Pediatr Radiol (2006) 36: 372–373 DOI 10.1007/s00247-006-0131-4

PE DIATRI C RAD IOLOGY CME ACTIVI TY

Pediatric Radiology Continuing Medical Education Activity

# Springer-Verlag 2006

Physician needs statement Pediatric Radiology Continuing Medical Education (CME) activity is designed to provide educational information primarily related to technology, techniques, and applications of pediatric and fetal imaging for radiologists and those involved in allied sciences. This material includes information on imaging appearances of normal growth and development, as well as injury and illness that effect the pediatric population.

Accreditation statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The American College of Radiology and The Society for Pediatric Radiology. The American College of Radiology is accredited by the ACCME to provide continuing medical education for physicians. The American College of Radiology designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s)TM. Physicians should claim only credit commensurate with the extent of their participation in the activity. The American Medical Association has determined that physicians not licensed in the U.S. who participate in this CME Activity are eligible for AMA PRA category 1 credit.

Learning goals and objectives Goals: To increase knowledge and understanding of both appropriate use and features of pediatric imaging evalua-

tion including basic anatomy, physiology, and growth and development, in both healthy and disease states. Objectives: General educational objectives of Pediatric Radiology CME consist of the following: After reading the article and successfully completing the Pediatric Radiology CME activity, the participant will: – Understand the variety of normal variations and disorders that effect pediatric population – Identify and apply appropriate imaging strategies for evaluation of normal variations and disorders – Recognize risks and benefits of imaging modalities – Recognize the features and understand the basic anatomic, physiologic, and cellular basis for normal growth and development as well as illness and injury Instructions: Participants 1. must access website (www.cme.pedrad.org) 2. must answer at least 70% of the questions correctly Completion of each test results in 1 hour of category 1 credit. This evaluation is an online activity. Only examinations completed on the website will be valid for CME credit. Please do not mail or FAX in responses to the questions following the CME article. Access to articles for CME credit will be up to one calendar year. In addition, participants will be provided immediate feedback through email notification. Documentation of credits earned for the year 2006 CME tests will be available to SPR members on the CME Gateway. More information on this service is forthcoming. Participation is free for members of the SPR For questions regarding the CME activity, contact: Donald P. Frush, M.D. Phone: +1-919-684-7293 Fax: +1-919-684-7151 E-mail: [email protected]

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Thyroid disease in the pediatric patient: emphasizing imaging with sonography Diane S. Babcock (Please see article in this issue. The author(s) have no financial interest, arrangement, or affiliation to disclose in the context of this CME activity. There is no investigational or “off-label” use of medical devices or other products, or pharmaceutical agents to disclose.)

a. b. c. d.

Thyroglossal duct cyst Absent thyroid gland Thyroid ectopia None of the above

5. Which one of the following best represents the percentage of children with thyroid nodules? a. 0.02 - 0.05% b. 0.2 - 1.5% c. 1.5 - 2% d. 2.5 - 5%

Learning objectives 1. To learn the embryology of the thyroid gland, 2. To understand the technique for sonographic assessment of the thyroid gland, 3. To learn the imaging appearance of the normal thyroid gland, 4. To be able to discuss the sonographic appearance of disorders of the thyroid gland in infants and children.

Questions 1. Which one of the following is true regarding the embryology of thyroid gland? a. Begins to form at 10 weeks post-conception b. Begins to form in the neck c. Passes ventral to the hyoid bone d. Assumes its definitive shape at 7 months of age 2. Which one of the following is true regarding the normal sonographic appearance of the thyroid gland in children? a. Adjacent muscles are hypoechoic compared with the normal gland. b. The isthmus is typically not seen. c. Strap muscles lie posterior and sternocleidomastoid muscles lie anterior to the gland. d. The size of the normal neonatal gland correlates with birth weight. 3. Regarding congenital hypothyroidism, which one of the following is true? a. More common in boys than girls b. Affects 1:400,000 neonates c. Higher incidence in African Americans than Caucasians d. 85% of cases due to thyroid dysgenesis 4. Which one of the following is the most common congenital thyroid anomaly depicted by sonography?

6. Which one of the following is true regarding benign thyroid nodules in children? a. Benign nodules are less common the malignant nodules. b. True cysts are more common than degenerated hyperplastic nodules. c. Benign adenomas are not able to be sonographically reliably distinguished from follicular carcinoma. d. Anechoic areas suggest malignancy. 7. Which one of the following is true regarding primary thyroid malignancies? a. Most are epithelial in origin. b. The follicular type is most common. c. Malignancy typically is diagnosed at a less advanced stage in children than adults. d. Malignancy is more common before 15 years of age than 15-19 years of age. 8. Which one of the following sonographic features is more commonly associated with malignant masses than benign masses? a. Hyperechoic appearance b. Hypovascularity c. Multinodular appearance d. Smooth halo 9. Which one of the following sonographic feature is most often associated with chronic autoimmune (Hashimoto’s) thyroiditis? a. Normal thyroid size b. Discrete micronodules c. Normal to increased vascularity d. Background homogeneous architecture 10. Which one of the following is not associated with an enlarged thyroid gland? a. Grave’s disease b. Multinodular goiter c. Chronic autoimmune thyroiditis d. Hypofunctioning thyroid adenoma