Clinical Focus


  • Diagnostic Radiology
  • Pediatric Radiology

Academic Appointments


Professional Education


  • Residency: Boston University Medical Center Radiology Residency (1982) MA
  • Residency: Boston Childrens Hospital Pediatric Residency (1980) MA
  • Fellowship: Boston Children's Hospital (1984) MA
  • Residency: Johannesburg General Hospital Complex (1978) South Africa
  • Board Certification: American Board of Radiology, Pediatric Radiology (1995)
  • Board Certification: American Board of Radiology, Diagnostic Radiology (1983)
  • Internship: Johannesburg General Hospital Complex (1977) South Africa
  • Medical Education: University of Witwatersrand (1976) South Africa

Clinical Trials


  • Controlled Ventilation CT in CF Infants Not Recruiting

    The objective of the study is to implement a new method of performing chest CT imaging in young children with cystic fibrosis at Packard Children's Hospital. This technique will be used to evaluate early lung disease comparing quantitative chest CT air trapping and airway measurements with lung function measurements in infants, toddlers, and young children with chronic lung disease.

    Stanford is currently not accepting patients for this trial. For more information, please contact Colleen Dunn, 650-736-0388.

    View full details

  • Outcome Measures in Infant/Early Childhood Lung Disease w/ Chest CT Scanning & Lung Function Testing Not Recruiting

    To implement a new method of performing chest CT imaging in young children at Packard Children's Hospital entitled controlled ventilation infant/young child chest CT scanning. This technique will be used to evaluate early lung disease comparing quantitative chest CT air trapping and airway measurements with lung function measurements in infants, toddlers, and young children with chronic lung disease.

    Stanford is currently not accepting patients for this trial. For more information, please contact Yan Ki Angela Leung, 650-723-5193.

    View full details

2023-24 Courses


Graduate and Fellowship Programs


  • Pediatric Radiology (Fellowship Program)

All Publications


  • Congenital Absence of the Pericardium: Pearls and Pitfalls. Seminars in ultrasound, CT, and MR Newman, B. 2022; 43 (1): 47-50

    Abstract

    Congenital absence of the pericardium is a very uncommon condition that may be focal, unilateral or bilateral but most frequently involves the left sided pericardium. Clinical signs and symptoms are often absent or nonspecific, overlapping with many other more common conditions. Imaging findings are distinctive if the features are sought and recognized.

    View details for DOI 10.1053/j.sult.2021.05.005

    View details for PubMedID 35164909

  • Magnetic resonance imaging for congenital lung malformations. Pediatric radiology Newman, B. 2021

    Abstract

    Congenital lung malformations are most often identified on prenatal US screening. Fetal MRI is often performed to further evaluate these lesions. Although some of these lesions might cause prenatal or early postnatal symptoms that require urgent management, the majority are asymptomatic at birth and might be subtle or invisible on chest radiographs. Postnatal imaging is frequently deferred until 3-6months of age, when surgery or long-term conservative management is contemplated. High-quality imaging and interpretation is needed to assist with appropriate decision-making. Contrast-enhanced chest CT, typically with angiographic technique, has been the usual postnatal imaging choice. In this review, the author discusses and illustrates the indications and use of postnatal MR imaging for bronchopulmonary malformations as well as some differential diagnoses and the advantages and disadvantages of MR versus CT.

    View details for DOI 10.1007/s00247-021-05018-7

    View details for PubMedID 33688989

  • Improved detection of air trapping on expiratory computed tomography using deep learning. PloS one Ram, S. n., Hoff, B. A., Bell, A. J., Galban, S. n., Fortuna, A. B., Weinheimer, O. n., Wielpütz, M. O., Robinson, T. E., Newman, B. n., Vummidi, D. n., Chughtai, A. n., Kazerooni, E. A., Johnson, T. D., Han, M. K., Hatt, C. R., Galban, C. J. 2021; 16 (3): e0248902

    Abstract

    Radiologic evidence of air trapping (AT) on expiratory computed tomography (CT) scans is associated with early pulmonary dysfunction in patients with cystic fibrosis (CF). However, standard techniques for quantitative assessment of AT are highly variable, resulting in limited efficacy for monitoring disease progression.To investigate the effectiveness of a convolutional neural network (CNN) model for quantifying and monitoring AT, and to compare it with other quantitative AT measures obtained from threshold-based techniques.Paired volumetric whole lung inspiratory and expiratory CT scans were obtained at four time points (0, 3, 12 and 24 months) on 36 subjects with mild CF lung disease. A densely connected CNN (DN) was trained using AT segmentation maps generated from a personalized threshold-based method (PTM). Quantitative AT (QAT) values, presented as the relative volume of AT over the lungs, from the DN approach were compared to QAT values from the PTM method. Radiographic assessment, spirometric measures, and clinical scores were correlated to the DN QAT values using a linear mixed effects model.QAT values from the DN were found to increase from 8.65% ± 1.38% to 21.38% ± 1.82%, respectively, over a two-year period. Comparison of CNN model results to intensity-based measures demonstrated a systematic drop in the Dice coefficient over time (decreased from 0.86 ± 0.03 to 0.45 ± 0.04). The trends observed in DN QAT values were consistent with clinical scores for AT, bronchiectasis, and mucus plugging. In addition, the DN approach was found to be less susceptible to variations in expiratory deflation levels than the threshold-based approach.The CNN model effectively delineated AT on expiratory CT scans, which provides an automated and objective approach for assessing and monitoring AT in CF patients.

    View details for DOI 10.1371/journal.pone.0248902

    View details for PubMedID 33760861

  • Congenital central pulmonary artery anomalies: Part 2. Pediatric radiology Newman, B., Alkhori, N. 2020

    Abstract

    There is a broad spectrum of congenital anomalies of the central pulmonary arteries including abnormalities of development, origin, course and caliber. These anomalies incorporate simple lesions such as isolated pulmonary valve stenosis to very complex anomalies with many associated abnormalities. Part 1 and Part 2 of this review describe the range of anatomical variations that are encountered as well as important aspects of anatomy, physiology and surgical correction. The authors summarize and illustrate both well-recognized and more complex anomalies to provide a broad and comprehensive understanding of these lesions and their appearances on CT and MR imaging. In Part 2 the authors review abnormalities in development, origin and course of the central branch pulmonary arteries as well as abnormal pulmonary artery caliber.

    View details for DOI 10.1007/s00247-020-04703-3

    View details for PubMedID 32500159

  • Congenital central pulmonary artery anomalies: Part 1. Pediatric radiology Newman, B., Alkhori, N. 2020

    Abstract

    There is a broad spectrum of congenital anomalies of the central pulmonary arteries including abnormalities of development, origin, course and caliber. These anomalies incorporate simple lesions such as isolated pulmonary valve stenosis to very complex anomalies with many associated abnormalities. Part 1 and Part 2 of this review describe the range of anatomical variations that are encountered as well as important aspects of anatomy, physiology and surgical correction. The authors summarize and illustrate well-recognized as well as more complex anomalies to provide a broad and comprehensive understanding of these lesions and their appearances on CT and MR imaging. Part 1 covers anomalous development or origin of the main pulmonary artery.

