Effectiveness of chloral hydrate sedation in pediatric patients who receive cone beam computed tomography examinations
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Abstract:
Objective
To discuss the success rate and image quality in pediatric patients who used chloral hydrate before their cone beam computed tomography exam.
Methods
1752 patients aged 1 to 6 were selected for this retrospective study. They were divided into sedated group (219 cases) and non-sedated group (1 533 cases). The success rate and image quality were compared between two groups.
Results
The sedated group had a higher success rate to non-sedated group: 99.5%(218/219) vs. 90.4% (1 386/1 533). The motion artifact in sedated group was lower than non- sedated group with I degree: 4.8% (15/314) vs. 20.1%(327/1 630) and II degree: 0.3%(1/314) vs. 12.2%(199/1 630).
Conclusion
Giving chloral hydrate to pediatric patients before their CBCT exam would improve both success rate and image quality, and reduce unnecessary radiation expose.
Key words:
Children; Chloral hydrate; Cone beam computed tomographyKeywords:
Chloral hydrate
Objective
To explore the clinical effect of standardized respiratory training applied in the chest examination of multi-slice spiral CT.
Methods
200 patients scheduled for chest CT examination in medical imaging department of our hospital from December 2014 to December 2015 were selected as the object of study, and randomly divided into observation group and control group. Patients in the observation group received standardized respiratory training before the examination, while patients in the control group were randomly informed of the matters need attention during the process of examination. The examination preparation time, image artifact score, the change of heart rate (HR) during the examination of two groups were compared.
Results
There was no statistically significant difference in the examination preparation time between two groups (P>0.05). The rate of increased HR in the observation group was significantly lower than that of the control group (P 0.05). Middle lung zone, lower lung zone image artifact scores and the overall image artifact score in the observation group were lower than those of the control group (P 0.05).
Conclusion
Standardized respiratory training can effectively reduce the middle and lower lung zone image artifact, ease tension of patients, improve image quality, does not increase the examination preparation time, has the value of popularization in clinic.
Key words:
Respiratory training; Respiratory artifact; Chest; CT examination
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Canine patients with acute abdominal signs are often clinically unstable and need a rapid and accurate diagnosis. Contrast-enhanced multi-detector computed tomography (CT) is the current modality of choice for evaluating acute abdominal pain in people. We hypothesized that contrast-enhanced multi-detector CT would be a feasible and safe technique for use in awake and lightly sedated dogs with acute abdominal signs. Eighteen client-owned dogs were enrolled, all presenting with acute abdominal signs. Dogs were scanned using a dual-phase protocol that included precontrast, arterial, and portal venous phases. Eight dogs were scanned awake and ten were given light sedation as chosen by the primary care clinician. Two observers who were unaware of clinical findings and sedation status scored image quality for each scan by consensus opinion. Mean serum creatinine in the sedated group was higher than in the awake group but was within the normal reference range. Other laboratory and physiologic measures did not differ between awake and sedated groups. No IV contrast-related adverse reactions were seen. Median scan time for all patients was less than 10 min. Sixteen of 18 contrast-enhanced multi-detector CT scans were scored fair to excellent in diagnostic quality, with no statistical difference in diagnostic quality for awake vs. sedated patients. Causes for two poor quality diagnostic scans included severe beam hardening from previously administered barium contrast agent and severe motion artifacts. We conclude that dual-phase contrast-enhanced multi-detector CT is a feasible and safe technique for evaluating awake and minimally sedated dogs presenting with acute abdominal signs.
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Irritability
Head trauma
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Abstract This study aimed to evaluate the need for radiation exposure in pediatric minor head trauma. Symptomatic patients after minor head trauma were observed for at least 24 hours in a 13-month period. A computed tomography (CT) scan was performed on children with a depressed neurological status. Two hundred fourteen patients with a mean age of 9.3 years were included. An intracranial hemorrhage (ICH) was diagnosed in three (1.4%) patients. The overall CT rate was 10.7%. The study concluded that neuro-observation without initial CT scans is safe in infants and children following minor head trauma. Special pediatric CT protocol can limit radiation exposure.
Head trauma
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Abstract Purpose To evaluate the use of an audio/visual (A/V) system in pediatric patients as an alternative to sedation in magnetic resonance imaging (MRI) in terms of wait times, image quality, and patient experience. Materials and Methods Pediatric MRI examinations from April 8 to August 11, 2008 were compared to those 1 year prior to the installation of the A/V system. Data collected included age, requisition receive date, scan date, and whether sedation was used. A posttest questionnaire was used to evaluate patient experience. Image quality was assessed by two radiologists. Results Over the 4 months in 2008 there was an increase of 7.2% (115; P < 0.05) of pediatric patients scanned and a decrease of 15.4%, (67; P = 0.32) requiring sedation. The average sedation wait time decreased by 33% (5.8 months) ( P < 0.05). Overall, the most positively affected group was the 4–10 years. The questionnaire resulted in 84% of participants expressing a positive reaction to the A/V system. Radiological evaluation revealed no changes in image quality between A/V users and sedates. Conclusion The A/V system was a successful method to reduce patient motion and obtain a quality diagnostic MRI without the use of sedation in pediatric patients. It provided a safer option, a positive experience, and decreased wait times. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.
