Pediatrics and point‑of‑care MR imaging.

The challenges with conventional imaging in pediatric care.

Before the invention of point-of-care MR imaging, children with acute and chronic conditions only had a few options for neuroimaging (ultrasound, CT, and conventional MRI), and they all have drawbacks.

Ultrasound offers the best point-of-care option and is relatively safe and feasible for newborns because there is visibility into their brains due to the fontanel magna still being open1. However, as infants grow, ultrasound may no longer be clinically feasible as their fontanelles close, and alternative imaging modalities are needed.

When point-of-care ultrasound is no longer an option, CTs become the primary brain imaging modality for the assessment of pediatric patients2. Head CTs are often the default imaging modality because they are fast, inexpensive, and readily available to evaluate a variety of neurological complaints, especially in the ED setting3. The challenge is that radiation exposure from CT affects children differently than adults. There is an increased risk of developing cancer because children are more sensitive to radiation as their brains grow4. Furthermore, conditions like possible shunt dysfunction in hydrocephalus patients or traumatic brain injury may require serial imaging, and overexposure to ionizing radiation may potentially produce radiation-induced brain tumors. Multiple studies have provided evidence that children under the age of nineteen who receive serial imaging have an increased likelihood of developing brain cancer or leukemia5.

Conventional MRI has been shown to provide better tissue differentiation and visualization of structures over CT6. However, there are challenges that clinicians face when imaging pediatrics with conventional MRI. Age alone can be the most significant reason pediatric patients still have a CT scan since many may require sedation for conventional MRI—CT can be considered faster and easier in these cases7. Additionally, access to a conventional MRI may be limited due to cost, accessibility, and availability in tertiary care centers that don’t have the staff to run their imaging facilities around the clock.

Swoop—the Hyperfine solution.

The Swoop® Portable MR Imaging System deploys at the point of care, enabling bedside imaging of children with various clinical conditions. A clinician in an outpatient neurosurgery clinic may check the ventricles of children with treated hydrocephalus or acute conditions in a pediatric intensive care unit. Moreover, in some hospitalized children, the evolution of a child’s condition merits serial imaging, an easy task for the Swoop system. By using the Swoop system, caregivers can track near-real-time changes in condition and recovery—and it accomplishes all of this without subjecting children to ionizing radiation.

The friendly design of the Swoop system is naturally applicable to pediatric brain imaging. The quiet operation, open layout, and built-in safety considerations allow caregivers and family members to be present and comfort a child by holding their hand during the scan.

Swoop system images can help the clinician diagnose the following neurological conditions:

  • Hydrocephalus (diagnosis and monitoring)
  • Acute mental status change
  • Head injury consequent to a fall or a sports injury
  • Leukodystrophy
  • Stroke recovery
  • Suspected abuse
Video

Swoop in Pediatric Facilities

Case Review

5-year-old patient with acute-onset severe headache with nausea and vomiting presented to the hospital and was imaged using Swoop. The patient has a known ventriculoperitoneal shunt with previously normal ventricular size. Swoop images aided in diagnosing acute obstructive hydrocephalus. The child was admitted and underwent a successful shunt revision.

Clinicians must be aware of the MRI-related compatibility for a particular implant or device. Please check the labeling for MR compatibility.

Case Review

13-year-old male presented to a remote clinic with focal abnormal neurological signs. EEG performed was abnormal. Bedside imaging was obtained using Swoop in the remote location. Swoop images aided in diagnosing a large intra-axial tumor with resultant obstructive hydrocephalus. The patient was referred to a large city hospital for neurosurgical examination.

1. Ichihashi K, Nonaka K. Point-of-care ultrasound for children. Journal of Medical Ultrasonics. Published online January 21, 2022. doi:10.1007/s10396-021-01169-0

2. Tekes, A., Jackson, E. M., Ogborn, J., Liang, S., Bledsoe, M., Durand, D. J., Jallo, G., & Huisman, T. A. G. M. (2016). How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children’s Center. American Journal of Neuroradiology, 37(6), 990–996. doi.org/10.3174/ajnr.a4658

3. Ramgopal, S., Karim, S. A., Subramanian, S., Furtado, A. D., & Marin, J. R. (2020). Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department. BMC Pediatrics, 20(1). doi.org/10.1186/s12887-020-1919-3

4. Radiation Risks and Pediatric Computed Tomography. (2018, September 4). National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/causes-prevention/risk/radiation/pediatric-ct-scans

5. Dopson G., Dalton A., Nicholson C., Jenkins A., Mitchell P., Cowie C. (2020) CT scan exposure in children with ventriculoperitoneal shunts: single-center experience and review of the literature. Child’s Nervous System. 36:591-599. doi.org/10.1007 /s00381-019-04345-3

6. Themes UFO. Magnetic Resonance Imaging in the Pediatric Patient. Radiology Key. Published August 20, 2019. https://radiologykey.com/magnetic-resonance-imaging-in-the-pediatric-patient/

7. Trost MJ, Robison N, Coffey D, Mamey MR, Robison RA. Changing Trends in Brain Imaging Technique for Pediatric Patients with Ventriculoperitoneal Shunts. Pediatric Neurosurgery. 2018;53(2):116-120. doi:10.1159/000485923