    View details for DOI 10.1007/s00247-020-04690-5

    View details for PubMedID 32474775

  • Mucus plugging, air trapping, and bronchiectasis are important outcome measures in assessing progressive childhood cystic fibrosis lung disease. Pediatric pulmonology Robinson, T. E., Goris, M. L., Moss, R. B., Tian, L., Kan, P., Yilma, M., McCoy, K. S., Newman, B., de Jong, P. A., Long, F. R., Brody, A. S., Behrje, R., Yates, D. P., Cornfield, D. N. 2020

    Abstract

    OBJECTIVE: To determine which outcome measures could detect early progression of disease in school-age children with mild cystic fibrosis (CF) lung disease over a two-year time interval utilizing chest computed tomography (CT) scores, quantitative CT air trapping (QAT), and spirometric measurements.METHODS: Thirty-six school-age children with mild CF lung disease (median [interquartile range] age 12 [3.7] years; percent predicted forced expiratory volume in 1second (ppFEV1 ) 99 [12.5]) were evaluated by serial spirometer-controlled chest CT scans and spirometry at baseline, 3-month, 1- and 2-years.RESULTS: No significant changes were noted at 3-month for any variable except for decreased ppFEV1 . Mucus plugging score (MPS) and QATA1 and A2 increased at 1- and 2-years. The bronchiectasis score (BS), and total score (TS) were increased at 2-year. All variables tested with the exception of bronchial wall thickness score, parenchymal score (PS), and ppFEV1 , were consistent with longitudinal worsening of lung disease. Multivariate analysis revealed baseline PS, baseline TS, and 1-year changes in BS and air trapping score were predictive of 2-year changes in BS.CONCLUSIONS: MPS and QATA1-A2 were the most sensitive indicators of progressive childhood CF lung disease. The 1-year change in the bronchiectasis score had the most positive predictive power for 2-year change in bronchiectasis.

    View details for DOI 10.1002/ppul.24646

    View details for PubMedID 31962004

  • Left ventricular retraining in corrected transposition: Relationship between pressure and mass. The Journal of thoracic and cardiovascular surgery Mainwaring, R. D., Patrick, W. L., Arunamata, A., Chan, F., Newman, B., Rosenblatt, T. R., Kamra, K., Hanley, F. L. 2019

    Abstract

    BACKGROUND: A subset of patients with corrected transposition of the great arteries (CC-TGA) will require left ventricular (LV) retraining before undergoing a double-switch procedure. LV retraining results in an immediate increase in LV pressure but not in LV mass. The purpose of this study was to evaluate the relationship between LV pressure and mass during LV retraining.METHODS: This was a retrospective review of 36 patients with CC-TGA who were enrolled in LV retraining. The median age at enrollment was 12months. The majority (82%) had an Ebstenoid tricuspid valve or moderate to severe tricuspid valve regurgitation before pulmonary artery banding.RESULTS: Twenty-seven of the 36 patients underwent LV retraining and a double switch, including 14 patients with a single pulmonary artery band (PAB), 12 patients with 2 PABs, and 1 patient with 3 PABs. There was no early or late mortality associated with these procedures. Ninety percent of the patients demonstrated a linear relationship between LV pressure and mass; however, 3 patients (10%) demonstrated a different LV retraining pattern characterized by excess LV mass compared to LV pressure. Two of these 3 patients are LV retraining failures, whereas the third patient did undergo a double switch.CONCLUSIONS: The data show that the majority of patients enrolled in LV retraining have a predictable relationship between LV mass and pressure. A minority demonstrate an excess accrual of mass with respect to pressure load. These results suggest there may be an important distinction between normal and pathological hypertrophy during the LV retraining process.

    View details for DOI 10.1016/j.jtcvs.2019.10.053

    View details for PubMedID 31761342

  • Ultrafast pediatric chest computed tomography: comparison of free-breathing vs. breath-hold imaging with and without anesthesia in young children PEDIATRIC RADIOLOGY Kino, A., Zucker, E. J., Honkanen, A., Kneebone, J., Wang, J., Chan, F., Newman, B. 2019; 49 (3): 301-307
  • Ultrafast pediatric chest computed tomography: comparison of free-breathing vs. breath-hold imaging with and without anesthesia in young children. Pediatric radiology Kino, A., Zucker, E. J., Honkanen, A., Kneebone, J., Wang, J., Chan, F., Newman, B. 2018

    Abstract

    BACKGROUND: General anesthesia (GA) or sedation has been used to obtain good-quality motion-free breath-hold chest CT scans in young children; however pulmonary atelectasis is a common and problematic accompaniment that can confound diagnostic utility. Dual-source multidetector CT permits ultrafast high-pitch sub-second examinations, minimizing motion artifact and potentially eliminating the need for a breath-hold.OBJECTIVE: The purpose of this study was to evaluate the feasibility of free-breathing ultrafast pediatric chest CT without GA and to compare it with breath-hold and non-breath-hold CT with GA.MATERIALS AND METHODS: Young (≤3years old) pediatric outpatients scheduled for chest CT under GA were recruited into the study and scanned using one of three protocols: GA with intubation, lung recruitment and breath-hold; GA without breath-hold; and free-breathing CT without anesthesia. In all three protocols an ultrafast high-pitch CT technique was used. We evaluated CT images for overall image quality, presence of atelectasis and motion artifacts.RESULTS: We included 101 scans in the study. However the GA non-breath-hold technique was discontinued after 15 scans, when it became clear that atelectasis was a major issue despite diligent attempts to mitigate it. This technique was therefore not included in statistical evaluation (86 remaining patients). Overall image quality was higher (P=0.001) and motion artifacts were fewer (P<.001) for scans using the GA with intubation and recruitment technique compared to scans in the non-GA free-breathing group. However no significant differences were observed regarding the presence of atelectasis between these groups.CONCLUSION: We demonstrated that although overall image quality was best and motion artifact least with a GA-breath-hold intubation and recruitment technique, free-breathing ultrafast pediatric chest CT without anesthesia provides sufficient image quality for diagnostic purposes and can be successfully performed both without and with contrast agent in young infants.

    View details for PubMedID 30413857

  • Tumor-induced Osteomalacia in a 3-Year-Old With Unresectable Central Giant Cell Lesions JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Crossen, S. S., Zambrano, E., Newman, B., Bernstein, J. A., Messner, A. H., Bachrach, L. K., Twist, C. J. 2017; 39 (1): E21-E24

    Abstract

    Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia involving overproduction of fibroblast growth factor 23. TIO has been described largely in adults with small mesenchymal tumors. We report a case of TIO in a child who presented with knee pain and radiographic findings concerning for rickets, and was found to have maxillomandibular giant cell lesions. The patient was treated with oral phosphorus and calcitriol, surgical debulking, and intralesional corticosteroids, which resulted in tumor regression and normalization of serum fibroblast growth factor 23and phosphorus. This case illustrates the occurrence of this rare paraneoplastic syndrome in children and adds to our knowledge about clinical manifestations and pathologic findings associated with pediatric TIO.

