Diagnostic-quality chest computed tomography (CT) images can be obtained of infants and young toddlers without general anesthesia with an ultrafast, high-pitch, sub-second examination performed on a dual-source multidetector scanner, pediatric radiologists report in the March 2019 issue of Pediatric Radiology.
Standard practice calls for children under age 3 to be anesthetized or sedated to obtain good-quality, motion-free CT scans. A breath-hold CT with general anesthesia using an intubation lung recruitment technique reduces the risk of lung atelectasis -- the partial or complete collapse of the lung. Using anesthesia, however, adds to the length, cost, and potential morbidity of the procedure.
Knowing that respiratory, cardiac and other motion artifacts can be reduced with an ultrafast high-pitch sub-second protocol, the authors initiated a study to evaluate the feasibility and quality of free-breathing ultrafast pediatric chest CT without anesthesia and compare the images to those acquired under anesthesia. The study subjects consisted of 45 children aged 9 to 33 months who were imaged with anesthesia with intubation, recruitment and breath-hold protocol, and 41 children aged 10 to 36 months imaged with a free-breathing protocol without anesthesia.
The images acquired with anesthesia had better diagnostic image quality and fewer motion artifacts. But the “no anesthesia” images were of good and acceptable clinical quality, with or without the use of contrast.
The researchers emphasized that effective immobilization was critical in non-sedated patients; they recommend overwrapping the legs to prevent kicking. They also said that “considerable time and effort” was needed by radiologic technologists, nurses, and child-life experts to distract the child and reassure the parent. “Nonetheless, the time and cost involved are much less than those related to sedation/anesthesia,” they wrote.
Still, the authors advise evaluating each patient individually and following the breath-hold intubation and recruitment technique and administering general anesthesia in cases where a high level of detail is required.
Successful chest CT scans can be performed without anesthesia on young children. Appl Radiol.