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Wake Radiology Pediatric Procedures

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Wake Radiology provides a full range of pediatric imaging services, from routine studies to those typically viewed as more complex or complicated. 

The Following are Common Pediatric Procedures

CT Studies

CT, or computed tomography, is a procedure that uses X-ray equipment to take detailed, cross-sectional images of your child’s body. The information obtained is processed in a computer that displays a cross-section of body tissues and organs that are interpreted by a radiologist. CT is particularly useful because it can show many different types of tissue with great clarity and images can be obtained quickly. The CT scanner itself is a large machine with a hole in the center, which has the appearance of a large donut. The child lies still on a table that slides into and out of the center of the hole and the machine takes pictures of small sections of the body that require investigation. You can assure your child that although the machine is large and makes ‘funny noises’, it will not touch him/her during the scan.

CT provides detailed views of many types of tissues, including the brain, airway, lungs, bones, soft tissues and blood vessels. This makes it an excellent choice for evaluating the chest and abdomen. It is often used to diagnose appendicitis, investigate headaches, chest pain, and fractures; and evaluate a child’s airway. Your child’s physician may request a CT scan to obtain specific diagnostic information that is not provided by other imaging technologies such as ultrasound, nuclear medicine, and magnetic resonance imaging. CT may be required to rule out disease or to facilitate medical, surgical, and other treatments for conditions of the central nervous system; eye, ear, nose, and throat, bones, joints, and muscles; heart and blood vessels, chest and lungs, abdominal organs, and gastrointestinal tract, kidneys, urinary tract, and pelvic organs. Such conditions may include congenital and developmental disorders, genetic and metabolic diseases, infections and inflammatory conditions, traumatic and other types of injury, vascular and blood diseases, and childhood cancers. Since it provides detailed information in a short period of time, it is often the imaging modality of choice in emergency situations. For instance, in trauma cases, CT can reveal internal injuries and bleeding quickly, providing important data that the medical care team may need to save a life. It is often used to evaluate whether a patient’s appendix is about to perforate or why a child has a headache or trouble breathing. The following are common CT procedures:

  • Abdomen: only, with pelvis
  • Angiography: renal artery
  • Arthrogram (specify joint)
  • Chest
  • Extremity
  • Head Temporal bones Facial bones Orbits
  • Neck
  • Orthopaedic CT w/ MPR, with 3D rendered images
  • Pelvis
  • Renal Colic CT (complete abdomen/pelvis)
  • Sinus screening comprehensive surgical planning
  • Spine CT with MPR, Cervical, Thoracic, Lumbosacral, With 3D rendered images
  • Urogram (CT abdomen/pelvis), with 3D rendered images

The role of low-dose CT

Despite the many benefits of CT, a disadvantage is the inevitable radiation exposure. This is why our group of fellowship-trained pediatric radiologists—all of whom trained under national leaders in the dose-reduction movement—is focused on minimizing our youngest patients’ radiation exposure while maintaining high-quality imaging. Learn more

Fluorescopy

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)

PPVCUGCoverTitle.pngA 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.
MRI Studies

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.

Nuclear Studies

Newborns and children less than one year old with a spectrum of diseases present differently from older children or adults. For these young children, nuclear medicine studies play an important role in evaluating a wide range of congenital conditions and can be helpful for evaluating acquired conditions such as infection, cancer and trauma.

Evaluation of these patients during the first year of life differs from that of other children and must accommodate a different range of clinical problems and special imaging requirements. Extra care and attention to the special needs of this population must be paid to acquire high-quality images that address the clinical question while delivering the lowest radiation dose possible. A full range of nuclear medicine studies that are typically obtained for patients in this age group includes oncologic studies and studies of the brain, thyroid, heart, lungs, liver, gastrointestinal tract, kidneys and genitourinary tract, spleen, lymphatic system and skeleton.