    View details for DOI 10.1097/MPH.0000000000000686

    View details for Web of Science ID 000391634100006

  • Congenital Variants and Anomalies of the Aortic Arch RADIOGRAPHICS Hanneman, K., Newman, B., Chan, F. 2017; 37 (1): 32-51
  • Congenital Variants and Anomalies of the Aortic Arch. Radiographics Hanneman, K., Newman, B., Chan, F. 2017; 37 (1): 32-51

    Abstract

    Congenital variants and anomalies of the aortic arch are important to recognize as they may be associated with vascular rings, congenital heart disease, and chromosomal abnormalities, and can have important implications for prognosis and management. The purpose of this article is to review cross-sectional imaging techniques used in the evaluation of the aortic arch, describe the embryology and anatomy of the aortic arch system, discuss aortic arch variants and anomalies, and review other malformations of the aortic arch, including interrupted aortic arch, hypoplastic aortic arch, and aortic coarctation. Aortic arch variants and anomalies will be reviewed in the context of a theoretical double aortic arch system. Arch anomalies can be associated with symptoms, such as dysphagia lusoria in the setting of left aortic arch with aberrant right subclavian artery. Arch variants that form a vascular ring, such as double aortic arch, can result in respiratory distress due to tracheal compression. Certain arch anomalies are strongly associated with congenital heart disease, including right aortic arch with mirror image branching. Other malformations of the aortic arch have important associations, such as type B interrupted aortic arch, which is associated with a locus 22q11.2 microdeletion. Noninvasive imaging at CT angiography and MR angiography allows for comprehensive evaluation of the aortic arch and branch vessels in relation to surrounding structures. Familiarity with the spectrum and imaging appearances of aortic arch variants, anomalies, and malformations is essential for accurate diagnosis and classification and to guide management. Online supplemental material is available for this article. (©)RSNA, 2016.

    View details for DOI 10.1148/rg.2017160033

    View details for PubMedID 27860551

  • Persistent fifth arch anomalies - broadening the spectrum to include a variation of double aortic arch vascular ring PEDIATRIC RADIOLOGY Newman, B., Hanneman, K., Chan, F. 2016; 46 (13): 1866-1872

    Abstract

    Fifth arch anomalies are rare and complex and frequently misdiagnosed or mistaken for other entities. We report a double arch vascular ring that is thought to consist of right fourth arch and left fifth arch components, a previously undescribed persistent fifth arch variant. The currently recognized spectrum and classification of fifth arch vascular anomalies are expanded along with illustrative images to justify the proposed changes. Reviewing and expanding the classification of fifth arch anomalies to include a double arch ring variant will promote recognition, correct diagnosis and appropriate management of these anomalies.

    View details for DOI 10.1007/s00247-016-3693-9

    View details for Web of Science ID 000388743000013

    View details for PubMedID 27669708

  • Tumor-induced Osteomalacia in a 3-Year-Old With Unresectable Central Giant Cell Lesions. Journal of pediatric hematology/oncology Crossen, S. S., Zambrano, E., Newman, B., Bernstein, J. A., Messner, A. H., Bachrach, L. K., Twist, C. J. 2016: -?

    Abstract

    Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia involving overproduction of fibroblast growth factor 23. TIO has been described largely in adults with small mesenchymal tumors. We report a case of TIO in a child who presented with knee pain and radiographic findings concerning for rickets, and was found to have maxillomandibular giant cell lesions. The patient was treated with oral phosphorus and calcitriol, surgical debulking, and intralesional corticosteroids, which resulted in tumor regression and normalization of serum fibroblast growth factor 23and phosphorus. This case illustrates the occurrence of this rare paraneoplastic syndrome in children and adds to our knowledge about clinical manifestations and pathologic findings associated with pediatric TIO.

    View details for PubMedID 27820122

  • Analysis of Kidney Ultrasound Dimensions by Body Habitus and Position JOURNAL OF UROLOGY Kouba, E., Newman, B., Shortliffe, L. M. 2016; 196 (3): 943-949

    Abstract

    Renal dimensions are an important assessment of the genitourinary tract used to evaluate critical aspects of renal growth and development. Understanding the effect of patient position is important to use and interpret these parameters. In this prospective study we determined the effect of patient position and general body habitus on renal length and parenchymal area in children undergoing renal ultrasound.Between October 2010 and January 2011 children underwent renal ultrasound while prone and supine. Bilateral renal length and renal parenchymal area were measured. Pearson and Bland-Altman statistical analyses were used to examine correlations, measurement bias and the degree of agreement between methods.Renal length measurements in both positions were complete for 201 right and 196 left kidneys. Parenchymal area measurements were complete for both kidneys in 177 children. When compared individually, supine and prone measures of renal length and parenchymal area highly correlated on Pearson analysis (greater than 0.96 and greater than 0.89, respectively). When compared by method, Bland-Altman analyses of differences vs means showed greater than 50% variance, representing wide limits of agreement with poor interrelation. Neither persistent systematic bias nor body habitus influenced results.While Pearson analysis showed high correlation for supine and prone renal measurements, Bland-Altman analysis of renal length and parenchymal area demonstrated wide limits of agreement, not allowing interchangeable use of prone and supine measurements. As such, renal ultrasound should specify standardized positions and benchmarks. These results provide guidance to standardize renal ultrasound measurements when renal size is used as an indicator of kidney health.

    View details for DOI 10.1016/j.juro.2016.02.044

    View details for Web of Science ID 000381272100107

  • Analysis of Kidney Ultrasound Dimensions by Body Habitus and Position. journal of urology Kouba, E., Newman, B., Dairiki Shortliffe, L. M. 2016; 196 (3): 943-949

    Abstract

    Renal dimensions are an important assessment of the genitourinary tract used to evaluate critical aspects of renal growth and development. Understanding the effect of patient position is important to use and interpret these parameters. In this prospective study we determined the effect of patient position and general body habitus on renal length and parenchymal area in children undergoing renal ultrasound.Between October 2010 and January 2011 children underwent renal ultrasound while prone and supine. Bilateral renal length and renal parenchymal area were measured. Pearson and Bland-Altman statistical analyses were used to examine correlations, measurement bias and the degree of agreement between methods.Renal length measurements in both positions were complete for 201 right and 196 left kidneys. Parenchymal area measurements were complete for both kidneys in 177 children. When compared individually, supine and prone measures of renal length and parenchymal area highly correlated on Pearson analysis (greater than 0.96 and greater than 0.89, respectively). When compared by method, Bland-Altman analyses of differences vs means showed greater than 50% variance, representing wide limits of agreement with poor interrelation. Neither persistent systematic bias nor body habitus influenced results.While Pearson analysis showed high correlation for supine and prone renal measurements, Bland-Altman analysis of renal length and parenchymal area demonstrated wide limits of agreement, not allowing interchangeable use of prone and supine measurements. As such, renal ultrasound should specify standardized positions and benchmarks. These results provide guidance to standardize renal ultrasound measurements when renal size is used as an indicator of kidney health.

    View details for DOI 10.1016/j.juro.2016.02.044

    View details for PubMedID 26874315

  • Improved Quantification and Mapping of Anomalous Pulmonary Venous Flow With Four-Dimensional Phase-Contrast MRI and Interactive Streamline Rendering JOURNAL OF MAGNETIC RESONANCE IMAGING Hsiao, A., Yousaf, U., Alley, M. T., Lustig, M., Chan, F. P., Newman, B., Vasanawala, S. S. 2015; 42 (6): 1765-1776

    View details for DOI 10.1002/jmri.24928

    View details for Web of Science ID 000368258100034

  • Improved quantification and mapping of anomalous pulmonary venous flow with four-dimensional phase-contrast MRI and interactive streamline rendering. Journal of magnetic resonance imaging : JMRI Hsiao, A., Yousaf, U., Alley, M. T., Lustig, M., Chan, F. P., Newman, B., Vasanawala, S. S. 2015; 42 (6): 1765-76

