Pediatric Studies

• Common Pediatric Fluoroscopy Procedures
  

  Enema: unprepped (Hirschsprung/constipation), prepped (rectal bleeding)

  Barium swallow/Upper GI series

  Chest/airway fluoroscopy

  Small bowel series (may take up to 4 hours)

  Upper GI Series

  Voiding cystourethrogram with urine culture

  The role of low-dose pulsed fluoroscopy

  Fluoroscopic studies are widely used for pediatric patients, most commonly for urinary tract infections, vomiting and dysphagia. To minimize children’s exposure, Wake Radiology’s new Siemens advanced low-dose “pulsed” fluoroscopic system in its West Raleigh office is able to reduce the dose for fluoroscopic studies by up to 80% versus continuous fluoroscopic imaging. This is particularly good news for children, who often need such procedures as VCUG and upper GI examinations.

  Barium Enema

  A barium enema is an X-ray study in which a small tube is inserted into your child’s rectum and the large intestine is then filled with barium. Barium is a non-toxic, contrast liquid that highlights organs to be studied. The preparation needed before a barium enema will depend on which type of enema is ordered. Please note which one has been scheduled and follow the appropriate instructions carefully. Failure to do so may mean that the test cannot be performed. If there are any questions, please call our office at 919-781-6707.

  • Enema, un-prepped (for constipation, or to rule out Hirschsprung’s disease): No prep necessary. Nothing in the rectum for 24 hours prior to the exam, including suppositories, enemas, or thermometers. No rectal exams. The day of the exam your child may continue to eat normally. If your child is taking any medicines by mouth, they can still be given.
  • Enema prepped (for rectal bleeding or polyps): 
    • Two days before the exam, it is important that the colon be thoroughly cleaned out. It will be easier to do this if the child is already having a soft bowel movement every day. If this is not happening, give 2 doses of Milk of Magnesia at the following doses and follow the Milk of Magnesia with a glass of liquid (8 oz). Stop giving it if diarrhea occurs. If your child has not had a bowel movement by the next morning, give one dose of the Milk of Magnesia that morning.
      • Age 12 years and older: 2 tablespoons twice a day
      • 6-11 years old: 1 tablespoon twice a day
      • 2-5 years old: 1 teaspoon twice a day
      • less than 2 years old: consult your physician
    • One day before the exam: Eat a light breakfast by 11:00 AM. After 11:00 AM, the patient may only have CLEAR LIQUIDS for the rest of the day and up until 2 hours before the enema. Clear liquids include drinks like Gatorade, Kool-Aid, sodas and soft drinks (regular only, not diet), clear juices such as apple or white grape juice, water, broth, home-made Jell-O (but NOT the pre-made cups), ice pops without fruit, Italian ice, hard candies, and sweetened tea. Do not use products that are red or purple in color, as this may look like blood during the procedure. Make sure your child drinks LOTS of clear liquids other than water to prevent dehydration and electrolyte imbalance.You will need to purchase 1 or 2 bottles of Magnesium Citrate (10 oz each) for the clean-out. Refrigerate these, as the medicine tastes better cold. Your child will take 3 doses of the Magnesium Citrate at 11:00 AM, 2:00 PM and 5:00 PM. Each dose is 4 ml per kilogram of body weight with a maximum of 5 oz (150 ml) per dose. This is your child’s dose:_______. Each bottle is 10 oz, so the maximum amount is ½ bottle per dose. This can be flavored with Kool-Aid powder, but be careful not to dilute this too much, as it just increases the volume your child will have to drink.If stools are not watery-clear by evening, please give your child one square of chocolate Ex-Lax the night before the exam. Be sure to keep this out of your child’s reach, as most children like it!
    • Day of the exam: If your child is taking any medicines by mouth, he or she may take them with a small amount of water.

  Upper GI Series (UGI)

  An upper GI (gastrointestinal) series is a type of x-ray procedure in which the child drinks a substance called barium which fills and coats the intestine, allowing the radiologist to accurately diagnose many illnesses which affect the esophagus, stomach and small intestine. In the upper GI (UGI) series, the study is limited to the esophagus, stomach, and first portion of the small intestine. In a study with small bowel follow-through (SBFT), the remainder of the small intestine is also studied.