Common Pediatric Nuclear Medicine Procedures

Bone scan: Whole body, Three-phase, Limited area, Multiple area, With Spect
X-ray for correlation of positive bone scan findings if indicated
Cystogram
Gastric emptying scan
Hepatobiliary (HIDA scan) with CCK
Meckel’s scan
Renal, DMSA
Renal with Lasix
Thyroid scan

Bone Scan

A bone scan is a sensitive and non-invasive imaging technique that is used to visualize the bones. It is different from plain X-rays or CT, which can provide exquisite anatomical detail, in that it shows bone metabolism. It can be helpful to evaluate damage to the bones due to exercise or trauma, bone infection or other causes of unexplained bone pain. Bone scanning can detect focal bone cancer and determine the presence of local or distant metastatic lesions. A Bone Scan can help assess:

  • Bone infection (osteomyelitis)
  • Back pain
  • Occult fracture(s)
  • Stress fractures and stress injuries
  • Avascular necrosis
  • Osteoid osteoma
  • Mandibular hypertrophy/hyperplasia
  • Certain types of caner
  • Mestastases in cancer
  • How to prepare for a bone scan

You will be greeted by one of our technologists who will explain to you and your child what will happen during the examination. A small amount of a radiopharmaceutical called Technetium-99m MDP will be injected into one of your child’s veins. Your child will be free to leave and then return 3 to 4 hours after the injection for the actual imaging. The technologist will give you/your child an exact time to return for imaging. While waiting, you and your child are welcome to leave the area, and can conduct normal activity including eating and drinking. It is important to try to drink extra fluids during the waiting time in order to promote bladder emptying at the time of imaging. After returning for imaging, your child will be asked to void. The number of images obtained and the total imaging time will vary depending on the diagnosis under consideration. It is important that your child remain still during the imaging in order to obtain the best quality images possible. Motion will degrade the images and the test would then need to be repeated.

Your child may experience some discomfort associated with the insertion of the intravenous needle. The needle used for the procedure is small. Once the radiopharmaceutical is injected, the needle is withdrawn and a gauze bandage with adhesive tape is 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 your child.

There is no preparation needed for this test. Your child may bring a security blanket/toy with him/her for the procedure. We have various videos or DVDs to choose from for your child to watch during the procedure or you can bring one from home.

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, your child will be free to leave and resume normal activity.

Gastric Emptying Study (gastroesophageal reflux study)

A gastroesophageal reflux study (gastric emptying study) is a diagnostic imaging procedure that measures the time it takes the stomach to empty and detects gastroesophageal reflux. This study can help:

  • Detect gastroesophageal reflux
  • Measure gastric emptying time
  • Detect aspiration
  • Evaluate a reason for nausea and vomiting
  • Evaluate why a child is not gaining weight
  • Assess why a child is having abdominal pain

What to Expect: You will be greeted by one of our technologists who will explain to you and your child what will happen during the examination. You/your child’s referring physician will determine if the study should be liquid or solid. If you/your child have allergies to either eggs or milk, please call you/your child’s doctor. The technologist will add a small amount of a radiopharmaceutical called Technetium-99m Sulfur Colloid to either scrambled eggs or oatmeal (if a solid study) or to formula/milk (if liquid study). The radiopharmaceutical is tasteless. It is important that the test food or liquid be consumed within 10 minutes. When eating is complete, imaging will begin for one hour. It is important that you/your child remain as still as possible during the images for the best quality images.

Although the camera may appear large and intimidating, it does not touch you/your child.

You/your child cannot eat or drink anything 4 hours prior to the examination. It is important not to have had a barium study within 48 hours prior. If you/your child are fed through a gastric tube, please bring the formula you use with you. If your child is bottle fed, please bring your infant’s formula with you. Your child may bring a security blanket/toy with him/her for the procedure. We have various videos or DVDs to choose from for your child to watch during the procedure or you can bring one from home.

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.

Hepatobiliary Scan

A hepatobiliary scan is a diagnostic imaging procedure that outlines the liver, and shows the flow of bile from the liver through the hepatic ducts (including the gallbladder) emptying in the small bowel. A hepatobiliary scan can help:

  • Assess abnormalities in liver function
  • Diagnose cholecytitis
  • Evaluate upper abdominal pain
  • Determine causes of jaundice
  • Identify obstruction in the gallbladder or blockages of the bile duct
  • Detect biliary atresia

What to Expect: You will be greeted by one of our technologists who will explain to you and your child what will happen during the examination. A small amount of radiopharmaceutical called Technetium-99m DISIDA is injected into one of you/your child’s veins and imaging will begin immediately. After one hour of imaging, a pediatric radiologist will determine if additional imaging is needed. If so, you/your child may need to drink a substance called Lipomul, which is a standard fatty meal. The fatty meal will stimulate the gallbladder to contract and imaging will begin for another 30 minutes. Additional images may be necessary at various other times depending on the results of the previous images and the condition under evaluation. It is important that you/your child remain as still as possible during all imaging to obtain the best quality images.

You/your child may experience some discomfort associated with the insertion of the intravenous needle. The needle used for the procedure is small. Once the radiopharmaceutical is injected, the needle is withdrawn and a gauze bandage with adhesive tape is 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.