    Abstract

    Cardiac MRI is routinely performed for quantification of shunt flow in patients with anomalous pulmonary veins, but can be technically-challenging to perform. Four-dimensional phase-contrast (4D-PC) MRI has potential to simplify this exam. We sought to determine whether 4D-PC may be a viable clinical alternative to conventional 2D phase-contrast MR imaging.With institutional review board approval and HIPAA-compliance, we retrospectively identified all patients with anomalous pulmonary veins who underwent cardiac MRI at either 1.5 Tesla (T) or 3T with parallel-imaging compressed-sensing (PI-CS) 4D-PC between April, 2011 and October, 2013. A total of 15 exams were included (10 male, 5 female). Algorithms for interactive streamline visualization were developed and integrated into in-house software. Blood flow was measured at the valves, pulmonary arteries and veins, cavae, and any associated shunts. Pulmonary veins were mapped to their receiving atrial chamber with streamlines. The intraobserver, interobserver, internal consistency of flow measurements, and consistency with conventional MRI were then evaluated with Pearson correlation and Bland-Altman analysis.Triplicate measurements of blood flow from 4D-PC were highly consistent, particularly at the aortic and pulmonary valves (cv 2-3%). Flow measurements were reproducible by a second observer (ρ = 0.986-0.999). Direct measurements of shunt volume from anomalous veins and intracardiac shunts matched indirect estimates from the outflow valves (ρ = 0.966). Measurements of shunt fraction using 4D-PC using any approach were more consistent with ventricular volumetric displacements than conventional 2D-PC (ρ = 0.972-0.991 versus 0.929).Shunt flow may be reliably quantified with 4D-PC MRI, either indirectly or with detailed delineation of flow from multiple shunts. The 4D-PC may be a more accurate alternative to conventional MRI.

    View details for DOI 10.1002/jmri.24928

    View details for PubMedID 25914149

    View details for PubMedCentralID PMC4843111

  • Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Seminars in ultrasound, CT, and MR Zucker, E. J., Epelman, M., Newman, B. 2015; 36 (6): 501-521

    Abstract

    Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.

    View details for DOI 10.1053/j.sult.2015.05.016

    View details for PubMedID 26614133

  • Added Value of Radiologist Consultation for Pediatric Ultrasound: Implementation and Survey Assessment. AJR. American journal of roentgenology Zucker, E. J., Newman, B., Larson, D. B., Rubesova, E., Barth, R. A. 2015; 205 (4): 822-826

    Abstract

    The purpose of this study was to determine whether radiologist-parent (guardian) consultation sessions for pediatric ultrasound with immediate disclosure of examination results if desired increases visit satisfaction, decreases anxiety, and increases understanding of the radiologist's role.Parents chaperoning any outpatient pediatric ultrasound were eligible and completed surveys before and after ultrasound examinations. Before the second survey, parents met with a pediatric radiologist on a randomized basis but could opt out and request or decline the consultation. Differences in anxiety and understanding of the radiologist's role before and after the examination were compared, and overall visit satisfaction measures were tabulated.Seventy-seven subjects participated, 71 (92%) of whom spoke to a radiologist, mostly on request. In the consultation group, the mean score (1, lowest; 4, highest) for overall experience was 3.8 ± 0.4 (SD), consultation benefit was 3.7 ± 0.6, and radiologist interaction was 3.7 ± 0.6. Demographics were not predictive of satisfaction with statistical significance in a multivariate model. Forty-six of 68 (68%) respondents correctly described the radiologist's role before consultation. The number increased to 60 (88%) after consultation, and the difference was statistically significant (p < 0.001). There was also a statistically significant decrease in mean anxiety score from 2.0 ± 1.0 to 1.5 ± 0.8 after consultation (p < 0.001). Sixty-four of 70 (91%) respondents indicated that they would prefer to speak with a radiologist during every visit.Radiologist consultation is well received among parents and associated with decreased anxiety and increased understanding of the radiologist's role. The results of this study support the value of routine radiologist-parent interaction for pediatric ultrasound.

    View details for DOI 10.2214/AJR.15.14542

    View details for PubMedID 26397331

  • Radiologist Compliance With California CT Dose Reporting Requirements: A Single-Center Review of Pediatric Chest CT AMERICAN JOURNAL OF ROENTGENOLOGY Zucker, E. J., Larson, D. B., Newman, B., Barth, R. A. 2015; 204 (4): 810-816

    Abstract

    Effective July 1, 2012, CT dose reporting became mandatory in California. We sought to assess radiologist compliance with this legislation and to determine areas for improvement.We retrospectively reviewed reports from all chest CT examinations performed at our institution from July 1, 2012, through June 30, 2013, for errors in documentation of volume CT dose index (CTDIvol), dose-length product (DLP), and phantom size. Reports were considered as legally compliant if both CTDIvol and DLP were documented accurately and as institutionally compliant if phantom size was also documented accurately. Additionally, we tracked reports that did not document dose in our standard format (phantom size, CTDIvol for each series, and total DLP).Radiologists omitted CTDIvol, DLP, or both in nine of 664 examinations (1.4%) and inaccurately reported one or both of them in 56 of the remaining 655 examinations (8.5%). Radiologists omitted phantom size in 11 of 664 examinations (1.7%) and inaccurately documented it in 20 of the remaining 653 examinations (3.1%). Of 664 examinations, 599 (90.2%) met legal reporting requirements, and 583 (87.8%) met institutional requirements. In reporting dose, radiologists variably used less decimal precision than available, summed CTDIvol, included only series-level DLP, and specified dose information from the scout topogram or a nonchest series for combination examinations.Our institutional processes, which primarily rely on correct human performance, do not ensure accurate dose reporting and are prone to variation in dose reporting format. In view of this finding, we are exploring higher-reliability processes, including better-defined standards and automated dose reporting systems, to improve compliance.

    View details for DOI 10.2214/AJR.14.13693

    View details for Web of Science ID 000351614700037

    View details for PubMedID 25794071

  • Vascular Lesions-Congenital, Acquired, and latrogenic: Imaging in the Neonate SEMINARS IN ULTRASOUND CT AND MRI Epelman, M., Johnson, C., Hellinger, J. C., Darge, K., Newman, B. 2015; 36 (2): 193-215

    Abstract

    The imaging of vasculitis, vasculopathies, and other vascular disorders in neonates presents unique challenges compared with the vascular imaging of older children or adults. These challenges include small-caliber vessels, the need for sedation or anesthesia, a high rate of vasospasm, higher respiratory rates, and a greater susceptibility to long-term effects of ionizing radiation. Duplex ultrasound (US) is typically the first-line imaging modality; in most cases, US provides key diagnostic information necessary for guiding initial management. Magnetic resonance or computed tomography angiography may be performed following US to further define vascular anatomy and relationships, to achieve a definitive diagnosis, and to guide endovascular or surgical planning when necessary. This review article presents and illustrates an update on the imaging strategies for congenital, acquired, and iatrogenic vasculopathies and vascular disorders in neonates.

    View details for DOI 10.1053/j.sult.2015.01.009

    View details for Web of Science ID 000355575300008

    View details for PubMedID 26001947

  • Meconium in Perinatal Imaging: Associations and Clinical Significance SEMINARS IN ULTRASOUND CT AND MRI Jerdee, T., Newman, B., Rubesova, E. 2015; 36 (2): 161-177

    Abstract

    An abnormal location, distribution, volume, or appearance of meconium is associated with a spectrum of bowel abnormalities, including atresia, obstruction, perforation, fistula, aganglionosis, immaturity, and absorptive dysfunction. This review discusses the fetal and perinatal imaging of these entities, their differential diagnoses, clinical significance, and appropriate imaging workup. Understanding the spectrum of normal and abnormal, specific and nonspecific appearances of meconium and its associated abnormalities on imaging will provide a practical, useful framework for performing and interpreting imaging studies and guiding clinical management.

