Browsing by Author "Jennings, S. Gregory"
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Item Characteristics of testicular tumors in prepubertal children (age 5–12 years)(Elsevier, 2018) Karmazyn, Boaz; Weatherly, David L.; Lehnert, Stephen J.; Cain, Mark; Fan, Rong; Jennings, S. Gregory; Ouyang, Fangqian; Kaefer, Martin; Radiology and Imaging Sciences, School of MedicineIntroduction Testicular tumors in children have two peaks with different types of tumors; in the first 4 years of life a third to half are benign with increased risk of malignancy during puberty. The pathology of testicular tumors between these peaks, at the age of 5–12 years, is not known. We hypothesized that because of the low level of testosterone at this time, the incidence of malignant tumors is very low. Objective To compare malignancy risk of primary testicular tumors in children in the prepubertal period (5–12 years) compared with younger (0–4 years) and pubertal (13–18 years) children. Study design We retrospectively (2002–2016) identified patients <18 years with surgery for primary testicular tumor. Patients with testicular tumor risk were excluded. Ultrasound studies were reviewed for contralateral testis volume, tumor morphology, and tumor maximal diameter, for three age groups: 0–4, 5–12, and 13–18 years. The Freeman-Halton extension of the Fisher exact probability test was adopted for categorical outcomes, and one-way ANOVA for continuous outcomes. Results Fifty-two patients (mean age 11.0 years, range 6 days–18 years) were identified. Malignant tumor prevalence significantly differed ( p < 0.01) among age groups ( Fig ).: 0–4 (72.7%, 8/11), 5–12 (0%, 0/16), and 13–18 years (44.0%, 11/25). The most common tumor types in 5–12 years were epidermoid cyst (31.3%, 5/16) and tumor mimics (37.5%, 6/16). Prevalence of cystic tumors in 5–12 year olds was not significantly different compared with other age groups. Contralateral testicular volume >4 mL (pubertal surge) significantly ( p < 0.01) differed among groups: 0–4 years (0/11), 5–12 years (3/16), and 13–18 years (19/20). In children aged 13–18 years the mean tumor maximal diameter (29.8 ± 4.4 mm) was significantly larger (p < 0.01) compared with children 5–12 years (9.3 ± 5.5 mm) and all malignant tumors had contralateral testicular volume >4 mL. Discussion We found that preadolescent children between the ages of 5 and 12 years have distinctive characteristics compared with the other age groups. Most importantly, no malignant testicular tumors were found in this age group. About a third of the children presented with an incidental testicular mass. The testicular tumors were significantly smaller (9.3 ± 6.7 mm) compared with those in children aged 13–18 years (29.8 ± 4.4 mm). There were limitations because of the retrospective nature of the study. Conclusion We found no malignant testicular tumors in children aged 5–12 years with no risk factors and prior to pubertal surge. Our study suggests use of more conservative treatment in this group of patients.Item A Comparison of Readings from Thermoluminescent Dosimeter Ring Badges Worn in Different Positions(SNMMI, 2020-12) Osborne, Keexia L.; Nielsen, Cybil J.; Bullock, John R.; Jennings, S. Gregory; Radiology and Imaging Sciences, School of MedicineOur purpose was to evaluate whether the position of a thermoluminescent dosimeter (TLD) crystal results in different exposure readings. Methods: Nine subjects wore 2 TLD badges (one facing inward, toward the palm, and one facing outward) for 2 mo. Both TLDs were worn on the middle finger of the dominant hand, with the inward-facing TLD placed at the bottom and the outward-facing TLD at the top. At the end of the first month, these TLDs were replaced with new ones for another month. Combined results from the badges for the 2 mo were recorded in millisieverts. A paired t test with 2-sample means was performed to compare the 2 positions in general nuclear medicine and PET/CT subjects, with an α of 0.05. Results: For all subjects and for the general nuclear medicine and PET/CT groups, mean exposure was greater for the inward-facing TLD. Conclusion: For a TLD worn on the dominant hand, extremity-exposure readings are maximized when the TLD faces inward.Item Compliance With Skeletal Surveys for Child Abuse in General Hospitals: A Statewide Quality Improvement Process(ARRS, 2019-05) Wanner, Matthew R.; Marine, Megan B.; Hibbard, Roberta A.; Ouyang, Fangqian; Jennings, S. Gregory; Shea, Lindsey; Karmazyn, Boaz; Radiology and Imaging Sciences, School of MedicineOBJECTIVE. The purpose of this study is to perform a statewide quality improvement process to improve compliance with the American College of Radiology (ACR) guidelines in performing skeletal surveys for suspected child abuse. SUBJECTS AND METHODS. We prospectively identified all outside hospital skeletal surveys for suspected child