A Kinder, Gentler Approach to Kidney Scans
Imaging children poses unique challenges. It can be difficult for children to hold still for an X-ray, or they may be frightened by the noise of a DMSA scan. Children’s pediatric radiologists, working with child life specialists, make their young patients’ experience as safe and pleasant as possible, while obtaining the high-quality images needed to rule out or diagnose vesicoureteral reflux, pyelonephritis, or other renal conditions.
Child friendly adventure rooms along with knowledgeable staff and dedicated, certified child life specialists help make the imaging experience as pleasant as possible for children. Child life specialists help patients cope with the anxiety and fear associated with the hospital by focusing on preparation, language, distraction, and parental involvement. They can also be a resource for parents prior to their child’s procedure and also for feedback once the procedure has been completed.
Imaging Methods
When it comes to urinary matters, three types of imaging techniques are typically applied:
Ultrasound can reveal obstructions of the urinary tract from the ureters between the kidneys and bladder, down to the urethra leading from the bladder. The latest AAP guideline suggests that for children up to 24 months, an ultrasound be done at the first febrile UTI.
Voiding cystourethrogram (VCUG) is an X-ray of the bladder and urinary tract at work that can be used to identify cases of reflux. This procedure requires catheterization, filling the bladder with a contrast substance, and then putting pressure on the abdomen so the child will void. The latest AAP guideline suggests that for infants and toddlers up to 24 months, a VCUG be done at the second febrile UTI, but not the first.
DMSA scans are used at Children's to determine the potential and extent of UTI-related kidney scarring, as well as the possible prevention of scarring, given treatment with steroids during UTI therapy.
In a DMSA scan, the radioisotope dimercaptosuccinic acid is injected intravenously, and the child must lay still for four images, each of which takes about four minutes to complete, a challenge when dealing with babies and energetic toddlers.
In many places throughout the country children are being sedated to do this, however Children’s Molecular Imaging team specializes in performing DMSA kidney scans without sedation. About 95 percent of the kidney scans are done successfully without sedation by employing distraction therapy in which the children are wrapped with a sheet while a child life specialist plays a movie or music.