    View details for DOI 10.1053/j.sult.2015.01.007

    View details for Web of Science ID 000355575300006

    View details for PubMedID 26001945

  • The incidental pulmonary nodule in a child Part 1: recommendations from the SPR Thoracic Imaging Committee regarding characterization, significance and follow-up PEDIATRIC RADIOLOGY Westra, S. J., Brody, A. S., Mahani, M. G., Guillerman, R. P., Hegde, S. V., Iyer, R. S., Lee, E. Y., Newman, B., Podberesky, D. J., Thacker, P. G. 2015; 45 (5): 628-633

    Abstract

    No guidelines are in place for the follow-up and management of pulmonary nodules that are incidentally detected on CT in the pediatric population. The Fleischner guidelines, which were developed for the older adult population, do not apply to children. This review summarizes the evidence collected by the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee in its attempt to develop pediatric-specific guidelines.Small pulmonary opacities can be characterized as linear or as ground-glass or solid nodules. Linear opacities and ground-glass nodules are extremely unlikely to represent an early primary or metastatic malignancy in a child. In our review, we found a virtual absence of reported cases of a primary pulmonary malignancy presenting as an incidentally detected small lung nodule on CT in a healthy immune-competent child.Because of the lack of definitive information on the clinical significance of small lung nodules that are incidentally detected on CT in children, the management of those that do not have the typical characteristics of an intrapulmonary lymph node should be dictated by the clinical history as to possible exposure to infectious agents, the presence of an occult immunodeficiency, the much higher likelihood that the nodule represents a metastasis than a primary lung tumor, and ultimately the individual preference of the child's caregiver. Nodules appearing in children with a history of immune deficiency, malignancy or congenital pulmonary airway malformation should not be considered incidental, and their workup should be dictated by the natural history of these underlying conditions.

    View details for DOI 10.1007/s00247-014-3267-7

    View details for Web of Science ID 000353234800002

    View details for PubMedID 25655369

  • Congenital peribronchial myofibroblastic tumor: case report of an asymptomatic infant with a rapidly enlarging pulmonary mass and review of the literature. Annals of clinical and laboratory science Brock, K. E., Wall, J., Esquivel, M., Newman, B., Marina, N., Albanese, C., Hazard, F. K. 2015; 45 (1): 83-89

    Abstract

    Congenital peribronchial myofibroblastic tumor (CPMT) is a rare, benign lung tumor of infants, with only 19 reported cases worldwide. It is often diagnosed by prenatal imaging or in the immediate postnatal period due to co-morbidities like polyhydramnios, fetal hydrops, respiratory distress, and heart failure.We report the oldest known infant (8 weeks old) diagnosed with CPMT, and present his clinical course including the relevant radiographic and histopathologic findings.CPMT is a rare tumor that should be considered among other primary lung tumors of infancy (developmental, benign, and malignant) even if not detected prenatally or in the immediate postnatal period.

    View details for PubMedID 25696016

  • Cystic Lung Lesions in Newborns and Young Children: Differential Considerations and Imaging SEMINARS IN ULTRASOUND CT AND MRI Newman, B., Caplan, J. 2014; 35 (6): 571-587

    Abstract

    Numerous diverse entities produce cystic lung changes in neonates and young children. This review provides an evidence-based, age-appropriate, differential diagnostic framework to use when confronted with pulmonary cystic changes. The categories of diseases that have been discussed include congenital cystic bronchopulmonary malformations, neoplastic conditions, infections, collagen or soft tissue abnormalities, and mimics of cystic lung disease. An understanding of the pathophysiology, imaging appearance, and demographics of these entities is essential in guiding optimal care. Important educational points include differentiating bronchopulmonary malformations from neoplasms and the management and surveillance of lung cysts in young children.

    View details for DOI 10.1053/j.sult.2014.07.001

    View details for Web of Science ID 000345612100004

  • Quality Improvement in Neonatal Digital Radiography: Implementing the Basic Quality Improvement Tools SEMINARS IN ULTRASOUND CT AND MRI Eslamy, H. K., Newman, B., Weinberger, E. 2014; 35 (6): 608-626

    Abstract

    A quality improvement (QI) program may be implemented using the plan-do-study-act cycle (as a model for making improvements) and the basic QI tools (used to visually display and analyze variation in data). Managing radiation dose has come to the forefront as a safety goal for radiology departments. This is especially true in the pediatric population, which is more radiosensitive than the adult population. In this article, we use neonatal digital radiography to discuss developing a QI program with the principle goals of decreasing the radiation dose, decreasing variation in radiation dose, and optimizing image quality.

    View details for DOI 10.1053/j.sult.2014.08.002

    View details for Web of Science ID 000345612100006

    View details for PubMedID 25454055

  • Cystic lung lesions in newborns and young children: differential considerations and imaging. Seminars in ultrasound, CT, and MR Newman, B., Caplan, J. 2014; 35 (6): 571-587

    Abstract

    Numerous diverse entities produce cystic lung changes in neonates and young children. This review provides an evidence-based, age-appropriate, differential diagnostic framework to use when confronted with pulmonary cystic changes. The categories of diseases that have been discussed include congenital cystic bronchopulmonary malformations, neoplastic conditions, infections, collagen or soft tissue abnormalities, and mimics of cystic lung disease. An understanding of the pathophysiology, imaging appearance, and demographics of these entities is essential in guiding optimal care. Important educational points include differentiating bronchopulmonary malformations from neoplasms and the management and surveillance of lung cysts in young children.

    View details for DOI 10.1053/j.sult.2014.07.001

    View details for PubMedID 25454053

  • Pediatric CT quality management and improvement program PEDIATRIC RADIOLOGY Larson, D. B., Molvin, L. Z., Wang, J., Chan, F. P., Newman, B., Fleischmann, D. 2014; 44: 519-524
  • Pediatric CT quality management and improvement program. Pediatric radiology Larson, D. B., Molvin, L. Z., Wang, J., Chan, F. P., Newman, B., Fleischmann, D. 2014; 44: 519-524

    Abstract

    Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve.

    View details for DOI 10.1007/s00247-014-3039-4

    View details for PubMedID 25304715

  • Perforated appendicitis: an underappreciated mimic of intussusception on ultrasound. Pediatric radiology Newman, B., Schmitz, M., Gawande, R., Vasanawala, S., Barth, R. 2014; 44 (5): 535-541

    Abstract

    We encountered multiple cases in which the US appearance of ruptured appendicitis mimicked intussusception, resulting in diagnostic and therapeutic delay and multiple additional imaging studies.To explore the clinical and imaging discriminatory features between the conditions.Initial US images in six children (age 16 months to 8 years; 4 boys, 2 girls) were reviewed independently and by consensus by three pediatric radiologists. These findings were compared and correlated with the original reports and subsequent US, fluoroscopic, and CT images and reports.All initial US studies demonstrated a multiple-ring-like appearance (target sign, most apparent on transverse views) with diagnostic consensus supportive of intussusception. In three cases, US findings were somewhat discrepant with clinical concerns. Subsequently, four of the six children had contrast enemas; two were thought to have partial or complete intussusception reduction. Three had a repeat US examination, with recognition of the correct diagnosis. None of the US examinations demonstrated definite intralesional lymph nodes or mesenteric fat, but central echogenicity caused by debris/appendicolith was misinterpreted as fat. All showed perilesional hyperechogenicity that, in retrospect, represented inflamed fat "walling off" of the perforated appendix. There were four CTs, all of which demonstrated a double-ring appearance that correlated with the US target appearance, with inner and outer rings representing the dilated appendix and walled-off appendiceal rupture, respectively. All six children had surgical confirmation of perforated appendicitis.Contained perforated appendicitis can produce US findings closely mimicking intussusception. Clinical correlation and careful multiplanar evaluation should allow for sonographic suspicion of perforated appendicitis, which can be confirmed on CT if necessary.

