All posts by CHOC Childrens

Radiology

CHOC Children’s Specialists pediatric radiologists provide the only specialized pediatric imaging services in the region. CHOC Children’s uses cutting-edge technologies to obtain the highest quality image, while at the same time reducing the patient’s exposure to radiation. This is especially important for children whose conditions require repeated studies over the years.

Our expert physicians and staff are dedicated to using the lowest dose of radiation necessary, without sacrificing the quality of images required for quick and accurate diagnoses. Many children are imaged in adult facilities where radiation doses can be up to 50 percent higher than at CHOC.

We are accredited by the American College of Radiology and follow the guidelines of the Image Gently® campaign, so you can rest assured that your child will receive the safest radiology services available.

The CHOC Children’s Radiology Department is one of only a handful of hospital radiology departments in the country to offer a child life specialist. Child life specialists have been shown to decrease the amount of sedation necessary for children undergoing imaging tests. From the imaging suites to our family lobby, the Imaging Department has been designed to be a calm and inviting unit for children of all ages—from infants to teens and young adults. The unit features a number of private areas that allow child life specialists, caregivers and doctors the opportunity to interact with patients as need before or after an exam. CHOC Children’s offers patients special goggles to use during MRI scans. These video goggles allow the patient to watch their favorite movie or television show while undergoing their MRI scan and have been proven to reduce the number of patients needing sedation for MRI procedures.

Services and State-of-the-art Equipment

  • 3T and 1.5T MRI
  • CT, X-ray, fluoroscopy, ultrasound, MRI
  • 3D modeling for cardiac, orthopaedic and brain imaging
  • Only hospital in Orange County that does pediatric brain mapping using functional MRI (fMRI)
  • 50 percent lower CT radiation dose than many community facilities. For example, American College of Radiology recommends a dose of no more than 50 CTDI for pediatric heads, and CHOC is averaging 8-15 CTDI for pediatric heads
  • 90 percent radiation reduction on fluoroscopic procedures by using pulse dose technique and image capture, compared to the more commonly used continuous fluoroscopy and full image acquisition
  • Techs on site 24/7
  • Board-certified pediatric radiologists and specially trained pediatric radiology technologists, nurses and child life specialists
  • Distraction techniques, toys and devices, such as iPads and MRI movie goggles, are used for patient’s comfort
  • ACR accredited – MRI, CT and ultrasound (pediatric accreditation)
  • CT Scans entire body in less than 5 seconds, drastically reducing the need for anesthesia and repeat scans due to motion

Neurology

The CHOC Specialists Neurology Specialty Division at CHOC Children’s is available for consultation 24-hours-a-day, 7 days a week and provides diagnostic services, medical treatment, and follow-up care to infants, children, and adolescents who have suspected or confirmed neurological disorders. Our pediatric neurologists manage and treat a variety of patients including those with epilepsy disorders, neuromuscular disorders and spasticity.

A pediatric neurologist has completed a residency in pediatrics and had additional training in adult and child neurology. All our pediatric neurologists have certification or are eligible for the American Board of Psychiatry and Neurology (with special qualifications in child neurology). Our group also has pediatric neurologists with Board certification in Clinical Neurophysiology (Epilepsy and Neuromuscular diseases), Palliative Care, and Neurodevelopmental Disabilities.

Pediatric neurologists combine the expertise in diagnosing and treating disorders of the nervous system (brain, spinal cord, muscles, nerves) with an understanding of medical disorders in childhood and the special needs of the child and their family. In many cases, pediatric neurologists work as a team with pediatricians or other primary care doctors. In addition, pediatric neurologists may work with other pediatric specialists to care for children with more complex or serious medical issues, such as epilepsy, birth defects, or developmental delay.

CHOC Hospital Comprehensive Epilepsy Program is recognized by the NAEC as a Level 4 epilepsy center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.

The following conditions may be best treated by a pediatric neurologist:

  • Epilepsy and seizures — including intensive long term video EEG monitoring for epilepsy and related disorders
  • Motor system disorders — including tics, Tourette’s Syndrome; neuromuscular diseases, including congenital myopathies, muscular dystrophy, hypotonia and other genetic muscular disorders; and cerebral palsy
  • Headaches with neurological findings or patients who have failed first line medications
  • Developmental and behavioral disorders — including learning disabilities, ADHD, developmental disorders and autism through the Thompson developmental center
  • Neurogenetic and neurometabolic disorders — including neurodegenerative diseases such as mitochondrial disorders, neurofibromatosis, tuberous sclerosis, Rett’s Syndrome and Down Syndrome
  • Neuroimmunological disorders — including dermatomyositis and post-infectious encephalopathy
  • Neurological aspects of head injuries, brain tumors, brain malformations, and hydrocephalus
  • Complications of central nervous system infection

Clinical services are complemented by the multidisciplinary care provided by other CHOC Specialists, nurses, pharmacists, EEG lab technicians, therapists, clinical dietitians, child psychologists and social workers at CHOC Children’s.

