Paeds Vivas · investigations-procedures-and-technology
Neuroimaging selection and radiation-aware practice — branching viva
Branching viva on choosing between CT, MRI, cranial ultrasound and skull radiograph in children: applying the PECARN head injury prediction rules, defending the modality of choice for the first unprovoked seizure, quantifying the attributable cancer risk of paediatric CT, and counselling a parent about radiation risk.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Emergency department: a 3-year-old is brought in after a fall from a playground slide. The examiner asks how you decide whether to image, what you would do with a younger sibling who is drowsy after a similar fall, how you would defend the radiation risk to an anxious parent, and how you would approach the imaging of a 7-year-old with a first unprovoked seizure.
Opening question
This 3-year-old is alert, interactive, has a Glasgow Coma Scale of 15, has not vomited, has no palpable skull fracture, and the parents feel he is acting normally after a one-metre fall. Walk me through how you decide whether he needs a CT head, and tell me what rule you are applying and why it lets you avoid the scan. [1]
References5ShowHide
- [1]Kuppermann N, Holmes JF, Dayan PS, et al Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study Lancet, 2009.PMID 19758692
- [2]Brenner D, Elliston C, Hall E, Berdon W Estimated risks of radiation-induced fatal cancer from pediatric CT AJR Am J Roentgenol, 2001.PMID 11159059
- [3]Pearce MS, Salotti JA, Little MP, et al Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study Lancet, 2012.PMID 22681860
- [4]Frush DP, Frush KS The ALARA concept in pediatric imaging: building bridges between radiology and emergency medicine Pediatr Radiol, 2008.PMID 18810422
- [5]Hirtz D, Ashwal S, Berg A, et al Practice parameter: evaluating a first nonfebrile seizure in children Neurology, 2000.PMID 10980722