    View details for DOI 10.1007/s00247-014-2873-8

    View details for PubMedID 24463638

  • Heterotaxy syndromes and abnormal bowel rotation. Pediatric radiology Newman, B., Koppolu, R., Murphy, D., Sylvester, K. 2014; 44 (5): 542-551

    Abstract

    Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial.To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management.Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings.Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review.We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates.

    View details for DOI 10.1007/s00247-013-2861-4

    View details for PubMedID 24419494

  • Chest CT in children: anesthesia and atelectasis. Pediatric radiology Newman, B., Krane, E. J., Gawande, R., Holmes, T. H., Robinson, T. E. 2014; 44 (2): 164-172

    Abstract

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity.To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children.Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases.Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred.Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain reliable and reproducible high-quality, motion-free chest CT images in children.

    View details for DOI 10.1007/s00247-013-2800-4

    View details for PubMedID 24202432

  • Comparison of Different Methods of Calculating CT Radiation Effective Dose in Children Annual Meeting of the Society-for-Pediatric-Radiology Newman, B., Ganguly, A., Kim, J., Robinson, T. AMER ROENTGEN RAY SOC. 2012: W232–W239

    Abstract

    CT radiation dose is a subject of intense interest and concern, especially in children. Effective dose, a summation of whole-body exposure weighted by specific organ sensitivities, is most often used to compute and compare radiation dose; however, there is little standardization, and there are numerous different methods of calculating effective dose. This study compares five such methods in a group of children undergoing routine chest CT and explores their advantages and pitfalls.Patient data from 120 pediatric chest CT examinations were retrospectively used to calculate effective dose: two scanner dose-length product (DLP) methods using published sets of conversion factors by Shrimpton and Deak, the imaging performance and assessment of CT (ImPact) calculator method, the Alessio online calculator, and the Huda method.The Huda method mean effective dose (4.4 ± 2.2 mSv) and Alessio online calculator (5.2 ± 2.8 mSv) yielded higher mean numbers for effective dose than both DLP calculations (Shrimpton, 3.65 ± 1.8 mSv, and Deak, 3.2 ± 1.5 mSv) as well as the ImPact calculator effective dose (3.4 ± 1.7 mSv). Mean differences ranged from 10.2% ± 10.1% lower to 28% ± 37.3% higher than the Shrimpton method (used as the standard for comparison). Differences were more marked at 120 kVp than at 80 or 100 kVp and varied at different ages. Concordance coefficients relative to the Shrimpton DLP method were Deak DLP, 0.907; Alessio online calculator, 0.735; ImPact calculator, 0.926; and Huda, 0.777.Different methods of computing effective dose for pediatric CT produce varying results. The method used must be clearly described to allay confusion about documenting and communicating dose for archiving as well as comparative research purposes.

    View details for DOI 10.2214/AJR.10.5895

    View details for Web of Science ID 000306686200012

    View details for PubMedID 22826426

  • Pulmonary reperfusion injury after the unifocalization procedure for tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Maskatia, S. A., Feinstein, J. A., Newman, B., Hanley, F. L., Roth, S. J. 2012; 144 (1): 184-189

    Abstract

    The aims of our study are to describe the incidence, clinical profile, and risk factors for pulmonary reperfusion injury after the unifocalization procedure for tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries. We hypothesized the following: (1) Pulmonary reperfusion injury is more likely to occur after unifocalization procedures in which a septated circulation is not achieved, (2) pulmonary reperfusion injury is directly related to the severity of stenosis in major aortopulmonary collateral arteries, and (3) pulmonary reperfusion injury leads to longer intubation time and longer hospitalization.Consecutive patients with tetralogy of Fallot/pulmonary atresia/major aortopulmonary collateral arteries who underwent unifocalization procedures over a 5-year period were identified in our institutional database. Chest radiographs before the unifocalization procedure, from postoperative days 0 to 4, and from 2 weeks after the unifocalization procedure or at discharge were evaluated by a pediatric radiologist for localized pulmonary edema. Determination of stenosis severity was based on review of preoperative angiograms. Statistical analyses using multivariate repeated-measures analyses were performed with generalized estimating equations.Pulmonary reperfusion injury was present after 42 of 65 (65%) unifocalization procedures. In 36 of 42 cases of reperfusion injury, unilateral injury was present. Risk factors for the development of reperfusion injury included bilateral unifocalization (P = .01) and degree of stenosis (P = .03). We did not identify an association between pulmonary reperfusion injury and time to tracheal extubation or hospital discharge.Pulmonary reperfusion injury is common after the unifocalization procedure for tetralogy of Fallot/pulmonary atresia/major aortopulmonary collateral arteries. Severity of stenosis and bilateral unifocalization are associated with the development of reperfusion injury.

    View details for DOI 10.1016/j.jtcvs.2011.12.030

    View details for Web of Science ID 000305412200031

    View details for PubMedID 22244564

  • Reply to commentary - CT radiation dose reduction: can we do harm by doing good? PEDIATRIC RADIOLOGY Newman, B., Callahan, M. J. 2012; 42 (4): 399-401

    View details for DOI 10.1007/s00247-011-2331-9

    View details for Web of Science ID 000302349900002

    View details for PubMedID 22302319

  • Combined respiratory and cardiac triggering improves blood pool contrast-enhanced pediatric cardiovascular MRI PEDIATRIC RADIOLOGY Vasanawala, S. S., Chan, F. P., Newman, B., Alley, M. T. 2011; 41 (12): 1536-1544

    Abstract

    Contrast-enhanced cardiac MRA suffers from cardiac motion artifacts and often requires a breath-hold.This work develops and evaluates a blood pool contrast-enhanced combined respiratory- and ECG-triggered MRA method.An SPGR sequence was modified to enable combined cardiac and respiratory triggering on a 1.5-T scanner. Twenty-three consecutive children referred for pediatric heart disease receiving gadofosveset were recruited in HIPAA-compliant fashion with IRB approval and informed consent. Children underwent standard non-triggered contrast-enhanced MRA with or without suspended respiration. Additionally, a free-breathing-triggered MRA was acquired. Triggered and non-triggered studies were presented in blinded random order independently to two radiologists twice. Anatomical structure delineation was graded for each triggered and non-triggered acquisition and the visual quality on triggered MRA was compared directly to that on non-triggered MRA.Triggered images received higher scores from each radiologist for all anatomical structures on each of the two reading sessions (Wilcoxon rank sum test, P < 0.05). In direct comparison, triggered images were preferred over non-triggered images for delineating cardiac structures, with most comparisons reaching statistical significance (binomial test, P < 0.05).Combined cardiac and respiratory triggering, enabled by a blood pool contrast agent, improves delineation of most anatomical structures in pediatric cardiovascular MRA.

