Mini thoracic CT adequately determines Haller index and decreases radiation exposure in children with pectus excavatum

Gosztyla, Carolyn; Petrosyan, Mikael; Kane, Timothy D.; Ma, Grace; Valaparla, Sunil Kumar; McCarter, Robert; Bulas, Dorothy; Lukish, Jeffrey R.

doi:10.1016/j.jpedsurg.2022.01.040

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…25,26 The concept of as low a radiation exposure as reasonably achievable (ALARA) should be applied in the design of all pediatric care strategies. 27 As part of a quality assurance initiative to adopt ALARA during mFB removal procedures, we introduced the concept and use of Ndy at Children's National Hospital. We have demonstrated that the utilization of Ndy can be safely and effectively employed to remove superficial (<2 cm from the skin surface) extremity soft tissue mFB in children.…”

Section: Discussionmentioning

confidence: 99%

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The Novel Use of Rare Earth Magnets for the Extraction of Metallic Soft Tissue Foreign Bodies in Children

et al. 2023

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Introduction Metallic foreign bodies (mFB) are common following penetrating injuries in children. The mFB commonly occur in the head and neck region and extremity soft tissues. Removal may be indicated due to morbidity related to pain or migration. Extraction can be challenging to localize, often requiring wide exposure, and may be difficult to achieve in cosmetically sensitive areas. Different technological adjuncts have been used to facilitate foreign body removal including fluoroscopy, ultrasound, and more recently in adults, surgical magnets. The most powerful commercially available magnets are rare earth magnets comprised of neodymium iron and boron (Ndy). With the goal of reducing radiation exposure and the morbidity of mFB removal with associated soft tissue injury in children, a strategy was introduced utilizing Ndy to optimize extraction with minimal soft tissue surgical dissection. Materials and Methods Two children with extremity mFB treated with Ndy between January 2021 and July 2021 were analyzed. We utilized commercially available ring type neodymium-iron-boron magnets with dimensions of 1 3/8-inch outer diameter x 1/8-inch inner diameter and 1/16 inch thick with a power of 13 200 gauss that were processed for use according to our hospital protocols. Our main clinical indication was for the detection and retrieval of small ferromagnetic foreign bodies embedded in superficial extremity soft tissues. Results In the operating room under general anesthesia, the mFB were localized utilizing fluoroscopy. A 1.0 cm skin incision was made into the subdermal soft tissues overlying the area of the mFB. No surgical tissue dissection was performed. The mFB could not be visualized in the soft tissue. Using fluoroscopy to localize the mFB, the Ndy was then placed into the wound in close proximity to the mFB. The mFB were immediately magnetized to the Ndy and the mFB were extracted from the soft tissues without any further surgical dissection. Two simple interrupted nylon sutures were placed to close the incision. The total operative time was 2 and 2.5 minutes respectively. The children recovered uneventfully and are without complication. Conclusions The use of Ndy to remove extremity soft tissue mFB in children appears to be feasible, safe, and efficient. Use of the Ndy allowed extraction via a small incision, optimizing the aesthetic result and avoiding the need for cross-sectional imaging, extensive surgical dissection, tissue reconstruction and prolonged operative time or x-ray exposure. The development of magnets of increasing energy density may be indicated to further optimize metallic soft tissue foreign body extraction in children in a minimally invasive manner.

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Section: Discussionmentioning

confidence: 99%

“…25,26 The concept of as low a radiation exposure as reasonably achievable (ALARA) should be applied in the design of all pediatric care strategies. 27…”

Section: Discussionmentioning

confidence: 99%

The Novel Use of Rare Earth Magnets for the Extraction of Metallic Soft Tissue Foreign Bodies in Children

et al. 2023

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“…Two other recent studies focused on the development of a CT imaging protocol to minimize radiation exposure. Gosztyla et al [2022] proposed a mini-thoracic CT for the calculation of the Haller index ( 17 ). This mini-CT involves the placement of a radio-opaque marker at the point of most severe depression, after which a column of 3 cm above and 3 cm below the marker is scanned using 5 mm slices.…”

Section: Conventional Preoperative Imaging Methodsmentioning

confidence: 99%

Advancements in preoperative imaging of pectus excavatum: a comprehensive review

Coorens,

Janssen,

Daemen

et al. 2024

J Thorac Dis

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Pectus excavatum, the most common pectus deformity, varies in severity and has been associated with cardiopulmonary impairment and psychological distress. Since its initial documentation, a multitude of imaging techniques for preoperative evaluation (i.e., diagnosis, severity classification, functional assessment, and surgical planning) have been reported. Conventional imaging techniques encompass computed tomography (CT), chest radiography, magnetic resonance imaging (MRI), echocardiography and medical photography, while three dimensional (3D) optical surface imaging is a promising emerging technique in the preoperative assessment of pectus excavatum. This narrative review explores the current insights and advancements of these imaging modalities. CT imaging allows for the calculation of pectus indices and evaluation of cardiac compression and displacement. Recent developments focus on automated calculations, minimizing radiation exposure and improving surgical planning. Chest radiography offers a radiation-reducing alternative for pectus index measurement, but is unsuitable for disproportionally asymmetric chest deformations. MRI is a radiation-free imaging method, and allows for the calculation of pectus indices as well as the assessment of cardiac function. Real-time MRI provides dynamic insights, while exercise MRI shows promise for comprehensive evaluation of cardiac function but requires additional developments. Using echocardiography, structural cardiac changes can be identified, but its use in evaluating cardiac function in pectus excavatum patients is limited. Medical photography combined with caliper measurements complements other imaging methods for qualitative and quantitative documentation of pectus excavatum. Emerging as an innovative technique, 3D optical surface imaging offers a rapid, radiation-free assessment of the deformity which correlates with conventional pectus indices. Potential applications include quantifying other morphological features and predicting cardiac compression. However, standardization and validation are needed for its widespread use. This review provides an overview of preoperative imaging of pectus excavatum, highlighting the current developments in conventional methods and the potential of the emerging 3D optical surface imaging technique. These advancements hold promise for the future of the assessment and surgical planning of pectus excavatum.

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Simultaneous Bilateral Thoracoscopy During the Nuss Procedure is Safe, Effective, and Allows for Optimal Visualization of the Bar Passer Throughout the Substernal Dissection

Lukish,

Kovler,

Shah

et al. 2024

Journal of Pediatric Surgery

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Mini thoracic CT adequately determines Haller index and decreases radiation exposure in children with pectus excavatum

Cited by 6 publications

References 15 publications

The Novel Use of Rare Earth Magnets for the Extraction of Metallic Soft Tissue Foreign Bodies in Children

The Novel Use of Rare Earth Magnets for the Extraction of Metallic Soft Tissue Foreign Bodies in Children

Advancements in preoperative imaging of pectus excavatum: a comprehensive review

Simultaneous Bilateral Thoracoscopy During the Nuss Procedure is Safe, Effective, and Allows for Optimal Visualization of the Bar Passer Throughout the Substernal Dissection

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