Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX.
Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.
Curr Probl Diagn Radiol. 2021 Sep-Oct;50(5):566-570. doi: 10.1067/j.cpradiol.2021.03.012. Epub 2021 Mar 8.
Foreign body ingestion is a common problem in children. Radiography is the mainstay of imaging, but many radiolucent items go undetected without further imaging by fluoroscopic esophagram. While studies in adults support the use of computed tomography (CT) for esophageal foreign body ingestion, CT has historically not been used in children given the typically higher radiation doses on CT compared with fluoroscopy. In distinction to an esophagram, CT does not require oral contrast nor presence of an onsite radiologist and can be interpreted remotely. At our institution, a dedicated CT protocol has been used for airway foreign bodies since 2015. Given the advantages of CT over esophagram, we retrospectively reviewed institutional radiation dose data from 2017 to 2020 for esophagrams, airway foreign body CT (FB-CT), and routine CT Chest to compare effective doses for each modality. For ages 1+ years, effective dose was lowest using the FB-CT protocol; esophagram mean dose showed the most variability, and was over double the dose of FB-CT for ages 5+ years. Routine CT chest doses were uniformly highest across all age ranges. Given these findings, we instituted a CT foreign body imaging protocol as the first-line imaging modality for radiolucent esophageal foreign body at our institution.
异物吞食是儿童常见的问题。放射学是影像学的主要手段，但许多不透射线的物品如果不通过荧光透视食管造影进一步成像，就会被遗漏。虽然在成人中，研究支持使用计算机断层扫描（CT）来诊断食管异物吞食，但由于 CT 与荧光透视相比通常会产生更高的辐射剂量，因此 CT 在儿童中并未得到广泛应用。与食管造影不同，CT 不需要口服造影剂，也不需要现场放射科医生在场，并且可以远程进行解读。在我们的机构中，自 2015 年以来，我们一直使用专门的 CT 方案来诊断气道异物。鉴于 CT 优于食管造影的优势，我们回顾了 2017 年至 2020 年的机构辐射剂量数据，包括食管造影、气道异物 CT（FB-CT）和常规 CT 胸部，以比较每种方式的有效剂量。对于 1 岁以上的儿童，使用 FB-CT 方案的有效剂量最低；食管造影的平均剂量显示出最大的变异性，对于 5 岁以上的儿童，其剂量是 FB-CT 的两倍多。常规 CT 胸部剂量在所有年龄组中均最高。基于这些发现，我们在我们的机构中制定了 CT 异物成像方案，作为诊断不透射线食管异物的一线影像学手段。
