098 EDU-099 EDU-100

Moy Otero Withdrawn Alazraki Shah



Teaching to the New Diagnostic Radiology Core Exam: An Innovative Audience Response Based-Approach via the Resident’s Cellphone or Tablet An efficient and cost-effective way to create videos for Radiology education Micro-learning: Pediatric Radiology skills and knowledge transfer in 5min or less through “You Tube®” Using Redcap (Research Electronic Data Capture) as a tool to perform research studies MR-HIFU: Applications in Pediatric Oncology and Surgery MR-HIFU: A Primer for Pediatric Radiologists Complications of Vascular Interventional Procedures in Children: A Radiographic Review Multi-compartmental steroid joint injections of the wrist and ankles in juvenile idiopathic arthritis: Rationale and comprehensive review A pictorial review of Lisfranc injury in pediatric patients Using Low Dose Digital Slot-Scanning for Orthopedic Imaging in Children: How we do it Impact of a Novel Upright Low-dose Slot Scanner Biplanar X-ray System (EOS) in Pediatric Orthopedics Whole Body MRI of Juvenile Spondyloarthritis: Protocol and Characteristic Patterns Imaging of Systemic Vasculitis in Childhood: A “Geographic” Pictorial Essay Fluoroscopic arthrography, a forgotten tool in evaluating shoulder pathology in the pediatric patient. Lytic acetabular tumors in the pediatric population Cartilage Injuries of the Pediatric Knee Transient patellar dislocation in pediatric patients: Evaluation of the preoperative, normal postoperative, and complicated postoperative states. Imaging of the pediatric sacrum and sacroiliac joints: sometimes a pain in the butt! Maturation of the Triradiate Cartilage on CT in Healthy Children MR Arthrogram of the Shoulder in Children: A Correlation between Radiologic and surgical Findings. “You Are My Density”: Sclerotic Bone Lesions in Children Palpable Masses of the Pediatric Foot and Ankle: Imaging Evaluation Vertebral lesions in children: A pictorial review Imaging of Non-Traumatic Pediatric Foot Deformities: A Clinical Perspective Ultrasound of “Lumps and Bumps”: A Pictorial Essay Susceptibility-weighted imaging: a powerful diagnostic tool in pediatric neuroimaging Acute Toxic Brain Injuries in Children: a Simple Approach to Rapid Radiological Diagnosis Zebras in the Pediatric Brainstem Pictorial review of pediatric syndromic CNS vascular disorders Pre- and Post-operative MRI Imaging of Endoscopic Third Ventriculostomy MRI Bone Marrow Patterns in the Normal Developing Head and Spine Not Just Another Lymph Node: Unusual Causes of Neck Masses in Infants and Children A Case Based Approach to Pediatric Pontine Lesions MR Imaging of Pediatric Bone Marrow Disease States Diffusion Tensor Imaging (DTI) in Pediatric Neuroradiology: An Overview From the Everyday to the Exotic: A Cased Based Review of Pediatric Head and Neck Tumors. The Imaging Workup of Childhood Ptosis A Multimodality Review of Nasal Masses in the Pediatric Population: Sniffing Out the Diagnosis The Phakomatoses: A Focus on Imaging of Neurofibromatosis Types I & II, Von Hippel-Lindau, Tuberous Sclerosis and Sturge-Weber Syndrome Taking a “Bite” out of the Mandible: A Wide Spectrum of Mandibular Lesions in the Pediatric Population MR Imaging in Children with Sellar Pathology Spectrum of Imaging Findings in Cerebellar Malformations The Skull Base Revisited: Anatomy of the skull base on CT Cervical Spine Radiographs: Normal or Not? Demystifying Premature Sutural Closure Sinonasal imaging in children The Chiari malformations, revisited: a pictorial essay Neonatal Jaundice Made Easy—The Nuclear Way Tc99M-MAG3 Diuretic Renography in Pediatrics: A Pictorial Review Hepatobiliary Scans and Supplemental Modalities (US & MRCP) in the Diagnosis of Biliary Atresia- an institutional review. The spectrum of imaging findings in renal lymphoma in the pediatric population Multimodality Imaging of Pediatric Head and Neck Neoplasms utilizing CT, MRI and 18FDG PET Pediatric Thyroid Ultrasound: To biopsy or not? Hair Apparent: Clinical and Radiological Features of Hairy Diseases and Their Mimickers in the Pediatric Population The Pediatric Breast: What to do with Lumps and Bumps

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Sharatz Braithwaite Serai Baines

EDU-106 EDU-107

Inarejos Clemente Baez

EDU-108 EDU-109

Baad Otrakji

EDU-110 EDU-111

Horsley Shah


Abnormal Calcifications in Infants and Young Children—A Pictorial Review Pictorial Review: Complications of implanted surgical devices in pediatric patients Early experience with gadoterate meglumine (Dotarem) at a large tertiary care, U.S. Children’s Hospital Understanding the potential for sedation-related complications associated with diagnostic imaging exams: An educational tool for parents Thyroglossal duct cysts in children: sonographic and histopathologic correlation—what matters? A Practical Approach to Pediatric Chest MRI: Bridging the Gap between Inherent Challenges and Clinical Practice Pediatric Upper Airway Emergencies Dual Energy CT in young children: a new low dose technique for characterizing focal lesions without general anesthesia Mass-like Lung Opacity in the Pediatric Population: Multimodality Pictorial Review How to approach Unilateral Hyperlucent Hemithorax in Children?

Scientific Exhibits SCI-001


SCI-002 SCI-003 SCI-004

Springer Ramirez-Giraldo Bernbeck









SCI-009 SCI-010

Deng Ekram



SCI-012 SCI-013

Sanghvi Fagen



SCI-015 SCI-016

Kuo-Bonde Kitami

SCI-017 SCI-018

Abdullah Sheybani

SCI-019 SCI-020 SCI-021 SCI-022

Loewen Kassis Almotairi Eslamy







Tool for rapid comparison of current exam dose to dose index registry values at the time of image acquisition and interpretation Effective Dose Estimates for Four Types of Fluoroscopy Examinations Performed at a Pediatric Hospital Radiation Dose and Image Quality in Pediatric Dual Energy CT: Phantom Study Pediatric Chest Radiography Dose Monitoring by S Values: An Efficient Way to Indirectly Monitor Exposure Indices at the PACS Station Radiation Exposure From Imaging Procedures In Pediatric Emergency Medicine—A Survey of Physician Knowledge and Risk Disclosure Practice Radiation dose and image quality in the use of low-dose C-arm CT in the treatment of head and neck vascular malformations Radiation dose and image quality in the use of low-dose C-arm CT in the treatment of temporomandibular joint arthritis in patients with juvenile idiopathic arthritis Coronary CT angiography in pediatric patients of different ages, using a second generation dual-source CT scanner Optimization of NATIVE TrueFISP protocol for non-contrast renal MRA Risk Factors for Compromised Venous Assess in Pediatric Patients with Congenital Heart Disease before Heart Transplant Towards radiation dose reduction in MDCT with iterative reconstruction for the prenatal diagnosis of skeletal dysplasia: the minimum radiation dose required to evaluate the normal fetal bones? A Novel Near-Infrared Imaging Approach to Visualizing Peripherally Inserted Central Catheters MRI in the Male Fetus with Megacystis: Imaging Features and Contributions to Diagnosis and Management Cerebral Perfusion Measurements using dynamic Color Doppler Sonography in Normal Neonates and Neonates with Mild Hypoxic Ischemic Encephalopathy MRA characterization of supraclavicular brown fat in infants Evaluation of fetal cystic lung lesions—“Hump sign” suggesting congenital pulmonary airway malformation type 1. Incidental Maternal Findings on Fetal MRI Studies Incidental Extra-intestinal Findings on Magnetic Resonance Enterography in Children with Inflammatory Bowel Disease Magnetic Resonance Enterography Identifies Silent Crohns Disease Imaging of extraintestinal manifestations of IBD in children and young adults Utility of MRI in pediatric multiple liver lesions. Effect of Slow Intravenous Infusion of Glucagon on Small Bowel Peristalsis in Magnetic Resonance Enterography Assessment of the value of upper gastrointestinal series for evaluation of malrotation and volvulus in patients with a distal obstructive bowel gas pattern on abdominal radiograph. Recognizing Causes of Inaccurate Ultrasound Diagnoses in Pediatric Appendicitis by Direct Imaging-Histology Correlation of Equivocal Cases Appendicoliths on Ultrasound are Highly Specific for Appendicitis in Patients with Abdominal Pain



Assessment of upper gastrointestinal studies (UGI) in children with 22q11.2 deletion syndrome.

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Patrick Swischuk Marine Cardenas Blask Blask Tse



SCI-035 SCI-036 SCI-037 SCI-038 SCI-039

Lungren Chand Vatsky Shah Kammen

SCI-040 SCI-041 SCI-042 SCI-043 SCI-044 SCI-045 SCI-046 SCI-047 SCI-048

McKinney AlRayahi Batmanabane Mubarak Kim Thompson Pluto Kucera Galassi

SCI-049 SCI-050 SCI-051 SCI-052

AlRayahi Vali Tsai Farley

SCI-053 SCI-054 SCI-055 SCI-056 SCI-057 SCI-058

Pugmire Li Chang Baez Tan Swerdlow

SCI-059 SCI-060

Tkach Tkach

Appendicitis in the Young Child—Pictorial Review Non-Fecalith Induced Appendicitis: Is There Another Etiology? Acute Abdominal Pain in Pediatric Patients with Chronic Colonic Dysmotiliy: Be aware of colonic volvulus. Medullary nephrocalcinosis: an overused diagnosis in pediatric patients? The sonographic diagnosis of testicular torsion in the pediatric patient: “Knot” that easy! Neonatal Testicular Torsion: Update on Sonographic Imaging and Management Diagnostic efficacy of novel vesicoureteric reflux imaging technique Voiding Urosonography (VUS): A systematic review Radiology Report Quality and Automated Speech Recognition Software Utilization: Errors and error rates—A 5year Assessment. Endovasular management of upper extremity deep venous thrombosis in children The Use of Totally Implantable Venous Access Devices for Chronic Apheresis in Children. Outpatient ultrasound guided renal biopsy: is it safe? Suprapubic Catheterizations in Pediatric Patients Rapid Two-Point DIXON Turbo Spin Echo (TSE) MR Imaging provides robust fat suppression for pediatric musculoskeletal imaging on 3T Assessing the Accuracy of MRI Sequences for Measurements of Pediatric Cartilage: A Phantom Study Skeletal dysplasia: Review and Approach A multimodal approach to imaging the visual pathway in pediatric syndromes with ocular involvement Brain MRI Findings in Patients with Developmental Delay With Correlation With Clinical Presentation Effect of Extracorporeal Membrane Oxygenation therapy on ventricular size. Cerebral Deep Venous Thrombosis in Children: Spectrum of Imaging Findings based on Structural Anatomy Pediatric Meningioma—Atypical and Typical Anatomic variants on neonatal spine ultrasound: frequency and clinical significance Role of magnetic resonance in the management of pediatric patient with Guillan-Barrè Syndrome in acute and chronic phase Correlation of Clinical Presentation and Brain MRI Findings in Children with Seizure Disorders The usefulness of FDG-PET/CT scan imaging at initial diagnosis of post-transplant lymphoproliferative disease. Normal FDG uptake in the pediatric thymus on PET imaging Misty Mesentery in Patients with Pheochromocytoma Corresponds to Activated Brown Adipose Tissue on F18-FDG PET-CT Early validation of combined 18F-FDG PET/MRI in pediatric cancer patients Single acquisition 3D versus multi-plane 2D pelvic imaging: Can a single sequence replace many? Analysis of thyroid masses detected on thyroid sonography in children Incidental Thyroid Nodules Detected on Thoracic Contrast Enhanced CT: Prevalence and Outcomes Congenital cystic lung lesions: computed tomography characteristics Fluoroscopic imaging, compared to endoscopic visualization, improves detection of esophageal stricture in children with Eosinophilic Esophagitis T2*-MRI Relaxometry Assessment of Liver Iron Concentration in Neonates: A Feasibility Study Cine MRI Evaluation of Intestinal Motility in Preterm Infants: A Feasibility Study

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The Society for Pediatric Radiology is dedicated to fostering excellence in pediatric health care through imaging and image-guided care. SITES OF PREVIOUS MEETINGS 1991 & IPR‘91 1992 1993

Stockholm, Sweden Orlando, Florida Seattle, Washington

1994 1995 1996& IPR‘96 1997 1998 1999 2000 2001 & IPR‘01 2002 2003 2004 2005 2006 & IPR‘06 2007 2008 2009 2010 2011 & IPR‘11

Colorado Springs, Colorado Washington, D.C. Boston, Massachusetts St. Louis, Missouri Tucson, Arizona Vancouver, British Columbia, Canada Naples, Florida Paris, France Philadelphia, Pennsylvania San Francisco, California Savannah, Georgia New Orleans, Louisiana Montreal, Quebec, Canada Miami, Florida Scottsdale, Arizona Carlsbad, California Boston, Massachusetts London, England

2012 2013

San Francisco, California San Antonio, Texas

FUTURE MEETINGS 2015 2016 & IPR‘16 2017

April 27-May 1, 2015 May 16–20, 2016 May 16–20, 2017


Board of Directors Sue C. Kaste, DO, Chair Richard A. Barth, MD, President Brian D. Coley, MD, President-Elect James Donaldson, MD, 1st Vice President Diego Jaramillo, MD, MPH, 2nd Vice President Christopher I. Cassady, MD, Secretary Molly E. Dempsey, MD, Treasurer George S. Bisset, MD Edward Y. Lee, MD, MPH Lisa H. Lowe, MD, FAAP Beverley Newman, MBBCh, FACR Cynthia K. Rigsby, MD Rafael Rivera, MD Neil D. Johnson, MBBS, Past President Dorothy I. Bulas, MD, Past President

Seattle, Washington Chicago, Illinois Vancouver, British Columbia, Canada


Donald P. Frush, MD, FACR, Past President M. Ines Boechat, MD, FACR, WFPI Liaison Marilyn J. Goske, MD, Image Gently Alliance Liaison Marta Hernanz-Schulman, MD, FACR, ACR Commission LiaisonPeter J. Strouse, MD, FACR, Editor Benjamin H. Taragin, MD, Web Editor Robert C. McKinstry, MD, PhD, SOCRCH President Maria-Gisela Mercado-Deane, MD, AAP Radiology Section Head Adbominal Imaging Committee Daniel J. Podberesky, MD, Chair Karen Blumberg, MD, FACR Jonathan R. Dillman, MD Edward Y. Lee, MD, MPH Arthur Meyers, MD Martha M. Munden, MD Ethan A. Smith, MD Andrew T. Trout, MD Bylaws Sue C. Kaste, MD, Chair Lisa H. Lowe, MD, FAAP Rafael Rivera, MD Cardiac Imaging Committee Dianna M. E. Bardo, MD, Chair Molly E. Dempsey, MD Sadaf T. Bhutta, MD, MBBS Lorna P. Browne, MB BS Harris L. Cohen, MD, FCR Maryam Ghadimi-Mahani, MD S. Bruce Greenberg, MD Shilpa Hedge, MD Jeffrey C. Hellinger, MD Joshua Q. Knowlton, MD Prakash M. Masand, MD Mike Seed, MBBS Cynthia K. Rigsby, MD, FACR Laureen M. Sena, MD Suraj Serai, PhD Shreyas S. Vasanawala, MD, PhD Sjirk J. Westra, MD Child Abuse Committee Jeannette M. Perez-Rossello, MD, Chair Leslie A. Bord, MD Stephen D. Brown, MD Jerry R.l. Dwek, MD Lynn A. Fordham, MD P. Ellen Grant, MD, MSc Laura L. Hayes, MD Thaddeus W. Herliczek, MD, MS Lisa H. Lowe, MD, FAAP Bradley A. Maxfield, MD Daniel M. Schwartz, MD Sabah Servaes, MD Andy Tsai, MD Consultants: Ingrid Holm, MD Carole Jenny, MD Paul K. Kleinman, MD Ms. Joelle Moreno

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Clinical Practices Steering Committee Christopher I. Cassady, MD, Co-Chair James Donaldson, MD, Co-Chair Dianna M. E. Bardo, MD Jerry R. I. Dwek, MD Judy A. Estroff, MD G. Peter Feola, MD Lynn A. Fordham, MD Geetika Khanna, MD Beth M. Kline-Fath, MD Beverley Newman, MBBCh, FACR Marguerite T. Parisi, MD, MS Jeannette M. Perez-Rossello, MD Daniel J. Podberesky, MD Tina Young Poussaint, MD Dennis W. Shaw, MD Shreyas S. Vasanawala, MD, PhD Sjirk J. Westra, MD Community Hospital-based Pediatric Radiologists Debra J. Pennington, MD, Chair Maria-Gisela Mercado-Deane, MD Contrast-Enhanced Ultrasound Task Force Kassa Darge, MD, PhD, Chair Dorothy I. Bulas, MD Brian D. Coley, MD Jonathan R. Dillman, MD Lynn A. Fordham, MD M. Beth McCarville, MD Sara M. O’Hara, MD Harriet J. Paltiel, MD Frank M. Volberg, MD CT Committee Sjirk J. Westra, MD, Chair Sheila C. Berlin, MD Steven L. Blumer, MD Michael J. Callahan, MD Jonathan R. Dillman, MD R. Paul Guillerman, MD Thaddeus W. Herliczek, MD, MS Edward Y. Lee, MD, MPH John D. MacKenzie, MD Grace S. Phillips, MD Anil G. Rao, DMRD, DNB Pallavi Sagar, MD Sabah Servaes, MD Alexander J. Towbin, MD Education – Curriculum Diego Jaramillo, MD, MPH, Chair Brian D. Coley, MD Molly E. Dempsey, MD Donald P. Frush, MD, FACR Sue C. Kaste, DO Arnold Merrow, MD Sarah S. Milla, MD Peter J. Strouse, MD, FACR Fellowship Program Directors Jane E. Benson, MD, Chair