You/your child must not eat or drink beginning 4 hours before the scan. Infants less than 6 months of age being evaluated for biliary atresia or neonatal hepatitis can eat and drink as normal. It is important to not have had any barium studies within 48 hours prior to the exam. In newborns, pre-medication with phenobarbital is commonly used to enhance the flow of bile by the liver. Your child may bring a security blanket/toy with him/her to hold during the procedure.

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.

Cystogram (RNC)

A radionuclide cystomgram (RNC) is a test used to determine whether your child has vesicoureteral reflux. This is a condition in which urine flows from the bladder back up to the kidneys. An RNC can help:

  • Diagnose reflux
  • Assess if your child has recurring urinary tract infections
  • To followup on patients with known urinary reflux following antibiotics or anti-reflux surgery
  • Assess if a sibling has reflux

What to Expect: There is no special physical preparation for this test. Typically a technologist of the nuclear medicine staff will contact you at home to go over the procedure/details and to answer any questions and/or concerns in preparation for your arrival. 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 your child has any cardiac problems, please contact WR Pediatric Imaging at 919-782-4830 prior to your appointment in case prophylactic antibiotics are indicated.

You and your child will be greeted by one of our technologists who will explain what will happen during the examination. Your child will be given a hospital gown to change into and will need to void before the study begins. 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 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 Xyelocaine 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 bag of saline solution containing a radiopharmaceutical called Technetium-99m. Imaging will begin and the liquid will flow from the bag into the bladder. When your child’s bladder is full, the catheter will be removed and your child will be asked to void into a plastic container. The camera will continue to take pictures 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 takes up to 30 minutes. It is important that your child remain still during imaging to obtain the best quality images.

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.

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, your child will be free to leave and resume normal activity. After the test, 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 your child has blood in the urine, pain, fever or is unable to urinate after eight hours.

DMSA Renal Scan

A DMSA renal scan is a diagnostic imaging procedure that is used to evaluate the anatomy and physiology of the kidneys. Your doctor can help assess:

  • Pyelonephritis
  • Relative (differential) renal function in the left and right kidneys
  • Renal ectopia
  • Infarction
  • Hypertension
  • Horseshoe kidney
  • Acute renal failure
  • Multicystic dysplastic kidneys
  • Trauma

What to Expect: There is no preparation needed for this test. Please be aware that between the DMSA injection time and the imaging time there is a 3 to 4-hour delay. In addition, the scan itself may take up to 30 minutes to one hour. Please schedule your day accordingly. Your child may bring a security blanket/toy to hold during the procedure.

You will be greeted by one of our technologists who will explain to you/your child what will happen during the examination. A small amount of a radiopharmaceutical called Technetium-99m DMSA will be injected into one of your/your child’s veins. After the injection, you/your child will be free to leave the office and will be given a time to return for imaging, typically three to four hours after the injection. This delay allows the kidneys to absorb the radiopharmaceutical. When you return, you/your child will be asked to void and imaging will begin. Imaging will be approximately 30–60 minutes. It is important that you/your child remain as still as possible to allow for the best possible images.

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, the needle is withdrawn and a gauze bandage with adhesive tape is 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.

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.

Thyroid Scintigraphy

A thyroid scan is a diagnostic procedure that produces functional images of the thyroid gland. It can help your physician determine the size, shape and position of the thyroid gland. A thyroid scintigraphy can help assess:

  • Neck masses
  • Hypothyroidism
  • Hyperthyroidism
  • Ectopic thyroid
  • Thyroid malignancy
  • Graves’ disease
  • Thyroglossal duct cyst
  • Benign diffuse goiter
  • Thyroiditis
  • Radiation therapy planning

What to Expect: The referring physician may ask that your child stop certain medications prior to having a thyroid scan. Your child cannot have anything to eat or drink one hour prior to administration of the radiopharmaceutical and for 30 minutes afterward.

You will be greeted by one of our technologists who will explain to you/your child what will happen during the examination. Your child will be asked to swallow a capsule or liquid containing a radiopharmaceutical called Iodine-123. Once the administration is complete, you are free to leave the department. The technologist will give your child an exact time to return for the actual imaging. Typically, imaging takes place at 4 and 24 hours after radiopharmaceutical administration. When you return, your child will be asked to void, and imaging will begin. The camera, which looks like a large upside down ice cream cone, comes very close to the patient’s neck. Three images of the thyroid gland are taken, each approximately 12 to 20 minutes in length. It is important that your child remain as still as possible during imaging to obtain the best quality images.

