Are you monitoring temperatures for neonates having MRI scans? Neonates are especially vulnerable to heat loss and special care should be taken to monitor temperatures for these patients. At Children's Healthcare of Atlanta, we are currently working on a protocol to monitor and intervene when necessary as well as take additional steps to keep infants warm during a scan. Current recommendations include pre-scan temperatures, turning off the fan inside the scanner, warm packs, warm blankets and frequent temperature monitoring. The length of the scan is a factor and longer scans need careful monitoring and interventions. Neonates under general anesthesia or sedation are also at higher risk for hypothermia. Paying extra attention to these details will help patients maintain temperature during MRI scans.

- Nancy Dennehy, Assistant Manager Nursing Radiology-Sedation, Children's Healthcare of Atlanta at Scottish Rite

Within the past two years, the Ultrasound Department at Children's Healthcare of Atlanta at Egleston has utilized eight ultrasound machines to replace systems at the end of production life. The first two systems purchased were a modification of current systems. Unfortunately, it did not take long before errors became present in the boot-up process. As the company tried to fix the systems, we relied on two loaner systems before it was determined that the systems required replacement.

We were offered two systems from a newer generation, ones the company believed would be the standard and platform for all of their future ultrasound machines. Those systems proved complicated and not user friendly, often adding 15 to 20 minutes to an ultrasound procedure. This turned out to be the final event that would end a 20+ year relationship. Today, we have a new vendor and two new systems, which have yielded technology that makes life easier for families and staff. We gained features that provide better image quality as well as the latest software to enable better diagnosis. It was not until we received the new systems that we realized what we had been missing.

In the end, we got what we wanted: the best for our patients and families.

Duane Griffith Supervisor, Ultrasound, Children's Healthcare of Atlanta at Egleston

Nuclear Medicine has been experiencing Tc99m shortages for a couple of years now, but it has never been as bad as it is now. The root of the issue is a shortage of molybdenum, a byproduct of nuclear fission. Molybdenum is then placed in containers called "generators" which, over a two week period, deliver a supply of Technetium-99m. Tc99m is used in more than 16 million nuclear imaging procedures per year nationwide. Due to the shortage, clinicians have adopted a range of strategies over the past few months, trying to use the available isotopes frugally by utilizing other modalities. Below is a brief history on what caused this shortage:

1. Canada's National Research Universal facility (NRU): Repair started May 2009 and is projected to last at least until August 2010. NRU produced 40% of the world's supply before the reactor went down.

2. Holland's Petten Reactor: Shut down for 6 months for regular scheduled maintenance until the end of July/August 2010. The Dutch reactor also prodcued 40% of the world's supply. With the two main reactors out of service, the severe shortage of Tc99m was created.

3. Poland's Maria Research Reactor: Could help produce molybdenum 99, but is not allowed to ship to the U.S. at this time.

4. Reactors in Belgium, France, Australia, and South Africa: Produced the lowest percentage of molybdenum 99 and have cranked up production to their maximum capacity. Regardless, these four reactors only produce 20% of the world's market.

Children's Healthcare of Atlanta has not felt the crunch as severely as many other facilities, but Children's still has been greatly affected for many procedures. The Nuclear Pharmacies for most parts can "squeeze" out the few drops of material we need for our kids. This is lucky for us, because nationwide Nuclear Medicine departments are affected by the reduction of work load, isotope shortages, cost increases, lay offs and/or reduction of hours worked, and lack of sufficient reimbursement for the now higher isotope costs. Lack of work in Nuclear Medicine was unheard of just a few years ago and there were not enough Nuclear Medicine Techs to go around. Now most Techs are holding on to their positions, which has decreased the turnover rate.

Ingrid Hall RT(N), Nuclear Medicine Team lead, Children's Healthcare of Atlanta at Scottish Rite

Children's Healthcare of Atlanta recently received a new addition to its Radiology department. Through the generosity of donors, Children's now has a "mock" scanner to assist staff in preparing children for MR procedures by affording a "dry" run of the exam without compromising staff member's schedules or tying up a scanner with a child who may not need sedation when given the opportunity to try without sedation first.

The "mock", as we call it at Children's, looks just like a standard closed bore MR unit. It has a moving table, faux cage-style head coil, and even makes sounds similar to that of the real thing. The new "toy" has already yielded great success, and we are hopeful that the sedation rate for patients aged 5 to 10 will continue to decline!

Scott Weisel RT(R)(CT)(MR) MRI Team leader Children's Healthcare of Atlanta at Scottish Rite

When you think of Radiology, most people think of X-rays, CTs and maybe even MRI or Ultrasound. Those of us who work in this field know something about Nuclear Medicine, but the average person may not even know it exists, and that we are actually a part of Radiology. I've heard things like, "Hmm, nuclear medicine, what exactly is that? I've never heard of that, is that like an X-ray?" I did an in-service for Radiology nurses that I have worked with for the last 8.5 years, and to my surprise, they were glued to my presentation as if it was a new and emerging modality! I thought they would be bored to pieces hearing information about a modality they work around every day. I learned that even though we had been working together for a long time, and that they had some knowledge about my department, there was still that bit of information that brought it all together for them. So for those of you that know a bit about us, but could stand to have a few gaps filled in, here goes:

Nuclear Medicine imaging involves administering radioactive pharmaceuticals into the body either orally or via IV, which attaches to organs, tissues, or bone. What that means is that a radioisotope is attached to a pharmaceutical that is specific for a body part. That pharmaceutical "carries" the isotope with it to that body part. These isotopes give off gamma rays, and our gamma camera "picks" up those gamma rays and through a series of internal electronics, the camera makes the picture. It takes several minutes for the camera to pick up those gamma rays to make a single picture so our imaging time is much longer compared to other modalities. The pictures we obtain are functional as opposed to seeing structure and anatomy like on an X-ray. For example, when you take an X-ray of the leg, you can see the structure of the leg and if there are any breaks or fractures and so forth. If we do a bone scan, our isotope goes to any place in the bone that is trying to "repair" itself. The repair could be from a fracture, break or even a cancerous process. The camera defines the actual function that is taking place within the bone. We may even pick up a fracture that could not yet be seen on X-ray because as soon as that fracture takes place an active process of repair starts that we can see. The same holds true for many other body parts. You name the organ, we probably have a scan that can tell you how that organ is functioning! So the mystery about Nuclear Medicine unfolds a bit more--yes, we are a part of Radiology, and in my humble opinion, a good compliment to our sister modalities!

