Ultrasound should be the first line imaging modality for many indications in the infant. For example, pyloric stenosis, sacral dimple, hip dysplasia until proximal femoral epiphyses are ossified (approximately 4 months postnatal age), soft tissue lesions, head ultrasound for germinal matrix hemorrhage and macrocrania, fluid collections, evaluation of intraabdominal pathology and urinary tract pathology.
Ultrasound is tolerable by most patients in various circumstances. It can help answer many questions and should be readily available and utilized for broad indications in pediatrics as first line study.
•Small field of view
•Ultrasound does not perform well for bone evaluation, however some institutions still utilize ultrasound as an adjunct for fracture evaluation.
•UGI remains the gold standard for evaluation of malrotation.
Safety profile of ultrasound is extremely favorable. In fact, ultrasound is the preferred modality in children due to lack of ionizing radiation. The AIUM states” Diagnostic ultrasound has been in use since the late 1950s. Given its known benefits and recognized efficacy for medical diagnosis, including use during human pregnancy, the American Institute of Ultrasound in Medicine herein addresses the clinical safety of such use: No independently confirmed adverse effects caused by exposure from present diagnostic ultrasound instruments have been reported in human patients in the absence of contrast agents. Biological effects (such as localized pulmonary bleeding) have been reported in mammalian systems at diagnostically relevant exposures but the clinical significance of such effects is not yet known. Ultrasound should be used by qualified health professionals to provide medical benefit to the patient.
Ultrasound exposures during examinations should be as low as reasonably achievable (ALARA).”
There is a small risk of cell damage due to heating in certain settings, this would require prolonged duration of scanning.
Use of ultrasound by licensed technologists and physicians with manufacturer and physicist oversight in the medical setting assures the patient of the safest and most reasonable study for diagnostic purposes. It is the responsibility of all involved; manufacturer, technologists and radiologists, to optimize parameters and techniques to minimize any potential risk, particularly in neonatal population.
As with any imaging, ALARA principle is applied, as low as reasonably achievable.
•American Institute of Ultrasound in Medicine (AIUM):
•AIUM includes practice parameters, guidelines for performance and documentation of images per study (includes hip, spine, head).
•American College of Radiology (ACR):
•ACR Appropriateness Guidelines- Suspected appendicitis
•ACR Appropriateness Guidelines-Urinary Tract Infection Child