  Patients who suffer from persistent vomiting, abdominal pain, bleeding into the gastrointestinal tract, or poor weight gain might be referred for an upper GI series (UGI). UGI is a type of X-ray procedure in which the patient drinks barium that fills and coats the intestine. Barium is a non-toxic, contrast liquid that highlights organs to be studied. An X-ray is taken with the barium in the patient’s intestines, allowing the radiologist to accurately diagnose many illnesses that affect the esophagus, stomach, and small intestine. UGI is limited to the esophagus, stomach, and first portion of the small intestine. The remainder of the small intestine is studied with a separate procedure, small bowel follow-through (SBFT) procedure. In most cases, you are informed of the results immediately after the test.

  To prepare for a UGI, a patient may not eat for some time prior to the procedure. Exactly how long depends on the age of the patient. In general, patients should not eat for the length of time that he or she normally waits between meals. Thus newborns should fast for no more than 2 to 3 hours before the study, while infants and young children should not eat for 3 to 4 hours. Specific instructions are given prior to your appointment.

  • What is an upper GI series, with or without small bowel follow-through? An upper GI (gastrointestinal) series is a type of X-ray procedure in that the child drinks a substance called barium that fills and coats the intestines, allowing the radiologist to accurately diagnose many illnesses that affect the esophagus, stomach, and small intestine. In the upper GI (UGI) series, the study is limited to the esophagus, stomach, and first portion of the small intestine. In a study with small bowel follow-through (SBFT), the remainder of the small intestines is also studied.
  • When should I get a UGI/SBFT? Some of the indications for UGI include vomiting, abdominal pain, bleeding into the gastrointestinal tract, and poor weight gain
  • How should the patient prepare for the procedure? The patient may not eat for some time prior to the procedure. Exactly how long depends on the age and weight of the patient. In general, the patient should not eat for the length of time that he or she normally waits between meals. Thus newborns should fast for no more than 2 to 3 hours before the study; infants and young children should not eat for 3 to 4 hours. Exact instructions will be given at the time of the appointment
  • What will happen during the procedure? After arriving at Wake Radiology Pediatric Imaging, one of our pediatric radiology technologists will help your child change into a hospital gown. A preliminary X-ray of the abdomen will be taken and evaluated by the radiologist. The patient will then be given the barium to drink while lying down under the X-ray camera. The radiologist will take pictures while the child drinks. There is really no more to the test than that. In the small bowel follow through, pictures are taken every half hour or so, until the entire intestine has been seen
  • How does this technique work? What does the radiologist see? The barium fills the intestine allowing the radiologist to diagnose many abnormalities that affect the intestine.
  • Resources: Download Fluoroscopy Barium Enema Overview Brochure

  Voiding Cystourethrogram (VCUG)

  A VCUG can help diagnose reflux, assess if your child has recurring urinary tract infections and follow-up on patients with known urinary reflux following antibiotics or anti-reflux surgery. Your doctor may request a VCUG to evaluate: reflux, recurring urinary tract infections, to follow-up on patients with known urinary reflux following antibiotics or anti-reflux surgery