Fetal Imaging Beth M. Kline-Fath, MD, Chair Leslie A. Bord, MD Dorothy I. Bulas, MD Maria A. Calvo-Garcia, MD Lucia Carpineta, MD, CM Kimberly A. Dannull, MD Monica Epelman, MD Judy A. Estroff, MD Shilpa Hegde, MD Hollie A. Jackson, MD Mariana L. Meyers, MD Cynthia K. Rigsby, MD Ashley J. Robinson, MBChB Erika Rubesova, MD Chetan C. Shah, MD Teresa Victoria, MD, PhD Finance Stephen F. Simoneaux, MD, Chair Brent H. Adler, MD Richard A. Barth, MD Brian D. Coley, MD Molly E. Dempsey, MD Diego Jaramillo, MD, MPH Matthew Schmitz, MD Randheer Shailam, MD History Alan Schlesinger, MD, Historian N. Thorne Griscom, MD, Consultant Honors Neil D. Johnson, MBBS, Chair Dorothy I. Bulas, MD Donald P. Frush, MD, FACR Informatics Alexander J. Towbin, MD, Chair R. Paul Guillerman, MD James D. Ingram, MD Neil D. Johnson, MBBS David B. Larson, MD, MBA Edward Y. Lee, MD, MPH Peter A. Marcovici, MD Janet R. Reid, MD Mahesh M. Thapa, MD, BS Keith S. White, MD Innovation Donald P. Frush, MD, FACR, Chair George S. Bisset, MD Brian D. Coley, MD Neil D. Johnson, MBBS Sue C. Kaste, DO Peter J. Strouse, MD, FACR Alexander J. Towbin, MD Jennifer K. Boylan, MA Angela R. Davis, CAE Corporate Colleagues: Cheri Gotke Cindee Guy Eugene Mensah, PhD, MBA Craig Peterson Chrisine Ziemba-Landon

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Interventional G. Peter Feola, MD, Chair Mark A. Bittles, MD John J. Crowley, MD Els Nijs, MD Rafael Rivera, MD Ashley J. Robinson, MBChB Andrew T. Trout, MD Judiciary Richard B. Gunderman, MD, FACR, Chair Stephen D. Brown, MD Neil D. Johnson, MBBS Charles D. Williams, MD MR Committee Shreyas S. Vasanawala, MD, PhD, Chair Adina L. Alazraki, MD Kiery A. Braithwaite, MD Govind B. Chavhan, MD DNB Taylor Chung, MD Jesse Courtier, MD Michael S. Gee, MD, PhD Ramesh S. Iyer, MD Arzu Kovanlikaya, MD Jeannie K. Kwon, MD Edward Y. Lee, MD, MPH Michael M. Moore, MD Anil G. Rao, DMRD, DNB Mahesh M. Thapa, MD, BS MSK Committee Jerry R. I. Dwek, MD, Chair Lynn A. Fordham, MD Tal Laor, MD Arthur Meyers, MD Beverley Newman, MBBCh, FACR Shawn E. Parnell, MD Neuroradiology Tina Young Poussaint, MD, Chair S. Srinivas Ganapathy, MD Marta Hernanz-Schulman, MD, FACR Paritosh C. Khanna, MD, DMRE Arzu Kovanlikaya, MD Sarah S. Milla, MD Sumit Pruthi, MD Raghu H. Ramakrishnaiah, MD Dennis W. Shaw, MD Cicero T. Silva, MD Aylin Tekes-Boyd, MD Lynn M. Trautwein, MD Newborn Judy A. Estroff, MD, Chair John B. Amodio, MD Leslie A. Bord, MD Christopher I. Cassady, MD Ellen Chung, MD Monica Epelman, MD Neil D. Johnson, MBBS Maria F. Ladino-Torres, MD Kathleen M. McCarten, MD, FACR Harriet J. Paltiel, MD Valerie L. Ward, MD Consultant: Richard Parad, MD



Nominating Sue C. Kaste, DO, Chair Ronald A. Cohen, MD Kassa Darge, MD, PhD Beth M. Kline-Fath, MD Edward Y. Lee, MD, MPH Lisa J. States, MD Raymond W. Sze, MD Nuclear Medicine Marguerite T. Parisi, MD, MS, Chair Lisa J. States, MD, Vice Chair Deepa R. Biyyam, MB BS Hedieh Eslamy, MD Marilyn J. Goske, MD Elizabeth A. Hingsbergen, MD Gerald A. Mandell, MD, FACR Lena Naffaa, MD Sara M. O’Hara, MD Victor J. Seghers, MD, PhD Sabah Servaes, MD Susan E. Sharp, MD S. Ted Treves, MD John B. Wyly, MD Oncology Committee Geetika Khann, MD, Chair M. Ines Boechat, MD, FACR Heike E. Daldrup-Link, MD, PhD Michael S. Gee, MD, PhD Michael J. Gelfand, MD Sue C. Kaste, MD Shailee Lala, MD M. Beth McCarville, MD Marguerite T. Parisi, MD, MS Sabah Servaes, MD Susan E Sharp, MD Marilyn J. Siegel, MD, FACR Thomas L. Slovis, MD Alexander J. Towbin, MD Shreyas S. Vasanawala, MD, PhD Stephan D. Voss, MD, PhD Consultants: Peter C. Adamson, MD Greg Reamon, MD Physician Resources Committee Rebecca L. Hulett-Bowling, MD, Chair Ramesh S. Iyer, MD Brooke S. Lampl, DO Jason B. Mitchell, MD Avrum N. Pollock, MD, FRCPC Mitchell L. Simon, MD Paul Thacker, MD Public Policy Richard M. Benator, MD, FACR, Chair Richard A. Barth, MD Kate A. Feinstein, MD, FACR Donald P. Frush, MD, FACR Matthew Schmitz, MD

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Publications Ashok Panigrahy, MD, Chair Dorothy I. Bulas, MD, FACR Edward Y. Lee, MD, MPH Ethan A. Smith, MD Christopher I. Cassady, MD, ex officio Sue C. Kaste, DO, ex officio Editors: Peter J. Strouse, MD, FACR Brian D. Coley, MD Geetika Khanna, MD Cynthia K. Rigsby, MD, FACR Research and Education Foundation Board Brian D. Coley, MD, President Richard A. Barth, MD, Vice President Christopher I. Cassady, MD, Secretary Molly E. Dempsey, MD, Treasurer Johan G. Blickman, MD, PhD, FACR Kassa Darge, MD, PhD Jonathan R. Dillman, MD Rajesh Krishnamurthy, MD Lisa H. Lowe, MD William H. McAlister, MD, FACR Richard L. Robertson, MD Stuart A. Royal, MS, MD, FACR Safety Dennis W. Shaw, MD, Chair George S. Bisset, MD Einat Blumfield, MD Lynn A. Fordham, MD Thomas R. Goodman, MBBCh Ramesh S. Iyer, MD David B. Larson, MD, MBA Michael M. Moore, MD Grace S. Phillips, MD Pallavi Sagar, MD Ramon Sanchez, MD Thomas L. Slovis, MD Dayna M. Weinert, MD Thoracic Imaging Beverley Newman, MBBCh, FACR, Chair Alan S. Brody, MD Maryam Ghadimi-Mahani, MD Shilpa Hedge, MD Ramesh S. Iyer, MD Edward Y. Lee, MD, MPH Daniel J. Podberesky, MD Peter J. Strouse, MD Paul Thacker, MD Sjirk J. Westra, MD Ultrasound Lynn A. Fordham, MD, Chair Ellen M. Chung, MD Harris L. Cohen, MD, FACR Monica Epelman, MD Ramesh S. Iyer, MD Shailee Lala, MD Martha M. Munden, MD Sara M. O’Hara, MD Cicero T. Silva, MD Andrew T. Trout, MD Dayna M. Weinert, MD


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Website Editorial Committee Benjamin H. Taragin, MD, Chair and Web Editor Amy R. Mehollin-Ray, MD, Assistant Web Editor Peter A. Marcovici, MD Representatives Richard M. Benator, MD, FACR, ACR Alternate Councilor Dorothy I. Bulas, MD, Academy of Radiology Research Brian D. Coley, MD, AIUM Kate A. Feinstein, MD, FACR, ACR Councilor Donald P. Frush, MD, FACR, ABR Trustee C. Matthew Hawkins, MD, ACR Council Steering Committeee Susan D. John, MD, FACR, ASER Maria–Gisela Mercado-Deane, MD, AAP Richard L. Robertson, MD, ASPNR Susan E. Sharp, MD, SNMMI Dennis W. Shaw, MD, ASPNR Member GOLD MEDALISTS 1988 1989 1990 1991 1991 1992 1993 1994

Frederic N. Silverman, MD John L. Gwinn, MD John F. Holt, MD John A. Kirkpatrick, Jr., MD Bernard J. Reilly, MB, FRCP Edward B. Singleton, MD Hooshang Taybi, MD Walter E. Berdon, MD

1994 1995 1995 1996 1996 1997 1997 1998 1999 2000 2001 2002 2003 2003 2004 2004 2005 2005

J. Scott Dunbar, MD Guido Currarino, MD Derek C. Harwood-Nash, MD, DSc Andrew K. Poznanski, MD Beverly P. Wood, MD N. Thorne Griscom, MD John F. O’Connor, MD William H. McAlister, MD E. Anthony Franken, MD Eric L. Effmann, MD Giulio J. D’Angio, MD David H. Baker, MD Brinton B. Gay, Jr., MD William H. Northway, Jr., MD Diane S. Babcock, MD Virgil R. Condon, MD Jerald P. Kuhn, MD Thomas L. Slovis, MD

2006 2006 2007 2008 2009 2010 2011

Robert L. Lebowitz, MD John C. Leonidas, MD Leonard E. Swischuk, MD Barry D. Fletcher, MD Charles A. Gooding, MD Janet L. Strife, MD Carol M. Rumack, MD

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 2012 2013 2014

Marilyn J. Goske, MD Stuart A. Royal, MS, MD David C. Kushner, MD, FACR

PIONEER HONOREES 1990 1991 1992 1993 1994 1995 1996 1996

John Caffey, MD M.H. Wittenborg, MD Edward B. Singleton, MD Frederic N. Silverman, MD John P. Dorst, MD E.B.D. Neuhauser, MD Edmund A. Franken, MD Kazimierz Kozlowski, MD

1996 1997 1998 1998 2000 2001 2001 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

M. Arnold Lassrich, MD Arnold Shkolnik, MD Heidi B. Patriquin, MD William H. Northway, Jr., MD Jerald P. Kuhn, MD Diane S. Babcock Fred E. Avni, MD, PhD Walter E. Berdon, MD G.B. Clifton Harris, MD Rita L. Teele, MD Robert L. Lebowitz, MD Carol M. Rumack, MD Paul S. Babyn, MD Kenneth E. Fellows, MD David K. Yousefzadeh, MD Massoud Majd, MD George S. Bisset, III, MD Barry D. Fletcher, MD


Diego Jaramillo, MD, MPH

PRESIDENTIAL RECOGNITION AWARDS 1999 2000 2001 2001 2002 2002 2003 2003 2004 2005 2005 2005 2006 2007

David C. Kushner, MD Paul K. Kleinman, MD Neil D. Johnson, MBBS Christopher Johnson Jennifer K. Boylan Thomas L. Slovis, MD Danielle K.B. Boal, MD Marta Hernanz-Schulman, MD Kenneth L. Mendelson, MD Taylor Chung, MD J. A. Gordon Culham, MD Shi-Joon Yoo, MD L. Christopher Foley, MD Donald P. Frush, MD

2008 2008 2008

Mary K. Martel, PhD Connie L. Mitchell, MA, RT(R)(CT) Harvey L. Neiman, MD


Pediatr Radiol (2014) 44 (Suppl 1):S1–S253

S42 2009 2010 2011 2011 2012 2012 2013 2014

Karen S. Schmitt Richard A. Barth, MD Kimberly E. Applegate, MD, MS, FACR Keith Strauss, MS, FACR David C. Kushner, MD, FACR Stuart A. Royal, MS, MD Alan E. Schlesinger, MD Richard M. Benator, MD, FACR

HONORARY MEMBERS 1985 1987 1987 1987

Jacques Sauvegrain, MD Bryan J. Cremin, MD Ole A. Eklof, MD Clement C. Faure, MD

1987 1987 1987 1987 1998 1989 1990 1990 1991 1991 1991 1991 1991 1991 1991 1992 1992 1992

Andres Giedion, MD Denis Lallemand, MD Arnold Lassrich, MD Ulf G. Rudhe, MD Frederic N. Silverman, MD John L. Gwinn, MD John F. Holt, MD Richard G. Lester, MD Gabriel L. Kalifa, MD Javier Lucaya, MD John P. Masel, MD Noemi Perlmutter-Cremer, MD Hans G. Ringertz, MD John A. Kirkpatrick, Jr., MD Bernard J. Reilly, MB, FRCP(C) Edward B. Singleton, MD Donald R. Kirks, MD Beverly P. Wood, MD

1993 1992/94 1994 1994 1994 1994 1994 1994 1995 1992/95 1995 1995 1996 1996 1996 1997 1996 1998 1998

Hooshang Taybi, MD Walter E. Berdon, MD Marie A. Capitanio, MD Edmund A. Franken, Jr., MD John C. Leonidas, MD William H. McAlister, MD Andrew K. Poznanski, MD J. Scott Dunbar, MD David H. Baker, MD Derek C. Harwood-Nash, MD, DSc N. Thorne Griscom, MD Guido Currarino, MD Francis O. Brunelle, MD Lloyd L. Morris, MD Heidi B. Patriquin, MD John F. O’Connor, MD Theodore E. Keats, MD Rita L. Teele, MD H. Ted Harcke, MD

1999 2000

J. Bruce Beckwith, MD Joseph Volpe, MD

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 2001 2001 2001 2002 2002 2003 2004 2005 2006 2007 2008 2009 2009 2009 2009 2010 2011 2011 2012 2013 2014

Ulrich V. Willi, MD Henrique M. Lederman, MD Mutsuhisa Fujioka, MD Eric J. Hall, DSc, FACR, FRCR Walter Huda, PhD Michael R. Harrison, MD Lee F. Rogers, MD Carden Johnston, MD, FAAP, FRCP Alan B. Retik, MD Robert R. Hattery, MD Professor Hassen A. Gharbi Dolores Bustelo, MD Pedro A. Daltro, MD Cristian Garcia, MD Antônio Soares de Souza, MD Stephen Chapman, MD Catherine M. Owens, MBBS Madan M. Rehani, PhD Harvey L. Neiman, MD, FACR Savvas Andronikou, MBBCh, FCRad, FRCR, PhD Timothy M. Cain, MBBS

PAST PRESIDENTS 1958–59 1959–60 1960–61 1961–62 1962–63 1963–64 1964–65 1965–66 1966–67 1967–68 1968–69

Edward B. Neuhauser, MD* Frederic N. Silverman, MD* John F. Holt, MD* Arthur S. Tucker, MD* John W. Hope, MD* R. Parker Allen, MD Edward B. Singleton, MD J. Scott Dunbar, MD* Harvey White, MD* M.H. Wittenborg, MD* David H. Baker, MD

1969–70 1970–71 1971–72 1972–73 1973–74 1974–75 1975–76 1976–77 1977–78 1978–79 1979–80 1980–81 1981–82 1982–83 1983–84 1984–85 1985–86 1986–87

John A. Kirkpatrick, Jr., MD* Norman M. Glazer, MD* Bertram R. Girdany, MD* Donald H. Altman, MD Hooshang Taybi, MD* John L. Gwinn, MD* Lawrence A. Davis, MD* Marie A. Capitanio, MD John P. Dorst, MD* Bernard J. Reilly, MB, FRCP (C) Walter E. Berdon, MD Andrew K. Poznanski, MD N. Thorne Griscom, MD Virgil R. Condon, MD Jerald P. Kuhn, MD Lionel W. Young, MD John C. Leonidas, MD* Derek C. Harwood-Nash, MD, DSc*

IPR ‘87 1987–88 1988–89

Denis Lallemand, MD (ESPR) Beverly P. Wood, MD John F. O’Connor, MD*


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S44 1989–90 1990–91 IPR ‘91 1991–92 1992–93 1993–94 1994–95 1995–96 IPR ‘96 1996–97 1997–98 1998–99 1999–00 2000–01 IPR‘01 2001–02 2002–03 2003–04 2004–05 2005–06 IPR‘06 2006–07 2007–08 2008–09 2009–10 2010–11 IPR‘11 2011–12 2012–13 *Deceased

E.A. Franken, Jr., MD Donald R. Kirks, MD Hans G. Ringertz, MD, PhD (ESPR) William H. McAlister, MD M. B. Ozonoff, MD Joanna J. Seibert, MD Eric L. Effmann, MD Kenneth E. Fellows, MD Paul S. Thomas, MD (ESPR) Diane S. Babcock, MD Charles A. Gooding, MD Robert L. Lebowitz, MD Thomas L. Slovis, MD Janet L. Strife, MD Francis Brunelle, MD (ESPR) Bruce R. Parker, MD Richard B. Towbin, MD David C. Kushner, MD Stuart A. Royal, MS, MD George A. Taylor, MD Richard Fotter, MD (ESPR) Marilyn J. Goske, MD Marta Hernanz-Schulman, MD M. Ines Boechat, MD Neil D. Johnson, MBBS Dorothy I. Bulas, MD Catherine M. Owens, MD Donald P. Frush, MD Sue C. Kaste, DO

SINGLETON-TAYBI AWARD 2006 2007 2007 2008 2009 2010 2011

Corning Benton, Jr., MD Michael P. D’Alessandro, MD Janet R. Reid, MD Dorothy I. Bulas, MD Lane F. Donnelly, MD Wilbur L. Smith, Jr., MD Ralph S. Lachman, MD, FACR

2012 2013 2014

Alan Daneman, MD Lisa H. Lowe, MD, FAAP Robert H. Cleveland, MD


This award is given to the author of the best paper presented by a Resident or Fellow at the SPR meeting. Beginning in 1995, the award became known as the John A. Kirkpatrick Young Investigator Award. 1993 1993 1994 1995 1996 1997

Philipp K. Lang, MD Stephanie P. Ryan, MD Sara O’Hara, MD Philipp K. Lang, MD Fergus V. Coakley, MB, FRCR Ronald A. Alberico, MD

1998 1999 1999 2000 2001

Laura J. Varich, MD A. E. Ensley, BS R.W. Sze, MD S. H. Schneider, MD Valerie L. Ward, MD

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Ricardo Faingold, MD Andrea Doria, MD Nina M. Menezes, PhD Lena Naffaa, MD Courtney A. Coursey, MD Ashley J. Robinson, MBChB Hee Kyung Kim, MD Conor Bogue, MD Albert Hsiao, MD, PhD Ethan A. Smith, MD Saivivek Bogale, MD Emma Raver, BA


Best Clinical Research Paper Swanson JO, Vavilala MS, Wang J, et al. Association of initial CT findings with quality-of-life outcomes for traumatic brain injury in children. Best Basic Science Paper Tkach JA, Hillman NH, Jobe AH. An MRI system for imaging neonates in the NICU: initial feasibility study. 2013 recipients will be announced at the meeting. For a list of prior recipients, please visit the SPR website.