abuse in children younger than 3 years referred to our tertiary children's hospital in 2016–2017. We included a 3-month baseline and 21-month intervention period. The quality improvement process was based on sending educational material to all ACR member radiologists in the state and making telephone calls to radiology technologist team leaders whenever the surveys were not compliant, followed by e-mails with guidance on performing skeletal surveys. We documented the views obtained and compared them with the ACR guidelines. The percentage of compliance with each individual view was assessed with the chi-square test. The total number of compliant views per survey was evaluated with ANOVA. RESULTS. Two hundred twenty-seven patients (105 female) with a mean age of 0.8 year (SD, 0.67 year; range, 0.01–3 years) were evaluated. These 227 surveys (baseline, n = 27; postintervention, n = 200) were performed at 69 different outside hospitals. Compliance significantly (p = 0.006) improved from 25.9% (7/27) during baseline to 54.0% (108/200) after intervention. There was a nonsignificant trend of improved compliance between the first (51.9%; 41/79) and last 7-month (62.3%; 33/53) periods of intervention. Among individual views, only rib oblique views showed significantly (p = 0.02) improved compliance after the intervention, from 51.9% (14/27) to 73.5% (147/200). CONCLUSION. The compliance rate with ACR guidelines for skeletal surveys in suspected child abuse at outside general hospitals significantly increased after implementation of a quality improvement process.Item The Effects on Technologist Occupational Exposure in PET/CT Departments When Working with Students at Various Levels of Supervision(SNM, 2020-09) Farkas, Jacob; Martin, Michael; Nielsen, Cybil; Jennings, S. Gregory; Radiology and Imaging Sciences, School of MedicineThe purpose of this study was to evaluate the effect that the presence of a student in the PET/CT department has on the technologist’s occupational radiation exposure and whether this effect is influenced by the type of supervision performed. Methods: This was a retrospective, institutional review board–approved study that collected data from 2 PET/CT departments. Dosimetry reports, correlated with the clinical schedules of the students, were normalized for workflow (amount of radioactivity), the number of technologists, and the number of monitored days in the department. A 2-sample t test assuming unequal variance with an α of 0.05 was used to compare doses between with-student and without-student groups and between direct-supervision and indirect-supervision groups. Results: The study consisted of a dataset of 42 dosimetry reports, 19 with students and 23 without students. When comparing with-student and without-student groups, the total (n = 42) extremity dose had a P value of 0.012 with a mean of 0.0011665 μSv/MBq/technologist/d; all other dose comparisons between groups were greater than 0.05 (P > 0.05). For indirect supervision (n = 21), the extremity-dose P value was 0.298. The other dose P values were all less than 0.05. For direct supervision (n = 21), the dose P values were all greater than 0.05. There was a trend toward decreasing exposure of technologists when students were in the department. Conclusion: Extremity dose decreases when students are present. There is a trend toward decreasing dose with indirect supervision.Item An Evaluation of Qualities of Nuclear Medicine Technology Programs and Graduates Leading to Employability(Society of Nuclear Medicine, 2019-03) Nielsen, Cybil J.; Brosmer, Sarah S.; Byrne, Patrick J.; Jennings, S. Gregory; Radiology and Imaging Sciences, School of MedicineOur rationale was to evaluate how the qualities of nuclear medicine technology (NMT) programs and graduates associate with employability. Methods: We identified all Nuclear Medicine Technology Certification Board applicants who passed the entry-level NMT examination between 2012 and 2017. Certificants were e-mailed a survey with questions on graduate qualities, program qualities, and initial employment. Each quality was quantified. Age, sex, and desired employment within or outside the United States were also documented. An employability scale was created from the initial employment questions. Subjects were separated into 4 employability groups based on their employability score: poorly employable, marginally employable, satisfactorily employable, and optimally employable. An ANOVA test was performed on each quality using the 4 employability groups; a P value of less than 0.05 was considered significant. Results: Of the 3,930 surveys distributed, 885 (22.5%) were completed and returned. Six of the 10 qualities evaluated were significantly associated with employability: overall education (P < 0.01), number of clinic hours (P < 0.01), grade-point average (P < 0.01), number of schools within a 