  • How to prepare for a VCUG? There is no special physical preparation for this test. You may want to explain to your child beforehand about the test if you feel that would best lower his/her anxiety. It is helpful to explain in simple age-appropriate terms why the test is needed, what will happen, and what you and your child can do to prepare for the test. Your child may bring a security blanket or toy with him/her to hold during the procedure. If you/your child have any cardiac problems please contact your primary care physician in case prophylactic antibiotics are indicated.
  • How is a VCUG performed? You and your child will be greeted by one of our technologists who will explain what will happen during the examination. You/your child will be given a hospital gown to change into and will need to void before the study begins. You/your child will be asked to lie on the imaging table. Girls will be asked to lie with their knees bent and dropped to the side with their feet together, in a “frog” position. Boys will be asked to lie with their legs straight. Your/your child’s urethra will be washed sterilely with soap and water using soft cotton balls. It is very important that this area stay extremely clean so not to introduce any bacteria to the area. A small amount of Xylocaine jelly, which acts as a lubricant and numbing agent, will be placed at the urethra opening and on the tip of the catheter (small flexible plastic tube). The technologist will gently slide the catheter through the urethra opening and into the bladder. The catheter will then be taped to the leg to hold it in place. Urine that is in the bladder will be collected for bacteriologic testing. The catheter will be connected to a bottle containing a clear liquid called X-ray contrast, which allows the radiologist to see inside the bladder. An X-ray camera will be positioned over you/your child and used to take pictures during the study. Imaging will begin and the liquid will flow from the bag into the bladder. When you/your child’s bladder is full, you/your child will be asked to void into a plastic container (or on the table). More pictures will be taken until the bladder is empty. A post-void image may be required if the bladder does not completely empty during the first phase of the study. The entire test may take up to 15 minutes.
  • What can be expected during the test? You/your child may feel discomfort with the placement of the catheter. Our personnel are aware of the sensitive nature of the area to be tested and every effort is made to ensure privacy and to make sure the patient is as comfortable as possible.
  • What happens after the study? Once the study is complete, you/your child will be free to leave and resume normal activity. After the test, you/your child may have pink urine or feel some discomfort the next two or three times when going to the bathroom. This can occur in some cases and will go away over time. Drinking extra fluids will help ease the discomfort. If your child is unable or unwilling to go to the bathroom following the test, try a warm bath. This usually helps ease the discomfort. Call your doctor if you/your child have blood in the urine, pain, fever, or are unable to urinate after eight hours. View the VCUG Overview Brochure

  Gastrointestinal Bleeding (GI Bleed)

  A GI bleed scan is a diagnostic imaging procedure that can help detect the origin of gastrointestinal bleeding.

  • How to prepare for a GI bleed scan? No preparation is necessary. It is important to not have had any barium studies 48 hours prior to having a GI bleed scan. Your child may bring a security blanket/toy with him/her to hold during the procedure.
  • How is a GI bleed scan performed? You will be greeted by one of our technologists who will explain to you and your child what will happen during the examination. At this time the technologist will place an IV catheter into one of your/your child’s veins and withdraw 1–3 ml of blood. This blood is obtained and labeled with a radioactive tracer called Technetium-99m. After thirty minutes the labeled red blood cells are re-injected into your/your child’s IV, and imaging will begin for one hour. It is important that you/your child remain as still as possible during imaging for the best quality images. Additional imaging may be requested by the pediatric radiologist and may be obtained at various intervals as needed, up to approximately 24 hours.
  • What can be expected during the procedure? You/your child may experience some discomfort associated with the insertion of the intravenous needle. The needle used for the procedure is very small. Once the radiopharmaceutical is injected and the scan is complete, the needle will be withdrawn and a gauze bandage with adhesive tape will be placed over the site of the injection. The area where the injection was given may be a little sore. Although the camera may appear large and intimidating, it does not touch you/your child.
  • What happens after the study? Once the study is complete, it will be evaluated for quality. If there was too much motion, the study may need to be repeated. If there was no motion, you/your child will be free to leave and resume normal activity.

   

 In an increasing number of cases, MRI (magnetic resonance imaging) is the right choice for imaging a young patient, and the modality uses no ionizing radiation. MRI is particularly useful as an alternative to CT in following chronic conditions for which the frequency of imaging would otherwise quickly lead to a large cumulative radiation dose. Examples of this include inflammatory bowel diseases, such as Crohn’s disease or some childhood cancers, in particular of the kidney or the liver. There are other indications for which MRI is a better initial test, including the workup of some pediatric cardiovascular abnormalities.

MRI and MR angiography (MRA) are performed at our Raleigh MRI office for children ages 6 and up. MRI imaging requires that patients remain still for periods of time, children unable to do this or those that require pediatric sedation are scheduled at the hospital in conjunction with the pediatric intensivists who administer and monitor the sedation.