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The SPR Research and Education Foundation is dedicated to promoting research and scholarship in pediatric radiology. The SPR Board of Directors has supported research through grants since 1990. The Foundation was established in 1994 with an initial donation from the Society’s reserves. The Jack O. Haller Award for Excellence in Teaching 2005 2006 2007 2008 2009 2010 2011

Alan Daneman, MD William R. Cranley, MD and John F. O’Connor, MD Cindy R. Miller, MD Sara J. Abramson-Squire, MD Michael A. DiPietro, MD George A. Taylor, MD Paul K. Kleinman, MD

2012 2013 2014 2014

Richard I. Markowitz, MD Gary L. Hedlund, DO Tal Laor, MD Carrie B. Ruzal-Shapiro, MD

The Heidi Patriquin International Fellowship 2005 2006 2006 2006 2007 2008 2009 2010 2011 2012

Luy Lyda, MD, Angkor Hospital for Children, Siem Reap, Cambodia Hakima Al-Hashimi, MD Salmaniya Medical Complex, Manama, Bahrain Pannee Visrutaratna, MD, Chiang Mai University, Chiang Mai, Thailand Juana Maria Vallejo, MD, Clinica del Country, Bogota, Colombia Nathan David P. Concepcion, MD, St. Luke’s Medical Center, Quezon City, Philippines Rolando Reyna Lopez, MD, Hospital Santo Tomas, Panama City, Panama Ahmed Mussa Jusabani, MD, Kilimanjaro Christian Medical Centre, Moshi Town, Tanzania Omolola Mojisola Atalabi, MD, College of Medicine, University of Ibadan, Nigeria Kushaljit Singh Sodhi, MD, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India) Wambani Sidika Jeska, MBchB, Kenyatta National Hospital, Nairobi, Kenya

2012 2013 2013 2014 2014

Yocabel Gorfu, MD, Addis Ababa University, Addis Ababa, Ethiopia Regina Nava, MD, St. Luke’s Medical Center, Quezon City, Philippines Olubukola Abeni Omidiji, MBBS, University of Lagos, Lagos, Nigeria Nneka I. Iloanusi, MBBS, University of Nigeria Teaching Hospital, Enugu, Nigeria Beatrice Mulama, MBChB, M. Med, Kenyatta National Hospital, Nairobi, Kenya

Pilot Award

Ashok Panigrahy, MD, Innovative Molecular and MR Neuroimaging Biomarkers of Pediatric Brain Tumors, Children’s Hospital of Pittsburgh of UPMC Seed Grants

Daniel B. Wallihan, MD, Liver Elastography as a marker for progressive hepatic disease and failing Fontan physiology, Cincinnati Children’s Hospital Medical Center Katharine L. Hopkins, MD, Pilot study of rapid multiparametric abdominal MRI in the diagnosis of pediatric appendicitis, Oregon Health and Sciences University Nancy Chauvin, MD, Early Knee Cartilage Changes in the Obese Child “Early Knee Cartilage Changes in the Obese Child, The Children’s Hospital of Philadelphia” Fellow Award

Aisling Snow, MB BCh BAO, Assessment of the diagnostic quality and clinical value of pediatric imaging studies performed at non-specialist imaging centers and imported to the radiology PACS system at a pediatric teaching hospital, Boston Children’s Hospital 2014 recipients will be announced at the meeting. For a list of prior grant recipients, please visit the SPR website.

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SOCIAL EVENTS SPR Research and Education Foundation Fun Run Underwritten by Texas Children’s Hospital Wednesday, May 14 6:00 a.m. (Meet in the lobby of the JW Marriott) Benefiting the Research and Education Foundation Join us for this 3-mile run on the National Mall and get your day off to a great start! Runners and walkers are all welcome. Entrance fee is $25 and includes a T-shirt. Welcome Reception Wednesday, May 14 6:15–7:30 p.m. JW Marriott Hotel Hors d’oeuvres and Refreshments Casual Attire Reception and Annual Banquet Friday, May 16 6:30–11:00 p.m. JW Marriott Reception, Dinner and Performance by Capitol Steps Business Casual Activities The JW Marriott Hotel employs a full-service concierge staff who are happy to share their detailed knowledge of Washington, D.C. and the surround area. The concierge desk is located on the lobby level of the Hotel. Additioanl information is included on the SPR website.


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SPR 2014 Gold Medalist The Gold Medal of The Society for Pediatric Radiology is our most distinguished honor. The SPR Medal is awarded to pediatric radiologists who have contributed greatly to the SPR and our subspecialty of pediatric radiology as a scientist, teacher, personal mentor and leader.

David C. Kushner, MD, FACR “Because Children Enhance Your Life” Edward Neuhauser Scientist, Teacher, Leader, Mentor—David C. Kushner is all these to so many people. His career has been characterized by outstanding leadership and great achievements while exuding an effortless efficiency, perennial smile, and twinkle in his eye. His astute guidance in business as well as medicine have uniquely helped the SPR, ACR, and the medical centers he has helped lead. David Kushner is a man of great vision who was lucky to have encountered many unique leaders throughout his career while wise enough to learn from them. Likely the only pediatric radiology gold medalist to be born in Fargo North Dakota, even as a young boy, he knew he wanted to be a doctor. Early in his life in Minnesota, he needed to earn money and went to a medical center at age 12 to find work. There he met Sewell Gordon, a pediatric radiologist when there were no pediatric radiologists. This encounter gave DCK the vision for his life’s work. He never looked back. With his goal of becoming a pediatric radiologist, Dr. Kushner first studied child development at the University of Minnesota. He went on to medical school at the University of Pennsylvania where he had the “best time of his life”. He met numerous giants in pediatrics (Lewis Barness, Frank Oski), pediatric surgery (C. Everett Koop, Judah Folkman.), taking over 1 ½years of pediatric electives during his Philadelphia years. Dr. Kushner spent 2 years at NIH completing a 2 years fellowship in embryology and teratology. Pursuing his life’s vision then led DCK to Boston where he completed a radiology residency at Massachusetts General and Boston Children’s Hospital. He met many radiology giants during that era including Juan Tavaras, Murray Janower, John Kirkpatrick, Clif Harris, Thorne Griscom, Edward Neuhauser, Bob Lebowitz, Roy Strand, Ken Fellows, Bob Wilkinson, Rita Teele, Ted Treves and Jack O’Connor. He become fondly known as “Mad Dog”, and was quickly appointed section chief of pediatric radiology at Massachusetts General in 1979. While there, he developed his superb administrative skills under the tutelage of the great Juan Tavaras. When an opening for Director of Pediatric Radiology became available at Children’s National Medical Center in 1988, he was up to the challenge of building a pediatric radiology in the nation’s capital. Over the next 15 years, he built the department, trained numerous fellows, and survived challenges from health care threats and competing initiatives. He loved the international culture of the city, the fine arts and music opportunities, taking guitar lessons and learning to love the blues. DCK thrived during these years and became an important national leader on the behalf of pediatric radiology. His pivotal work for the Society for Pediatric Radiology included being SPR Treasurer and President of the Research and Education Foundation helping launch the fundraising “Campaign for Children”. He served as SPR President from 2003 to 2004 running a successful Savannah meeting. As Chair of the Board of Directors he led a strategic planning process which resulted in more focused divisions and clearly defined board responsibilities. Dr. Kushner also became an important leader in the American College of Radiology advocating tirelessly for children’s health while serving on the Council Steering Committee, then Council Vice Speaker and Speaker. He helped establish a pediatric radiology caucus at the annual ACR meeting. He brokered the SPR partnership with the ACR re society management and helped establish the first pediatric commission of the ACR while on the Board of Chancellors. He tirelessly contributed to the pediatric component of the ACR practice guidelines. When the opportunity came to move to Norfolk in 2005, DCK took up the challenge. He has thrived at King’s Daughters where he now works with great partners and staff. With his wife Peggy, DCK now lives on the waters of the Chesapeake where his love of sailing and fishing can be fulfilled. With five children and six grandchildren, his life remains full.

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David C. Kushner’s official title on his business card says much about this creative visionary. 1. 2. 3. 4. 5. 6.

Grandfather Unemployed musician Fly fisherman Sailor Italian cook Professor of Radiology and Pediatrics

DCK states “Everything that I can be said to have accomplished has come to me through the grace, charity and mentoring of others; and from plain dumb luck.” The Society for Pediatric radiology is lucky to have this tour de force as an advocate, mentor, and educator for children’s health. Dorothy I. Bulas, MD


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SPR 2014 Pioneer Honoree Pioneer Honorees were first acknowledged in 1990 as a means to honor certain physicians who made special contributions to the early development of our specialty.

Diego Jaramillo, MD, MPH Dr. Diego Jaramillo is the recipient of the 2014 SPR Pioneer Award in recognition of his numerous significant scientific and educational endeavors to advance the mission of the SPR and improve the healthcare of children. Throughout his career, Dr. Jaramillo has embodied the spirit of a pioneer by trailblazing new areas of research in pediatric musculoskeletal imaging. Diego was born in Cali, Columbia. His father was a gastroenterologist, who performed barium studies as part of his practice. Diego has early memories of red goggles and developing radiographs with images of upper GI’s and enemas. From his mother he remembers above all her kindness and intelligence, and a beautiful combination of discipline and reverence. He received his MD degree with Valedictorian recognition in 1981, from the Pontificia Universidad Javeriana in Bogota, Colombia, followed by a diagnostic radiology residency at the University of Texas in Houston. Subsequently, he trained as a pediatric radiology fellow at the Boston Children’s Hospital in 1987, where he was highly influenced by Dr. John A Kirkpatrick. Diego credits Dr. Kirkpatrick as a great mentor, who led by example and taught him about radiology, life, and the pediatric skeleton. Dr. Jaramillo was appointed to the faculty of Harvard Medical School from 1990 to 2004, serving as an attending radiologist at Boston Children’s Hospital and subsequently as division chief of pediatric radiology at the Massachusetts General Hospital. Diego also earned a Masters degree at the Harvard School of Public Health in 2002. In 2004, Dr. Jaramillo was appointed Radiologist-in-Chief and the Van Alen Chair of Radiology at the Children’s Hospital of Philadelphia and Professor of Radiology at the University of Pennsylvania School of Medicine. Diego has developed a renowned Department of Radiology at CHOP emphasizing excellence in pediatric radiology, pediatric care, expansion of knowledge, and the creation of a collegial environment. Under his leadership the department has expanded from 13 to 32 radiologists. Dr. Jaramillo’s greatest expertise and scientific contributions are in the areas of imaging of musculoskeletal disorders of childhood and pediatric magnetic resonance imaging. Diego has advanced the fundamental understanding of normal and abnormal development of epiphyseal cartilage and the growth plate and evaluation of physeal injuries via magnetic resonance imaging. He has published 124 peer-reviewed research papers and in 1995 received the prestigious John Caffey Award from the SPR for his seminal work on perfusion of the normal and ischemic cartilaginous epiphysis via gadolinium enhanced MRI. Frederic Shapiro, an orthopedic surgeon with a deep understanding of growth disorders and bone histology, and Tal Laor, a pediatric radiologist, friend, and a source of many great ideas have been his main research partners. Throughout his professional career, Dr. Jaramillo has worked tirelessly to advance the mission of the Society for Pediatric Radiology. He has served on the Research and Education Foundation Board, the Board of Directors, and on numerous committees including the Research and Technology Assessment Committee and SPR’s National Radiation Safety Initiative. He currently serves on the Board of Directors as Second Vice President in line to become President in 2017. Diego also serves on the editorial boards of Radiology and Pediatric Radiology. Diego has been widely recognized for his excellence in teaching and research with numerous awards from prestigious organizations including the International Society for Magnetic Resonance Imaging in Medicine, the Radiological Society of North America, and the Massachusetts General Hospital. He has mentored and collaborated with numerous trainees in pediatric radiology, many of whom have gone on to illustrious academic careers. Dr Tal Laor, one of Diego’s early trainees and collaborators, captures the essence of Diego perfectly: “Diego has been seminal in the development of “modern” pediatric musculoskeletal imaging. His research has advanced immeasurably our understanding about normal bone growth and abnormal development. Moreover, his passion has inspired countless colleagues and trainees to pursue similar areas of investigation. In one way or another, like “six degrees of separation”, the majority of pediatric musculoskeletal radiologists and their research endeavors are somehow connected to Diego! His enthusiasm is infectious, his fund of knowledge is extensive, and his wisdom is only matched by his salsa dancing skills!” Diego is the proud father of two children, Livia and Ricardo Jaramillo. Livia is currently a college student at Brown University and Ricardo is completing high school in Philadelphia. Diego is grateful to his children and Erika Rubesova, also a pediatric radiologist, for their inspiration and joie de vivre. The SPR and pediatric patients are highly fortunate to have benefitted from Diego’s outstanding contributions and dedication to the care of children. The Society for Pediatric Radiology is very proud to bestow the 2014 Pioneer Award on Dr. Diego Jaramillo. Richard A. Barth, MD

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SPR 2014 Presidential Recognition Award The Society bestows Presidential Recognition Awards on members orother individuals whose energy and creativity have made a significant impact on the work of the Society and its service to its members.

Richard M. Benator, MD, FACR Some accolades are stretch to find; some speak for themselves. Those of Richard Benator shout, if only we listen with the right ear. And the right ear is to recognize the care and quality of this care we deliver as pediatric radiologists. This starts, with Richard, with a tradition of business, of hard work, and of green smocks…which I will return to. For those of you who don’t know Dr. Benator, essentially a career pediatric radiologist at All Children’s in St. Petersburg Florida, his undergraduate training was at Tulane in biomedical engineering, with a subsequent MD from Medical College of Georgia, Radiology residency at University of Tennessee (Memphis), Pediatric Radiology fellowship at LeBonhner Hospital and St Jude’s Cancer and Research hospital, a couple of years at the Medical College of Virginia (Currently VCU) in Richmond as an assistant Professor in Radiology, and finally his home at All Children’s Hospital with a faculty appointment in the Radiology Department at the University of South Florida. Leadership positions include Florida Radiology Society (Program and Education Committee, Chair; Pediatric Radiology Committee, Chair; Education Foundation, President; Society Secretary, Treasurer, Vice-president, President), Florida West Coast Radiological Society (Secretary-Treasurer, Vice President and President), SPR Public Policy Chair, and the American College of Radiology (Alternate Counselor, and Counselor Florida; Alternate and Counselor for SPR; Committee on Government Relations for the Commission on General & Pediatric Radiology, and ACR Pediatric Radiology Commission member). We are getting to the green smocks. Most recently, he has been instrumental in establishing an ACR Medicaid Network, which by default emphasizes our Pediatric Radiology concerns as Pediatric imagers service a disproportionate large percentage of Medicaid patients. This is an accomplishment for our subspecialty, as previously; the emphasis of the ACR had been primarily focused on Medicare. He advocates for the missions of the Society for Pediatric Radiology and the American College of Radiology through promoting the value of diagnostic imaging and image-guided care for children. He has been a consistent presence in College activities for many years, and the first role as chair of the Pediatric Economics Committee under the newly formed (finally) Pediatric Commission, with membership on the Commission on Economics. Bibb Allen, M.D. past Economics Commission Chair and current ACR vice chairman recently commented, “Richard’s work on behalf of children’s radiology while on the Commission on Economics was invaluable. Richard led the effort to develop a grass-roots ACR Medicaid Network similar to the Medicare Contractor Advisory Committee Network for Medicare. That network tracked Medicaid coverage policies from state to state and helped promote fair coverage and payment. This was a big undertaking and occurred in addition to keeping up with other reimbursement issues affecting pediatric radiologists. Congrats to Richard!”. Richard has continued to advocate for our subspecialty emphasizing quality and expertise in pediatric imaging care. These focused efforts are with a backdrop of his widely recognized representation for Pediatric Radiology in the College. David Kushner, himself a pioneering voice for the SPR in the College commented, “Richard certainly deserves the award…he has been instrumental in carrying on the very important Pediatric Caucus at the ACR. We started the caucus perhaps 10 years ago, to organize the voice of advocacy for children in the many actions of the ACR Council….Richard has been part of the action from the very beginning…. The Caucus has been effective in getting advocacy for children in front of Council during the debates on every ACR Policy, Technical Standard and Guideline. Before the Caucus, pediatrics had no organized voice and pediatric issues were frequently glossed over. The Caucus was instrumental in persuading the ACR to invite the SPR to serve as joint sponsor of all appropriate documents. Finally, the Caucus has served as the advocate for children to encourage ACR Leadership to incorporate ‘pediatric issues’ in all new programs including the Learning Center and [the] Image Gently Campaign. Richard has played a very important role in all of these things. He has become a resource for pediatric radiologists who are new to Council and serves to coordinate the annual review of all ACR documents that will come before Council for consideration. None of this is glamorous. All of this is tedious and thankless. All of this is Democracy in Action on behalf of our pediatric patients. Rich has been a stalwart team member and leader. I am pleased that he is getting the award”. I have had the pleasure and privilege of working with Dr. Benator who has been enthusiastic and focused in his undertakings. He is currently recognized and will certainly be long acknowledged for his successes in the College on behalf of the SPR. I have to say he continues this while in full time practice. He meets challenges, always with a smile and a positive approach. The SPR is fortunate to have our prospects better for his efforts. Richard, you relayed that a “green smock” was the uniform (and emblematic) of your parents and preceding generations, and their tireless efforts in retail business. You have noted, “One of the lessons [we learned], is that one needs conviction and sometimes, without an immediate expectation of reward, you just need do to


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some things that’s for the greater good, because it is what you believe needs to done. In receiving the 2014 SPR Presidential Recognition Award, thank you for doing what needs to be done, for keeping that concern for the business of what we do in focus, and for wearing the green smock for the Society for Pediatric Radiology and the kids we serve. Donald P. Frush, MD, FACR

SPR 2014 Honorary Member The Society extends Honorary Membership to individuals outside of pediatric radiology who have made outstanding contributions to the care of children.

