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compared to prior practice patterns, but helpful first step in evaluating if CT testing can be reduced. Rettenbacher et al. 2001 [ 8 ] Prospective US evaluation of 149 patients with hernia. US findings correlated with need for surgery. Sonographic signs suggestive of incarceration included free fluid in hernia sac (91% of surgery cases) and bowel wall thickening (88% of surgery cases). Defined US characteristics when evaluating hernia that predict incarceration. Suri et al. 1999 [ 9 ] 32 patients with suspected intestinal obstruction had plain film, US, and CT performed and final diagnosis compared to imaging test results. CT sensitivity 93%, specificity 100% for diagnosis of intestinal obstruction. US sensitivity 83% and specificity 100%. Plain films sensitivity 77% and specificity 50%. While CT is more accurate, this study showed that US is superior to plain films, and that perhaps US should be used as first-line screening test. Diagnostic ultrasound 239 Gastrointestinal ultrasound
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a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography pathway. Acad Emerg Med 2009; 16 : 1258–65. 5. Sivit CJ, Siegel MJ, Applegate KE, Newman KD. When appendicitis is suspected in children. Radiographics 2001; 21 : 247–62. 6. Young J, Gilbert AI, Graham MF. The use of ultrasound in the diagnosis of abdominal wall hernias. Hernia 2007; 11 : 347–51. 7. Bradley M, Morgan J, Pentlow B, Roe A. The positive predictive value of diagnostic ultrasound for occult herniae. Ann R Coll Surg Engl 2006; 88 : 165–7. 8. Rettenbacher T, Hollerweger A, Macheiner P, et al. Abdominal wall hernias: cross-sectional imaging signs of incarceration determined with sonography. AJR Am J Roentgenol 2001; 177 : 1061–7. 9. Suri S, Gupta S, Sudhakar PJ, et al. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol 1999; 40 : 422–8. 10. Grassi R, Romano S, D’Amario F, et al. The relevance of free fluid between the intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults. Eur J Radiology 2004; 50 : 5–14. 11. Schmutz GR, Benko A, Fournier L, et al. Small bowel obstruction: role and contribution of sonography. Eur Radiol 1997; 7 : 1054–8. 12. Verschelden P, Filiatrault D, Garel L, et al. Intussusception in children: reliability of ultrasound in diagnosis. A prospective study. Radiology 1992; 184 : 741–4. 13. Lee DH, Lim JH, Ko YT, Yoon Y. Sonographic detection of pneumoper- itoneum in patients with acute abdomen. AJR Am J Roentgenol 1990; 154 : 107–9. 240 Diagnostic ultrasound Gastrointestinal ultrasound
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13 Pediatric ultrasound Introduction In the past five years, the number of publications looking at pediatric applications for bedside emergency or “point-of-care” ultrasound has increased exponentially. The growing interest in point-of-care ultrasound by pediatricians is logical, as pediatric patients are most at risk for exposure to repeated radiation [ 1 ]. The Alliance for Radiation Safety inPediatric Imaging (also known as the Image Gently Alliance: ) was formed to address the concern over radiation dosing in children. The American College of Radiology, American Institute of
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