East of England Branch meeting: paediatric imaging

East of England Branch meeting Paediatric Imaging Meeting organised by the East of England Branch of The British Institute of Radiology Friday 3 October 2014 Norwich Radiology Academy 09:00

Registration and refreshments

09:30

The paediatric acute abdomen: the surgical perspective Mr Richard England, Paediatric Surgeon, Norfolk and Norwich University Hospital

10:00

The acute abdomen in neonates Dr Fred Pickworth and Dr Duncan MacIver, Consultant Radiologists, Norfolk and Norwich University Hospital

10:30

The acute abdomen in children Dr Fred Pickworth and Dr Duncan MacIver, Consultant Radiologists, Norfolk and Norwich University Hospital

11:00

Refreshments

11:15

Paediatric neuroradiology Dr Rob Dineen, Clinical Associate Professor of Neuroimaging, University of Nottingham

11:45

Paediatric chest radiology Dr Alistair Calder, Consultant Paediatric Radiologist, Great Ormond Street Hospital

12:15

Non-accidental injury Dr Anna Gomez, Consultant Radiologist, Addenbrooke’s Hospital

Incorporated by Royal Charter Patron - Her Majesty The Queen

President Prof Andrew Jones BSc MSc FIPEM CSci FBIR Chief Executive Ms Jacqueline Fowler BA, MInstF(Cert)

The British Institute of Radiology 48-50 St John Street London EC2M 4DG

T : +44(0)20 3668 2226 E : admin@bir.org.uk www.bir.org.uk

Registered Charity No. 215869 VAT Registration No. GB 233 7553 63

12:45

Lunch

13:45

Specific issues in paediatric MSK radiology Dr Andoni Toms, Consultant Radiologist, Norfolk and Norwich University Hospital

14:15

Paediatric rheumatology: the clinical perspective Dr Kate Armon, Consultant Paediatrician, Norfolk and Norwich University Hospital

14:45

Paediatric orthopaedics: the surgeon’s perspective Mr Anish Sanghrajka, Consultant Orthopaedic Surgeon, Norfolk and Norwich University Hospital

15:15

Refreshments

15:30

The role of antenatal MRI in obstetric and neonatal care Dr Sarah Fleming ???

16:00

Quiz Dr Elia Petridou, Radiology ST5, Norfolk and Norwich University Hospital

16:45

Close of meeting

CPD: 6 credits Please complete the meeting evaluation survey online at: https://www.surveymonkey.com/s/paediatricimaging We will email your CPD certificate within the next two weeks once the survey has been completed.

We are most grateful to

For supporting this conference

Speaker profiles and abstracts (where supplied) Biography Mr Richard England FRCS Ed (Paed Surg), Consultant Paediatric Surgeon Norfolk and Norwich University Hospital Richard England qualified in medicine in 1999 at Sheffield University. He went on to complete basic surgical training in Sheffield before beginning specialist training for paediatric surgery in Leeds. Further training was completed back at Sheffield Children’s Hospital followed by a year working at the Red Cross Children’s Hospital in Cape Town, South Africa. He qualified as a consultant in 2012 and took up his current post in Norwich in 2013. Specialist interests include paediatric colorectal surgery and neonatal surgery.

Abstract The paediatric acute abdomen: the surgical perspective The classic causes of the acute abdomen in children are age dependent. A premature baby may be prone to necrotising enterocolitis and an incarcerated inguinal hernia should be looked for in any distressed neonate. From 3 months to 3 years intussusception should be high in the differential. Appendicitis crosses age boundaries but the presentation can vary considerably throughout childhood. In adolescence the menstrual cycle becomes an important part of the history and increasingly gallstones should be considered. While it is satisfying to reach a clinical or radiological diagnosis a substantial number of patients are left with a diagnosis of non-specific abdominal pain. The careful exclusion of a surgical pathology is often the greatest challenge facing the radiologist and surgeon.

Aim: To give an overview of the age related differential diagnosis of acute abdominal pain in children. I will also expand into areas of perioperative management.

Learning objectives: • Identify the common causes of abdominal pain for each age group.

• Predict the questions that a paediatric surgeon will ask a radiologist.

• Understand how radiology may help in the treatment of certain conditions.