Timothy M. Cain, MBBS Dr. Tim Cain is the Directory of Medical Imaging at the Royal Children’s Hospital in Melbourne, Australia, the largest free standing children’s hospital in the Southern Hemisphere. Tim decided that he wanted to be a doctor while a foreign exchange student at Winneconne High School. It is in the small town near Oshkosh, Wisconsin that he realised how much he enjoyed being with people and that any vocation had to include personal interactions as well as intellectual stimulation. His plans changed slightly when he met the woman of his dreams during his studies at the University of Adelaide in South Australia. Married before completing his Medical degree and a father four times before completing his specialist training, children and family were destined to influence his career choice and love of paediatric imaging. During his radiology training in South Australia Tim rotated through the Adelaide Women’s and Children’s Hospital (WCH) where he was first exposed to dedicated paediatric radiologists including Drs. Lloyd Morris and Gary Lequesne who are well known to many senior SPR members. He followed his diagnostic radiology training with 2 years additional experience in Nuclear Medicine thus acquiring dual specialist qualifications. Tim’s radiology career started as a private practice radiologist with a sessional appointment as a Nuclear Radiologist at Flinders Medical Centre in Adelaide. While still a partner of the Radiology practice, he started working as a Nuclear Medicine Specialist at the WCH in 1997. This turned into an unconventional form of paediatric fellowship and marked a change in his career path that had him leave the private practice for a full time role in a teaching hospital. This role soon became the head of Paediatric and Women’s imaging at the WCH. At that time he realised that there was more to leadership than ‘standing up the front’ and this was his incentive to complete a Masters of Business Administration. This stimulating academic activity also provided Tim with tools to assist with the challenges of heading a recently merged Paediatric and Women’s imaging department. However, the opportunity to concentrate on paediatric imaging presented itself in 2005 when he became head of department at the Royal Children’s Hospital Melbourne (RCH). The prospect of being the 7th Director of Medical Imaging at the RCH in an 8 years period was a challenge he has successfully risen to, and he has now completed more than 8 years in the role. One of his first tasks as new Director was to assist in the design of the Medical Imaging Department for the new RCH which opened in December 2011. Among other achievements he ensured that there was provision for MR PET which has been a focus of much of his energy for the last few years. Even during his 10 years in private practice (he refers to this as his ‘previous life’), when having a large young family brought its own demands, Tim has always actively served on professional bodies. He sat on the South Australian branch of the Royal Australian and New Zealand College of Radiologists (RANZCR) executive committee for 10 years, including 6 years as Honorary Secretary. His interest in radiation safety was recognised by his Ministerial appointment as a member of the Radiation Protection Committee of the South Australian Government, Environment Protection Authority - Radiation Protection Division. He is currently the Chairman of the RCH Radiation Safety Committee. He has been a member of various other hospital Committees including Medical Appointment, Credentialing, Patient Safety, Quality and Safety, and Ethics technical review panel, and he currently represents the RCH Medical Staff Association as a Councillor for the Victorian Branch of the Australian Medical Association. Tim served as Secretary of the Australian and New Zealand Society for Paediatric Radiology (ANZSPR, formerly Australasian Society for Paediatric Imaging) for 5 years up to 2011 and was briefly the treasurer in 2012. He has become active with the World Federation of Pediatric Imaging (WFPI) where he is an Asian and Oceanic Society for Paediatric Radiology (AOSPR) representative and serves as the Membership Secretary and Vice Treasurer. He has recently been elected to the position of Vice President of the AOSPR. His desire to share knowledge with international colleagues has been stimulated by the many overseas trained radiologists who train in paediatric medical imaging at the RCH in one of the six available paediatric imaging fellowship positions he has helped establish.

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Actively involved in medical education, Tim was the convenor of the 53rd RANZCR Annual Scientific Meeting in Adelaide 2002, and the paediatric section convenor of the Asian and Oceanic Congress of Radiology in Sydney, 2012. With colleagues at the Royal Children’s Hospital in Melbourne, he was co-convenor of the Australian and New Zealand Society for Paediatric Radiology Annual meeting in Melbourne 2007. He is involved in undergraduate and postgraduate radiology education via the University of Melbourne and presents regularly at local, national and international radiology meetings. He also attends management courses to help maintain skills acquired during his MBA. He has published over 20 scientific articles in peer reviewed journals. Above all other aspects of his medical career, Tim enjoys the contact with patients and their families and carers. He practices an interesting blend of paediatric imaging, mixing Nuclear Medicine with some interventional radiology and body imaging. The patient contact keeps his focus and counters the demands of management and modern bureaucracy. He is supportive of his colleagues’ professional development and is a strong advocate for quality paediatric imaging locally and nationally. Tim is fortunate to have a supportive and healthy family. Tina, his wife of more than 30 years, has adapted to the challenges of being the partner of an overcommitted medical professional, although she refers to the RCH as the ‘other women with whom she competes for Tim’s attention’. Their four children have chosen diverse careers (Medicine, commerce, electronic media and advertising) and are proudly independent. Two grandchildren bring delight and a reminder of the challenges of raising young children. Paediatric radiology and involvement in AOSPR and WFPI allow Tim to combine his professional interests with his desire to meet like minded people and travel. He derives pleasure from interacting with his international colleagues by sharing knowledge and is always keen to discuss issues common to paediatric imaging departments around the world. The collegiality and professionalism of his RCH, national and international colleagues have been a driver for his continued involvement in his chosen career. His nomination for Honorary Member of the SPR is a tribute to his role in increasing the world wide profile of paediatric imaging in Australia, New Zealand and the Asian Oceanic Region through his roles in the ANZSPR, AOSPR and more recently the WFPI. Michelle Fink, MRCP (UK), FRCR (UK), FRANZCR

SPR 2014 Singleton-Taybi Award The Singleton-Taybi Award is given in honor of Edward Singleton and Hooshang Taybi, in recognition of their personal commitment to the educational goals of the SPR. Initiated in 2006, the Award is presented annually to a senior member of the SPR whose professional lifetime dedication to the education of medical students, residents, fellows, and colleagues has brought honor to him/her and to the discipline of pediatric radiology.

Robert Harris Cleveland, MD, FACR Robert Harris Cleveland is an extraordinary person. It is my great pleasure to introduce him and to write on his behalf. Bob Cleveland was born in 1945 in Dallas, Texas. He received his education at the University of Texas, the University of Texas Medical Branch and Harvard University. He received his hospital training at Rhode Island Hospital in Providence, Charity Hospital in New Orleans, State University of New York in Syracuse, and Children’s Hospital in Boston. He has progressed in his academic appointments from Instructor to Professor of Radiology at Harvard Medical School. He has worked professionally at Massachusetts General Hospital where he progressed to Director of the Division of Pediatric Radiology and Children’s Hospital in Boston where he progressed to Chief of the Division of General Radiology and Director of Quality Improvement for the Department of Radiology. He has received multiple honors including Fellowship in the American Academy of Pediatrics, Fellowship in the American College of Radiology, Best Scientific Exhibitor at the European Society of Pediatric Radiology, the Lawrence L. Robbins Teaching Award of the Massachusetts General Hospital and Distinguished Service and Lifetime Service Awards from the American Board of Radiology and the New England Roentgen Ray Society. His hospital committee work spans four pages of single spaced small font listings. He is and has been a member of 13 medical societies and a participant in numerous society committees. He has served as Examiner for the American Board of Radiology. Bob Cleveland has been active as a scholar and investigator. His research interests have covered radiation reduction, evaluation of infant swallowing, the manifestations of HIV infection in children, and many areas of pediatric pulmonary disease. He has participated in more than 150 publications, case reports, reviews, chapters, abstracts, presentations and posters. Seventy five publications have been peer-reviewed original publications. Bob has also published a successful book: “Imaging in Pediatric Pulmonology”.


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Robert Cleveland has been extraordinarily active as a teacher, speaking literally at hundreds of sessions. The listings run seven pages in his CV. These activities have included presentations to medical students, radiology residents, pediatric residents, surgical residents, fellows in all specialties, lectures at postgraduate courses, invited lectureships and many Visiting Professorships in the United States and Europe,. Bob’s true focus has been “the basics”. He has championed the excellence of radiography in a time with most people were more fascinated with so called “advanced imaging”. His forte has been teaching about the standard radiographic chest examination and the wealth of information that can be gleaned from this ancient technology. He has observed that younger radiologists and trainees are less prepared to properly diagnose from a standard chest x-ray or other basic radiograph than more modern techniques. In this effort, Bob has developed a superb and effective teaching style that is disarming, charming and effective. I have known and admired Bob Cleveland for almost 40 years. He is an extraordinary person and clearly follows in the footsteps of Ed Singleton and Hoosh Taybi—both of whom have served as my mentors and whom I have known and admired for my entire career. Both Ed and Hoosh would be pleased and proud that Bob Cleveland will be receiving an honor in their name. Congratulations Dr. Cleveland! David C. Kushner, MD, FACR John Caffey, MD 1895–1978

Dr. Caffey was regarded throughout the world as the father of pediatric radiology. His classic textbook, “Pediatric X-Ray Diagnosis”, which was first published in 1945, has become the recognized bible and authority in its field. The seventh edition of this book was completed several months before his death in 1978. It has been among the most successful books of its kind in the medical field. Dr. Caffey was born in Castle Gate, Utah on March 30, 1895. It is interesting that he was born in the same year that Roentgen discovered the x-ray. Dr. Caffey was graduated from University of Michigan Medical School in 1919, following which he served an internship in internal medicine at Barnes Hospital in St. Louis. He spent 3 years in Eastern Europe with the American Red Cross and the American Relief Administration, and returned to the United States for additional training in medicine and in pediatrics at the Universities of Michigan and Columbia, respectively. While in the private practice of pediatrics in New York City at the old Babies Hospital of Columbia University College of Physicians and Surgeons, he become interested in radiology and was charged with developing a department of pediatric radiology in 1929. He frequently expressed appreciation and admiration for the late Ross Golden, Chairman of Radiology at Columbia Presbyterian Hospital, who allowed him to develop a separate department of diagnostic radiology without undue interference, and who was always available to help and advise him. Dr. Caffey’s keen intelligence and inquiring mind quickly established him as the leader in the fields of pediatric x-ray diagnosis, which recognition became worldwide almost instantaneously with the publication of his book in 1945. Dr. Caffey received many awards in recognition of his achievements. Outstanding among these were the Mackenzie Davidson Medical of the British Institute of Radiology in 1956, the Distinguished Service Award of the Columbia Presbyterian Medical Center in 1962, the Outstanding Achievement Award of the University of Michigan in 1965, the Howland Award of the American Pediatric Society in 1967, the Jacobi Award of the American Medical Association in 1972, and the Gold Medal Award of the American College of Radiology in 1975. He had been a member of the American Journal of Roentgenology. He was a counselor of The Society for Pediatric Radiology and was an honorary member of the European Society of Pediatric Radiology. Dr. Caffey’s contributions to the pediatric radiologic literature were many. He was instrumental in directing attention to the fact that a prominent thymic shadow was a sign of good health and not of disease, an observation that literally spelled the end to the practice of thymic irradiation in infancy. Infantile cortical hyperostosis was described by him and is called “Caffey’s Disease”. Dr. Caffey in 1946 first recognized the telltale radiographic changes that characterize the battered child, and his students helped disseminate his teachings about these findings. It was Dr. Caffey who first recognized and descried the characteristic bony changes in vitamin A poisoning. He recognized and described the findings associated with prenatal bowing of the skeleton.

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In 1963, 3 years after his retirement from Babies Hospital, he joined the staff of the Children’s Hospital of Pittsburgh as associate radiologist and as Visiting Professor of Radiology and Pediatrics at the University of Pittsburgh School of Medicine. Although Dr. Caffey came to Children’s Hospital and the University of Pittsburgh in an emeritus position, he worked daily and on weekends throughout the years he was there. In Pittsburgh, he made four major new contributions to the medical literature. He described the entity, “idiopathic familial hyperphosphatasemia”. He recognized and described the earliest radiological changes in Perthes’ Disease. He called attention to the potentially serious effects of shaking children, and used this as a subject of his Jacobi Award lecture. He described, with the late Dr. Kenny, a hitherto unrecognized form of dwarfism which is now known as the Caffey-Kenny dwarf. The John Caffey Society, which includes as its members pediatric radiologists who have been intimately associated with Dr. Caffey, or who have been trained by his students, was established in 1961. This society is now among the most prestigious in the field of radiology. His book and the society named in his honor will live on as important memorials to this great man. His greatness was obvious to all who worked with him. He was warm, kind, stimulating, argumentative, and above all, honest in his approach to medicine and to x-ray diagnoses. His dedication to the truth was expressed in his abiding interest in the limitations of x-ray signs in pediatric diagnosis and in his interest in normal variation in the growing skeleton. He was concerned with the written and spoken word and was a skilled semanticist. His book and his articles are masterpieces of language and construction. He stimulated and was stimulated and loved by all who had the privilege of working with him. Radiology and Pediatrics have lost a great man, but they shall ever have been enriched by his presence. Bertram R. Girdany, MD Caffey Award for Best Basic Science Research Paper 2005 2006 2007 2008 2009 2010 2010 2010 2010 2011 2012 2013

Quantitative Measurement of Microbubble Ultrasound Contrast Agent Flow to Assess the Efficacy of Angiogenesis Inhibitors In Vivo. McCarville B, Streck C, Li CS, Davidoff A 64 Cu-Immuno-PET Imaging of Neuroblastoma with Bioengineered Anti-GD2 Antibodies. Voss SD, Smith SV, DiBartolo NM, McIntosh LJ, Cyr EM, Bonab AA, et al. MR Imaging of Adenocarcinomas with Folate-Receptor Targeted Contrast Agents. Daldrup-Link HE, Wang ZJ, Meier R, Corot C Evaluation of Quality Assurance Quality Control Phantom for Digital Neonatal Chest Projection Imaging. Don S. Faster Pediatric MRI Via Compressed Sensing. Vasanawala S, Alley M, Barth R, Hargreaves B, Pauly J, Lustig M Clinical Evaluation of Readout-Segmented-EPI for Diffusion-Weighted Imaging. Bammer R, Holdsworth S, Skare S, Yeom K, Barnes P High-Resolution Motion-Corrected Diffusion-Tensor Imaging (DTI) in Infants. Skare S, Holdsworth S; Yeom K; Barnes P, Bammer R 3D SAP-EPI in Motion-Corrected Fast Susceptibility Weighted Imaging (SWI). Bammer R, Holdsworth S, Skare S, Yeom K, Barnes P T1-Weighted 3D SAP-EPI for Use in Pediatric Imaging. Bammer R, Holdsworth S, Skare S, Yeom K, Barnes P An MR System for Imaging Neonates in the NICU. Tkach J, Giaquinto R, Loew W, Pratt R, Daniels B, Jones B, Donnelly L, Dumoulin C Advantages of a Nanoparticle Blood Pool Contrast Agent Over Conventional Intravascular Glomerular-Filtered Contrast Agents for Pulmonary Vascular Imaging. Annapragada A, Guillerman RP, Hoffman E, Kaczka D, Ghaghada K, Badea C Psychometric Function: A Novel Statistical Analysis Approach to Optimize CT Dose: Steven Don, MD, Mallinckrodt Institute of Radiology, St. Louis, MO, Bruce Whiting, David Politte, Parinaz Massoumzadeh, Charles Hildebolt

