title: Incidence of clinically silent malrotation detected on barium swallow examination in children.
abstract: BACKGROUND
  Duodenojejunal flexure (DJF) orientation is often examined routinely during contrast swallow studies, including those performed for purely oesophageal queries. We examine the radiation burden and the incidence of malrotation in patients undergoing contrast swallow, without clinical suspicion for malrotation.
  
  
  METHODS
  Two hundred eighteen consecutive contrast swallow studies were reviewed. Patients whose history may potentially suggest malrotation were identified (n = 90), and remaining children were grouped based on whether DJF was examined (Group 1; n = 88) or not (Group 2; n = 40). Data extracted include demographics, radiographic parameters (dosage, screening time, number of images obtained) and examination findings. Outcome measures comprised: (i) prevalence of clinically incidental malrotation; and (ii) influence of additional evaluation of DJF on patient dosage (mean ± SEM).
  
  
  RESULTS
  Malrotation was identified in 2 of 90 patients (2.2%) examined with clinical indications for possible malrotation, but none in Group 1 (13% already had normal DJF confirmed on previous examinations). Groups 1 and 2 were comparable with respect to age and gender (P = ns). Additional evaluation of DJF (Group 1) meant that 54% more images were acquired (48.5 ± 2.9 vs. 31.4 ± 3.4 images in group 2; P = 0.0002) and 24.9% increased screening time (130.8 ± 9.3 vs. 104.7 ± 13.0 seconds in group 2; P = 0.089), resulting in 32.6% increased patient dosage (1.36 ± 0.21 vs. 1.02 ± 0.16 microGym(2) /kg in group 2; P = 0.19).
  
  
  CONCLUSIONS
  This study highlights the increased radiation exposures involved with routine screening for DJF position in those patients without clinical suspicion of malrotation, and raises questions about the validity of this practice; however, further research is needed.
authors.affiliation: Department of Medical Imaging, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Atkin
authors.forename: Moti M
authors.initials: MM
authors.lastname: Chowdhury
authors.forename: Murray
authors.initials: M
authors.lastname: Bartlett
mesh_terms: D000284:Administration, Oral; D001466:Barium Sulfate / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D003679:Deglutition; D005260:Female; D006801:Humans; D033162:Incidental Findings; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D018570:Risk Assessment; D014739:Victoria / Q000453:epidemiology
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: abdomen; gastrointestinal imaging; paediatric imaging