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The authors describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in their population of patients with hydrocephalus by 50% within 6 months. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system and data collection continued postintervention and during the control phase. The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases. The authors conclude that the lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders.

This study investigated whether diffusion tensor imaging tractography-based connectome can differentiate global developmental delay from speech delay in young children. Twelve children with pure speech delay, 14 children with global developmental delay, and 10 children with typical development underwent 3T DTI. Whole-brain connectome analysis was performed by using 116 cortical ROIs. Network metrics were measured at individual regions: strength, efficiency, cluster coefficient, and betweeness. Compared with typical development, global and local efficiency were significantly reduced in both global developmental delay and speech delay. Nodal strength of the cognitive network was reduced in global developmental delay, whereas the nodal strength of the language network was reduced in speech delay. This finding resulted in a high accuracy of >83% to discriminate global developmental delay from speech delay.