    View details for DOI 10.1007/s00247-011-2196-y

    View details for Web of Science ID 000297621800005

    View details for PubMedID 21786125

  • Pause and Pulse: Radiation Dose in Pediatric Fluoroscopy PEDIATRICS IN REVIEW Newman, B., John, S., Goske, M., Hernanz-Schulman, M. 2011; 32 (9): E83-E90

    View details for DOI 10.1542/pir.32-9-e83

    View details for PubMedID 21885657

  • ALARA (as low as reasonably achievable) CT 2011--executive summary. Newman, B., Callahan, M. J. 2011: 453–55

    View details for PubMedID 21847721

  • Ultrasound body applications in children. Pediatric radiology Newman, B. 2011; 41: 555-561

    Abstract

    A major goal of imaging is to obtain the correct examination to answer the clinical questions with the lowest possible radiation exposure. While CT examination provides essential information in many cases, other modalities that do not entail ionizing radiation exposure may be appropriate substitutes either as an initial screening study or as an alternative to CT. US has become a valuable imaging tool in children encompassing many different clinical scenarios. This manuscript highlights some of the less well-accepted applications of US as the first imaging study in pediatric patients, especially in the emergency room environment. These include evaluation of suspected appendicitis, abdominal mass, pleural effusion/empyema, thymic abnormality vs. mediastinal mass and extremity soft-tissue mass or vessel patency. Adoption of US imaging as a problem-solving tool for issues such as these requires appropriate allocation of resources to ensure high-quality performance and interpretation of pediatric US studies around the clock.

    View details for DOI 10.1007/s00247-011-2107-2

    View details for PubMedID 21847738

  • Pneumonia in Normal and Immunocompromised Children: An Overview and Update RADIOLOGIC CLINICS OF NORTH AMERICA Eslamy, H. K., Newman, B. 2011; 49 (5): 895-?

    Abstract

    Pneumonia is an infection of the lung parenchyma caused by a wide variety of organisms in pediatric patients. The role of imaging is to detect the presence of pneumonia, and determine its location and extent, exclude other thoracic causes of respiratory symptoms, and show complications such as effusion/empyema and suppurative lung changes. The overarching goal of this article is to review cause, role of imaging, imaging techniques, and the spectrum of acute and chronic pneumonias in children. Pneumonia in the neonate and immunocompromised host is also discussed.

    View details for DOI 10.1016/j.rcl.2011.06.007

    View details for Web of Science ID 000295387500006

    View details for PubMedID 21889014

  • Point/counterpoint: dose-related issues in cardiac CT imaging. Pediatric radiology Newman, B., Vasanawala, S. S. 2011; 41: 528-533

    Abstract

    This manuscript reviews some of the more controversial dose-related issues in cardiac CT imaging. Discussion covers the relative merits of cardiac CT versus MR, advantages and concerns regarding gated versus nongated cardiac CT and advantages and concerns regarding the use of breast shields in girls undergoing cardiac CT imaging.

    View details for DOI 10.1007/s00247-011-2153-9

    View details for PubMedID 21847735

  • Thoracic Neoplasms in Children RADIOLOGIC CLINICS OF NORTH AMERICA Newman, B. 2011; 49 (4): 633-?

    Abstract

    This article presents an overview of the benign and malignant neoplasms that affect the chest in children and their imaging characteristics. The relative roles of plain film, fluoroscopy, ultrasound, CT, MR imaging, and nuclear imaging in assessing these lesions are reviewed. Areas covered include the mediastinum, heart, lungs, airway, pleura, and chest wall.

    View details for DOI 10.1016/j.rcl.2011.05.010

    View details for Web of Science ID 000294371900005

    View details for PubMedID 21807166

  • PULMONARY REPERFUSION INJURY AFTER THE UNIFOCALIZATION PROCEDURE FOR TETRALOGY OF FALLOT, PULMONARY ATRESIA AND MAJOR AORTOPULMONARY COLLATERAL ARTERIES 60th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC) / I2 Summit / ACCF/Herman K. Gold Young Investigator's Award in Molecular and Cellular Cardiology Maskatia, S., Feinstein, J. A., Newman, B., Hanley, F. L., Roth, S. J. ELSEVIER SCIENCE INC. 2011: E419–E419
  • Effectiveness of a Staged US and CT Protocol for the Diagnosis of Pediatric Appendicitis: Reducing Radiation Exposure in the Age of ALARA RADIOLOGY Krishnamoorthi, R., Ramarajan, N., Wang, N. E., Newman, B., Rubesova, E., Mueller, C. M., Barth, R. A. 2011; 259 (1): 231-239

    Abstract

    To evaluate the effectiveness of a staged ultrasonography (US) and computed tomography (CT) imaging protocol for the accurate diagnosis of suspected appendicitis in children and the opportunity for reducing the number of CT examinations and associated radiation exposure.This retrospective study was compliant with HIPAA, and a waiver of informed consent was approved by the institutional review board. This study is a review of all imaging studies obtained in children suspected of having appendicitis between 2003 and 2008 at a suburban pediatric emergency department. A multidisciplinary staged US and CT imaging protocol for the diagnosis of appendicitis was implemented in 2003. In the staged protocol, US was performed first in patients suspected of having appendicitis; follow-up CT was recommended when US findings were equivocal. Of 1228 pediatric patients who presented to the emergency department for suspected appendicitis, 631 (287 boys, 344 girls; age range, 2 months to 18 years; median age, 10 years) were compliant with the imaging pathway. The sensitivity, specificity, negative appendectomy rate (number of appendectomies with normal pathologic findings divided by the number of surgeries performed for suspected appendicitis), missed appendicitis rate, and number of CT examinations avoided by using the staged protocol were analyzed.The sensitivity and specificity of the staged protocol were 98.6% and 90.6%, respectively. The negative appendectomy rate was 8.1% (19 of 235 patients), and the missed appendicitis rate was less than 0.5% (one of 631 patients). CT was avoided in 333 of the 631 patients (53%) in whom the protocol was followed and in whom the US findings were definitive.A staged US and CT imaging protocol in which US is performed first in children suspected of having acute appendicitis is highly accurate and offers the opportunity to substantially reduce radiation.

    View details for DOI 10.1148/radiol.10100984

    View details for PubMedID 21324843

  • Development and Validation of Automated 2D-3D Bronchial Airway Matching to Track Changes in Regional Bronchial Morphology Using Serial Low-Dose Chest CT Scans in Children with Chronic Lung Disease JOURNAL OF DIGITAL IMAGING Raman, P., Raman, R., Newman, B., Venkatraman, R., Raman, B., Robinson, T. E. 2010; 23 (6): 744-754

    Abstract

    To address potential concern for cumulative radiation exposure with serial spiral chest computed tomography (CT) scans in children with chronic lung disease, we developed an approach to match bronchial airways on low-dose spiral and low-dose high-resolution CT (HRCT) chest images to allow serial comparisons. An automated algorithm matches the position and orientation of bronchial airways obtained from HRCT slices with those in the spiral CT scan. To validate this algorithm, we compared manual matching vs automatic matching of bronchial airways in three pediatric patients. The mean absolute percentage difference between the manually matched spiral CT airway and the index HRCT airways were 9.4 ± 8.5% for the internal diameter measurements, 6.0 ± 4.1% for the outer diameter measurements, and 10.1 ± 9.3% for the wall thickness measurements. The mean absolute percentage difference between the automatically matched spiral CT airway measurements and index HRCT airway measurements were 9.2 ± 8.6% for the inner diameter, 5.8 ± 4.5% for the outer diameter, and 9.9 ± 9.5% for the wall thickness. The overall difference between manual and automated methods was 2.1 ± 1.2%, which was significantly less than the interuser variability of 5.1 ± 4.6% (p<0.05). Tests of equivalence had p<0.05, demonstrating no significant difference between the two methods. The time required for matching was significantly reduced in the automated method (p<0.01) and was as accurate as manual matching, allowing efficient comparison of airways obtained on low-dose spiral CT imaging with low-dose HRCT scans.

