Diagnostic Radiology Pediatric Imaging Hariqbal Singh
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1Jaypee Gold Standard Mini Atlas Series® PEDIATRIC RADIOLOGY
3Jaypee Gold Standard Mini Atlas Series® PEDIATRIC RADIOLOGY
Hariqbal Singh MD DMRD Professor and Head Department of Radiology Shrimati Kashibai Navale Medical College, Narhe Pune 411 041 (Maharashtra), India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Jaypee Gold Standard Mini Atlas Series® Pediatric Radiology
© 2011, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2011
9789350251843
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Printed at Ajanta Offset
5To
My CT, MR and X-ray technicians Rahul, Thomas, Raghvendra, Bala, Premswarup, Mritunjoy, Sudhir, Deepak, Vinod, Parameshwar and Adi for their devotion to the field of radiology6
7CONTRIBUTORS 11PREFACE
Change is the paramount feature of science and technology, so is true with field of medicine. What is novel today becomes old tomorrow. Therefore, a doctor has to be vigilant and constantly updated with the change. With increase in armaments in the field of imaging, the imaging specialist plays a more decisive role in diagnosis, which is important in treatment.
In this mini atlas more emphasis has been laid on the chapter of ‘Brain’ which is perplexing, more so after the advent of MRI which has revolutionized the field of pediatrics, particularly neonatal neurology. This has been done at the cost of other chapters which have been truncated, as they are better understood, and at the same instance, prevented this mini atlas on Pediatric Radiology from being voluminous.
This book is meant for the residents, radiologists, pediatricians, general practitioners and other specialists. It is also meant for medical colleges, institutional and depart-mental libraries and for stand-alone pediatric and imaging establishments.
Hariqbal Singh
12ACKNOWLEDGMENTS
I express my gratitude to Professor MN Navale, Founder President, Sinhgad Technical Educational Society and Professor Arvind V Bhore, Dean, Smt Kashibai Navale Medical College for their kind go-ahead in this venture.
I profusely thank the Consultants Prashant Naik, Rahul Ranjan, Rajlaxmi Sharma, Dinesh Pardesi, Mrunalini Shah, Manasi Bhujbal, Anubhav Khandelwal, Sushant Bhadane and Sushil Kachewar for their genuine help in building up this educational entity. I extend appreciation to Perfint Healthcare for providing CT-guided precision biopsy images. I express gratitude to Siemens Ag, Germany for providing MRPET images prior to its commercial launch.
My gratitude to Manjusha Chikale, Nursing Sister, Snehal Nikalje, Anna Bansode and Sachin Babar for their clerical help.
I am thankful and grateful to Almighty and mankind who have allowed me to have this wonderful experience.
13INTRODUCTION
The field of pediatrics comprises of growth, development and wellbeing of the child. It begins when conception is manifested and continues during growth and developmental processes till 21 years of age. However, various institutes consider the upper age for pediatric group from 12 to 21 years.
Pediatrics differs from adult medicine by the obvious body size and maturational changes. The smaller body of an infant or neonate is substantially different physiologically. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than to general physicians, so is true with pediatrics’ imaging.
Irradiation in utero can lead to developmental abnormalities (8–25 weeks) due to DNA damage and can also lead to malignancy which can be expressed in childhood or during adulthood. Preconception maternal irradiation in therapeutic doses gives rise to defects in 1 out of 10 exposed children. Non-urgent radiological examination should not be done between 8 and 17 weeks of gestation, which is the most sensitive period for organogenesis. Children are 10 times more sensitive for hazards of radiations than adults. Hence, radiography with high kV and low mAs technique is recommended for children to prevent against secondary 14radiations. Lead or bismuth shields/aprons/protective devices should be used to cover eyes, thyroid, breasts, gonads, whenever possible, particularly in pediatric group, to minimize their exposure to radiations.