State-of-the-Art Pediatric Sleep Disorders & Neurophysiology Center

Directed by CHOC Specialists Neurologists, this center provides clinical care and electrophysiological monitoring for primary sleep disorders, including narcolepsy and sleep disorders secondary to neurological and other organ disorders. CHOC Specialists Neurology physicians also direct the Neuro-Diagnostic Center at CHOC, providing inpatient and outpatient 24-hour EEG videotelemetry.

Leading-Edge Neurodiagnostic Services

The CHOC Specialists Neurology team is fully equipped with advanced diagnostic equipment:

  • Routine and 24-hour EEG videotelemetry for monitoring of status epilepticus, pseudoseizures and neonatal seizures
  • Evoked potentials including intraoperative recording
  • MRI and MRA
  • Pediatric Intracranial Angiography
  • Transcranial doppler
  • Cranial ultrasound
  • EMG and nerve conduction studies
  • Polysomnography with or without epilepsy monitoring and intensive gastrointestinal cardiac or pulmonary evaluation
  • Neuropsychological and psychological evaluation

Cardiothoracic Surgery

CHOC Children’s Specialists Cardiothoracic Surgery provides cardiothoracic surgery, medical treatment and follow-up care to infants, children and adolescents to repair congenital heart defects. Our pediatric cardiothoracic surgeons have completed a residency in general surgery as well as thoracic or cardiothoracic surgery, and a fellowship in congenital cardiac surgery.

CHOC has long been a leader in cardiac surgical care. Our team was instrumental in the development of new systems used to protect children’s hearts during surgery and improve heart-lung machine technology. We worked with bioengineers at Quest Medical to develop techniques and instruments that could be used to bring cardiopulmonary bypass technology to children and infants, previously available only for adults. CHOC was the first institution to offer this lifesaving technology that is now used in more than 60 institutions around the globe.

CHOC’s cardiothoracic surgeons lead the way in raising the standard of care and surgical outcomes for neonates undergoing open heart surgery. CHOC Children’s heart surgery program has the only facility in Orange County that performs newborn and pediatric open-heart surgery, and has dedicated cardiovascular operating rooms with extracorporeal life support (ECLS) and a Cardiovascular Intensive Care Unit (CVICU).

Our cardiothoracic surgeons direct the ECLS program for the hospital.  The ECLS program at CHOC is a member of the International Extracorporeal Life Support Organization (ELSO) and has been designated an ELSO “Center of Excellence” .  CHOC’s ECLS program provides life saving technology  to neonates thru adolescents with heart and/or lung failure.

For more than a decade, CHOC has been a member of the Society of Thoracic Surgeons (STS) National Database, an international benchmarking organization that sets the highest standards for hospitals performing heart surgery. CHOC was among the first 15 institutions to join the registry and report surgical outcome data. Today, there are more than 130 premiere hospitals in the STS database.

The CHOC Specialists Cardiothoracic team offers a full range of surgical procedures to correct heart and thoracic defects:

Heart Conditions

In addition to congenital heart defects, our cardiothoracic surgeons perform procedures to correct lung and chest wall defects as well as complex vascular procedures to place specialized lines for renal dialysis and chemotherapy.

Thoracic Conditions

  • Chest wall and lung malignancies
  • Lung defects – congenital pulmonary airway malformations, pulmonary sequestration, spontaneous pneumothorax
  • Lung infections
  • Pectus excavatum
  • Complex vascular access

Multidisciplinary Approach

CHOC’s multidisciplinary care complements these clinical services. Other members of the care team include additional specialists, interventionists, anesthesiologists, perfusionists, intensivists, cardiovascular nurse practitioners, respiratory therapists, dietitians, social workers, child life specialists and case managers, all of whom have specialized training and expertise.


Leading-Edge Cardiodiagnostic Services

The CHOC Children’s Specialists Cardiothoracic team is fully equipped with advanced cardiodiagnostic equipment:

 

Neurosurgery

While every effort is made for nonsurgical intervention, surgery can often be the answer to saving or improving a child’s life.

Our board certified neurosurgeons bring the highest levels of expertise and experience to even the most complex disorders of the brain, spine and central and peripheral nervous systems. They have been widely recognized for their innovation in advancing the field, including new or improved treatments for hydrocephalus, spasticity, dystonia and chronic pain. Our participation in clinical trials also provides new options for children who need more than conventional treatments.