Caffey Award for Best Clinical Research or Education Paper 2005

Evaluation of High Resolution Cervical Spine CT in 529 Cases of Pediatric Trauma: Value Versus Radiation Exposure. Shiran D, Jimenez R, Altman D, DuBose M, Lorenzo R


Alterations in Regional O2 Saturation (StO2) and Capillary Blood Volume (HbT) with Brain Injuries and ECMO. Grant PE, Themelis G, Arvin K, Thaker S, Krishnamoorthy KK, Franceschini MA Evaluation of Single Functioning Kidneys Using MR Urography. Grattan-Smith D, Jones R, Little S, Kirsch A, Alazraki A Evaluating the Effects of Childhood Lead Exposure with Proton MR Spectroscopy & Diffusion Tensor Imaging Neuroradiology. Cecil KM Improving Patient Safety: Effects of a Safety Program on Performance and Culture in a Department of Radiology at a Children’s Hospital. Donnelly L, Dickerson J, Goodfriend M, Muething S

2007 2008 2009 2010 2011 2012 2013

Juvenile Osteochondritis Dissecans (JOCD): Is It a Growth Disturbance of the Secondary Physis of the Epiphysis? Laor T, Wall E; Zbojniewicz A Quantitative Assessment of Blood Flow with 4D Phase-Contrast MRI and Autocalibrating Parallel Imaging Compressed Sensing. Hsiao A, Lustig M, Alley M, Murphy M, Vasanawala S Multidetector CT Pulmonary Angiography in Children with Suspected Pulmonary Embolism: Thromboembolic Risk Factors and Implications for Appropriate Use. Lee EY, Tse SK, Zurakowski D, Johnson VM, Donald TA, Boiselle PM Prospective Comparison of MRI and Ultrasound for the Diagnosis of Pediatric Appendicitis Robert Orth, MD, PhD, Texas Children’s Hospital,Houston, TX, R. Paul Guillerman, Prakash Masand, MD, Wei Zhang, George Bisset

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CAFFEYAWARD FOR POSTERS 2005 2006 2006 2007 2008 2009

3D MRI and CT in the Evaluation of Congenital Anomalies of the Aortic Arch. Dehkharghani S, Olson K, Richardson R Diffusion Weighted Imaging in Pediatric Neuroradiology: A Primer. Sagar P, Grant PE Imaging of Suprarenal Fossa in Children: Radiological Approach and Clinico-Pathological Correlation. Kukreja K, Restrepo R, D’Almeida M Neuroimaging of Nonaccidental Trauma: Pitfalls and Controversies. Lowe L, Obaldo RE, Fickenscher KA, Walsh I, Estimation of Cumulative Effective Doses from Diagnostic and Interventional Radiological Examinations in Pediatric Oncology Patients. Thomas KE, Ahmed BA, Shroff P, Connolly B, Chong AL, Gordon C Case Report : Multi-Modality Imaging Manifestations of the Meckel’s Diverticulum in Pediatric Patients. Kotecha MK, Bellah RD, Pena AH, Mattei P

2009 2009

Educational: MR Urography: Functional Analysis—Made Simple! Khrichenko D, Darge K Scientific: MRI Findings in the Term Infant with Neonatal Seizures. An Etiologic Approach. Rebollo Polo M, Hurteau-Miller J, Laffan E, Tabban H, Naser H, Koujok K 2010 Scientific: Dual Phase Intravenous Contrast Injection in Pediatric Body CT. Mann E, Alzahrani A, Padfield N, Farrell L, BenDavid G, Thomas K 2010 Educational: Hemangiomas Revisited: The Useful, the Unusual and the New. Restrepo R, Palani R, Matapathi U, Altman N, Cervantes L, Duarte AM, Amjad I 2010 Case Report: MRI of Congenital Urethroperineal Fistula. Mahani M, Dillman J, Pai D, Park J, DiPietro M, Ladino Torres M 2011 Scientific: Updated Estimated Radiation Dose for Pediatric Nuclear Medicine Studies. Grant F, Drubach L, Treves ST, Fahey F 2011 Educational: Button Battery Ingestion in Children: What the Radiologist Must Know. Kappil M, Rigsby C, Saker M, Boylan E 2011 Case Report: MR Imaging Features of Fetal Mediastinal and Intrapericardial Teratomas. Rubio E, Kline-Fath B, Calvo-Garcia M, Guimaraes C 2012 Case Report: Neuroimaging in Hemiplegic Migraine: Cases and Review of the Literature. Stence NV, Kedia S, Maloney JA, Armstrong-Wells J, Bernard T 2012 Educational: Primary and Secondary Amenorrhea in Pediatric Patients: From the Beginning to the End. Cortes C, Ramos Y, Restrepo R, Diaz A, Sequeira L, Lee EY 2012 Scientific: Prenatal Evaluation of Limb Body Wall Complex with Emphasis on MRI. Aguirre-Pascual E, Victoria T, Johnson A, Chauvin N, Coleman B, Epelman M 2013 Scientific Exhibit: TIE Phantom Iterative Reconstruction Technique (PIRT)-a quantitative ALARA method to test iterative reconstructions effect on image quality and dose in the pediatric population Anne McLellan, Medical, Radiology, Phoenix Children’s Hospital, Phoenix, AZ; James Owen, John Egelhoff, John Curran, Jeffrey Miller, MD, Padmaja Naidu Morbidity associated with delayed treatment of cholelithiasis in pediatric patients with sickle cell disease Heather Imsande, MD, Boston Medical Center, Boston, MA The top four candidates from each category (Educational, Case Report/Case Series/Technical Development and Scientific) for a Caffey Scientific Exhibit Award will present their work during one of the scheduled breaks at the Annual Meeting.

For a list of Caffey Award papers and posters prior to 2005, please visit the SPR website.

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2014 Edward B. Neuhauser Lecture

The Future of American Medicine—The Impact of Health Care Reform

Robert Pearl, MD Executive Director and CEO The Permanente Medical Group President and CEO Mid-Atlantic Permanente Medical Group Dr. Robert Pearl is Executive Director and CEO of The Permanente Medical Group and President and CEO of the Mid-Atlantic Permanente Medical Group. Together these organizations are comprised of over 9,000 physicians and 34,000 staff members. Dr. Pearl is responsible for the health care that is delivered to approximately four million Kaiser Permanente members in the states of California, Virginia, Maryland and the District of Columbia. Board certified in Plastic and Reconstructive Surgery, Dr. Pearl received his Medical Degree from Yale University School of Medicine. He completed his residency in Plastic and Reconstructive Surgery at Stanford University and currently serves on the faculty as a Clinical Professor of Plastic Surgery. He is also on the faculty of the Stanford Graduate School of Business where he teaches courses on strategy and leadership, as well as lectures on the subject of health care technology. Selected by Modern Healthcare as one of the most powerful physician leaders in the nation, Dr. Pearl has published more than 100 articles in various medical journals and has been a contributor to many books. He has made over 100 presentations at national meetings in the areas of both clinical medicine and medical economics. In the past several years, he has been a visiting professor at the Johns Hopkins School of Medicine, Haas School of Business and Harvard School of Public Health. Recently, Dr. Pearl was a featured speaker at both the Commonwealth Club and the Institute for Healthcare Improvement’s National Quality Forum event. In addition, he participated in the Bipartisan Congressional Task Force on Delivery System Reform and Health IT. Most recently, he became the Chairman of the National Council of Accountable Physician Practices (which includes the largest medical groups from across the country such as the Mayo Clinic, Geisenger and Intermountain Healthcare). Dr. Pearl is a frequent lecturer on the opportunities to use 21st Century tools and technology to improve both the quality and cost of health care, while simultaneously making care more convenient and personalized. As a regular contributor to, Dr. Pearl publishes a weekly blog on the nexus of health care and business and provides frequent updates through Twitter. He is an advocate for the power of integrated, prepaid and technologically enabled health care delivery systems. He is also a strong believer that organizations like Kaiser Permanente in which physicians collaborate rather than compete, and in which a multi-specialty medical group works in partnership with a not-for-profit health plan and hospital system, are able to provide superior quality of care over fragmented insurance-based systems. Previous Neuhauser Lectures 1997 1998 1999 2000 2001 2002

S. Steven Potter, PhD, Cincinnati, Ohio “Homeobox Genes and Pattern Formation (Master Genes)” Roy A. Filly, MD, San Francisco, California “Fetal Thoracic Surgery” Harold A Richman, PhD “Child Abuse: From a Radiologist’s Discovery to a Major Issue of Public Policy. What Have We Wrought?” William D. Lyman, PhD, Detroit, Michigan “Prenatal Molecular Diagnosis and Fetal Therapy” Jerry R. Dwek, MD, Columbus, Ohio “Médecins Sans Frontiéres/The Doctors Without Borders Experience—Afghanistan” Eric J. Hall, DSc, FACR, FRCR, New York, New York


2003 2004 2005 2006 2007 2008 2009

Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 “Lessons We Have Learned From Our Children: Cancer Risks From Diagnostic Radiology” Jeffrey A. Towbin, MD, Houston, Texas “Molecular Cardiology: Laboratory to Bedside” Bruce R. Rosen, MD, PhD, Boston, Massachusetts “New Advances in MRI: A Guide for the Practicing Pediatric Radiologist” Bruce R. Korf, MD, PhD, Birmingham, Alabama “Pathobiology and Management of NF1 in the ‘Genomic Era’” Richard M.J. Bohmer, MD, MPH “Evolution, Innovation and the Changing Nature of Healthcare Delivery” Nogah Haramati, MD “21st Century Radiology: Growth and Development of Our Workflows and Processes” Emanuel Kanal, MD, FACR, FISMRM, AANG MR Technology: Where Are We, Where Are We Going?

Roberta G. Williams, MD “Cardiology and Radiology: Partners in Producing Healthy Adults with Congenital Heart Disease” 2010 Regina E. Herzlinger, PhD “The Economic Basis of Change in Healthcare” 2011 Sanjiv Gambhir, MD, PhD “Molecular Imaging” 2012 William R. Hendee, PhD “Past and Future Patient Benefits of Radiologist/Physicist Collaboration” 2013 James R. Downing, MD The Pediatric Cancer Genome Project—Implications for Clinical Medicine For a list of Neuhauser Lecturers prior to 1997, please visit the SPR website.

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S59 How to Get the Lowest Dose in Abdominal CTA? Beverley Newman, MBBCh, FACR

Tuesday, May 13, 2014


The goal of ALARA in CT is to use the minimum amount of radiation necessary while preserving diagnostic image quality. To do this, radiologists must have a means of estimating image quality. Historically, image noise has been the most commonly-used metric. Specific challenges with image noise include the facts that 1) image noise is highly susceptible to post-acquisition image processing, 2) there is currently no satisfactory means of measuring image noise directly on the image, and 3) the target image noise varies depending on patient size and diagnostic task. Until direct image quality measures can be established, indirect image noise estimation is a reasonable means of evaluating CT image quality for the purpose of minimizing radiation dose. For CT abdomen and pelvis, the size-specific dose estimate (SSDE) can be used as a surrogate for image quality measurement. Like target image noise, the target SSDE changes as a function of patient size. While the target SSDE also changes depending on the indication for the examination, only a few image quality target settings will suffice for a large number of indications. CT dose optimization is achieved by measuring SSDE on representative studies, determining an SSDE target curve as a function of patient size by evaluating perceived diagnostic image quality, coordinating with the manufacturer to adjust the protocols to consistently meet those targets, and monitoring SSDE for all studies. To be practical in the clinical setting, this requires the use of a CT monitoring application, preferably one that incorporates patient size.

How to Perform a Contrast Enhanced PET/CT? Stephan D. Voss, MD, PhD

Computed tomographic angiography (CTA) is a highly effective tool for imaging diseases of the blood vessels. Current multi-detector row CT scanner can scan a 1-m body length in 1 s at a resolution less than one millimeter. Performance improvements in successive generations of scanner help reduce the volume of contrast agent, the need of sedation, and the radiation dose. Special properties of CTA may be exploited to further reduce the last. For example, imaging different vascular beds normally require multiple scan passes. A properly shaped contrast injection profile can opacify multiple vascular beds at once that can be scanned in a single pass. A CTA generates an image composed of two dichotomous spaces: a contrast filled vascular space and everything else. Since the attenuation of the iodinated contrast increases with a lower tubevoltage, CTA works well with low voltage techniques that also reduce radiation dose. Excepting bones and metals, the attenuation difference between the first-pass contrast-enhanced vascular space and the nonvascular space is usually large. A reader of CTA may tolerate a greater level of noise compared to non-vascular CT studies. This permits a lower tube-current setting and a reduction in radiation dose. Finally, image- and model-based iterative reconstruction algorithms, now clinically available, help suppress image noise while preserving definition at the vascular margins. Today, high quality CTA of the abdomen for children can be routinely achieved at a radiation dose less than 3 mSv per study. How Do I Get the Highest Resolution MRA? Taylor Chung, MD

In this short 10-min discussion, emphasis will be place on reviewing the trade off between temporal and spatial resolution in contrast-enhanced MRA for body imaging, various acceleration schemes to increase the speed of acquisition, scan parameter manipulations related to acceleration schemes, and generic clinical protocols. The goal of this short discussion is to provide a generic understanding of how to achieve a robust contrastenhanced MRA in your clinical practice. What is a b Value and How Should I Choose It? Govind B. Chavhan, MD, DNB, DABR

PET/CT scanners use a multi-detector PET system coupled to multidetector row helical CT scanner. Standard PET/CT protocols include both a PET scan and a low dose attenuation correction CT (CT/Ac). The CT/ Ac is an essential component of the PET/CT examination. In additional to allowing anatomic co-localization of PET abnormalities, attenuation correction of PET data is necessary for accurate qualitative and quantitative measurements of metabolic activity. While it is suitable for colocalization and image fusion, the standard low dose CT/Ac does not utilize intravenous contract agents and is not considered adequate for diagnostic purposes. As such, patients often undergo a second diagnostic CT scan, using IV and oral contrast and conventional diagnostic CT imaging parameters, adding to the patients’ overall radiation burden. As a first step toward optimizing PET/CT protocols to reduce unnecessary duplicate CT imaging, the purpose of this presentation is to discuss the use of intravenous and/or oral contrast agents during PET/CT imaging. We will discuss potential for artifacts produced by contrast agents on the PET emission data, and consider basic imaging protocols in which: (1) low dose CT/ Ac imaging is performed with IV contrast, (2) diagnostic contrastenhanced CT images are used for attenuation correction, and (3) hybrid techniques that allow both low dose CT/Ac and diagnostic CT techniques to be combined in a single helical acquisition. In summary, the use of contrast-enhanced CT for attenuation correction can contribute significantly to reducing patient dose and enhancing the quality of the PET/CT examination.

The b-value indicates magnitude of diffusion weighting provided by diffusion gradients. The b-value depends on and increases with the amplitude, duration of application of the two diffusion gradient pulses and temporal separation of these pulses. The b-value is measured in s/mm2 unit. As the bvalue increases, sensitivity of the sequence to the diffusion increases and signal from water molecules reduces. At high b-value, tissues with either restricted water molecule mobility or very long T2 relaxation time will have high signal. The b-value needs to be chosen based on T2-relaxation time of the tissue in question. In body imaging, to counteract the low SNR from short T2 relaxation time of solid organs like the liver, lower ‘high bvalues’ than those typically found in neuroimaging are used. High b-values of 500–600 s/mm2 for liver and 800–1000 s/mm2 for kidneys are suitable in abdominal diffusion imaging. High b-values of around 800 are usually suitable for bowel and MSK imaging. Low b-values in the range of 50–100 are useful for detection of lesions especially in the liver. Can 3 Testa Be Used for Fetal MRI? Teresa Victoria, MD, PhD

Three testa MR imaging aims at improved image quality by increasing signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) when compared to 1.5 T. The search for better anatomic delineation and evaluation


of the fetus warrants evaluation of the feasibility of imaging at 3 T. Another reason to consider fetal imaging at 3 T is that some imaging centers may only have one magnet available for all of their imaging needs, that magnet being a 3 T system. In the past, fetal imaging at 3 T has been done with often disappointing results with numerous artifacts impeding image analysis. Better magnets and coils and improved technology now allow imaging of the fetus at greater magnetic strength, while still encountering some hurdles in the shape of imaging artifacts. The goal of this talk is to review our experience of imaging the fetus at 3 T, with emphasis in technical parameters, artifact, and safety concerns. When Should Eovist and Ablavar Be Used? Shreyas S. Vasanawala, MD, PhD

Various MRI contrast agents with unique properties are now available, requiring careful assessment of the clinical goals of each MRI exam to ensure optimal contrast agent selection. Although most abdominal and pelvic applications are best served by standard extracellular agents, gadoxetate (Eovist/Primovist), and gadofosveset (Ablavar) are valuable in certain indications. Gadoxetate helps with biliary leaks, follow-up evaluation of known hepatic metastases, and evaluation of suspected focal nodular hyperplasia may be aided by gadoxetate. Conversely, evaluation of venous pathology may be facilitated with gadofosveset. How Do I Optimize Doppler Ultrasound Images and Waveforms? Marta Hernanz-Schulman, MD, FAAP, FACR

