Neck CT angiography examinations for pediatric oropharyngeal trauma: diagnostic yield and proposal of a new targeted tec
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ORIGINAL ARTICLE
Neck CT angiography examinations for pediatric oropharyngeal trauma: diagnostic yield and proposal of a new targeted technique Jungwhan John Choi 1,2
&
Christiane Sarah Burton 1,2 & Amy R. Danehy 1,2 & Stephan D. Voss 1,2
Received: 9 December 2019 / Revised: 26 April 2020 / Accepted: 22 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Neck computed tomography (CT) angiography is commonly ordered for pediatric patients with soft palate trauma to exclude vascular injury. Debate exists regarding what type of imaging is indicated in this setting, particularly amid growing concern that standard neck CT angiography results in considerable radiation exposure. Objective To assess the diagnostic yield and estimated dose reduction of a novel targeted protocol extending from the skull base to the hyoid bone to evaluate pediatric oropharyngeal trauma. Materials and methods A retrospective imaging and medical chart review was performed of patients for whom a neck CT angiography was obtained for an indication of oropharyngeal trauma between 2008 and 2018. Effective dose and size-specific dose estimates (SSDEs) were estimated for standard and targeted neck CT angiography protocols with calculation of percent dose reduction of the targeted exams. Results Ninety-eight CT angiography examinations were reviewed. No cases were positive for neurological or major vessel injury; one case was positive for small vessel extravasation. Clinically significant nonvascular findings included phlegmonous change, retained foreign body, retropharyngeal/mediastinal air and pterygoid process fracture. With the exception of mediastinal air, all findings would have been included in the targeted protocol. Effective dose and SSDE were calculated for all cases where CTDIvol (volume CT dose index) had been reported (n=72). There was a statistically significant reduction in dose for the targeted protocol with an effective dose decrease of 69.7%±10.5% (P=0.009) and SSDE decrease of 53.9%±14.7% (P=0.01). Limiting ionizing radiation to the lung apices, esophagus and thyroid gland provided the greatest dose savings. Conclusion Based on low diagnostic yield and high radiation dose associated with standard neck CT angiography for evaluating oropharyngeal trauma, a targeted protocol is recommended, resulting in significantly less dose to the neck, while preserving diagnostic yield. Keywords Children . Computed tomography . Computed tomography angiography . Neck . Oropharynx . Radiation dose . Soft palate . Trauma
Introduction Oropharyngeal trauma is a relatively common chief complaint encountered in the pediatric emergency department, most often occurring in the setting of a fall with a foreign body in the mouth [1, 2]. The overwhelming majority of cases are limited
* Jungwhan John Choi [email protected] 1
Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA
2
Harvard Medical School, Boston, MA, USA
to oral mucosal injury and are associat
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