Biography Dr Rob Dineen, Clinical Associate Professor of Neuroimaging University of Nottingham I am currently Clinical Associate Professor of Neuroimaing at the University of Nottingham and Honorary Consultant Neuroradiologist at the Queen's Medical Centre in Nottingham.

My major research interest is the application of neuroimaging techniques to characterise pathophysiological mechanisms in neurological diseases. During my PhD thesis I used MRI (including perfusion imaging and diffusion tensor imaging) to study the mechanisms of cognitive dysfunction in MS. I aim to develop this interest by using advanced neuroimaging to explore functional deficits, particularly in cognitive processing, in different diseases.

I have interests in cerebrovascular imaging and am a neuroimaging lead for two large international multicentre randomised controlled acute stroke trials (the TICH-2 and TARDIS studies). As a practicing clinical neuroradiologist I have particular expertise in paediatric neuroimaging, including the assessment of paediatric neurotrauma, neuro-oncology and neonatal imaging.

Abstract Paediatric neuroradiology In this talk we will review imaging approaches to evaluating paediatric brain tumours, and will use some example cases to illustrate how non-conventional MRI techniques can contribute to diagnosis and management.

Learning objectives: • Be aware of the range and variability of clinical features of newly presenting paediatric brain tumours • Understand the role of the radiologist in informing the multidisciplinary team • Be aware of standard imaging protocols • Have an appreciation of the contribution of non-conventional MRI techniques diffusion, perfusion, spectroscopy - to the evaluation of brain tumours Biography Dr Alistair Calder, Consultant Paediatric Radiologist Great Ormond Street Hospital Dr Calder is a Consultant General Paediatric Radiologist at GOSH. His special interests include paediatric thoracic imaging, particularly CT, and skeletal dysplasia.

Abstract Paediatric chest radiology This talk will enable the delegate to: • Give an overview of imaging modalities used in paediatric chest radiology • Discuss the latest in paediatric chest CT techniques including immobilisation, dose reduction and the importance of contrast administration • Describe the role of radiology in common clinical presentations including acute chest infection, the child with recurrent cough and the child with cystic fibrosis • Use frameworks for understanding rarer lung diseases in children, including congenital lung malformations and diffuse (interstitial) lung diseases Biography Dr Andoni Toms, Consultant Radiologist Norfolk and Norwich University Hospital Andoni graduated from medical school in London in 1991. After a surgical rotation and completing the FRCS he undertook radiology training in Cambridge followed by subspecialty fellowship training in musculoskeletal radiology in Toronto. He was appointed as a Consultant Radiologist at the Norfolk and Norwich University Hospital in 2002. Since then he has completed a PhD in musculoskeletal imaging and published over 90 peer reviewed articles. He holds an Honorary Professorship at the University of East Anglia.

Abstract Specific issues in paediatric MSK radiology To describe common diagnostic problems affecting the growth plate and developing bone marrow.

The Growth Plate The anatomy of the physis means that children are prone to unique patterns of injury. The growth plate acts as a stress riser in the relatively elastic young bone through which applied forces preferentially shear. The standard patterns of Salter-Harris type injuries are complicated by the presence of a nearby apophysis and the progressive fusion that occurs in late adolescence. Growth plate arrest can complicate direct trauma, or may result from infection or congenital anomalies such as Madelung’s deformity. Metaphyseal sclerosis paralleling the growth is an increasingly common finding in patients undergoing pulsed cycles of bone sparing treatment.

Bone Marrow The key sequences for detecting marrow infiltration are T1 weighted but MR imaging of paediatric bone marrow is complicated by the gradual transition from haematopoietic tissue to the adult distribution of yellow fat. Under the age of 1 it is common to see marrow that is hypointense to disc on T1W sequences. In these patients the “bright T1 disc” does not equate to marrow infiltration but after the age of 2 it probably does. Hyperintense T2W signal changes persist on T2 fat saturated or STIR sequences into adolescence and need to be differentiated from bone marrow oedema associated with trauma.