In the imaging of children, the physical principles governing ultrasound coalesce with patient body size to allow a comprehensive window into pediatric anatomy and physiology. This short session will review some of the fundamental principles which affect the pediatric examination. The reflected sound undergoes a frequency shift, caused by motion of the interrogated object, which falls within the range of the human ear and can be partially analyzed aurally. These frequency shifts are based on a flow vector directed towards (0°) or away (180°) from the transducer. The magnitude of the frequency shift (fD) is governed by the Doppler equation: fD =(2f0vcosθ)/c, where f0 =insonating frequency, v=velocity, and θ=the angle of interrogation from the 0° to 180° axis. Thus one can see at a glance that the Doppler shift will be increased with use of a higher frequency transducer and at angles of insonation as close to 0° and 180° degrees as possible (cos θ=1), while flow at 90° to the transducer (cos θ= 0) will be undetected or depicted ambiguously due to spectral broadening and poor convergence of the ultrasound beams from the main beam axis. In color Doppler, there is no angle correction; therefore the color depicted in the intravascular voxels is dependent on the angle of insonation across each portion of the vessel. Pulse Repetition Frequency (PRF) needs to be set appropriately: too high a setting will lead to loss of flow information, whereas too low a setting below the Nyquist frequency will lead to aliasing artifacts; in color Doppler imaging, such higher velocities will “wrap around” to the opposite direction color encoding, a misleading phenomenon which can be detected by comparison with the spectral waveform. Careful application of these and other principles augments gray-scale information, and allows an extremely useful window into pediatric vascular patency and hemodynamic phenomena. THORACIC IMAGING: FOCUS ON THE LUNGS Cystic Fibrosis Update & Scoring: What Does the Pulmonologist Want to Know? Robert H. Cleveland, MD

The clinical role of pulmonary imaging in CF is unchanged. Acutely, issues such as pneumonia, hemorrhage, atypical mycobacteria and ABPA

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dominate. Depending upon the question, either CXR or CT is appropriate. In the earliest phases when diffuse peribronchial thickening (PBT) is the only imaging finding, CXR is adequate. In the chronic phase, CT is preferred as it best detects progressive bronchiectasis and mucous plugging. However, high radiation exposure and financial costs of CT limit its use for routine serial imaging. Consequently CXR remains the common modality for longitudinal follow-up. This may be changing. CT doses approaching that of CXR are recently reported. As image acquisition times decrease and resolution increases, MRI may replace CT. MRI can reveal regional air trapping and hypoperfusion before PBT is evident. All three modalities have scoring systems to quantify disease severity. These are not to replace subjective assessment of acute issues or incremental change. Rather they are used in research to determine differences in rates of decline. They have shown effectiveness of treatment modalities, differences based on genotype and to predict future progression. In this setting, CXR data is as strong as CT data. With multiple serial CXR the standard of care, a large volume of images is readily available. With concerns surrounding dose and cost, neither CT nor MRI approach CXR in volume of studies. Two CXR scoring systems are most commonly in use, the Brasfield and Wisconsin. They perform almost identically compared to the gold standard (PFT) with high correlation to each other. Children’s Interstitial Lung Disease (ChILD) 2014 Catherine M. Owens, MRCP, FRCR

The term ‘interstitial lung disease’ sets to confuse, as the disease processes often also involve the alveoli, airway, blood vessels, lymphatics and pleura. Disease classification is based primarily on clinicopathological patterns and expert opinion, and pedantically should be described as ‘diffuse lung disease’ The ATS/ERS Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias was developed for the adult population so is inappropriate for chILD. Hence the chILD Research Cooperative based on presumed aetiology proposed a classification for diffuse lung disease in young children. According to this scheme, unique diseases more prevalent in infancy include the diffuse developmental disorders (lung growth abnormalities e.g. chronic neonatal lung disease, chromosomal disorders such as Downs’ syndrome), pulmonary interstitial glycogenosis (PIG), neuroendocrine cell hyperplasia of infancy (NEHI), and hereditary surfactant dysfunction disorders. Other categories include disorders of the normal host: constrictive (obliterative) bronchiolitis, aspiration, disorders of the immunocompromised host :(diffuse alveolar damage, opportunistic infection), disorders related to systemic disease: (collagen-vascular diseases, storage diseases), and ‘masqueraders’ such as pulmonary arterial hypertensive vasculopathy, pulmonary veno-occlusive disease (pVOD), and lymphatic disorders. Recent publications report diagnostic imaging findings for newer specific forms of chILD, which include mutations of the filamin A (FLNA) Xlinked gene (periventricular heterotopia, cardiovascular anomalies, skeletal dysplasia, Ehlers-Danlos variants, and a lung growth disorder characterized by alveolar oversimplification and pulmonary hypertensive changes. Other conditions such as pleuroparenchymal fibroelastosis (PPFE) will be introduced. Whatever the disorder, meticulous attention to imaging technique is required to enable evaluation of these complex disorders. This lecture will address imaging techniques, salient imaging findings in various forms of chILD, emphasizing more recently described disorders for the attendees. How Do I Perform a Dynamic Airway CT in Infants and Children? S. Bruce Greenberg, MD

Wide-detector computed tomography allows for simultaneous imaging of the airway and lungs in infants and small children. Continuous scanning during a single breath is used to create multiple dynamic phases which

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allow for creation of 3D or multiplanar cine-loop imaging of the airway and lungs. Intravenous contrast allows for cardiopulmonary evaluation and is particularly useful in the infant or small child following surgery for congenital heart disease. The gantry speed is adjusted to the patient respiratory rate to limit radiation exposure. Intubated infants typically are scanned with the respiratory rate set at 40 breathes per minute and imaged for a total of 1.4 s. Positive end expiratory pressure is turned off during the examination. Radiation exposure is typically < 1 mSv due to 80 kVp energy, low mA current and aggressive use of iterative reconstruction. mA is determined by the weight based formula: mA=[(kg× 1.5)+5]÷gantry speed in seconds. Tracheobronchomalacia is quantified using dynamic cross-sectional images. Lobar malacia is identified. Fixed stenosis is distinguished from malacia. Airtrapping, atelectasis and airspace disease can also be evaluated. The technique is a new standard for evaluating the relationship between vascular and airway abnormalities for children with congenital heart disease. Changes in medical or surgical management following dynamic airway computed tomography in children with congenital heart disease is common due to the identification tracheobronchomalacia or previously unidentified or poorly characterized vascular abnormalities. Update on Pulmonary Embolus in Children: What Does the Radiologist Need to Know? Pallavi Sagar, MD

Pulmonary embolism (PE) in children is an uncommon diagnosis that can be clinically silent and occasionally fatal. The clinical signs described in adults are less common in children. The overall incidence of PE in children is unknown but is expected to rise likely due to improved survival of children with chronic diseases and increased usage of central venous lines (CVL), the latter reported to be the most common predisposing factor. Other risk factors include immobility, prior PE, deep venous thrombosis, thrombophilia, congenital heart disease, nephrotic syndrome, estrogen usage and malignancy. Most of the recommendations regarding management of PE in children are extrapolated from adult studies. Unlike adults, where the clinical probability score and D- dimer estimation play a major role, they lack utility in children. CT pulmonary angiography (CTPA) the imaging modality of choice and the standard of care in evaluating PE. A chest radiograph should be obtained within the last 24 h to rule out other cardiopulmonary etiologies. Doppler study of the lower extremities is performed instead of CT venography to minimize radiation. In children with iodine allergy, ventilation-perfusion scan is the imaging modality of choice. In hemodynamically unstable patients with a high clinical suspicion of significant PE, echocardiography should be considered to evaluate for right ventricular dysfunction. Recently, dual energy CT has been studied in evaluating PE with some promising results by providing both anatomical and functional information. It not only detects emboli but also provides perfusion maps of the lungs, demonstrating perfusion defects in a setting of acute PE. However, it has to be further validated for its clinical utility and radiation exposure, with some reports suggesting that it is usually dose neutral. CTPA has a higher radiation dose and should be cautiously used in children only in the presence of compelling clinical signs and multiple risk factors. Pediatric Lung Neoplasms: Understanding Underlying Genetic Causes R. Paul Guillerman, MD

Pleuropulmonary blastoma (PPB), the most common pediatric primary lung malignancy, is also the most frequent tumor occurring in the recently recognized Pleuropulmonary Blastoma Family Tumor and Dysplasia Syndrome (PPB-FTDS). This genetic syndrome affects 30–40% of patients or families in which PPB is diagnosed and is characterized by autosomal dominant inheritance (~75% of cases are associated with


heterozygous germline DICER1 gene mutations) and a distinctive constellation of mostly childhood tumors and dysplasias. The most characteristic manifestations of PPB-FTDS are PPB, cystic nephroma, multinodular goiter, differentiated thyroid cancer, Sertoli-Leydig cell tumor, cervical embryonal rhabdomyosarcoma, pituitary blastoma, pineoblastoma, nasal chondromesenchymal harmatoma, and ciliary body medulloepithelioma. Less common manifestations include hamartomatous polyps of the bowel and other tumors. Recognition of a characteristic manifestation of this syndrome should prompt genetic evaluation to identify and counsel carriers in affected kindreds. Most affected individuals have one or two manifestations, but there are no overt manifestations in 50% or more of DICER1 mutation carriers. Counseling and screening are complicated by the low penetrance, pleiotropy, lack of genotype-phenotype correlation, and generally non-lifethreatening nature of most of the manifestations, with exception of the blastomas. Screening for PPB in asymptomatic infant carriers should be considered due to the potential to detect PPB by chest imaging in the highly curable, cystic form in infancy before transformation into the less curable, solid form later in childhood. Using SSDE to Manage Thoracic CT Radiation Dose in Children Keith J. Strauss, MSc, FAAPM, FACR

The challenge is to carefully mange pediatric CT image quality and radiation dose during examinations of pediatric patients. One approach involves developing a detailed technique chart specific to each scanner within the department that lists scan parameters for each type of examination as a function of patient size (pediatric emphasis). The staffing required to achieve this may only be available in large, academic, tertiary care centers. Yet, the majority of pediatric CT scans in the US are performed in adult focused hospitals. A more direct approach develops patient specific scan parameters (based on patient size and type of exam) appropriate for use on any CT scanner in the department. This approach verifies the appropriate pediatric scan parameters just prior to the patient scan once the size of the patient, type of examination, and which CT scanner will be used becomes known. Essentially, the voltage and mAs used for the scan are adjusted to provide the patient dose that matches previously developed department Diagnostic Referecce Levels (DRLs). The method addresses manual vs modulated tube current, reduced voltage techniques for small body parts, and iterative reconstruction dose reductions for examinations of the head, thorax, and abdomen/pelvis. HRCT in Pediatric Patients: When & How? Shilpa V. Hegde, MBBS

Indications for high resolution CT (HRCT) in infants are persistent unexplained respiratory distress and an abnormal chest radiograph. Common indications in older children include evaluation of cystic fibrosis, chronic cough and abnormal lung function tests. Traditionally, chest HRCT is performed by obtaining thin, non- contiguous axial CT images. High spatial resolution algorithm images are viewed at a level of −500 HU and width of 1500 HU. Expiratory scans are sometimes contributory. Volume acquisitions using MDCT obtained in a single breath hold are replacing the older step and shoot technique. Thin non- contiguous slice reconstructions are created from the volume data. Sedation and anesthesia is less prevalent in small children due to shorter scan time. Scans can also be performed during quiet breathing if a child is unable to breath hold. The radiation settings (kvP and mA) are kept as low as possible to achieve a low dose technique. Abnormal findings are subgrouped as consolidation, ground glass changes, mosaic attenuation, septal thickening, and nodular opacities. HRCT findings are often non specific, but when correlated with the clinical


findings, can narrow the differential diagnoses. HRCT is also helpful in guiding biopsy. MRI of the Lungs and Airways: Current Practical Imaging Approach Edward Y. Lee, MD, MPH

In recent years, magnetic resonance imaging (MRI) has been receiving a lot of attention particularly in pediatric patients mainly because pediatric patients have greater sensitivity to the potentially harmful effects of ionizing radiation associated with other imaging modalities. However, the physical properties of the lungs and airways present many challenges to obtaining diagnostic quality MR images, which have limited the clinical use. Fortunately, there have been several new MRI techniques that can be used to overcome these challenges. Therefore, the overarching goal of this presentation is to provide up-to-date information on these new MRI techniques, including pediatric patient preparation, imaging protocols, and imaging findings for the optimal management of pediatric patients with lung and airway disorders. Fast MR imaging sequence for evaluation of lung parenchyma and spirometer-controlled MR imaging of the large airways in pediatric patients are highlighted. GASTROINTESTINAL IMAGING: FOCUS ON THE PANCREAS & BOWEL How to Perform & Interpret a Secretin MRCP? Andrew T. Trout, MD

This lecture will address the basic elements of performing and interpreting magnetic resonance cholangiopancreatography in the pediatric patient. The three basic types of pancreaticobiliary MR exam (pancreatic parenchymal, standard MRCP, secretin-enhanced MRCP) will be reviewed with emphasis on when to use each. Basic elements of a routine MRCP exam will be covered including: sequence selection, sequence optimization, and key elements to assess on each imaging sequence. The use of intravenous contrast and secretin will be discussed, emphasizing when to use these adjuncts. The indications and contraindications to secretin will be reviewed and the basic structure of a post-secretin imaging sequence will be described. The two types of post-secretin imaging (dynamic and static) will be introduced with review of the role of each. Which Pancreatic Ductal Variants Predispose to Pancreatitis? Sudha A. Anupindi, MD

Although ultrasound is the first line of imaging to assess pancreatitis, in acute recurrent or chronic pancreatitis further evaluation with Magnetic Resonance Cholangiopancreatography (MRCP) is required to evaluate the ductal anatomy. MRCP has become the new gold standard for evaluating pancreaticobiliary abnormalities. The most common ductal variants that may lead to pancreatitis include: pancreas divisum (PDV), anomalous pancreaticobiliary junction (APBJ), choledochal cysts and annular pancreas. Pancreas divisum is the most common of the congenital anomalies resulting from failure of fusion of the ventral and dorsal anlage of the pancreas. In those with recurrent pancreatitis, 12–26% of patients have PDV. The main imaging feature of PDV on MR is that the main dorsal duct is in continuity with the duct of Santorini and drains into the major papilla and the ventral duct (not communicating with dorsal duct) joins the CBD and drains into the minor papilla. Due to obstruction at the minor papilla, there is often inadequate drainage of secretions resulting in pancreatitis. The clinical relevance of this entity is controversial, as most

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patients are asymptomatic. Anomalous PBJ is defined as premature union of the bile and pancreatic ducts outside of the duodenal wall which results in a long common channel. Pancreatitis occurs when there is a reflux of secretions into the pancreatic duct (PD) when bile duct pressure exceeds PD pressures. APBJ is often seen in conjunction with choledochal cysts. Large choledochal cysts without APBJ can also cause pancreatitis due to mass effect and back pressure on the PBJ. Finally, pancreatitis from annular pancreas is rare in children. Based on large published series, the majority of children present with a duodenal obstruction. Knowledge of pancreatic embyrology, ductal variants and their appearance on MRCP is essential in order to diagnose these disorders and help guide management. What are the Imaging Signs of Pancreatic Ductal Trauma? Michael J. Callahan, MD

Pancreatic injuries are relatively uncommon in children, particularly those involving the pancreatic duct. Most blunt pancreatic injuries are associated with additional hepatic, splenic and duodenal injuries, and the most common mechanism of injury in children is direct compression of the gland against the spine in the setting of a motor vehicle accident, sports injury, or bicycle handlebar injury. The primary imaging modalities used for the initial evaluation of suspected pancreatic injuries are ultrasound and computed tomography, and identification of potential signs of pancreatic ductal injury can directly impact initial patient management. Endoscopic retrograde cholangiopancreatography is the most reliable method to define continuity of the pancreatic duct, and can be used for therapeutic stent placement in the correct clinical setting. The goal of this presentation is to present the imaging findings of pancreatic ductal injury in children, and familiarize the audience with potential pitfalls in the diagnosis of pancreatic ductal injuries. How to Distinguish Acute Inflammation from Chronic Fibrosis in Crohn’s Disease? Ethan A. Smith, MD

Crohn disease is relatively common in children and the incidence is increasing. Active bowel wall inflammation in Crohn disease can lead to luminal narrowing and obstruction. Chronic inflammation leads to bowel wall fibrosis, which can also result in luminal narrowing and obstruction. In patients with known Crohn disease, determining the presence of bowel wall fibrosis is clinically important, as patients with luminal narrowing due to inflammation may respond to medical management, whereas those with fibrostenotic disease may require surgical resection to relieve obstructive symptoms. Several imaging features have been investigated in an attempt to distinguish fibrosis from active inflammation in patients with luminal narrowing and obstruction. These include evaluation of dynamic bowel wall enhancement at MR enterography and assessment of T2 weighted signal characteristics of the bowel wall. The evidence supporting these techniques, as well as their limitations, will be discussed. So far, the utility of these techniques has been limited to the observation that the segments of bowel with the most fibrosis are often also those with the most ongoing active inflammation. Novel imaging techniques undergoing investigation will also be described, including dynamic contrast enhanced ultrasound and acoustic radial force impulse elastography, which assesses bowel wall stiffness as a surrogate for fibrosis. Future directions will be briefly discussed, such as the use of novel biomarkers to determine fibrosis from superimposed active inflammation. How to Image and Classify Perianal Fistulae? Jonathan R. Dillman, MD

Perianal/perineal involvement by Crohn’s disease is common in the pediatric population. Manifestations include simple cutaneous

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inflammation, skin tags, fistulae, and abscesses, and they can take on a variety of appearances at magnetic resonance imaging (MRI) and physical examination. On occasion, such abnormalities may present prior to the recognition of intestinal inflammation. High-resolution, small fieldof-view, multi-parametric MRI at a field strength of 3 T permits comprehensive evaluation of perianal/perineal Crohn’s disease, including determination of the number and location of fistulae and abscesses (and their relationships to the internal and external anal sphincters) and assessment of inflammatory activity. MRI also helps guide surgical management of perianal/perineal Crohn’s disease and has been shown to improve outcomes in adults. My presentation will present an up-to-date review of perianal/perineal Crohn’s disease in children, including MRI technique, imaging features of fistulae and abscesses, and radiologic classification. In addition, the imaging appearances of medical conditions that can mimic perianal Crohn’s disease will be presented. How to Interpret a Pelvic MRI After Rectal Pullthrough? Alexander J. Towbin, MD