100-mile (161-km) radius (P < 0.01), number of attempts to pass the board examination (P < 0.01), and number of clinics (P = 0.04). The qualities that were not statistically significant were age, sex, employment location sought, board score, single versus dual certification, program level of education, and number of graduates in the class. Conclusion: There are multiple graduate and program qualities that are predictive of the employability of NMT graduates.Item Osteomyelitis of the ribs in children: a rare and potentially challenging diagnosis(Springer, 2020) Crone, Allison M.; Wanner, Matthew R.; Cooper, Matthew L.; Fox, Thomas G.; Jennings, S. Gregory; Karmazyn, Boaz; Radiology and Imaging Sciences, School of MedicineBackground Rib osteomyelitis is rare in children and can mimic other pathologies. Imaging has a major role in the diagnosing rib osteomyelitis. Objective To evaluate clinical presentation and imaging findings in children with rib osteomyelitis. Materials and methods We performed a retrospective (2009–2018) study on children with rib osteomyelitis verified by either positive culture or pathology. We excluded children with multifocal osteomyelitis or empyema necessitans. We reviewed medical charts for clinical, laboratory and pathology data, and treatment. All imaging modalities for rib abnormalities were evaluated for presence and location of osteomyelitis and abscess. We calculated descriptive statistics to compare patient demographics, clinical presentation and imaging findings. Results The study group included 10 children (6 boys, 4 girls), with an average age of 7.3 years (range, 3 months to 15.9 years). The most common clinical presentations were fever (n=8) and pain (n=5). Eight children had elevated inflammatory indices (leukocytosis, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]). Localized chest wall swelling was found initially in six children and later in two more children. Rib osteomyelitis was suspected on presentation in only two children. All children had chest radiographs. Rib lytic changes were found on only one chest radiograph, in two of the four ultrasound studies, and in four of eight CTs. Bone marrow signal abnormalities were seen in all eight MRIs. In nine children the osteomyelitis involved the costochondral junction. Six children had an associated abscess. Staphylococcus aureus was cultured in eight children. Osteomyelitis was diagnosed based on pathology in one child with negative cultures. Conclusion While rib osteomyelitis is rare, imaging findings of lytic changes at the costochondral junction combined with a history of fever, elevated inflammatory markers or localized soft-tissue swelling in the chest should raise suspicion for this disease.Item Ultrasound findings in classic metaphyseal lesions: emphasis on the metaphyseal bone collar and zone of provisional calcification(Springer, 2019) Marine, Megan B.; Hibbard, Roberta A.; Jennings, S. Gregory; Karmazyn, Boaz; Radiology and Imaging Sciences, School of MedicineBackground The classic metaphyseal lesion (CML) is highly specific for non-accidental trauma in infants. While the radiographic findings are well documented, there is little literature on the ultrasound (US) appearance. Objective To evaluate US findings in CMLs identified on radiographs. Material and methods This institutional review board-approved, retrospective evaluation of targeted US of CMLs was performed in selected groups of children from 2014 to 2017. Only CMLs confidently identified on radiography by a consensus of two radiologists were included. US images were obtained with a linear transducer, including longitudinal images at lateral, anterior, medial and posterior aspects. Two pediatric radiologists evaluated the US appearance, specifically the metaphyseal bone collar for thickness, deformity and fracture, as well as the sonographic zone of provisional calcification for irregularity and appearance of multiple lines. Radiography was the reference standard. Results Twenty-two patients (13 female; mean age: 4.2 months) were identified, with 39 CMLs in the tibia (n=22), femur (n=11), humerus (n=3), radius (n=2) and fibula (n=1). Thirty-three of the 39 CMLs (85%) were identified on US, while 6 (15%) were not seen (false negatives). Thirty of the 39 (77%) had metaphyseal bone collar thickening, 29 (74%) had collar deformity and 12 (31%) had visible fracture of the collar. At the sonographic zone of provisional calcification, 16/39 (41%) had irregularity and 5 (13%) had multiple lines visible. Conclusion Identifying metaphyseal bone collar and zone of provisional calcification abnormalities is key to recognizing CMLs on US. While additional studies are necessary to evaluate the accuracy of US in the diagnosis of CMLs, our findings suggest US may have a potential role in either confirming or evaluating radiographically equivocal/occult CMLs.