Biography Dr Kate Armon, Consultant Paediatrician Norfolk and Norwich University Hospital Kate Armon is a Consultant Paediatric Rheumatologist at NNUHFT (11 years) and an honorary senior lecturer at UEA. She runs a networked paediatric rheumatology service across Norfolk, Suffolk and into Cambridge. She is the Principle investigator of the NIHR funded BENDY study and the PI locally for several multicentre paediatric rheumatology trials both nationally and internationally, and is the paediatric research lead at the NNUHFT. She serves on the ARUK/MCRN (Medicine for Children Research Network) paediatric rheumatology Clinical Studies Group and on the Clinical Affairs and Research groups of the British Society for Paediatric and Adolescent Rheumatology. She chairs the East of England Paediatric Rheumatology Forum.

Abstract Paediatric rheumatology: the clinical perspective This talk will update you on the differential diagnosis of childhood musculoskeletal complaints, with particular emphasis on infectious and inflammatory conditions. We will discuss the imaging essential to the clinician for diagnosis and ongoing management in complex cases. The talk is illustrated throughout with case presentations and associated imaging.

Learning objectives: • To understand the differential diagnoses of a child presenting with bone/joint problems – medical perspective • Questions asked of imaging • Revise Juvenile Idiopathic Arthritis (JIA) • History and examination • Investigation and imaging • Subtypes • Understand how subtype of JIA affects treatment and prognosis • Understand the way in which imaging in JIA affects treatment decisions

Biography Mr Anish P Sanghrajka, Consultant Orthopaedic Surgeon Norfolk and Norwich University Hospital Trained on the Royal London Hospital Trauma and Orthopaedic program, Anish has completed specialist fellowships in Children’s Orthopaedics at The Great Ormond Street Hospital for Children, Sheffield Children’s Hospital and The Children’s Hospital at Westmead, Sydney, Australia.

A Consultant at the Norfolk and Norwich University Hospitals, he exclusively practices in paediatric orthopaedics, with special interests including Limb reconstruction, the management of developmental dysplasia of the hip and paediatric trauma. He has published and presented research in these areas, amongst others.

Abstract Paediatric orthopaedics: the surgeon’s perspective Like every Orthopaedic subspecialty, Paediatric Orthopaedics is dependent on a number of imaging modalities, and the expertise of radiologists. This talk will be an overview of the role of imaging in modern Paediatric Orthopaedic and trauma practice.

The talk will include: Ultrasound management of DDH and the NIPE guidelines Radiological assessment of paediatric limb deformity Imaging for Children’s musculoskeletal infection Avoiding diagnostic pitfalls in children’s trauma and orthopaedics The talk will be based on the published literature, national guidelines and, perhaps most importantly, the views and perspective of one self-centred, opinionated Orthopaedic surgeon.

Our platinum sponsors

Philips is a diversified health and well-being company and a world leader in healthcare, lifestyle and lighting. Our vision is to make the world healthier and more sustainable through meaningful innovation.

We develop innovative healthcare solutions across the continuum of care, in partnership with clinicians and our customers to improve patient outcomes, provide better value, and expand access to care.

As part of this mission we are committed to fuelling a revolution in imaging solutions, designed to deliver greater collaboration and integration, increased patient focus, and improved economic value. We provide advanced imaging technologies you can count on to make confident and informed clinical decisions, while providing more efficient, more personalised care for patients.

The Siemens Healthcare sector is one of the world’s largest suppliers to the healthcare industry and a trendsetter in medical imaging, laboratory diagnostics, medical information technology and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare. By optimising clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more cost-effective. For further information please visit: /www.siemens.co.uk/healthcare

FORTHCOMING EVENTS Midlands Branch meeting: military trauma imaging 9 October 2014 Birmingham Optimisation in interventional radiology 10 October 2014 Birmingham

BIR Annual Congress 2014 22 - 23 October 2014 London BIR UK MRI course 4 - 7 November 2014 London Welsh branch meeting: to report or not to report....what is the answer?

11 November 2014 Bridgend The journey from research to publication 20 November 2014 London The future of radiology in the NHS: top tips for interviews 21 November 2014 London Diagnostic radiology for advanced head and neck cancer planning 26 November 2014 London State of the art radiotherapy education day 10 December 2014 London Wessex branch meeting 10 December 2014 Southampton Advances in radiotherapy for prostate cancer: from theory to practice 12 December 2014 Cardiff The spine in health and disease 21 January 2015 London

VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

NOTES ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

NOTES ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

NOTES ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

NOTES ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________