title: Evaluation of image quality and patient safety: paired inspiratory and expiratory MDCT assessment of tracheobronchomalacia in paediatric patients under general anaesthesia with breath-hold technique.
abstract: OBJECTIVE
  The purpose of our investigation was to evaluate image quality and patient safety in infants and young children who required general anaesthesia with breath-hold technique for paired inspiratory and expiratory multidetector CT (MDCT) assessment of tracheobronchomalacia (TBM).
  
  
  METHODS
  Our hospital's institutional review board approved the review of radiological and clinical data of a consecutive series of 20 paediatric patients who underwent MDCT under general anaesthesia with breath-hold technique for evaluation of TBM from May 2006 to December 2008. For each MDCT study, two fellowship-trained paediatric radiologists reviewed the inspiratory and expiratory MDCT images in an independent, randomised and blinded fashion for the presence of motion artefact at three anatomic levels (upper, middle and lower central airways). The clinical history and anaesthesia outcome, including the occurrence of any adverse events during or following the MDCT examinations until discharge, were also reviewed and recorded.
  
  
  RESULTS
  The study population consisted of 20 infants and young children (13 boys/seven girls, mean age 1.7 ± 1.4 years, age range 11 days to 4 years). The imaging quality of all 20 MDCT studies was diagnostic with no motion artefact in 16 studies (80%) and minimal motion artefact in the remaining four studies (20%). Minor adverse events occurred in three patients (15%) that included one patient (5%) with a brief (<60 s) oxygen desaturation during MDCT study, which resolved with oxygen, and two patients (5%) with either a brief (<60 s) oxygen desaturation (n = 1, 5%) or cough (n = 1, 5%) during recovery period, which were completely resolved with oxygen and dexamethasone, respectively.
  
  
  CONCLUSIONS
  Diagnostic quality paired inspiratory and expiratory MDCT imaging with breath-hold technique can be safely performed in infants and young children under general anaesthesia for evaluation of TBM.
authors.affiliation: Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA. Edward.Lee@childrens.harvard.edu
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Maria d'Almeida
authors.initials: Md
authors.lastname: Bastos
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stark
authors.forename: Maureen
authors.initials: M
authors.lastname: Carrier
authors.forename: Keira P
authors.initials: KP
authors.lastname: Mason
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D016477:Artifacts; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061330:Multidetector Computed Tomography / Q000009:adverse effects / Q000379:methods*; D061214:Patient Safety; D012119:Respiration; D012189:Retrospective Studies; D055089:Tracheobronchomalacia / Q000000981:diagnostic imaging*