Although the camera may appear large and intimidating, it does not touch your child.

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, your child will be free to leave and resume normal activity.

Ultrasound

Common Pediatric Ultrasound Procedures

peds-ultrasound

Wake Radiologist technologist during a ultrasound procedure with one of Wake Radiologist young patients.

Ultrasound is an imaging technology that uses high frequency sound waves to view internal organs and produce diagnostic pictures of the human body. No radiation is used. Wake Radiology Pediatric Imaging Center is specially designed, equipped, and staffed to obtain high-quality ultrasound examinations of pediatric patients of any size, age and medical condition, including tiny newborns, small infants, toddlers, young children, and maturing adolescents.

In many things pediatric, ultrasound often makes the best first choice in imaging modalities because it is radiation free. This imaging technology uses high-frequency sound waves to view internal organs and produce diagnostic images of the human body. Ultrasound’s weaknesses as a modality for adults are its strengths for children. It has the advantage of not producing any radiation, and the fact that it’s insensitive to motion makes it the perfect modality for pediatric imaging, especially for young children or infants who can’t stay still for CT scans or even X-rays (AKA plain films). Ultrasound can penetrate only a certain number of centimeters through soft tissue, which is fine for kids but can be limiting in adults. Common Pediatric Procedures include: 

Abdomen: complete, Appendix, Appendix with Pelvis Pylorus, Gallbladder/RUQ, Urachal tract, Intussusception
Breast/soft tissue chest (suspected breast buds/abscess)
Head
Hip: developmental dysplasia, joint effusion
Neck
Pelvis and adrenals, precocious puberty (pelvis/limited abdomen)
Pelvis, Complete
Renal Complete
Soft tissue
Scrotum/Testicles
Spine
Thyroid

Abdominal Ultrasound

An abdominal ultrasound is an ultrasound of the internal organs, including the liver, gallbladder, spleen, pancreas, kidneys, and urinary bladder. Blood flow to some of these organs also can be checked.

There are many indications for performing abdominal ultrasound including looking for a cause of belly pain, for stones in the gallbladder or kidney, or for a cause for enlargement of an abdominal organ. Pyloric stenosis, one cause of vomiting in babies, can be diagnosed with ultrasound. Appendicitis also can sometimes be diagnosed with ultrasound.

Cranial Ultrasound

A cranial ultrasound is an ultrasound of the brain. It looks at the brain tissues and ventricles. It is usually performed on infants who still have a soft spot (called the anterior fontanelle) in their skull. Indications for cranial ultrasound include: enlarging head circumference in a baby; screening for bleeding in the brain; especially in premature babies; looking for signs of infection; and screening for congenital abnormalities.

What to Expect: The baby will lie on his or her back on an examining table. The technologist or doctor will put a small amount of gel (a lotion) on a transducer (similar to a microphone) and place it on the soft spot of the baby’s head. The technologist or doctor will take several pictures. You may be asked to help hold your child during the test that usually takes 15 to 30 minutes. This test looks at the structure of the brain and the size of the ventricles. This test can also look at some aspects of blood flow to the brain with a type of ultrasound called a Doppler.

Hip Ultrasound

A hip ultrasound is used to take pictures of the hips of babies to look for a dislocated or underdeveloped hip. It can be performed in babies from the newborn period to about 6 to 8 months of age. A hip ultrasound may be needed if there is an abnormality found through physical examination of a baby’s hip, a family history of hip dysplasia, breech presentation, and for other reasons.

What to Expect: The baby will lie on an examining table on his or her back. The technologist or doctor will place some warm gel (a lotion) on a transducer (similar to a microphone) and place it on the baby’s hip and take some pictures. Both hips will be examined. The test usually takes 30 minutes or less to perform.

Kidney Ultrasound

A kidney ultrasound takes pictures of both kidneys and the urinary bladder. It does not test the function of the kidneys.

Indications for a kidney ultrasound include: prenatally detected abnormalities (such as hydronephrosis); urinary tract infection; blood in the urine; high blood pressure; back or abdominal pain; known or suspected kidney stones; or a family history of kidney disease. There are also some syndromes and conditions associated with kidney abnormalities for which ultrasound is performed

What is a kidney ultrasound?
A kidney ultrasound takes pictures of both kidneys and the urinary bladder. It does not test the function of the kidneys.