Increasingly, MRI is being used to identify post-operative complications in patients who have had prior corrective surgery for an anorectal malformation. When MRI is performed, the colorectal surgeon requires very specific information. After attending this lectures, radiologists should be able to describe the course of the rectum in relation to the levator sling/ sphincter complex; describe the appearance of the pelvic floor musculature; identify when the original rectum has been resected and the sigmoid colon has been pulled through; identify posterior urethral diverticula; identify previously missed masses or anomalies; and identify persistent rectourethral fistulas What is the Role of Ultrasound in Intestinal Malrotation? Alan Daneman, MBBCh, FRCPC

In the past two decades there has been an increasing use of ultrasound for the diagnosis of midgut malrotation. However, the exact role and relationship of ultrasound and fluoroscopically guided contrast examination of the upper gastrointestinal (UGI) tract for the diagnosis of anomalies of midgut rotation +/or fixation is yet to be addressed in a large series of children who have either normal rotation and fixation or those with an anomaly of midgut rotation +/or fixation. Several authors have advocated that ultrasound is the modality of choice for excluding such anomalies. Adequate depiction of the whirlpool sign of midgut volvulus on ultrasound obviates the necessity for an UGI series. The relationship of the superior mesenteric vessels as a sign on its own can be misleading. In more recent years attention has been focused on the position of the third part of the duodenum (D3) on ultrasound. It has been suggested that the normal position of D3 between the aorta and superior mesenteric artery excludes the risk of volvulus and obviates the need for an UGI series. This latter claim, however, has been challenged with both ultrasound and CT images with very small numbers of cases. The potential dire consequence of missing the diagnosis of an anomaly of midgut rotation demands that we be cautious of how we interpret the images from whatever modality we are using. Meticulous attention to technique is essential. One should never be reluctant to use a second modality if one is unsure of the diagnosis.


focusing on this issue in various high-impact journals draw attention to the importance of this topic. The chronicity of the disease coupled with the need of repetitive diagnostic imaging raise the exposure of radiation to these patients. Such imaging modalities and the respective effective dose estimate are as follows: abdominal x-ray 0.7 mSv, upper gastrointestinal series 3.0 mSv, small bowel follow-through 5.0 mSv, Barium enema 7.0 mSv, abdominal/pelvic CT 10–15 mSv. The yearly exposure to radiation from medical imaging alone in patients with IBD is estimated to be 3–5 mSv. In about 6% of the IBD patients the cumulative effective dose (CED) is greater than 50 mSv, a level that has been associated with an increased risk of cancer development. In addition to all the known reasons for higher radiation risk in children, patients with IBD have inherently increased risk of cancer due to the disease itself and also related to some of the potent medications that are currently used in this condition. Consequently, reducing the radiation dose to “as low as reasonably achievable (ALARA)” is a diagnostic imaging necessity. Even better is avoiding imaging studies with radiation exposure and replacing them with those without. In this regard ultrasound and MR imaging play an important role. GENITOURINARY IMAGING: FOCUS ON GONADAL RADIOLOGY What is the Role of Imaging in Testicular Trauma and its Follow-up? Laura Z. Fenton, MD

Pediatric blunt scrotal trauma is most commonly due to sports-injury (>50%) followed by motor vehicle accidents (17%). Ultrasound (US) with color flow and Doppler imaging is the first-line imaging modality to guide therapy. Traumatic injuries diagnosed include hematoma, hydrocele, hematocele, testicular fracture and testicular rupture. As an accurate history is difficult to obtain from young children, US findings may be the first indication of trauma. In equivocal cases, MR imaging may aid in defining the injury. Timely diagnosis of testicular rupture, based on US finding of discontinuity of the echogenic tunica albuginea, is critical as surgery results in salvage of the testis in 80–90% if performed within 72 h The presence of heterogeneous testicular echotexture and loss of normal contour without direct discontinuity of the tunica albuginea have been reported as sufficient to diagnosis testicular rupture, with 100% sensitivity and 65–93% specificity. Controversy in the urology literature regarding management of testicular rupture after blunt trauma exists; historically operative approach has been advocated with a conservative approach akin to management of renal traumatic injuries recently suggested. Scrotal trauma may be associated with acute epididymitis, epididymo-orchitis and testicular torsion. Reportedly, 10–15% of testicular tumors are found incidentally at imaging following scrotal trauma. Following scrotal trauma, ultrasound imaging is performed for new or worsening symptoms. Scrotal tunica cyst and scrotal calculi following trauma have been reported. Torsion of the Testis: What is the Role of Doppler and What are Concerning Flow Patterns? Lynn A. Fordham, MD

What is Known About Radiation Issues in Imaging of IBD? Kassa Darge, MD, PhD

In patients with inflammatory bowel disease (IBD), exposure to radiation from imaging studies is a major concern. The many publications just

Go the operating room or discharge to home? In this presentation we will review normal and abnormal waveforms obtained during testicular ultrasound as well as discuss the secondary findings that counter or confirm a diagnosis of testicular torsion.

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S64 How and When Should a Radiologist Reduce Testicular Torsion? Laurent Garel, MD

Rationale Testis viability following intravaginal torsion ranges from 62 to 85% and depends on the duration of ischemia. Restoration of flow within 6 h is correlated with a 90 to 100% range of testis preservation, whereas a 6 to 12-h deprivation of flow results only in a 20 to 50% salvage rate. How



& &

Experimentally, a 540o twist of the spermatic cord completely occludes arterial flow. Accordingly, manual detorsion should be performed by 180–360° increments in cases of common torsion with completely absent arterial flow. Detorsion is lateral (“open the book” technique), caudal to cranial, under CDU monitoring, with or without sedation. Any resistance to initial lateral detorsion, should lead to medial direction of maneuver (10–30% of cases). Successful detorsion is indicated by the immediate relief of pain, the elongation of cord (testis mobility) and the restoration of flow (immediate or progressive). A known pitfall of manual detorsion is the partial reduction of 720° or greater twist, hence the importance of monitoring the restoration of flow by CDU.


& & &

Outside the neonatal period (extravaginal torsion). When the testis is still viable (preserved homogeneous echogenicity). When time delay (duration of torsion, access to OR) is significantly hampering testis recovery.

Clinical Relevance

& &

Manual detorsion is an old, effective and safe technique that results in 68 to 86% success rate. Manual detorsion is not a substitute for exploration and fixation: bilateral orchidopexy remains imperative.

When and How to Find the Undescended Testicle: To Search or Not to Search? Kate A. Feinstein, MD

The undescended testis is a common congenital abnormality, affecting up to 3% of term newborns. Most testes descend during the first few months of life, resulting in a prevalence of 10 mL or presence of >12 small follicles 2–9 mm should be present using TVUS—during follicular phase. In adolescents, ovaries should be > 10.8 mL (transabdominal) at any time if amenorrheic. Polycystic ovarian morphology (PCOM)—peripheral follicles, >6 (4–10 mm) follicles and/or dense stroma is not addressed in current criteria yet is common in puberty and can be confused with PCOS PCOS accounts for most cases of adolescent androgen excess but diagnosis is difficult. Oligo/anovulation may be physiologic, anovulation must be present for > 2 years (or primary ammenhorea at age 16) to meet criteria. PCOM can be present in 40% of normals or ovaries may not appear abnormal until 2 years after menarche. Only 30% of adolescents with PCOS have ovarian vol > 10 mL. Hyperandrogenism can be present in normal adolescents (75%) with acne. Differential includes physiologic cysts, endometrioma, benign and malignant neoplasms (serous/mucinous cystadenomas, teratoma, choriocarcinoma). While adults with PCOS have 85–100% PCOM, only 35–67% of adolescents with menstrual irregularities and hyperandrogenism have PCOM. Over diagnosis can also be a problem as PCOM can be present in normals. Caution is needed in over and under interpreting sonograms.

Wednesday, May 14, 2014 MUSCULOSKELETAL IMAGING: FOCUS ON ONCOLOGY Radiographic and CT Characterization of Aggressive Bone Lesions Tal Laor, MD

A child with a bone lesion may present with symptoms such as pain, a palpable mass, or a pathological fracture. However, some bone lesions are incidental findings when imaging is performed for another reason. The American College of Radiology Appropriateness Criteria state that the first imaging modality for a suspected bone lesion should be radiography. Radiographs offer clues from which to determine the aggressiveness of a


lesion, to formulate a differential diagnosis, and to direct further investigation. Radiographic features that characterize an aggressive bone lesion include cortical disruption, a moth-eaten or permeative pattern of bone destruction, a wide zone of transition between lesion and surrounding bone, periosteal new bone formation in a sunburst or onion-skin pattern, a Codman triangle, and an associated soft tissue mass. These findings usually indicate malignancy, although benign etiologies, such as osteomyelitis may present with worrisome radiographic characteristics. Tumoral mineralization, such as osteoid production, may be a clue to etiology. Although aggressive lesions may be central, eccentric, cortical, or parosteal, anywhere along the length of a bone, most malignancies in children tend to be metaphyseal or metadiaphyseal. Patient age at presentation also should be used to formulate a differential diagnosis. CT imaging occasionally is obtained if MRI is not possible when further investigation is indicated. Features similar to those characteristic of aggressive bone lesions on radiography also can be seen with CT imaging. Occasionally, subtle mineralization, cortical breakthrough or pathologic fracture not identified on radiographs may be evident. However, the overall role of CT in the evaluation of aggressive bone lesions is considered limited. MRI Characterization of Bone Lesions Diego Jaramillo, MD, MPH

Analysis of MR characteristics of osseous lesions in children is key to differential diagnosis. A destructive lesion with a large soft tissue mass in a child under 5 years. is likely metastatic neuroblastoma, between 5 and 10 years., Ewing sarcoma and above 10 years., osteogenic sarcoma. Epiphyseal lesions suggest chondroblastoma or infection; metaphyseal lesions, infection, and osteogenic or chondrogenic tumors; and diaphyseal lesions, Ewing sarcoma or histiocystosis. Borders indicate perilesional edema and not malignancy. Inflammatory benign tumoral lesions (chondroblastoma, osteoid osteoma, osteoblastoma, histiocytosis) cause edema larger than the tumor extending circumferentially to the adjacent marrow and soft tissues. Traumatic lesions, if not associated with cortical break, produce marrow abnormality that extends along the shaft without substantially affecting adjacent soft tissues. Osteomyelitis resembles benign inflammatory tumors, but has nonenhancing areas in the marrow, subperiosteal space and soft tissues. Physeal transgression occurs with both inflammatory and malignant lesions, but in aggressive lesions the metaphyseal involvement is much larger than the physeal disruption. Chondroid lesions are of high T2 signal intensity and are nonenhancing unless highly malignant. Fibrous lesions and lesions with hemosiderin demonstrate low T2 signal intensity and enhance avidly.. Many aggressive lesions have well-circumscribed margins on T1-weighted images. Low T2 signal intensity within the marrow cavity indicates either osteoid formation or reactive bone formation. However, large areas of decreased signal intensity in the soft tissue component of the tumor strongly suggest osteoid tumor bone and thus osteogenic sarcoma. Staging and Assessment of Treatment Response in Osteosarcoma and Ewing Sarcoma Kirsten Ecklund, MD

The purpose of this brief talk is to review the imaging techniques currently utilized for staging, and subsequent monitoring of treatment response in patients with osteosarcoma and Ewing sarcoma. The goals of these techniques include improved image resolution and quality, lesion tissue characterization, and increased acquisition speed. Standard morphologic as well as diffusion weighted (DW) and perfusion MR imaging techniques and PET/CT will be discussed.

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DWI can aid in the differentiation of benign from malignant lesions, which generally have restricted diffusion. There is even greater potential for DWI in the assessment of tumor response to therapy. The apparent diffusion coefficient (ADC) maps are critical to accurate interpretation of diffusion sequences. ADC maps distinguish between restricted diffusion and T2 effect, both of which appear bright on DWI. Both qualitative and quantitative tissue assessments can be made with DWI. Challenges for DWI in the pediatric musculoskeleton include susceptibility artifacts from bone, motion vulnerability, and geometric distortion at larger fields of view. Our current protocols and parameters for DWI will be presented. Perfusion imaging of MSK tumors is generally done with dynamic contrastenhanced (DCE) MR using one of a variety of vendor specific sequences. Qualitative and quantitative assessments of inflow and distribution of contrast have been shown to help differentiate between benign and malignant lesions and to evaluate drug efficacy during therapy. This technique is especially promising in those patients undergoing antiangiogenic therapy. MRI of Bone Marrow Nancy A. Chauvin, MD

strategies to greatly increase the conspicuity of normal anatomy and reveal previously hidden lesions. Proper MRI pulse sequence selection and modifications at 1.5 and 3-T will be covered. Optimization of CT scan parameters will also be covered including pre and post-scan modifications. Examples of these techniques will be presented in phantoms and patients. The goal of the presentation is to give the audience tools to confidently image around orthopedic hardware. Tips for MRI:—Use STIR over T2 fat sat

– – – – –

Turn off fat sat for FSE imaging (e.g. acquire a pre T1 with post T1 contrast imaging, both without fat sat) Reduce the echo train length for FSE Doubling the readout BW at 3-T will cause susceptibility artifact similar to that at 1.5-T Decrease FOV and increase the matrix Avoid GRE imaging Tips for CT:—Expect a dose penalty

Magnetic Resonance (MR) imaging is the primary modality used to evaluate bone marrow. The MR appearance of bone marrow depends on the specific pulse sequence used and quantity of marrow water, fat, protein and cells. Alterations in chemical and cellular composition can be readily depicted using conventional imaging techniques such as spin-echo, fatsuppressed and short tau inversion recovery (STIR) sequences. In the growing skeleton, normal marrow transformation from hematopoietic to fatty marrow occurs in a predictable systematic pattern beginning in the appendicular skeleton and progressing to the axial skeleton. Within the long bones, transformation occurs first in the epiphyses, followed by the diaphyses, and ultimately the metaphyses, with adult marrow achieved by the middle of the third decade. Pathologic processes such as marrow hyperplasia, replacement disorders, depletion disorders and myelofibrosis can disrupt the marrow production and alter bone marrow signal intensity on MR imaging. In addition, treatment related effects due to irradiation or chemotherapy and marrow stimulating medications can cause local or generalized changes to bone marrow signal. Knowledge of the agerelated marrow signal changes is imperative in order to accurately differentiate normal cellular marrow from focal or diffuse neoplastic involvement as well as to recognize therapy related effects and tumor recurrence. Whole Body MRI with DWI for Tumor Staging and Surveillance Jesse Courtier, MD

Pediatric oncology patients will undergo a number of imaging studies over the course of their lifetimes. Awareness of this fact, coupled with the increased understanding of the need for judicious use of ionizing radiation exams has led to the investigation of non-radiation alternatives for the imaging evaluation of pediatric tumors. Whole body MRI with Diffusion-weighted imaging (WB-DWI) is an emerging technique that offers the potential of a non-radiation alternative to PET/CT for pediatric tumor staging and surveillance. Specifically, the application of this technique in the staging of lymphoma is of particular interest in the pediatric population. This presentation will discuss the technique, potential applications, and current challenges/controversies in whole body MRI with WB-DWI in pediatric oncologic imaging.

Increase kVp & mAs Decrease pitch Narrow collimation width

– – – –

Reconstruct with thick slices Use soft tissue recon algorithm and advanced IR Reconstruct in Sag/Cor rather than axial plane Orient hardware perpendicular to CT beam

Osteonecrosis in BMT & Oncology Patients Sue C. Kaste, DO

Osteonecrosis is a significant toxicity of disease and therapy in pediatric oncology that is of increasing importance due to the growing recognition of its prevalence, impact on the patient’s life, and lack of standardization of diagnosis and intervention guidelines. Children in whom osteonecrosis most frequently develops are those whose treatment includes exposure to glucocorticoids such as patients undergoing treatment for acute lymphoblastic leukemia and brain tumors and patients undergoing hematopoietic stem cell transplantation. MR is the most sensitive available modality for detecting osteonecrotic lesions and will serve as the primary modality discussed in this presentation. Lesion size is the best predictor of clinical joint outcome with. MR-determined lesions occupying more than 30% of the femoral head have a high likelihood of joint deterioration necessitating surgical intervention. As osteonecrosis is typically asymptomatic until late in the disease process, imaging necessary for its detection may be delayed even in high-risk patients. Thus, diagnostic imaging is critical for its detection and characterization and to follow its progression and effects of intervention. This presentation is designed to provide a brief review of the pathophysiology of osteonecrosis, describe the patient groups at risk for its development, patterns of involvement, imaging characteristics and techniques used for detection.

