(MacGregor and Freeman, 1975; that there is a striking relationship between the incidence of renal scarring and the severity of VUR, and also throw further light on the reputedly rare appearance of new renal scars in patients while under observation.
Patients and methodsThe case records and radiographs of all children who attended the renal clinic during 1974 with recently diagnosed or previous UTI have been reviewed.Children with neurological disorders affecting bladder function, e.g. spina bifida, were excluded, as were those with anatomical urinary tract malforma-
Justification of radiological requests, standardization of procedures and optimization of protection measures are key principles in the protection of individuals exposed to ionizing radiation for diagnostic purposes. Nowhere is this more pertinent than in the imaging of children and, following the recent introduction of the Ionising Radiation (Medical Exposure) Regulations, there is now a regulatory requirement for diagnostic radiology departments to demonstrate compliance with these principles. A study was undertaken to compare all aspects of paediatric radiological practice at two specialist and two non-specialist centres. An initial study involved analysis of nearly 3000 patient doses. The second phase of the project involved assessment of referral criteria, radiographic technique and approximately 100 radiographs at each centre by two consultant paediatric radiologists. While all radiographs were found to be diagnostically acceptable, major differences in technique were evident, reflecting the disparity in experience between staff at the specialist and non-specialist centres. The large number of sub-optimum films encountered at the latter suggests that there is a need for specific training of less experienced radiographic and clinical staff.
In three children, presenting in chronic renal failure at the ages of six, four and three years radiology suggsested the diagnosis of Jeune's syndrome (asphyxiating thoracic dysplasia). In each case the skeletal survey showed widespread diagnostic features of this condition. The syndrome is characterized by varying degrees of repiratory distress in infancy and early childhood, with osseous dl three children in this study died from juvenile nephronopthisis. The correct diagnosis is essential for patient management and prognosis and also for genetic counselling. This report emphasizes the importance of the renal lesions in older children with Jeune's syndrome.
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