WG 1 - Ultrasound of the lung parenchyma: a diagnostic tool for the paediatric radiologist or for the clinician?
WG 1 - Ultrasound of the lung parenchyma: a diagnostic tool for the paediatric radiologist or for the clinician?Wednesday, March 1, 08:30 - 10:00 Room: Z Session Type: ESR Working Group on Ultrasound Topics: Imaging Methods, Chest Moderator: C. Owens (London/UK) Add session to my schedule In your schedule (remove)
1. To define technical requirements and main protocols for use in lung ultrasound.
2. To describe normal and abnormal findings in childhood.
3. To understand artefacts and limitations in lung ultrasound.
The objective of this presentation is to present and discuss the role, the potential and the limitations of ultrasonography (US) in paediatric lung and chest conditions. The technical equipment, transducer selection and device setting will be listed. Furthermore, the course of the examination is demonstrated. Requirements for standardisation will be discussed, such as sitting position for quantifying potentially associated effusions. Typical queries that can be addressed by US will be listed and normal as well as abnormal findings will be demonstrated. Besides the great potential of US in pleural and lung conditions, limitations have to be respected and artefacts have to be known to avoid pitfalls and mismanagement. Particularly, one needs to accept that US cannot replace plain film or chest CT, despite its huge potential for many queries. Lung (and chest) US have become a valuable tool for addressing chest conditions in childhood both for diagnosis as well as for follow-up. US helps to reduce other irradiating imaging, but restrictions and artefacts have to be acknowledged and other imaging such as plain film and CT need to be considered as additional methods helping to solve sonographically equivocal findings.
How does lung parenchymal ultrasound change the clinical management of the sick child: the paediatric radiologists' perspective
1. To discuss the appropriate use of US, x-ray, CT and MRI in the management of children presenting with thoracic diseases.
2. To define if and how paediatric radiologists should be trained in chest US.
The imaging of the chest in paediatrics needs a specific cultural approach planned to integrate and optimise the techniques available. The prevalence of air represents a particular challenge for the radiologist. It limits the intrathoracic ultrasound (interfaces between soft tissue and lung generate very strong echoes due to a large acoustic impedance gradient), is a problem for the MRI (low proton density and the susceptibility differences between tissue and air), determines an excellent contrast resolution for the conventional radiology and CT that remains the gold standard. Technically, CT is conditioned by a cost/benefit ratio that means dose/diagnosis relationship. Risk of chest PA and lateral is negligible. Classical indications for chest US (in the presence of an acoustic window) are opaque hemi-thorax, assessment of vascular abnormalities, evaluation of diaphragmatic motion and juxta-diaphragmatic processes, detection characterisation of a suspected mediastinal disease, evaluation of chest wall lesions, to confirm and characterise pleural effusions guiding for pleural drainage procedures. New extensive use of sonography as clinical portable tool takes information also from physical acoustic phenomena that are not directly convertible into images of the human body. These artefacts are non-anatomical images, which are at best a sensitive but, unfortunately, a very nonspecific sign of lung injury common to many conditions. Young paediatric radiologists can easily learn the traditional chest ultrasound and they should know strengths and weaknesses of “new” imaging.
How does lung parenchymal ultrasound change the clinical management of the sick child: the clinicians' perspective
1. To illustrate the role of bedside lung parenchymal US in comparison with x-ray and CT in management of sick children.
2. To define and discuss the paediatricians perspective.
In the last two decades, lung ultrasound (LUS) has become popular both in adult and children for the clinical evaluation of pulmonary diseases. In neonatal and paediatric age, LUS has been utilized by the clinician as point of care tool to address the decision making process. LUS features of the most common neonatal respiratory diseases (respiratory distress syndrome, transient tachypnoea of the newborn, meconium aspiration, pneumothorax, pleural effusion, pulmonary haemorrhage) as well as its functional application on the respiratory therapy will be presented.