Indications for a kidney ultrasound include: prenatally detected abnormalities (such as hydronephrosis); urinary tract infection; blood in the urine; high blood pressure; back or abdominal pain; known or suspected kidney stones; or a family history of kidney disease. There are also some syndromes and conditions associated with kidney abnormalities for which ultrasound is performed

How should the patient prepare for the procedure?
There is generally no preparation. If the ultrasound is being performed because of blood found in the urine, a full bladder is necessary. This will require drinking several glasses of water before the examination

What will happen during the procedure?
The patient will lie on an examining table. The technologist or doctor will put warm gel (a lotion) on the patient’s lower belly and use a transducer (similar to a microphone) to look at the bladder. The technologist also will look at the upper belly and back in this way to get pictures of the kidneys. Ultrasound does not test the function of the kidneys, but it can evaluate certain aspects of blood flow. The examination usually takes 30 minutes or less.

Pelvic Ultrasound

A pelvic ultrasound is used to take pictures of the pelvic organs, and is usually done to look at the uterus and ovaries in a girl. It may also be used to look at the bladder. Pelvic ultrasound can also be performed on boys. Indications for pelvic ultrasound include looking for a cause of pelvic pain or searching for a possible mass.

A spine ultrasound is used to take pictures of the spinal cord in a baby who is usually 3 to 4 months old or less. A baby is usually referred for a spinal ultrasound because of a dimple, hair patch, or discoloration of the skin above the anus. The study is done to look for an abnormality of the spinal cord.

How should the patient prepare for the procedure? It depends on what is being looked for and the age of the patient. Usually, the patient should have nothing by mouth (NPO) for a few hours before the examination. This varies with the patient’s age. Often, the referring physician will know how long the patient should be NPO. If not, call us at 919-232-4700 and ask to speak to an ultrasound technologist.

What will happen during the procedure? The patient will lie on his or her back on an examining table. The technologist or doctor will place some warm gel (a lotion) on the patient’s belly and then look at the abdominal organs with a transducer (similar to a microphone). This will require looking at all parts of the abdomen. It usually takes less than 30 minutes.

The radiologist will generally see pictures of the liver, spleen, gallbladder, kidneys, pancreas, and urinary bladder. If indicated, blood flow to one or more organs can be looked at and pictures taken of this.

What is a pelvic ultrasound?
A pelvic ultrasound is used to take pictures of the pelvic organs, and is usually done to look at the uterus and ovaries in a girl. It may also be used to look at the bladder. Pelvic ultrasound can also be performed on boys. Indications for pelvic ultrasound include looking for a cause of pelvic pain or searching for a possible mass.

How should the patient prepare for the procedure?
A full bladder is generally needed for this examination, which requires that the patient drink several glasses of water before arriving.

What will happen during the procedure?
The patient will lie on her or his back on an examining table. A technologist or doctor will place warm gel (a lotion) on the lower belly and then take pictures with a transducer (similar to a microphone). After the pictures are developed, the patient may go to the bathroom and empty his or her bladder.

The radiologist will see the bladder, uterus, and ovaries in girls, and the bladder and possibly prostate in boys.

Spine Ultrasound

What is a spine ultrasound?
A spine ultrasound is used to take pictures of the spinal cord in a baby who is usually 3 to 4 months old or less. A baby is usually referred for a spinal ultrasound because of a dimple, hair patch, or discoloration of the skin above the anus. The study is done to look for an abnormality of the spinal cord.

What will happen during the procedure?
The baby will lie on his or her stomach on an examining table. Sometimes a towel will be placed underneath the baby’s chest to elevate it. The technologist or doctor will place warm gel (a lotion) on a transducer (similar to a microphone), and place this on the baby’s back to take pictures. The test takes about 15 to 30 minutes. The radiologist will see if the spinal cord looks normal and if it is in the normal position.

X-Ray

Pediatric X-Ray Procedures

Radiography, more commonly known as X-ray, is the oldest and most frequently used form of medical imaging. Conventional diagnostic radiography uses small doses of ionizing radiation to produce diagnostic pictures of the human body on film. The image is created when the X-ray passes through bone and tissues onto film or a digital-image recording plate. 

