Is It Time for a Dedicated Pediatric MRI ACR Accreditation Program?
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. Electronic address: .Journal of the American College of Radiology: JACR (Impact Factor: 2.84). 12/2012; 10(4). DOI: 10.1016/j.jacr.2012.07.011
Participation in ACR accreditation programs has become an essential practice for adult and pediatric imaging centers across the country. The responsibility for these ACR programs is vested in the Commission on Quality and Safety, 1 of 7 operational commissions in the ACR. The MRI Accreditation Program evaluates the qualifications of personnel, quality control programs, MR safety policies, and image quality specific to MRI. Currently, the ACR MRI Accreditation Program is designed primarily to evaluate adult MRI practices, which are in many ways not applicable to pediatric applications and facilities. In this article, the authors describe the difficulties faced during the ACR MRI Accreditation Program at a dedicated children's hospital and offer suggested changes for the process.
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ABSTRACT: The purpose of this study was to evaluate the feasibility of performing magnetic resonance elastography (MRE) as a screening tool for elevated liver stiffness in patients' status-post Fontan procedure. With greater numbers of Fontan patients surviving far into adulthood, a factor increasingly affecting long-term prognosis is the presence of hepatic congestion and fibrosis. If detected early, steps can be taken to potentially slow or halt the progression of fibrosis. MRE is a relatively new, noninvasive imaging technique, which can quantitatively measure liver stiffness and provide an estimate of the extent of fibrosis. A retrospective study was conducted using MRE to evaluate liver stiffness in patients with a history of Fontan procedure. An MRE was performed in the same session as a clinical cardiac MRI. The liver was interrogated at four slice locations, and a mean liver stiffness value was calculated for each patient using postprocessing software. The medical records were reviewed for demographic and clinical characteristics. During the time frame of this investigation, 17 MRE exams were performed on 16 patients. All patients had elevated liver stiffness values as defined by MRE standards. The median of the individual mean liver stiffness values was 5.1 kPa (range: 3.4-8.2 kPa). This range of liver stiffness elevation would suggest the presence of mild to severe fibrosis in a patient with standard cardiovascular anatomy. We found a significant trend toward higher liver stiffness values with greater duration of Fontan circulation (rs = 0.55, P = .02). Our preliminary findings suggest that MRE is a feasible method for evaluating the liver in Fontan patients who are undergoing surveillance cardiac MRI. Further investigation with histologic correlation is needed to determine the contributions of hepatic congestion and fibrosis to the liver stiffness in this population.
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