We surgically treat the full spectrum of neurological conditions and injuries with the latest procedures:

Epilepsy

When medication isn’t enough, a number of different surgical options may help alleviate a child’s seizures. The most common procedure removes the part of the brain that is causing seizures or disconnects certain nerve pathways that spread the seizure impulses. Our neurosurgeons were among the first to perform a less invasive surgical option that places a vagus nerve stimulation device in a patient’s chest – much like a pacemaker – and sends pulses that minimize seizures.

Cerebral Palsy and Spasticity

Cerebral palsy may cause a child to have muscle weakness, poor motor control, shaking, or stiffness of the arms or legs. Our neurosurgeons have been at the forefront of treating these symptoms, and we were the first in the region to implant an intrathecal pump that delivers low-dose medication to the spinal cord and brain, causing the muscles to relax. Other surgical options include selective and non-selective dorsal rhizotomy, which involves cutting sensory nerve fibers in the spinal cord to balance out the messages of flexibility and stiffness that are sent to the muscles.

Hydrocephalus

We are the region’s leader in treating complex multicystic hydrocephalus, a condition that causes too much cerebrospinal fluid in parts of the brain. Our neurosurgeons have pioneered two unique treatments: a valve that is implanted in the brain and drains fluid, and an endoscopic third ventriculostomy, which involves making a tiny hole in the wall of the third ventricle, allowing fluid to move out of the blocked ventricle and eliminating the need for a valve.

Tumors of the Brain and Spine

Our neurosurgeons work closely with neurologists and neuro-oncologists to determine the most effective treatment plan for brain and spine tumors, including gliomas, medulloblastomas, meningiomas and pituitary gland tumors, which can often be removed endoscopically. Diagnosis and removal of a tumor are often done during the same procedure to increase the chances for a cure. Surgery may be used in combination with chemotherapy and radiation therapy to eliminate a tumor.

Moyamoya Disease

Surgery is the only option for long-term treatment of Moyamoya disease, which is a rare condition causing a narrowing of the arteries at the base of the brain and preventing blood flow to the brain. Surgery at the microvascular level requires extreme precision and expertise. Our neurosurgeons are highly experienced in treating Moyamoya disease with brain revascularization, which involves creating new vascular pathways that reroute blood flow to the brain from other areas.

Craniofacial Syndromes

At birth, a baby’s skull bones are still developing and fusing together, a process that takes about a year. Bones that fuse too early or too late can result in a craniofacial syndrome, which can damage the brain. Surgery can correct the malformations by removing, replacing or recontouring parts of the skull. We specialize in distraction osteogenesis, a method of moving two parts of a bone slowly so that new bone fills in the gap, as well as an endoscopic procedure that corrects a craniofacial problem using surgical instruments through the nasal passage, rather than opening a patient’s skull.

Birth Defects

Birth defects of the head and spine can include: encephaloceles, when a baby is born with a part of his or her brain protruding from the skull; a Chiari malformation, when brain tissue extends into the spinal canal; syringomyelia, when a cyst or hole forms in the spinal cord; spina bifida, when the spinal bones don’t close properly; and a tethered spinal cord, when the spinal cord becomes attached to the spinal column rather than floating freely. Our neurosurgeons are adept at a number of surgical procedures to repair and improve a host of congenital birth defects, including the rarest cases.

Brain Cysts

Cysts in the brain, such as a dermoid or arachnoid cyst, are tumor-like spheres filled with liquid. Surgery can be used to remove all or part of a cyst so that vital functions of the brain are not impaired. We specialize in an endoscopic procedure that corrects the problem using surgical instruments through the nasal passage, rather than opening a patient’s skull.

Concussion and Head/Spinal Cord Trauma

A traumatic injury to the head or spine requires immediate care and may require a surgical procedure such as surgical decompression, craniotomy and surgical drainage, surgical debridement and evacuation, surgical elevation and decompressive craniotomy with duraplasty.

Dr. Pankaj Mistry

Mistry, Pankaj – MD

Pankaj Mistry, MD, is a Neonatologist with the CHOC Children’s Specialists. Dr. Mistry is board certified in pediatrics and neonatal-perinatal medicine. Dr. Mistry attended medical school at Goa Medical College, Goa, India. He completed his residency training program in pediatrics at Interfaith Medical Center, SUNY/Downstate Medical Center, Brooklyn, New York. Dr. Mistry served his fellowship in neonatal–perinatal medicine at UCLA Medical Center, Los Angeles, California.

Physician Profile