X-rays are commonly used to assist physicians in the diagnosis and assessment of many conditions, including arthritis, bone fractures, pneumonia, and scoliosis. In the case of a broken bone, X-rays can show very fine hairline fractures or chips and ensure that a fracture has been properly realigned and stabilized. Common Pediatric X-Ray Procedures include: 

Abdomen XRay Neck, soft tissue
Bone age Scoliosis
Bone Density (DXA) Shunt series
Cervical spine for Down syndrome Sinuses
Chest XRay Skeletal survey
Joints & extremities XRay Skull  
Leg length XRay Spine XRay
Lower extremities, standing XRay Swallowed foreign body XRay

We Minimize Radiation Exposure

The technologists at WR Pediatric Imaging are trained to deliver high-quality and rapid X-ray examinations at the lowest possible radiation doses for pediatric patients of any size, age, and medical condition, including tiny newborns, small infants, toddlers, young children, and maturing adolescents. Wake Radiology is committed to the ALARA (As Low As Reasonably Achievable) standard for radiation doses and adheres also to the Image Gently campaign of ACR.

Pediatric Imaging Center

peds-tech-FluoroMeyer

Wake Radiologist technologist and radiologist with one of our young patients.

At our pediatric imaging center, we go above the standard of care, ensuring that a highly trained pediatric radiologist is always in the room, performing the ultrasound (versus interpreting it after a technologist has conducted the test). By taking this hands-on approach, our pediatric radiologist can tailor the exam for the specific patient and ask the child to tell us when we are directly over the site of the pain. Our physicians can also feel palpable abnormalities to make sure they have used the ultrasound to image the exact/precise area of concern that the pediatrician identified during their physical exam.

Wake Radiology Pediatric Imaging Center is specially designed, equipped and staffed to obtain high-quality ultrasound examinations of pediatric patients of any size, age and medical condition, including tiny newborns, small infants, toddlers, young children and maturing adolescents.

Less complicated pediatric cases performed at our other Wake Radiology offices are reviewed remotely by a pediatric radiologist before the child leaves to ensure a complete study is done. Our unique approach exemplifies individualized care when compared to all other competitive outpatient or inpatient locations.

The Wake Radiology outpatient Imaging Center in West Raleigh is the first – and only – pediatric imaging hub in the Triangle. The Wake Radiology pediatric radiologists and technologists are skilled in handling children. They are experts at getting children to hold still using age-appropriate distraction and coping techniques. This allows us to get high-quality studies done quickly, which reduces the amount of stress on both the child and caregivers, and decreases the number of repeat exams. Our radiologists get directly involved in almost every case at our West Raleigh office, and this hands-on approach allows us to tailor exams for every patient, thereby increasing diagnostic accuracy. Our outpatient Pediatric Imaging Center offers all radiology modalities except MRI (which is performed at our Raleigh MRI Center) and serves as the hub for all pediatric imaging we provide at our other Triangle locations. It’s also a convenient option for families needing follow-up appointments after hospitalization. The office is located in the medical neighborhood surrounding UNC REX Healthcare, and a pediatric radiologist is on-site Monday-Friday from 8am-5pm

  • Convenient West Raleigh location: Wake Radiology Pediatric Imaging Center 4301 Lake Boone Trail, Suite 100 Raleigh, NC 27607
  • Outpatient pediatric imaging at our other offices: During the work week, parents can also bring their children to most of our other outpatient offices for routine examinations. Images taken at these locations are immediately sent electronically for interpretation by one of our pediatric radiologists at the Pediatric Imaging Center. On Saturday, parents can bring their children to our Cary and Garner locations to have the imaging study taken “closer to home.” When a child needs a non-urgent study, parents who really want to be present for the procedure (but can’t get off of work) really like this option. Magnetic resonance studies (MRI, MRE and MRA) are performed Monday – Saturday at our Raleigh MRI and Garner offices and seven days a week at our Cary office. When appropriate, a pediatric radiologist collaborates with our MR radiologists on the interpretation.
  • Inpatient imaging continuity at UNC REX Hospital: Our pediatric radiologists not only interpret imaging studies taken at all Wake Radiology outpatient locations, but they are also on staff at UNC REX healthcare. This approach delivers an important level of imaging continuity that improves the care provided by the area’s pediatric community and its increasing number of pediatric subspecialists.

EASY SCHEDULING

Our scheduling team is available to answer questions about imaging procedures and insurance as well as assist in promptly scheduling your appointment. Contact our team by calling 919-232-4700

CONVENIENT LOCATION

Wake Radiology offers convenient office locations throughout greater Triangle including Raleigh, Cary, Garner, Wake Forest, and Chapel Hill with parking just steps away from check-in. 

INSURANCE

Wake Radiology is a participating provider for most major managed care insurance plans. We provide imaging services and file claims on behalf of all patients, including those with out-of-network insurance plans where a higher cost share may apply. Learn more about insurance.

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