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The purpose of this study was to compare the image quality of thoracic CT angiography (CTA) studies performed with two techniques--with general anesthesia and without general anesthesia--for infants and for children younger than 5 years.All consecutively registered infants and young children (age, ≤ 5 years) who underwent contrast-enhanced thoracic CTA from November 2005 to October 2010 were categorized into two groups: general anesthesia and awake (i.e., no general anesthesia). Two radiologists independently evaluated image quality by quantifying the degree of motion artifact at three anatomic levels (upper, middle, and lower lung zones). Motion artifacts were graded on an ordinal scale (0, no motion; 1, mild; 2, moderate; 3, severe), and the Pearson chi-square test was used to assess whether the degree of motion artifact differed between the general anesthesia and awake groups in the upper, middle, and lower lung zones. Logistic regression analysis was performed to determine whether image quality based on the presence or absence of motion artifact in any lobe was related to general anesthesia versus the awake state; age and sex were covariates. Interobserver agreement between two reviewers was evaluated with kappa statistics.There were a total of 135 patients (mean age 1.0 year), 95 in the awake group (70%) and 40 in the general anesthesia group (30%). No significant difference was found between the two groups in percentage of studies with motion artifact detected in each lung zone and the total motion artifact score. Results of multivariable logistic regression analysis indicated that image quality was not influenced by age (p = 0.52) or sex (p = 0.20). There was excellent interobserver kappa agreement between reviewers for detecting motion artifact in the upper, middle, and lower lung zones (all κ > 0.90, p < 0.001).There is no significant difference in image quality of thoracic CTA with 64-MDCT assessed by degree of motion artifact with and without general anesthesia. The results of this study support use of thoracic CTA without general anesthesia in the care of young pediatric patients who meet screening criteria for awake imaging studies.
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Studies show equivalent accuracy of abdominal computed tomography (CT) using rectal contrast compared with oral contrast for diagnosing appendicitis. The authors evaluated whether emergency department (ED) length of stay and satisfaction differed by route of contrast administration for abdominal CT.This before-and-after intervention evaluated adult patients in an urban academic ED who were undergoing abdominal CT to screen for suspected appendicitis. Phase 1 subjects had a CT after oral contrast. Phase 2 patients had a CT after rectal contrast infused by gravity drip. Patients were interviewed after CT scan to assess satisfaction and discomfort. The primary outcome was ED length of stay. Medians, 95% binomial confidence intervals (CI), and Wilcoxon rank sum test of differences were calculated.One hundred twelve patients were enrolled; half received rectal contrast. There was a significant decrease in length of stay for patients who were administered rectal contrast (261 min, 95% CI = 236 to 305 min) vs. oral contrast (332 min, 95% CI = 299 to 362 min), p = 0.009. Although subjects in the rectal-contrast group waited 65 minutes longer than did oral-contrast patients before receiving contrast after the CT order, the time from contrast administration to CT was 13 minutes, vs. 150 minutes for patients receiving oral contrast (p < 0.001). Patient satisfaction and discomfort did not differ by route of contrast administration.Rectal contrast for patients undergoing abdominal CT to rule out appendicitis reduced ED length of stay by more than an hour and did not affect patient satisfaction or discomfort. Rectal-contrast administration for abdominal CT may significantly shorten patient throughput time for individuals undergoing evaluation for appendicitis.
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Objective:To discuss the effect of nursing methods on result of coronary artery double sources CT scan on aged patient.Methods: 138 subjects planed to receive double sources CT scan were included and questionnaire surveyed by designed forms.Patients were divided into the experiment and the control groups.The experiment group received physiological and psychological heath education before examination as well as been explained the adverse effect might be appear during scan and guided the correct corresponding measurements.The control group received general nursing.Results:The awareness rate of scan examination items,procedure and drug reactions was 80 % vs 74.5 % in subjects of the experiment and the control groups.100 % vs 92.75 % gained 3 or 4 grade image in the experiment group wand the control respectively.8.57 % vs 20.29 % of subjects had side effects in these two groups.The scan period of those patients in the experiment group were shortened which decrease the radiation quantity.Conclusion:Better quality of coronary artery double source CT scan image could be gained by health education before examination in aged patients.
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