Gina Griffin, CNMT Children's Healthcare of Atlanta at Egleston Team Leader-Nuclear Medicine and PET/CT

As I sat here reading the blog posts on this site, I noticed an article on the left side of the page titled "Radiofrequency Ablation Safe and Effective for Reducing Pain From Bone Metastases Working in Interventional Radiology." This spurred my interest of the article since this is a procedure that we perform at Children's Healthcare of Atlanta. While reading the article I stopped to think about how beneficial this procedure is. The article mentions a study that was performed and the outcome of the procedures on the patients observed. It does not specify the ages of the patients, but in the pediatric hospital setting RFAs have been a blessing for children and their families. In regards to pediatrics, an RFA is a minimally invasive procedure, with quick results, and a quick recovery time. RFAs allow children to have the lesion that is causing them pain treated and allow them to return to an active life in less time than would be required if a surgery were to occur. When speaking to some of the children after the procedure, they have stated that right then they can feel the pain from the procedure but that there is already a lessening of the pain associated from the lesion. The parents have also commented about the changes that they see in the children post procedure. In dealing with pediatric patients, shorter times in both procedures and recovery is a boon to everyone involved.

Raymond Woodall, RT(R) Children's Healthcare of Atlanta at Scottish Rite

Big things are ahead in Interventional Radiology at Children's Healthcare of Atlanta at Egleston. Children's will install a new Philips Interventional lab this summer, which is BIG news for us and our patients. This equipment will greatly improve image quality. Two Children's Radiology staff members will take the Interventional Registry this year to solidify their skills as IR technologists. Children's outpatient procedures have grown to include Radiofrequency Ablation and Venous Embolizations, which provide an alternative to open operations. I am celebrating my five-year anniversary in October, and I still love what I do and who I work for. Children's is a great place to work and, especially with the additions on the horizon for this summer, it's a great place to grow as an IR technologist. Mike Bryant, RT(R)CV Children's Healthcare of Atlanta at Egleston

Children's Healthcare of Atlanta at Egleston recently added a portable CT scanner to further improve care for critically ill patients. The scanner is called a CereTom and it was developed by NeuroLogica. The purchase of the portable CT scanner was made possible through donor funds. Children's staff members are able to take the portable CT to ICUs to care for critically ill patients that might otherwise not be able to be transported to radiology, such as patients with dangerously high intracranial pressure or patients on ECMO. Children's averages seven portable exams each month.

The scanner is an 8-slice scanner, and produces images of the same quality as a non-mobile unit. A task force of critical care physicians, radiologists, and CT technologists worked together to establish guidelines for determining which cases will most benefit from the use of the portable scanner. An assessment of the acuity of the patient dictates whether the mobile unit is necessary. In most cases, patients are transported to the radiology suite, as the process is more time efficient and also affords the advantages of a 64-slice scan.

Renee Ahmed, RT (R) (CT) CT Team Leader Children's Healthcare of Atlanta, Egleston

At Children's Healthcare of Atlanta, the ultrasound department realizes that its staff makes a difference in a child's life every day. One way is by utlilizing emergent ultrasounds. The thin body habitus of a child is especially suited to ultrasound evaluation. What emergent ultrasound exams are done on the pediatric patient? The most common is to evaluate for the acute abdominal condition. Abdominal studies look for obstructions such as intusseption and pyloric stenosis. Abdominal ultrasound also evaluates the abdomen for gallstones, kidney stones or abscess or fluid collections. Pelvic ultrasounds are performed for ovarian torsion, hemorrhagic ovarian cysts, or fluid collections and abscesses. Scrotal ultrasounds are used to diagnose testicular torsion. Children's performs everything from deep vein thrombosis Doppler studies to hip ultrasound for effusions. Superficial foreign bodies can be seen on ultrasound that may not be seen by diagnostic radiography. More and more, the emergency department requests ultrasound studies. Ultrasound in the acute situation is very dependent on the skill and expertise of the sonographer. Children's has a dedicated team of sonographers that are the best of the best. They are all very passionate about their work and extremely proud of the work they do. The ultrasound department at Children's is a wonderful place to work.

Alice Spinks, Radiology Team Leader, Children's Healthcare of Atlanta at Scottish Rite

The importance of image quality is recognized at Children's Healthcare of Atlanta by radiology leadership. A high standard of image quality is required to assure the radiologist accurate reading of images. This assists the attending physician in making a diagnosis and safety treat the patient. The Children's quality team has developed a system called Z-coding where the radiologist will attach a letter code to their dictation. Some examples of the factors coded are positioning, collimation, shielding, rotation, motion, unacceptable and excellent. This Z-coding system enables us to maintain on-going education for technologists that may need assistance in those areas. In addition, we are able to monitor trends that would indicate areas for improvement. - Susan Freeman RT(R) Education Analyst Children's Healthcare of Atlanta Egelston