    View details for DOI 10.1007/s10278-009-9199-3

    View details for Web of Science ID 000284163300011

    View details for PubMedID 19756866

    View details for PubMedCentralID PMC3046688

  • Congenital extrahepatic portosystemic shunt associated with heterotaxy and polysplenia PEDIATRIC RADIOLOGY Newman, B., Feinstein, J. A., Cohen, R. A., Feingold, B., Kreutzer, J., Patel, H., Chan, F. P. 2010; 40 (7): 1222-1230

    Abstract

    Heterotaxy with polysplenia is associated with many cardiovascular anomalies including the occasional occurrence of congenital extrahepatic portosystemic shunts (CEPS). Missing this anomaly can lead to inappropriate and ineffective therapy.To emphasize the importance and associated anatomy of CEPS in conjunction with heterotaxy with polysplenia.Review of three young children who presented with cyanosis and pulmonary hypertension without a cardiac etiology. They were known (1) or discovered (2) to have heterotaxy with polysplenia.There was absence of the intrahepatic inferior vena cava (IVC) with azygos or hemiazygos continuation in all three cases. In spite of normal liver function, they were discovered to have large portosystemic shunts, splenorenal in location, along with diffuse peripheral pulmonary arterial dilatation suggestive of CEPS (Abernethy malformation) with hepatopulmonary or, more accurately, portopulmonary syndrome. All CEPS were ipsilateral to the spleens. Patency of the portal veins in these cases allowed for percutaneous shunt closure with resolution of cyanosis.CEPS is associated with heterotaxy with polysplenia and can be symptomatic because of pulmonary arteriovenous (AV) shunting. Portal and hepatic vein patency are critical for determining feasibility of CEPS closure.

    View details for DOI 10.1007/s00247-009-1508-y

    View details for PubMedID 20069288

  • Rudhe syndrome: reversible right middle lobe emphysema in infants with left-to-right shunts-an historical review PEDIATRIC RADIOLOGY Collins, L. K., Levin, T. L., Berdon, W. E., Cowles, R. A., Newman, B. 2010; 40 (5): 762-765

    Abstract

    In 1971, the Swedish radiologist Ulf Rudhe wrote a provocative paper on right middle lobe emphysema in infants with left-to-right shunts in which he suggested cardiac surgery rather than lung resection. At the time, this was counter to accepted medical practice. Earlier diagnosis and better medical management of ventricular septal defect in infants has proved Rudhe correct. However, two current cases of large left-to-right shunts in infants with emphysema of the right middle lobe prompt this historical review of what seemed a closed-episode in pediatric cardiac surgery.

    View details for DOI 10.1007/s00247-009-1530-0

    View details for Web of Science ID 000276149500016

    View details for PubMedID 20135111

  • Evaluation of a Radiation Dose Reduction Strategy for Pediatric Chest CT AMERICAN JOURNAL OF ROENTGENOLOGY Kim, J., Newman, B. 2010; 194 (5): 1188-1193

    Abstract

    The purpose of our study was to quantify the effect of changes made to the CT chest protocol on patient dose, image quality, and image noise when using a kilovoltage (kVp)-lowering strategy.We retrospectively selected 120 children who underwent chest CT: 60 in 2006 and 60 in 2008. In each group there were 30 children weighing less than 15 kg and 30 between 15 and 60 kg. In 2006 the CT protocol was 120 kVp and the reference current (mAs) was 65. In 2008, the kVp was 80 for < 15 kg and 100 for 15-60 kg, with reference mAs of 55. For each examination, the volume CT dose index (CTDI(vol)) and dose-length product (DLP) were recorded. Effective dose (ED) was estimated using the DLP method. Image noise was measured. Overall image quality was subjectively evaluated.For a weight < 15.0 kg, the CTDI(vol), DLP, and ED were reduced by 73%, 75%, and 73%, respectively (p < 0.05). For the weight range 15-60 kg, the CTDI(vol), DLP, and ED were reduced by 45%, 44%, and 48%, respectively (p < 0.05). Measured noise increased by 55% in the younger children and 41% in the older group (p < 0.05). All studies were considered diagnostically adequate.Significant radiation dose reduction can be achieved for routine pediatric chest CT by weight-based decreases in kVp in addition to low mAs. Increased noise was considered an acceptable trade-off for decreased dose, and image quality was acceptable.

    View details for DOI 10.2214/AJR.09.3726

    View details for Web of Science ID 000276906400005

    View details for PubMedID 20410401

  • Left Pulmonary Artery Sling-Anatomy and Imaging SEMINARS IN ULTRASOUND CT AND MRI Newman, B., Cho, Y. A. 2010; 31 (2): 158-170

    Abstract

    Distinctive imaging findings are present when the left pulmonary artery (LPA) arises from the right pulmonary artery and forms a sling around the airway passing between airway and esophagus to reach the left lung. It is important to recognize the 2 distinct types of pulmonary sling. The less complex type I is associated with tracheobronchomalacia and is often managed successfully by LPA reimplantation. The more common and more complex type II is strongly associated with long segment tracheal stenosis. Appropriate management needs to address the airway abnormality in addition to the aberrant LPA. Both types, especially type II, are associated with cardiovascular, pulmonary, and other abnormalities that also need to be considered in therapeutic decisions. The role of imaging is to identify, define, and display the relevant anatomic relationships to facilitate appropriate management. Recent surgical advances have increased the likelihood of success of surgical correction of long segment airway stenosis.

    View details for DOI 10.1053/j.sult.2010.01.004

    View details for Web of Science ID 000276295500009

    View details for PubMedID 20304323

  • A pitfall of radioisotope quantification of the ratio of pulmonary blood flow to systemic blood flow (Qp/Qs) in a patient with severe postoperative pulmonary venous obstruction CLINICAL NUCLEAR MEDICINE Newman, B., Grosse-Wortmann, L., Charron, M., Yoo, S. J. 2008; 33 (8): 521-524

    Abstract

    We report a case with initial misinterpretation of the radionuclide angiocardiographic study that was obtained in a child with persistent tachypnea and concern for residual left to right shunt after prior repair of total anomalous pulmonary veins and an atrial septal defect.Ultrasound, radionuclide angiocardiogram, and magnetic resonance imaging studies were obtained.The radionuclide study was ordered after an unremarkable ultrasound. Unsuspected severely reduced left pulmonary arterial flow associated with high-grade ipsilateral pulmonary venous obstruction led to misinterpretation of the radionuclide study as a large residual shunt. Later replotting of the graphic data using each lung separately corrected the error. Magnetic resonance played a key role in making the correct diagnosis.Significant asymmetric pulmonary flow due to vascular obstruction is an important additional potential pitfall to recognize in interpreting radionuclide angiocardiographic studies.

    View details for Web of Science ID 000258941600001

    View details for PubMedID 18645367

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