Strategies to Image Around Hardware After Limb Salvage Surgery John D. MacKenzie, MD

MSK Tumor Imaging—What the Pediatric Orthopedic Surgeon Wants to Know John P. Dormans, MD, FACS

Several simple strategies can drastically reduce the image artifact produced by metallic orthopedic hardware. We will review MRI and CT

Diagnosis and treatment of MSK tumors involves a close collaboration between the orthopedic surgeon and radiologist. Imaging will often

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dictate the course of action taken by the surgical team. Features identified by advanced imaging are integral to characterizing the malignancy of bone and soft tissue tumors. Beyond determining the potential for malignancy, imaging can define size, location, extent, relationship to other structures or anatomical compartments, and presence of skip metastases of suspected tumors. Though imaging is crucial in tumor detection and diagnosis, it also plays a role throughout patient treatment and posttreatment surveillance. Information provided by radiologists will ensure proper image guided or open biopsy and surgical resection of tumors. For pediatric tumors, radiation dose to the patient is also of increasing interest and scrutiny. Overall, advanced imaging of MSK tumors is vital to all phases of patient care, requiring continuous communication between the surgical team and radiologists. CHILD ABUSE & NOT CHILD ABUSE: FOCUS ON RADIOGRAPHY Classic Metaphyseal Lesion-Micro-CT/Histopathologic Correlation Andy Tsai, MD, PhD


“rickets—nonaccidental trauma controversy” involves little scientific debate. The contention is that infants with multiple fractures who are thought to have been abused, may actually have insufficiency fractures from rickets, even without radiographically apparent rickets. There is no convincing evidence that such cases exist. Rather, infants with rickets and fractures usually have severe rickets and fractures other than those with a high specificity for NAT. With multiple fractures and significant rickets, evaluation includes the severity of bone disease, the types of fractures, and other clinical considerations. Rib Fractures: Location and Mechanisms Paul K. Kleinman, MD

Rib fractures are the most common high specificity injuries encountered in abused infants. This presentation explores the morphologic alterations, anatomic distributions, imaging patterns, and the mechanisms of these important injuries. Imaging of the Skull: Is that a Fracture? Peter J. Strouse, MD, FACR

The classic metaphyseal lesion (CML) is a common high specificity indicator of infant abuse. The injury patterns have been extensively studied radiographically, and the imaging features have been correlated histologically. Micro-CT with 3D modeling permits elucidation of the complex morphology and spatial relationships of the CML—a critical step in understanding the biomechanics of this distinctive injury. Differential Diagnosis of Metaphyseal Fractures Sabah Servaes, MD

Metaphyseal irregularities can be found in a variety of entities ranging from normal variants to fractures secondary to inflicted trauma. Distinguishing between these diagnoses is critical for the appropriate care and disposition of the patient and family. The appearances of the metaphyseal findings and additional imaging and clinical features can be helpful to the radiologist in making the distinction between these etiologies. The imaging features of these entities and a review of the scientific literature supporting our current understanding of the etiology of metaphyseal irregularities will be reviewed. Some of the more controversial purported etiologies and assessment of the evidence to date will be discussed. Rickets Richard M. Shore, MD

Vitamin D deficiency impairs intestinal absorption of calcium, leading to rickets and osteomalacia. Rickets entails deficient mineralization and endochondral ossification of the growth plates whereas osteomalacia is deficient mineralization of non-endochondral bone. The ossification defect results from failure of chondrocyte apoptosis. Hyperparathyroidism, caused by inadequate calcium absorption, plays a key role in the pathophysiology of rickets. Radiographic features reflect these disorders of mineralization and ossification with loss of mineralization of the zone of provisional calcification (ZPC) and excessive disorganized “rachitic cartilage” which has failed ossify. As the ZPC is lost, metaphyseal bone gradually fades into the lucent physis. Although the expanded rachitic cartilage is usually lucent, it may have variable cartilage calcification when the deficient ossification is more severe than deficient mineralization. The diaphyseal findings reflect the combined effects of osteomalacia and hyperparathyroidism. There is major scientific controversy regarding human vitamin D requirements, in part related to whether a multitude of proposed non-skeletal effects of vitamin D are sufficiently established. In contrast, the

Simple linear skull fractures are considered of low specificity for child abuse. Complex skull fractures are considered of moderate specificity for child abuse. Findings raising suspicion for child abuse include lack of a history of trauma, complex fractures occurring in the home, bilateral fractures, greater than one fracture line, fractures of the occipital bone, and fractures which are branching, stellate and/or diastatic. In order to properly identify fractures of the skull, knowledge of the normal sutural anatomy of the skull is paramount. Normal sutures such as the metopic, mendosal and squamous sutures may be mistaken for fracture. Widening of sutures should be recognized as indicative of an intracranial process. Extracranial soft tissue swelling is indicative of an impact injury. Variant fissures within the skull, most commonly occurring within the parietal and occipital bones, may be mistaken for fracture. Aids in differentiation of a fissure from a fracture include location and appearance and knowledge of normal anatomy. Small Wormian bones may be seen as a normal variant; however, significant Wormian bones are associated with osteogenesis imperfecta, Menkes syndome and other disorders, but are rare in normal children. In the evaluation of the skull, radiography and CT are considered complementary modalities. Proper technique and positioning for each modality aids interpretation. Thin CT source images allow for quality 2D (sagittal and coronal) and 3D (volume rendered) reformats. Dating of Fractures Michele M. Walters, MD

In this session the current literature on fracture dating in infants and young children will be reviewed. The relevance of available data to fractures of abuse will be discussed. A scientific system for dating fractures will be proposed, and several cases will be shown to highlight how such a system may be used clinically. What is the Role for Follow-up Skeletal Surveys? Jeannette M. Perez-Rossello, MD

The follow-up skeletal survey adds additional information in a significant number of suspected child abuse cases. It can identify new fractures, confirm suspected fractures and aid in dating. We will review recent studies that suggest decreasing the number of images performed in the follow-up studies.

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S68 What Does the Child Abuse Physician Need to Know & How to Tell Us Allison M. Jackson, MD, MPH, FAAP

Child maltreatment is a public health problem that impacts nearly 700,000 children each year with estimates of over four fatalities daily. Of these children, maltreatment is often repetitive resulting in multiple injuries, some of which are visible on physical exam, most of which are not. Radiologists play an integral role in the assessment of child physical abuse in particular. Diagnostic imaging can reveal acute and remote injuries resulting from abuse. Therefore, it is important for the radiologist to provide information in a manner that aids child abuse practitioners in the diagnosis and management of abuse-related injuries. These children do not always present with an injury complaint or concern for abuse, but instead often present with nonspecific signs and symptoms. Astute radiologists, therefore, have a unique opportunity to identify not only suspected injuries, but also unexpected injuries through diagnostic imaging. The radiographic evolution of acute and healing injuries helps to create a timeline that may assist in determining when a child was injured. Furthermore, radiologists can contribute to the differential diagnosis which may include medical conditions that may be mistaken for abuse. This presentation will give radiologists guidance on what information is most helpful to child abuse professionals in identifying and assessing musculoskeletal, head and visceral injuries associated with child abuse.

SCIENTIFIC PAPERS Authors are listed in the order provided. An author listed in bold identifies the presenting author.

extremity, and 6/10 for pelvis. Relapse occurred at the primary site in 24 (56%) and at a metastatic site in 19 (44%). There was no relation between relapse site (primary vs. metastatic) and survival after relapse (36% vs. 41%, p=0.7). Stage and Clinical Group at diagnosis were associated with survival after relapse, confirming previous reports. These results did not change when the analyses were performed only on patients who completed therapy (n=24). Conclusions: Our results suggest that routine imaging surveillance for relapsed disease in children with rhabdomyosarcoma is not associated with longer patient survival. Validation of these results in a larger study and more limited use of surveillance imaging could reduce medical costs and radiation exposure without compromising patient outcome. Paper #: PA-002 Prognostic Value of Image-Defined Risk Factors in High-Risk Neuroblastoma Karen Lyons, MB, BCh, BAO, BMedSc, MRCPI, FFRRCSI, Baylor College of Medicine, Houston, TX, [email protected]; R. Paul Guillerman, MD, Yesenia Rojas, Chrystal Louis, Jed Nuchtern, Wei Zhang

Purpose or Case Report: Image-defined risk factors (IDRFs) were proposed in 2009 to facilitate consistent and uniform reporting of pediatric neuroblastoma (NB) according to the new International Neuroblastoma Risk Group Staging System (IINRGSS). Since these IDRFs have not previously been evaluated for prognostic value, we aimed to assess IDRFs for predicting outcome in NB. IDRF

Paper #: PA-001 Does Surveillance Imaging of Childhood Rhabdomyosarcoma Improve Patient Survival? Jody Lin, Baylor College of Medicine, Houston, TX, [email protected]; R. Paul Guillerman, MD, Heidi Russell, Philip Lupo, Mehmet Okcu

Purpose or Case Report: While routine imaging is often obtained for surveillance of disease relapse in children with rhabdomyosarcoma, there has been a lack of evaluations to determine if imaging surveillance improves patient outcome. We aimed to compare survival in patients in whom relapse was detected on the basis of clinical symptoms versus surveillance imaging. Methods & Materials: All children with relapsed rhabdomyosarcoma treated at Texas Children’s Hospital from 1993 to 2012 were identified, and their cross-sectional imaging studies were reviewed to define the anatomic sites of disease. Survival time after relapse was compared between two groups: (1) patients presenting with a symptom related to relapse; and (2) patients whose relapse was initially detected by imaging prior to symptoms. Differences in survival time were evaluated with Kaplan-Meier plots and log rank tests. Survival differences were also evaluated using Cox proportional hazards models to adjust for age, stage, Clinical Group, and histology at diagnosis. Results: Of the 43 children with relapsed rhabdomyosarcoma, 26 (60%) had metastatic disease at diagnosis and 19 (44%) had alveolar histology. With a median follow up time of 21 months in 17 survivors, overall survival was 38% (95%CI: 22%–54%) at 2 years. There was no difference in overall survival between patients in whom relapse was diagnosed based on imaging (n=13) versus clinical symptoms (n=30) (2-year survival 39% vs. 37%, p=0.28). The proportion of relapses that were initially detected by imaging prior to symptoms for each site were 1/7 for CNS, 2/11 for head/neck, 3/3 for lung, 1/8 for abdomen/trunk, 0/4 for

Lower mediastinal tumor infiltrating the costovertebral junction between T9 & T12 Tumor encasing the aorta, origin of the celiac artery or the origin of the SMA Tumor encasing the inferior vena cava

Timing of Study

Hazard Ratio (Increased Risk of Death) At diagnosis 1.874


Pre-op 2.446 At diagnosis 1.74

0.0331 0.1982

Pre-op 1.488 At diagnosis 1.576

0.2819 0.2703

Pre-op Infiltration of porta hepatis, At diagnosis hepato-duodenal ligament or duodenopancreatic block Pre-op Tumor invading the SMA At diagnosis branches at root of the mesentery or infiltrating the mesentery Pre-op Tumor encasing At diagnosis iliac arteries Pre-op Invasion of more than one At diagnosis third of the spinal canal in the axial plane Pre-op

p value

1.529 2.362

0.2394 0.0169

1.889 1.201

0.146 0.6145

0.739 0.835

0.5058 0.6918

0.718 0.650

0.6527 0.5566



Pediatr Radiol (2014) 44 (Suppl 1):S1–S253 Pericardial infiltration Diaphragmatic infiltration Liver infiltration Imaging Findings not established as IDRFs Multifocal primary Pleural effusion (malignant or not) Ascites Other Risk Factors

MycN amplified status Abdominal (non-adrenal) tumor location vs thoracic location Adrenal tumor location vs thoracic location


At diagnosis 1.181


At diagnosis 1.658


Pre-op 1.347 At diagnosis 2.273 Pre-op 2.566 Hazard Ratio (Increased Risk of Death) At diagnosis 1.357 Pre-op 1.439 At diagnosis 2.810

0.4700 0.0480 0.0411 p value

0.5345 0.5519 0.0058

Pre-op 1.452 At diagnosis 1.409 Pre-op 1.957 Hazard Ratio (Increased Risk of Death) At diagnosis 2.587 At diagnosis 1.929

0.4494 0.340 0.2170 p value

0.0291 0.5580

At diagnosis 1.598


Methods & Materials: An institutional oncology database was queried for high-risk NB patients who underwent surgical resection between 01/01/2000 and 11/30/2012. Cross-sectional imaging studies obtained at diagnosis, pre-operatively after neoadjuvant chemotherapy, and post-operatively were reviewed and the status of IDRFs and 3D sizes of the primary tumors were recorded. Evidence of organ damage on post-operative studies was also noted. The patients’ medical charts were reviewed, and outcome measures including time to death or last follow-up and relapse were recorded. The independent prognostic power for all-cause mortality of each IDRF and groups of IDRFs was analyzed by univariate Cox’s regression. Fisher’s exact tests were conducted to study association between renal infiltration/hilar abutment and renal injury or nephrectomy. Pearson rank correlation coefficients were calculated and two-tailed paired t tests performed to compare changes in tumor maximal length and volume. Results: Sixty-one patients (30 M: 31 F) with mean age at diagnosis of 2.8 years (range 0.44–8.91) constituted the study cohort. Primary tumors were adrenal in 82%, extra-adrenal abdominal in 11.4%, and thoracic in 6.6%. At diagnosis, presence of a pleural effusion, infiltration of the liver or of the porta hepatis/hepatoduodenal ligament/duodenopancreatic block was significantly associated with mortality. Pre-operatively after chemotherapy, infiltration of the liver or invasion of the lower three costovertebral junctions was significantly associated with mortality. No significant association was found between renal infiltration/hilar abutment and renal injury (p 0.26), but the study was underpowered to test this association. A high correlation (r = 0.80, p < 0.0001) was found between change in tumor maximal length and volume. Conclusions: Certain IDRFs confer increased mortality from high-risk NB when present at diagnosis and pre-operatively, and special attention should be paid to their detection on imaging. The high correlation between changes in tumor maximal length and volume implies that unidimensional response criteria may provide adequate representation of tumor size.

Paper #: PA-003 The DICER1 Pleuropulmonary Blastoma Family Tumor and Dysplasia Syndrome (PPB-FTDS): Role of the Pediatric Radiologist in Diagnosis and Screening R. Paul Guillerman, MD, Department of Pediatric Radiology, Texas Children’s Hospital, Houston, TX, [email protected]; M. John Hicks, Surya Rednam, John Priest

Purpose or Case Report: Pleuropulmonary Blastoma Family Tumor and Dysplasia Syndrome (PPB-FTDS) is a recently recognized syndrome affecting 30–40% of families in which PPB is diagnosed and is characterized by autosomal dominant inheritance (~75% of cases due to DICER1 gene mutations), low penetrance, highly variable expressivity and a distinctive constellation of mostly childhood tumors and dysplasias. To promote recognition by radiologists, we describe our institution’s experience with PPB-FTDS. Methods & Materials: A retrospective study was conducted entailing review of the medical charts and imaging exams of all patients with the distinctive conditions of PPB-FTDS at our children’s hospital from 1990 to 2013. Results: Six patients (3 M:3 F) had PPB-FTDS. The most common tumor was PPB: five cases (two Type I, two Type Ir, one Type II) with detection age from prenatal to 10 years. Three patients had cystic nephroma (CN) at age 0– 2 years, three patients had pineoblastoma (PinB) at age 2–10 years, one patient had a small bowel hamartomatous polyp at age 6 months, one patient had multiple thyroid nodules (age of presentation undefined due to incomplete medical records) and one patient had ovarian Sertoli-Leydig cell tumor (OSLCT) at age 16 years, cervical embryonal rhabdomyosarcoma (cERMS) at age 17 years, and brainstem ERMS (bERMS) at age 21 years. The proportion of FTDS cases among all cases of each tumor over the study period was 5/16 for PPB, 3/6 for CN, and 3/7 for PinB. In all 5 PPB patients, detection of PPB either preceded or coincided with the detection of the other tumors. Clinical presentations varied: incidental detection by imaging in Type I and Ir PPB and CN cases, neurologic signs/symptoms in PinB and bERMS cases, amenorrhea in the OSLCT case, vaginal bleeding in the cERMS case, and intussusception in the small bowel hamartoma case. The patient with Type II PPB died of disease; the others are either undergoing antitumor therapy or show no evidence of disease at post-treatment follow-up. Except for bERMS, the conditions encountered are typical of PPB-FTDS. Conclusions: DICER1 PPB-FTDS is a unique syndrome distinguished by a predisposition for certain tumors and dysplasias across a variety of organs over the first two decades of life, with PPB typically being the earliest and most frequent. Recognition of the imaging manifestations of this syndrome should prompt genetic evaluation to identify and counsel familial carriers, with imaging screening considered for those at risk.

Paper #: PA-004 MR imaging patterns of leukemia and lymphoma Jie Nguyen, M.D., M.S., Pediatric Radiology, CHOP, Philadelphia, PA, [email protected]; Diego Jaramillo

Purpose or Case Report: Leukemia and lymphoma (36% of pediatric malignancies) are often diagnosed incidentally. Due to variable presentation and increased use of MRI, they are sometimes detected because of abnormal marrow signal. We hypothesize that there are significant differences in the pattern of bone marrow involvement among acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and lymphoma. Methods & Materials: We retrospectively reviewed radiologic examinations, medical records and pathology reports in 377 leukemic and 492 lymphoma children who had undergone MRI between 1/1/1995 and 8/26/ 2013. We excluded patients with insufficient data, no MRI prior to treatment, or other associated bone marrow processes. Twenty three leukemic and 31 lymphoma patients with a total of 57 (22 ALL, 4 AML, 31 lymphoma) MR studies were included. A blinded pediatric musculoskeletal radiologist

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classified bone marrow infiltration patterns on T1-weighted images as diffuse, patchy, focal, or normal. Differences were analyzed using Chi-square test. Results: Of 19 children with ALL, marrow involvement was diffuse in 89% (17/19) and patchy in 11% (2/19). Of four children with AML, involvement was diffuse in 75% (3/4) and patchy in 25% (1/4). Of 31 children with lymphoma, involvement was diffuse in 23% (7/31), patchy in 26% (8/31), and focal in 19% (6/31), while the remainder had normal marrow. Overall, the pattern of marrow involvement was significantly different among the three malignancies (P=0.005). Specifically, diffuse bone marrow infiltration favored ALL (P

Abstracts from the American College of Pediatric Radiology Annual Meeting, May 14-17, 2014, Washington DC.

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