MRI, or magnetic resonance imaging, is a routine diagnostic procedure that employs strong electromagnets, radio-frequency waves, and powerful computers to generate two- and three-dimensional images of the body’s organs, tissues, and bones. MR imaging does not use ionizing radiation (X-rays) so there is no radiation exposure to your child. This pediatric procedure is performed at Wake Radiology Raleigh MRI. For location information, click here.

MRI, or magnetic resonance imaging, is a routine diagnostic procedure that employs strong electromagnets, radiofrequency waves, and powerful computers to generate two- and three-dimensional images of the body’s organs, tissues, and bones. MR imaging does not use ionizing radiation (X-rays) so there is no radiation exposure to your child. MR uses a large, tube-shaped magnet that creates a strong magnetic field around the patient. A radio-frequency coil is placed over the body part that is to be imaged. The magnetic field, along with applied radio-frequency waves, alters the alignment of hydrogen protons found in water molecules within the body. Computers reconstruct the images based on the radio-frequency signals emitted by the protons.

Your physician may request an MRI study for a number of reasons. MRI is often used to obtain specific diagnostic information not already provided by other imaging technologies such as ultrasound, computed tomography (CT), and nuclear medicine. MR may be needed to rule out disease and to facilitate medical, surgical, and other treatments for conditions of the brain, spinal column, and spinal cord; eye, ear, nose, and throat; bones, joints and muscles; heart and blood vessels; chest; abdominal organs and digestive tract; and kidneys, urinary tract, and pelvic organs. These conditions may include congenital and developmental disorders, genetic and metabolic diseases, infections and inflammatory conditions, traumatic and other types of injury, and vascular and blood diseases.

MR Enterography (MRE) and adolescents

Crohn’s disease (AKA Crohn syndrome or regional enteritis) predominantly affects the small bowel (ileum, jejunum and duodenum), but can affect any segment of the GI tract. In Crohn’s disease, since symptoms typically begin in children around ages 8 to 10, these young patients stand to receive as many as 40 or 50 CT scans in their lifetimes. While ongoing imaging for Crohn’s was previously conducted with CT almost exclusively, MRI (which uses no radiation) can now replace CT as the imaging method for determining disease activity and response to medical therapy.

MR Enterography (MRE), a study specifically designed for Crohn’s disease patients, is available at our Cary and Raleigh MRI offices. This allows Crohn’s patients in the Triangle greater options and convenience for their required, lifelong imaging surveillance needs.

• MR Enterography (MRE) performed at our Raleigh MRI and Cary locations

MR Arthrogram

An MRI arthrogram, or MR arthrogram, is an imaging procedure that demonstrates the joint spaces. An injection of a liquid contrast material into the joint space allows joints to be particularly visible during the MRI.An MRI arthrogram is needed when a problem with the joint cartilage is suspected.

What to Expect: There is no specific preparation needed. Explaining what will happen before the procedure is the best preparation.

When you arrive the day of the test, a technologist will explain the procedure to you and your child, answer your questions, and obtain your written consent. During the first part of the procedure, your child will need to lie on an X-ray fluoroscopy table. The pediatric radiologist will look at the area being examined with fluoroscopy and mark the joint space with a felt pen. He or she will then cleanse the injection area with a sterile soap. Next, he or she will inject a mixture of local anesthetic and two liquid materials that will be visible with X-ray and MRI. After a small amount of liquid has been injected, the needle will be removed. This portion of the procedure generally takes about 20 minutes. Your child will then be moved to an MRI room where the imaging will be performed. The injection may cause some discomfort and there may be some pain at the injection site for a short period of time afterwards. Local anesthetic and an anesthetic injected into the joint are used to minimize this discomfort.

MRI is a type of imaging that allows us to see inside the body using a large magnet, radio waves and a computer. Water molecules within the body’s organs and tissues respond to the MRI’s magnetic field, generating radio signals that are then processed by a computer into images that can be analyzed by the radiologist. The MRI takes from 30 to 45 minutes and requires your child to lie very still.

This pediatric procedure is performed at Wake Radiology Raleigh MRI. For location information, click here.